Recurrence location probabilities post-RP

[ManuteBol1]

Hi All. I’m hoping someone here can help me. I’ve come across this presentation from Dr. Pete Carroll at UCSF that basically says the probability of the prostate bed being the site of recurrence is only about 15%.

youtu.be/8zxQ7kb22Yo(Not working as expected?)

On some other google searches, I’ve seen this number to be more like 80%, but those search results are just things like statements on a local urology office’s website like this:

santishealth.org/prostate-c...

The reason I’m having difficulty is that Dr, Carroll is reputable source. However, his YouTube presentation showed no citations, and I want to be sure that I’m not missing something, like not understanding the cohort. My gut tells me that 15% seems way too low (and that 80% is likely too high but closer to the answer than 15%.)

Has anyone here come across any papers that show the likelihood of recurrence in various locations post-RP? Thanks for the info.

[9020B]

It is logical to believe most recurrence after RP will be in the prostate bed. Here is the big question- is the recurrence confined to the prostate bed?The likelihood of micro metastasis beyond the prostate bed may be born out in the cure rates after salvage therapy.

[Tall_Allen]

Remember that imaging can only detect tumors that are≥ 5 mm in length. In mpMRI studies before PSMA PET scans, the site of the anastomosis and other sites in the prostate bed show up as major sites of failure:

bjui-journals.onlinelibrary...

ro-journal.biomedcentral.co...

Your profile does not show that you have a biochemical failure.

[Justfor_]

Realistic numbers from the video of a presentation by an Australian RO: Success rate of sRT, i.e. 5 year BCR freedom, 65% tops for low risk patients, dropping down to "30% if not 20% on high risk" (his exact words) leading to an average of 50%.

[gsun]

My brother saw Dr. Carroll. He is highly regarded and has run many trials.

[chefjlu]

Not sure what the concern is? I had RP in 2019, Gleason 9 - 1 lymph node removed positive, 3 years no PSA, at recurrence 1 spot found in the pelvic area just off the edge of the prostate bed - ADT & Salvage Radiation - now 2 1/2 years undetectable PSA and no signs of cancer in scans. Doesn't mean I won't continue to be monitored with blood tests and scans as needed to keep everything in check. ---- So many variables in each of our diagnosis

[StayingOptimistic]

I did the SRT thing and I regret it every day

[doorknob5]

At PSA 0.018, my RO ordered a MRI.

Findings:

"No definite residual soft tissue is visualized. A 0.5 x 0.4 cm focus of restricted diffusion is seen in the region of the left puborectalis musculature (series 10 image 16) with possible corresponding early focal contrast enhancement. There is no definite correlate on T2-weighted imaging."

The RO tells me that this small lesion (5mm x 4mm) is located near the prostate bed and could be the source of my recent PSA rise from 0.012 to 0.018. But the lesion is too small for a biopsy, to confirm for malignancy.

Hope that helps.

[doorknob5]

MRI Imaging for Local Recurrence after RP

ajronline.org/doi/epdf/10.2...

pmc.ncbi.nlm.nih.gov/articl...