Looking for options with intent to cure if recurrence is limited to prostate only, pending PET-PSMA. Have read about these options:
Prostatectomy/Brachytherapy/Cystoprostatectomy/Cryotherapy
Anybody have any knowledge or studies that might suggest a direction? Still hoping for the possibility of a cure and avoid the ADT train awhile. ADT naive at this point as not given at time of initial therapy 5 1/2 years ago.
Here ya go:
prostatecancer.news/2017/09...
Thanks, TA. I was hoping you would have something as you back your opinion with solid research. Wondering since it has been 6 years from some of these studies, has anyone's current research show one standing out above the others? I keep reading about SABR/SBRT at MSK, but don't know if it is just their advertising!
Look at the table at the end - it is illustrative, not comprehensive. There isn't one best choice (although salvage surgery is certainly the worst). PSMA PET (especially the newly approved rh-PSMA-7.3) and mpMRI are useful tools. Consider things like number, position and extent of the recurrence. Does it make more sense to go with whole gland (if multifocal) or focal? How close to the urethra? How long since radiation?
Salvage SBRT can be done on VMAT linacs (like the one at MSK) or with MRI guidance (like MRIdian at UCLA). Expert HDR-BT practitioners may be difficult to find.
I did read the table at the end, but again, these studies are over 6 years old. I have learned in the world of modern cancer treatments, that can be eons, and newer studies can refute older ones. So far Spyder54 seems to have had recent good success at MSK.
Live in Texas, so both MSK and UCLA are a bit of logistic and support challenge. Wonder if Korn's group at MD Anderson has anything similar to offer?
Thanks again for the help and information you give to all of us to make better health decisions. Now on to a PSMA PET, as all the rest may be a moot point after that.
I would recommend Dr E Efstathiou at Houston Methodist. She only does GU Med Onc. One of the top in the field. I travel from TN to see her.
To go from TN says quite a bit about a doctor. Ty.
That is not to say the med onc's at MDA aren't just as good. She came out of MDA to start her program at Houston Methodist
I was originally treated my PCa (Gleason 8, Pirads4,PSA 10.4) with SBRT in 01-2019. Retained continence / sexual function. Recurrence 10-2022, Gleason 10, PSA 7.4 PSMA PET showed no mets. Opted for whole glad cryo on 12-23. Slight incontinence, complete impotence. PSA since .38, .45-.50 so still may have to do follow up treatment if PSA keeps climbing and scans show active cancer in prostate or elsewhere.
Thank you for your sharing your experience---every piece of information helps people make better decisions as they travel their own path.
You might want to research HIFU. I consider it the mirror image of cryotherapy (heat instead of cold). Cryotherapy is a blunt instrument. The difference is that High Intensity Focused Ultrasound provides both real time position and temperature feedback as the tissue is being ablated one tiny blip at a time. Worked for me as the primary treatment. Seven years later I am doing fine. This was full gland, not focal ablation. Surgeon recommended that and it made sense. More thorough treatment. Zero problems with incontinence or erectile dysfunction. Zero. Be ready for this suggestion to be criticized.
When it comes to treatment, nothing is off the table.
As an added note, I had TURP surgery 10 years prior to HIFU. This is somewhat of a prerequisite for full gland HIFU. Something to discuss with surgeon anyway.
Sorry to hear about your recurrence so soon after the five year Mark. For me the first thing I would look at is my PSA doubling time. Here is a podcast that talks about this important metric. If you can delay ADT do so at all cost. When you need it, take it; until then avoid it.
healthunlocked.com/active-s...
…next see if you can slow down PSA grows by using Sulphoraphane. There are a lot of studies that show that this supplement can have an impact on PSA progression. If you can slow down PSA progression, you can delay the need to start ADT treatment and potentially additional medical procedures. I have published these findings.
healthunlocked.com/active-s...
healthunlocked.com/active-s...
Vitamin D3 also has a role.
healthunlocked.com/active-s...
….otherwise, your experience is not in my wheelhouse. I had a radical prostatectomy, followed by radiation treatment when I had recurrent PSA six weeks after my operation. But if I were you, I would try to see if my PSA growth was sufficient to warrant immediate action. Then try everything I could to slow it down. Then I would also avoid ADT until I absolutely needed to take it. I would also not take it for more than six months unless I had to. Good luck. Rick.
The goal (before getting confirmation of local progression only) is definitely to not get on the ADT train until needed.
Research,
Have you done a procedure yet? I have a BCR after having done EBRT 19 years ago…Thinking of salvage focal cryotherapy. There is only one tumor so urologist is recommending focal …PSMA is clear …would also like to find someone who has done many of them…
TY, Bill
Ideas for the best options
My Dad Stage 4 Pca - MO happy to settle for PSA 30, as its not 'curative'!
Correct Therapy for High Risk PCa (Gleason 9)
