Surgery after Radiation for Prostate Cancer

Hi, I’m Dr. Scholz.

Everyone seems to think that you can’t do surgery if you’ve had previous radiation for prostate cancer. Actually, you can do surgery if you’ve had previous radiation. The problem is the risk of side effects of the surgery go up a lot, and honestly the amount of side effects that you see with surgery even without previous radiation—in my view—is unacceptable. So you're looking at a much greater incidence of incontinence, a much greater risk of impotence, and thankfully there are a number of other options to consider.

But why can’t you do the surgery? What is the problem?

Well it turns out that the radiation therapy around the edge of the prostate causes a scarring—a hardening of the tissue—and a destruction of the normal anatomical planes that the surgeon uses to go in and separate the prostate from the other tissues. So since he’s not quite clear where he’s cutting and where he’s going due to the previous radiation there’s a lot higher incidence of cutting in the wrong place, complications, and the like.

There’s also a concern because previously radiated tissue doesn’t heal as well. So that’s going to increase the complication as well.

There are doctors out there that specialize in doing surgery after radiation, and they get the job done, but inevitably they do encounter higher side effects even though they are very proficient at what they do.

So the basic problem excess scar tissue around the gland. That’s what makes it hard to do surgery after previous radiation