Sabre radiation or Surgery for node positive removal?

[Flydoggy]

I am scheduled for 24th of September surgery for node removal after a positive PSMA scan showed a small recurrence in one of the lymph nodes. (DX in Dec.15, Gleason score 5+4=9...I am post RP and 33 sessions of radiation to the prostate bed) I have an appt on the 17th to consult with a radiation oncologist who is using the Sabre technology. Would love some feedback/opinions/knowledge regarding experience with this technology as I have to decide quite quickly after this appointment whether to go ahead with the surgery or choose radiation.

[Tall_Allen]

I think that any metastasis-directed therapy (whether SBRT or surgery) is a poor idea. If the PSMA scan showed that cancer was detected only in one or more pelvic lymph node, it's a reasonable bet that there is undetectable cancer in more of the pelvic LNs. If you want to go for the cure, you should either have extended pelvic lymph node dissection (ePLND) or radiation to ALL pelvic LNs.

[tallguy2]

With a Gleason score of 9 you and I are traveling similar paths. Have you considered additional imaging, such as the PET with Axumin? In any event please do not rule out chemotherapy. As Tall_Allen mentions it is highly likely there is more going on (there was with me, per the PET scan).

Blessings and good luck to you!

[Winston40]

I have had SABRE radiation to the lymph nodes along with others that I met at the treatment center, all with reasonable success. Choice of a radiologist with extensive experience is essential and be aware that it will most likely require around 38 treatments which could possibly pose a threat to your immune system due to your prior radiation.

[David20451]

I had a large lymph node on the iliac chain blasted with SBRT. Actually had it done twice, one year apart. Good success.

[jimk_mb]

I am in a similar situation and assessing surgery versus radiation option. I talked to 2 patients who had individual LNs identified by the PSMA scan surgically removed. They did not get any lasting response in PSA. Realize 2 is a small sample set, but better than no input. I also listened to a Tanya Dorff (MO at City of Hope and formerly of USC) presentation where she stated that taking out a single hot LN does not make any sense.

I've talked to a number of Rad Oncs and the recommendations from them span the spectrum regarding 1) IMRT versus SBRT versus IMRT with SBRT boost to node; 2) HT or not and what type and 3) What to radiate (individual nodes versus chain of node.)

So I've found that there are no easy decisions. Treatment of oligomets is somewhat new. I guess we just need to weigh the inputs and make a decision we are most comfortable with. Good luck.

[tallguy2]

This is great information. Thanks for sharing it!