Radiation prostrate treatment

[Mgtd]

For many of us learning about the various initial and recurring cancer options etc can be very confusing. In my journey I am at the point where I am past all the work up data and have already had my initial treatment and am now looking into potential identification of recurrence.

Just some things that may spark your attention.

1. How many of you have heard or read that radiation can only be done once?

2. How many have heard recurrence after radiation is defined as a PSA of Nadir + 2?

Looking forward to your comments and please do not shoot the delivery guy I am only trying to help with providing a reliable/credible source of information.

[ToolBeltZia]

Yes, BCR is nadir plus 2.0. And radiation can be used again, for example SBRT to zap a node.

Stay Strong Brother, we got this.

[Mgtd in reply to ToolBeltZia]

I posted those two questions because the doctor commented on those that drew my attention. Basically he said that definition was outdate by new scans. Radiation can be done twice according to him. He makes some other interesting points.

By the way he is not some snake oil quack.

[ToolBeltZia in reply to Mgtd]

NCCN Guidelines Version 1.2024 Prostate Cancer define BCR " as nadir plus 2 with or without ADT." Use whomever you want to determine a standard, but for me I will follow NCCN.

[Mgtd in reply to ToolBeltZia]

No argument with your classical definition of BCR.

Sometimes it takes awhile for thinking to change and to make it into NCCN guidelines.

[ToolBeltZia in reply to Mgtd]

Just pulled up the 2025 NCCN Guidlines, and this is the footnote regarding BCR.

" RTOG-ASTRO Phoenix Consensus: 1) PSA increase by ≥2 ng/mL above the nadir PSA is the standard definition for PSA recurrence after EBRT with or without

hormone therapy; and 2) a recurrence evaluation should be considered when PSA has been confirmed to be increasing after radiation even if the increase above nadir

is <2 ng/mL, especially in candidates for secondary local therapy who are young and healthy. Retaining a strict version of the ASTRO definition allows comparison with

a large existing body of literature. Rapid increase of PSA may warrant evaluation (prostate biopsy) prior to meeting the Phoenix definition, especially in patients who

are younger or healthier"

[Mgtd in reply to ToolBeltZia]

Really appreciate your posting that. That will help others see the complete thinking of why nadir + 2 exists and its usefulness in research. Clinically there maybe a better definition evolving.

Well I had to smile in a good way when I read the NCCN footnote. I meet 50% of their criteria. I am in excellent health other than the initial prostrate cancer diagnosis at 78. The “younger” chronically part in their footnote left the station a while back.

On a personal note after my initial shot at a cure which I took with radiation and short term ADT, I have been wrestling with the issue of QOL over the next 5 to 8 years coupled with how long do I really want to live. Facing mortality head on at my age is a reality. Do I let nature just run its course?

Time to take the dogs for their daily hike in the forest and then off to the gym for me. We had some light snow last night so they are ready to go. Kind of like young kids.

[ToolBeltZia in reply to Mgtd]

Have a great walk with the "kids"! Heading off to the gym myself in a bit.

[drzaius in reply to Mgtd]

Yes, I agree. My QOL at age 75 became front and center to me after my radiation for gl6 with a high decipher score at 74. Friends have told me if they have a recurrance, they will just let it ride out and be palliative about it, no chemo or hormones for them. I can see their point of view now. Best of luck to you and Godspeed.

[SongofFred]

Good find. I always appreciate seeing the latest by Dr. Kishan.

[dhccpa]

I've heard and read both of those things. I suspect there are some nuances to be considered, but each case is different.

[NanoMRI]

Yes, nuances and disparities to sort through.

My understanding is radiation to exact same area is a no no - but elsewhere is doable - I hold additional RT in reserve.

If it is recurrence at PSA of Nadir + 2 how can it not be before?

[Seasid in reply to NanoMRI]

I am not a doctor but I believe that PSA is not a cancer nor is a PSMA. Therefore a recurrence is defined at nadir plus 2.

Only my thinking. Maybe you could do mpMRI and PSMA pet CT scan with contrast and see the correlation of the scans and maybe you could just do a biopsy at the recurrence definition or just a little bit earlier.

