Allan recommended salvage brachy or SBRT to your last post. I think this are better alternatives than cryo. You can add adjuvant Casodex then which will probably work for a long time once the recurrence has been destroyed.
75.6 Gy is not a high dose for primary radiation; in fact, it's lower than contemporary standards (which may explain your recurrence). MSK and Mayo have found that most failures after radiation are salvageable:
Brachytherapy and SBRT can be applied if the area had been radiated before. SBRT allows to radiate very small spots with a high dose. So you can just destroy the recurrence area.
However, you will have to talk for advice to doctors who have these machines available and not to the ones who have never used these.
If you are speaking of biochemically recurrent PCa,my understanding is that it is by definition not curable, as it occurs after initial treatment (i.e. RP or some other form of primary treatment that has destroyed the primary tumor) after reaching your nadir for PSA (hopefully undetectable). The steady rise of your PSA level to .2 and higher over several months means that the primary treatment has failed and PCa has escaped theprimary tumor site and is now systematic.
To me, all the follow-up treatments come down to trade offs between quality of life, effectiveness at achieving your personal treatment goals, how the sequencing of treatment modalities effects your future treatment options. (i.e. EBRT for the primary prostate cancer tumor may make salvage radiation or surgical solution infeasible-if the EBRT is done first) and what viable options you have left.
We all have opinions based on our own experiences but everyone's response to treatment will vary. As an example, you have major problems with side effects from Lupron and I do not have as many, so that may not make sense for you (depending on progression and efficacy) and would make more sense for me.
The ablation technique is very interesting but I am not sure how it applies to BCR because it is site-specific (used to treat individual tumors). I am guessing this is why your MO is proposing Lupron, also because it has stronger replacement treatments that fight a more resistant disease later.
ADTwill provide "suppressive fire" on testosterone while the PCa remains systematic (but undefined), hopefully slowing metastasis. If you treat individual tumors at this phase, you will likely not be able to find enough of them, if at any or you will be be playing "wack-a-mole". If the disease is aggressive, it will progress systematically while you are fighting individual tumor sites. My goal would be to slow down the progression of the overall disease and attack individual tumors as you can identify them through newer more-sensitive PET/CT scans. This fights on the macro and micro scale. Meanwhile, maybe an immuno-therapy treatment may come along to change the paradigm for good in our favor!
I hope you find the treatment plan that's best for you. Good luck!
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PSA dropped from 28.5 to 0.57
When ADT fails, we continue it anyway... why not Zytiga?
Testosterone level rising toward end of Lupron cycle
Stopping Casodex before stopping Lupron
