Has it been enough years...

[Handdrummer777]

...to compare the cure efficacy of SBRT to IMRT over ten years? Does SBRT have a lower incidence of salvage radiation?

[Tall_Allen]

An estimated 20% of recurrences are local for SBRT vs about 50% for IMRT. I'm sure salvage radiation is underutilized for either.

[Handdrummer777 in reply to Tall_Allen]

As opposed to what? Surely not salvage surgery.

[Tall_Allen in reply to Handdrummer777]

I hope not. Many RT failures were just treated with ADT historically. It's changing, certainly at the top cancer centers, but not in community practice.

[Handdrummer777 in reply to Tall_Allen]

I see. What is SBRT's record AS a salvage radiation, in case I need it?

[Tall_Allen in reply to Handdrummer777]

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

[Handdrummer777 in reply to Tall_Allen]

Thx very much

[billfenley2 in reply to Tall_Allen]

TA, I read this piece, and it seems you're talking about patients who've had IMRT or brachytherapy, one or the other. I had both (brachy boost) and my doctor thinks that's a lot of radiation for salvage SBRT. Probably so? Thanks.

[Tall_Allen in reply to billfenley2]

I agree. In your case, stick with focal salvage brachytherapy rather than whole gland salvage SBRT.

prostatecancer.news/2017/09...

[billfenley2 in reply to Tall_Allen]

Wow, thanks! But, not salvage brachytherapy for me, right? since I've already had brachytherapy. My doctor (Oliver Sartor) is leaning toward the cryo, like with Thomas Polascik at Duke. Thanks TA.

[billfenley2 in reply to billfenley2]

I'm sorry -- on the last chart, there's a reference to "LDR brachy after LDR brachy (focal)" -- which indeed sounds like salvage brachytherapy after initial brachytherapy?

[Tall_Allen in reply to billfenley2]

Correct- one can add more seeds - especially if it has been a while since you had it originally. Better yet, focal salvage HDR brachy may have less toxicity than LDR brachy. But an experienced RO should decide that. And he has to look at exactly where in the prostate the recurrence is. Oliver Sartor is one of the top MOs, but this is something where one should get a consult from someone with experience at salvage radiation. Maybe talk to Joe Hsu at UCSF about it. I am squeamish about cryo, even focal cryo - you can see on that chart that the numbers are not as good.

[billfenley2 in reply to Tall_Allen]

What a blessing you are, TA. I have a May appt with Wm Robert Lee (Duke) to talk with him about it -- but I don't know what experience he has here.

[billfenley2]

What a blessing you are, TA. I have a May appt with Wm Robert Lee (Duke) to talk with him about it -- but I don't know what experience he has here.