Salvage options?

[EvFC]

Hello again,

I have a few more questions, to help my husband decide between surgery and brachyboost. For context, he is localized Gleason 9.

(1) Is the course of salvage radiation after RP typically the same as it would have been if the initial treatment had been radiation therapy? Or would it require more or fewer sessions?

(2) Are the side effects of salvage radiation therapy the same as if radiation was the initial treatment option?

(3) What is the SOC for salvage hormone therapy (that is combined with salvage radiation) after RP? How long do you need to take hormones for?

(4) What options are available for salvage treatment if radiation therapy results in recurrence?

(5) When primary treatment results in recurrence, is the recurrence typically in the prostate area or wider spread in the body? Does this vary with Gleason grade? Does it vary with the primary treatment option chosen?

Thank you!

[Tall_Allen]

(1) lower dose for salvage, but higher rates of adverse urinary effects.

(2) No. Not even close.

(3) 6 months, unless PLND finds cancer

(4) If local recurrence, focal radiation to site of recurrence:

prostatecancer.news/2017/09...

(5) Recurrence rate for high risk RP is about 80% -- fill this out:

mskcc.org/nomograms/prostat...

Recurrence rate for high risk BBT is 17% (ASCENDE-RT)

Not even close.

[EvFC in reply to Tall_Allen]

Thanks very much!

[EvFC in reply to Tall_Allen]

Do you happen to know statistically where prostate cancer is likely to recur with RP vs brachyboost? Does it tend to be local vs more distant mets with either option? Thanks!

[Tall_Allen in reply to EvFC]

For high risk patients, the 10-year rates of distant metastases was 46% for RP and 13% for BBT. Regional recurrences are far more likely for RP - I just gave you the link- did you look at it?

[EvFC in reply to Tall_Allen]

I did. Thank you!

[vintage42]

"4) What options are available for salvage treatment if radiation therapy results in recurrence?"

After IMRT in 2021 I had recurrence in the prostate and mets to a lymph node. A PSMA-PET scan in late 2023 showed the prostate tumor was growing and I looked at salvage options. I was told it was too soon for any kind of additional radiation. I consulted with a local HIFU expert and he said my QOL was too good put at risk. He said HIFU was risky enough as initial treatment, riskier as salvage, and as a matter of practice he would not salvage the prostate if there were mets already.

I had a second IMRT in 2023 for pelvic nodes, and much too late, started ADT with Orgovyx and Abiraterone in Jan 2024. I have had no side effects the two radiations (being 81 now, I had ED and urinary urgency for years before the cancer), and minimal side effects from the ADT.

[EvFC in reply to vintage42]

Thank you!

[tarhoosier]

For the answer to #2 from Tall Allen his answer was "not even close" hich he means for you to understand that the salvage radiation side effects are more than for original (curative) radiation. Side effects for salvage is more than curative and the difference is not close.

I hope he chooses brachyboost.

[EvFC in reply to tarhoosier]

Thank you very much. Understood. We were able to talk to our radiation oncologist yesterday and she said the same thing. She said it partially depends on the surgery outcomes, but also mentioned that surrounding tissues are more exposed to radiation after RP so the side effects can be greater as a result. She mentioned they would likely use a lower dose with salvage to be protective of surrounding tissues, but use more treatments. What was you experience with salvage radiation?

[tarhoosier]

Mine was 6 years after surgery for G9 in 2006. RT was in 2012. After recovery of T I had a 14 month period with no or nearly no psa. Once re-established the previous doubling time resumed and I have been on and off drugs, different types and dosage since that time. My original treatment was in 2006 and great strides have been made since then. If I were diagnosed today with the knowledge I have now I would choose RT with brachy boost. I would find a center with the best practitioners as it is not the arrow but the archer. The best people obtain best results.

My response to pharmaceuticals is not normal and do not base decisions on my anecdotal history.

[EvFC in reply to tarhoosier]

Thank you. It’s helpful hearing about your experience. We feel confident in his radiation oncologist, should my husband choose to go that route. It’s a very tough decision, but he’s leaning towards brachyboost at the moment. He has an appointment with the surgeon on Tuesday so ask final questions, and then he’ll make up his mind.

[j-o-h-n]

My age at the time was: 68 + years old (Fried during Feb. March and April 2005).

I don't know if this applies to your dear Husband.

Greetings: Radiation - I've posted this before so to those people who have already seen this please forgive me.

I had 8 weeks of salvage radiation to "the bed". 5 days a week (not weekends) for 8 weeks minus 1 day for a total of 39 sessions at MSKcc. The actual radiation was like getting an x-ray by my dentist. I never had any side effects during the whole 39 sessions. However, 2 years later my left urinary tract was "fried" as per my urologist (or from passing prior kidney stones he was not sure). So, I had to have a urinary stent placed up my urinary tract (through my willy which is really nothing - sounds terrible but it's nothing) to aid in passing my urine (which was never a problem anyway). So I had stents in and out every three months for many years and now I'm stent free, However today 15% of urine from left kidney and 85% from right kidney, but not a problem. So make sure you get a good radiologist. Also, I don't know if this would apply to you but guys here recommend SPACEOAR HYDROGEL to be inserted for protection of parts of your body. Make sure you ask your R.O. about the space oar and make sure you ask here on this forum before getting fried.

Good Luck, Good Health and Good Humor.

j-o-h-n

[EvFC in reply to j-o-h-n]

Thank you for sharing your experience. His radiation oncologist recommended SPACEOAR gel to protect his rectum, if he does radiation. I think she mentioned it’s because he has a smaller prostate and perhaps because he is slim too? Appreciate your feedback.