Radiation 10+ years after initial imrt

[Tommyj2]

Psma detected a small area of cancer in what is left of my prostate…..psa of 20 at that time. After 3 months of eligard ,abiraterone and prednisone dropped to 0.04. MO and local radiologic oncologist are recommending a consult at MSK for tx of this area by whatever means might be the most safe and effective with an eye toward getting me off the meds( at least for a while) or with luck for the foreseeable future( I am nearing 72)……anyone here have experience to share re: radiation ( or cryo or hifu) after initial whole prostate irradiation? Feelings or knowledge about the safest way to go?

What questions to ask at MSK?

[Tall_Allen]

This may help:

prostatecancer.news/2016/08...

The biggest question is focal or whole gland salvage? Even the best imaging (mpMRI and Posluma PET) can only see lesions ≥ 5 mm. There may be cancer throughout the gland that is too small to visualize.

OTOH, focal HDR brachy can target the cancer and spare surrounding tissues.

Proximity of the tumor to the urethra and surrounding tissues also has to be considered.

[Tommyj2 in reply to Tall_Allen]

Thank for the response Allen…..I worry about whole gland salvage due to higher risk to surrounding tissue but on balance if there are undetectable tumors it could be more effective……seems that anyway I go I’m going to incur one or another risk……I’ll read your suggested article of course and mull it over prior to meeting with MSK folks.

[vintage42]

"... anyone here have experience to share re: radiation ( or cryo or hifu) after initial whole prostate irradiation? Feelings or knowledge about the safest way to go?"

Two years after IMRT I had recurrence in the prostate. Too soon for any form of salvage radiation, I was told. I had a consultation with a HIFU expert and he declined me, partly because of risk, but generally because I had mets to nodes. He said HIFU was risky enough on a virgin gland, but more so on a radiated gland. And that any salvage of the prostate is only recommended if the cancer has not spread outside of it.

[Tommyj2 in reply to vintage42]

Thank you for the response……the info you received flies in the face of other info I have read…..but that’s why I put it out there to everyone……..salvage not outside the prostate makes little sense to me…..that’s why it is called salvage.

[vintage42 in reply to Tommyj2]

I said "salvage of the prostate is only recommended if the cancer has not spread outside of it." And you replied "salvage not outside the prostate makes little sense to me…..that’s why it is called salvage."

I don't understand your reply. Salvage can only be done on the prostate itself, or maybe also its bed. . But salvage is apparently only worthwhile if the cancer is still contained to the prostate area. Salvage of the prostate is apparently not done if the cancer has already spread to nodes.

[Tommyj2 in reply to vintage42]

I’m speaking of a second course of radiation when a first has failed to cure the disease…..by that time it could be beyond the prostate (metastatic)…..also salvage radiation but on a larger scale. At least I have heard it discussed as such in this forum.

[vintage42 in reply to Tommyj2]

You said "a second course of radiation when a first has failed to cure the disease…..by that time it could be beyond the prostate (metastatic)…..also salvage radiation but on a larger scale."

I had that, but any radiation outside the prostate is not called salvage.

When radiation failed to stop my disease and it spread to a node, I had radiation to that node and simultaneously to the whole pelvis to treat undetectable cells. That is not salvage.

[Tommyj2 in reply to vintage42]

There are those on this forum who refer to it as such……what would YOU call it? I’m not invested in being right…but in clarity. BTW….was your second round of radiation successful? Side effects that have remained with you?

[vintage42 in reply to Tommyj2]

I have not seen anyone refer to radiation of metastases as "salvage". It is not the correct use of the term, and causes confusion rather than clarity. Salvage means rescue, of a prostate previously treated.

My second radiation to the one lymph node plus the whole pelvic area was successful: a follow up PSMA PET scan 6 months later showed the node had diminished. The scan said that node "no longer has high activity and is decreased in size. Currently, activity is inseparable from the blood pool and nearby ureter." And that was before I started ADT, so I expect might no longer show on a scan.

Neither the 2021 radiation of the prostate, or the 2023 radiation to the node and pelvis, caused any side effects during or since the treatments.

[Tommyj2 in reply to vintage42]

I think I have been mistaken here or if I have read other forms of radiation referred to as salvage those individuals were incorrect……I stand corrected. Glad your second round of radiation appears to have been symptom free so far…..good luck.

[TJGuy]

Oh course a radiated prostate becomes more difficult to then remove surgically. But particular renowned cancer centers have surgeons who can perform these operations. This is another potential option.

[Tommyj2 in reply to TJGuy]

All I’ve ever heard are horror stories when guys attempt this……do you know anyone who has had this done successfully?