I was thinking much about all of this and made a decision not to overreact and not to do anything before the definition of the recurrence is fullfilled especially I would wait at least 2 years after the radiation with anything like biopsy even PSMA pet scan and maybe even mpMRI.

[Seasid in reply to Seasid]

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

link.springer.com/article/1...

[petabyte]

Excellent! Thank you.

They were discussing this paper as well.

ASCO 2023: Prognostic Impact of PSA Nadir (N) ≥0.1 ng/mL Within 6 Months After Completion of Radiotherapy for Localized Prostate Cancer: An Individual Patient-Data Analysis of Randomized Trials from the ICECaP Collaborative

urotoday.com/conference-hig...

[Mgtd in reply to petabyte]

Thanks for posting that. Not sure I really understand or comprehend all the statistics involved. My statistics knowledge is limited.

I am currently trying to look ahead and be proactive because in the natural evolution of things that could probably be my next hurdle at some point in this journey. Although being a “half full” guy I think maybe I am in remission. Only time will tell.

Every time I see my one oncologist she brings up the point that I will need to be back on meds if BCR occurs. Really not sure why she slips this in other than to plant the seed and over come my resistance.

[JWS13 in reply to Mgtd]

because she never had prostate cancer and was never on that "demon" ADT!

[Mgtd in reply to JWS13]

My thoughts too. I just keep saying no.

[petabyte]

I think I'm similar. Hoping for the best but preparing for the worst. I found the video you posted quite reassuring and also learning that there are many local treatment options in case of BCR. I read one of your posts about not having a pet scan and doubting that the hospital even has a machine.

If you ever do have BCR (unlikely according to the video) maybe consider finding a more specialized centre? I looked up the professor in the video and he is taking patients 😉

[Mgtd in reply to petabyte]

Thanks petabyte for the input and remembering that post. Honestly your suggestion was in my thinking. Know what I know now and Getting that PET scan the second time around if necessary would be very important. Hopefully I can avoid that.

On a one time visit basis I could pay someone to help with my wife and dogs and I could make it up and back to the Mayo Clinic in Scottsdale in a long day. There was no way I could have done that for say 2 weeks of SBRT and never for 25 or 40 sessions of normal radiation.

Did my first chair group Yoga class yesterday at the gym and feel great. Really loosed up my back. Who knew waving your hands and arms around could be so effective. Live, experience and learn. Going back next week.

[maley2711 in reply to petabyte]

I don't see a video in the post? Let us know where you saw it? I have been told that PCa videos aren't allowed here!!! I included a video by a PCa specialist and my post was deleted!!

[Mgtd in reply to maley2711]

Maley2711, I am confused. I did not mention a video in my post directly above. Did you mean your post from someone else?

[Mgtd in reply to maley2711]

I read my first post and yes that video was deleted. I guess that is not allowed. Sorry.

[maley2711 in reply to Mgtd]

I would love to see that video......what was the title and I will Google it !!! I GREATLY disagree with the policy here......I guess such videos are considered competition for viewership here? To me, just depriving folks here from expert /specialist expertise.

[Mgtd in reply to maley2711]

I can not remember the exact title but it was a talk by Dr Amar Kishan UCLA. The point that really impressed me was that radiation within certain parameters could be done again to the prostrate. That it is not just a one and done solution. As someone mentioned in the post above there were probably nuances that were not brought up in the video.

Sorry I can not be more specific I assumed that my reference to the video would stay with my post.

[maley2711 in reply to Mgtd]

any opinion on HU's policy....they allow us amateurs to offer opinions, but they do not allow PCa specialists, via videos, to do so??? That does not seem patient-oriented IMHO? Confusingly, they do allow posting of written info/opinions from the same specialists??????

[Mgtd in reply to maley2711]

Their ballpark; their rules.

[maley2711 in reply to Mgtd]

But.....do you like those rules? Patient-friendly?

[maley2711]

By moderate, do you mean censor???? I have never heard a professional PCa specialist say things that would need "moderating". So, they moderate articles written by the same specialists?

[Seasid]

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

link.springer.com/article/1...