Possible Treatments with Recurrence after Radiation?

[redonthehead]

If one's PSA returns (2.2?) after one of the radiation treatments (IMRT/SBRT/Brachy/etc) what are the choices of available treatments and their success rates?

[Tall_Allen]

How long ago was your treatment? What was the lowest PSA reached after treatment?

[redonthehead in reply to Tall_Allen]

sorry, I should have not have posted without more thought. I have not had RT nor any other treatment. I am studying to choose one. I am concerned with RT as a primary treatment (which has perhaps 85% rate of cure) what happens when you are in the 15% that needs to have some sort of salvage therapy after RT.

I believe I have read of a nadir goal of 0.2, and a 2.0 rise over that suggests salvage therapy is required.

[Tall_Allen in reply to redonthehead]

Thanks - I understand now. The kind of prostate cancer you have is called "favorable intermediate risk." 7-year cure (biochemical recurrence-free survival) rates (with SBRT) are 91% vs about 81% for surgery:

prostatecancer.news/2018/10...

But your question is -what if I am in the remaining 9%? The first step would be to establish whether the biochemical recurrence is an actual clinical recurrence, and if it is, is it local, regional, or distant. If local, it can be treated with focal brachytherapy or whole-gland SBRT. The new PET scans will be very useful in categorizing patients. You can get an idea of the relative success rates (w/o PET scans) in the chart here:

prostatecancer.news/2017/09...

If regional, the pelvic LNs can be treated with external beam radiation.

If distant, the cancer is managed with systemic therapy.

[redonthehead in reply to Tall_Allen]

If local, it can be treated with focal brachytherapy or whole-gland SBRT. So one can have whole gland SBRT done twice? - assuming the first treatment is whole gland also.

Thanks for the input.

[Tall_Allen in reply to redonthehead]

Yes. Don Fuller in San Diego does that, but remember, it would be a few years afterwards, giving tissues time to recover. But recurrences after initial SBRT are very rarely local. It is much more likely to have a local recurrence after IMRT.

[billy1950 in reply to Tall_Allen]

TAllen, Would brachytherapy be appropriate for someone who originally had IMRT? There is some scarring already there from the initial radiation (15 years ago). Thanks

[Tall_Allen in reply to billy1950]

Salvage focal brachytherapy has been used to good effect in men who had had IMRT originally.

prostatecancer.news/2017/08...

[billy1950 in reply to Tall_Allen]

TAllen, I suppose my concern centers around the fact that my radiation treatment was done 15 years ago. I don’t see in the article how long before men experienced the recurrence after initial radiation.

Thanks, Billy

[Tall_Allen in reply to billy1950]

If you were treated recently, I'd understand why you might be more concerned. A lot of healing occurs in 15 years. The longer time since radiation should make you more confident in salvage radiation, so I don't understand why you are concerned.

[billy1950 in reply to Tall_Allen]

TAllen,Yesterday, the results of the biopsy is that i have recurrent cancer on the right side of the prostate 4+3...The urologist says that all the cancer wasn’t radiated originally . He talked about possible salvage treatments, brachytherapy being one of them. This summer i plan to have a further consultation with MSK in NY. I prefer getting salvage over going now on ADT....Any input would be appreciated. Thanks

[Tall_Allen in reply to billy1950]

You can have salvage brachytherapy at MSK:

prostatecancer.news/2017/08...

Or you can get in on this trial for salvage SBRT at NIH:

clinicaltrials.gov/ct2/show...

[billy1950 in reply to Tall_Allen]

Thanks for all of the information...

[billy1950 in reply to Tall_Allen]

TAllen...one more question about salvage...with scarring or strictures, can brachytherapy be done as salvage treatment or else does the scarring present a concern?

[Tall_Allen in reply to billy1950]

It depends where the recurrence is. You have to get an RO to look at the imaging.

[curtisbirch in reply to redonthehead]

There is a lot of misconception around here as to nadir after RT. It is why the bounces that are common after radiation cause so many questions (and often concerns of a recurrence when there’s nothing to be worried about). I also believe there is a lot of confusion over bio chemical recurrence vs. clinical recurrence. One of them isn’t a recurrence of cancer —i.e. one of more of my bounces were higher than 2 points. My baseline PSA, nearly 3 years after treatment, I am being told could be as high as 2 by Dr Chris King who gave me a 2nd opinion on my PSA chart. I never knew someone could have a nadir of 2. He was a pioneer of SBRT and probably has seen more post RT PSA results than anyone. Per Tall Allen, the chances of success make RT highly recommended if you are favorable risk intermediate, or even intermediate in my case.

[redonthehead in reply to curtisbirch]

Thanks Curtis. Here is a video of Dr Kishan discussing SBRT where he mentions the PSA bounce at 26:03

youtube.com/watch?v=kbFTfIW...(Not working as expected?)

[redonthehead in reply to redonthehead]

oops 24:06

[billy1950 in reply to curtisbirch]

Hi,Where is Dr. Chris located?

Thanks!

[Magnus1964]

You could go on ADT treatment.