What treatment for recurrent prostate cancer?

[PCPatient]

I'm new here.

At a general health check end 2010, a PSA of 28 was detected. After MRI, CT scan and biopsy, cancer in prostate was detected with Gleason score of 8. I had hormone therapy with Casodex 150, followed by Radiation treatment for a 7 week period from March to August 2011.

After treatment, my PSA fell to a level around 1, and was constant at a level between 0.5 and 1.5 up to 2018. At a blood test in Feb 2019, it had suddenly increased to 4.5, and again to 8.5 in March 2019, and 8.7 in April 2019.

MRI and CT scan detected a small local tumor in one side of prostate.

I am very uncertain about what treatment to select:

- keep it at rest via hormone treatment, or

- surgery/prostate removed, or

- cryotherapy, or??

I have checked other options, such at Proton Therapy, or Cyber Knife therapy, but when they see my past Gleason score of 8 and radiology treatment, the do not recommend these treatment's.

Anybody who has had similar experiences or knowledge about recurrent prostate cancer, please add your comments/suggestions.

[Tall_Allen]

Whatever you do, don't have salvage surgery.

As far as salvage SBRT goes, you have to find someone who specializes in salvage after radiation. That would be Don Fuller in San Diego. Even better is the NIH clinical trial which treats you for free:

clinicaltrials.gov/ct2/show...

pcnrv.blogspot.com/2016/08/...

Another good option is salvage focal brachytherapy. That and several other options are discussed here:

pcnrv.blogspot.com/2017/09/...

The hard part is finding the specialists in those salvage therapies. You may have to travel for treatment. Where do you live?

[PCPatient in reply to Tall_Allen]

Hi Tall_Allen,

Thank you for valuable info.

I live in Spain, but would be ready to travel for the right treatment.

[Tall_Allen in reply to PCPatient]

If you follow the links in the article on salvage SBRT, several are in Europe, and some have used focal SBRT on small numbers of patients. The Zerini study was done at the European Institute of Oncology in Milan, the Mbeutcha study was at the Univesity of Nice, the Leroy study was at the Centre Oscar Lambert in Lille, and the Loi study was at the University of Florence. You may wish to contact them.

The Ahmed/Emberton group at University College in London is doing a trial of focal salvage HIFU and focal salvage cryo after RT failure. There is also this trial of focal salvage HIFU in Lyons starting next year:

clinicaltrials.gov/ct2/show...

Constantinos Zamboglou at the University of Freiberg has been treating patients with focal salvage HDR brachytherapy. Here's contact details: Constantinos Zamboglou, MD, Department of Radiation Oncology, University of Freiburg Medical Center, Robert-Koch Straße 3, 79106 Freiburg, Germany. phone: [phone], fax: [phone]. e-mail: [e-mail]

[PCPatient in reply to Tall_Allen]

Hi Tall_Allen,

I have been in contact with most of the possible clinical trials, but for various reasons, it is not possible to enroll in any of these.

I am now most tempted to go for Cryotherapy. I believe that with the recurrent PC identified and located inside the prostate, there should be a good chance for a successful treatment with Cryotherapy. I will now undergo another more detailed MRI around my prostate, to be followed by a biopsy, which should create the best basis for a successful Cryotherapy.

Any comments/advises from your side?

Thanks in advance.

Best regards!

[Tall_Allen in reply to PCPatient]

I think a template mapping biopsy is the most definitive. Tissue changes from radiation make MRIs difficult to interpret. It helps to have a radiologist who has experience with irradiated tissue. Biopsies are difficult to interpret too. It helps to have a pathologist with experience in this kind of thing. An Axumin or PSA PET scan may be useful.

Cryo equipment has advanced in the last few years - improved accuracy and less damage to healthy tissue. Make sure the equipment is state-of-the-art and the doctor is experienced. If cancer is found near the urethra, bladder neck or neurovascular bundles, you may want to look for a different kind of salvage. I think they treat 3 times in the same place to get complete ablation. It's not a bad idea to have a follow-up biopsy in a year.

[PCPatient in reply to Tall_Allen]

Thanks, Tall-Allen!

[dadzone43]

Just attended today the all day conference of the Mass Prostate Cancer Coalition. Most of the program was about advanced PCa and available treatments. The oncologists favored repeated imaging. If MR does not identify the active areas, then PET scan. Exciting changes in metastatic disease response if fewer than 5 mets. That will guide what kind of therapy to pursue. Good luck and good wishes.