Salvage treatment for radiorecurrent PCa

[hwrjr]

If I’m lucky I’ll soon be facing a decision as to which salvage treatment to have for radiorecurreent PCa. By lucky I mean that if upcoming tests show no spread outside of the prostate and I’m a candidate for salvage treatment. The salvage treatments I’m considering are SBRT, Brachytherapy and Cryotherapy. My urologist at Duke Cancer Center would perform the salvage Cryotherapy treatment and Dr Zelefsky at NYU Langone’s Perlmutter Cancer Center would perform the salvage treatment using SBRT, Brachytherapy or a combination. Either of these treatments has about a 50% chance of being curative, and both have considerable side effects.

If these upcoming tests show metastatic spread or these doctors don’t consider me a candidate for salvage, then ADT seems the likely next step either immediately or in the near future.

From what I’ve read, very few men in my position opt for salvage treatment. I’m not sure if that’s because most go along with their urologist’s opinion or recommendation to start ADT or they’ve done the research and decided salvage treatment is not for them. I have to admit, it’s a difficult decision— between a rock and a hard place.

As to which salvage treatment I lean towards I’d say it’s SBRT/Brachytherapy but not sure why I feel this way. With my tumor in the Apex region with close proximity to the urethra I worry that heating the urethra may have the effect of negating some of the freezing effect with Cryotherapy. OTOH, I’ve had lots of radiation already as primary treatment, so adding to that with Brachytherapy and/or SBRT might not be such a good idea either. I haven’t had a thorough conversation with either doctor so those conversations will have to happen first.

Both have a curative rate of around 50%. That number may come up in future studies since many of the patients in existing studies who were considered candidates then wouldn’t qualify now with PSMA scans. Of the 50% who fail in a few years, 80% are metastatic at failure, suggesting that they were probably metastatic at treatment but didn’t know it. Even today it’s difficult to know for sure. As for side effects, both have potential for serious problems.

So here’s the rock and the hard place. Don’t do salvage treatment and eventually go on ADT with its side effects. Call that the rock. Opt for salvage and maybe get a cure, or be one of the unlucky halves and fail in a few years and end of on ADT anyway with additional side effects from the treatment. Call that the hard place.

I’d love to read your thoughts on this.

[Justfor_]

My N=1 adaptive treatment, not suitable for "cure" belivers and kitchen sink throwers:

healthunlocked.com/prostate...

[maley2711 in reply to Justfor_]

very dismissive of those here who place hopes in things with more supportive data than the "adaptive" approach has? Like your adaptive approach is proven? to do what?

[NanoMRI]

I felt between the rock and a hard place several times. First after my unsuccessful RP when there seemed no imaging capable of identifying at least some of the spread. I settled on salvage RT to bed only, not (yet) willing to take on risks of pelvic radiation. I also declined ADT for the side-effects.

My salvage RT was unsuccessful and there I was again in hard place. I still felt I was too young and otherwise too fit and active for ADT. I found my way to successful imaging and salvage extended pelvic lymph node surgery with frozen section pathology method. That was over six years ago and achieved the success I wanted.

As I write this jut received notification on phone the pathology report of recently identified liver lesion is in my inbox. May find myself in hard spot again. All the best!

[Tall_Allen]

If you go for the cure now you are no worse off if it doesn't work. zFocal brachytherapy would be my choice.

[hwrjr in reply to Tall_Allen]

True, apart from any side effects from the salvage.

[maley2711]

Might the EMBARK study apply to your question?

nejm.org/doi/full/10.1056/N...

[j-o-h-n]

THIS IS OLD, BUT LIKE IT'S AUTHOR..... IT'S STILL WONDERFUL*..

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

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 (Dr. M. Zelefsky) . 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.

*p. s. I will be 88 years old in two weeks....

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Να τα εκατοστήσεις.

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

Επίσης. Με Τύχη, Υγεία και Χιούμορ.

Good Luck, Good Health and Good Humor.

j-o-h-n