Recurrence after HDRBT

[CarverD]

Underwent HDR BT October 2020 to treat 6(3+3), 7(3+4), and one unknown tumor missed by TRUS. Late 2024 PSA doubles from 1.51 ng/ml to 3.28 in 4 months, then to 5.08 four months later. Last Thur/Fri underwent PSMA PET and MRI at Roswell Park, Buffalo, NY. Major worry of metastasis is off the table. Tumor is back where it started - right in my irradiated prostate. Either we missed some with the HDRBT or the prostate isn't as fried as I thought. My guess is the next step will be a biopsy, haven't heard yet. Roswell offers treatment options of IGRT, IMRT or HDR BT. I'd welcome any thoughts on what I consider to be a strange recurrence, whether you would treat or just wait and watch, and/or pros and cons of the three treatment options. Thanks!

[Tall_Allen]

It depends on the biopsy (not imaging). If there is an intraprostatic recurrence Biopsy determination is difficult in irradiated tissue. You may want a second opinion from Jonathan Epstein ($450):

advanceduropathology.com/co...

If there is an intraprostatic recurrence, there are lots of choices:

prostatecancer.news/2017/09...

prostatecancer.news/2016/08...

You first have to decide if you want to just re-treat the one area focally, or treat the whole gland. You may want to ask for an mpMRI.