SBRT left common iliac node

I have had a prostatectomy 1 yr later it came back did 37 rounds of radiation 2yrs later came back in 1 lymph node biopsy came back not enough samples.3 scans later .o5 cm.they recommend sbrt 5 rounds..no meds anyone with the same situation. THANKYOU

I had a prostatectomy and 3 1/2 years later it came back so I had salvage Radiation. It came back again years later, and I had a metastasis on my spine. They used SBRT to zap it, And I’ve been undetectable for 14 months since then. 15 years since first detected cancer. As soon as the cancer came back after radiation (2.5 years later) I was put on ADT.

Doing SBRT to zap up to five metastasis is very common. Not something to worry about. I’m a little surprised They don’t want to put you on ADT Because there might be other micro metastasis they are ignoring. This really does increase the chance of your cancer coming back.

Thankyou.

Had my Simulation Yesterday. Proton Beam SBRT on Friday.
Anxiety as usual - all research says I'm safe, results may vary.
No mandate for ADT yet.
Very cool Doc with tons of experience.
I wish I was still drinking!

I had the same treated with SBRT at Georgetown Medstar and it's gone.
Incidentally. I've read there's some evidence that pc in both the left common iliac and perirectal lymph nodes can occur as a result of the prostatectomy itself, ie, they may not be de novo.

There's some debate over the efficacy of the ADT in your situation- ie, whether it really enhances the efficacy of the radiotherapy in killing the cancer cells. I had it with my salvage radiotherapy and I tolerated it well. Also my testosterone came back quickly. Best to discuss with your docs. They have the best feel for your individual situation. Good luck!

You'll find a range of treatment options...

There is debate about whether or not SBRT by itself can be "curative."

Most literature I've read leans towards SBRT by itself as "palliative," used for PCa control, delaying the need for ADT.

With a single lymph node SBRT may very well control the PCa, have a period of radiographic progression free survival, I've seen literature that says it can be used in up to 3-5 metastases.

I've also seen literature that equates to "where there's smoke, there's' fire...!" That just means micro-metastatic PCa imaging can't see.

If so, ADT can be added. More questions to ask and answer, how long, which agent, do you add an ARI....the answer may lie in your other clinical data, Gleason Score, Grade Group, PSADT and PSAV, time to BCR.i am high risk, GS8, GG 4, PSADT around three months, 18 months to BCR...so we did SBRT and 12 months Orgovyx. Oncologist wanted to do 24 months and add ARI (EMBARK). I was thinking six so 12 was a compromise between he and I. We also agreed to hold the ARI and only add if PSA did not drop to undetectable in the first three months, it did.

My radiologist supported six or 12, said in the tumor board reviews the oncologists were all over the map about duration of ADT, adding ARI.

You still get all the wonderful side effects with Orgovyx, I mean no T is exactly they whether Lupron or Orgovyx. The recovery is a hell if a lot quicker though!

The VA's proposal is a definite no!

Kevin

As one who is still going thru the mill begun in 2018 and has gone thru prostatectomy w a stellar path report - neg margins, Gleason 3+4 w 4 at only 20%; no EPE ; lymph node sentinels negative; no semivesicles
Still some got out
So salvage radiation- w good initial results. Then IMRT w good initial results to undectable nadir lasting 4 months.
Then MDT via SBRT w PSA now under 2 and still falling.
It's been 7 years since diagnosed.
Except for 6 month ADT for
the IMRT, avoided it.
Still a continuing debate on role of ADT for my case of favorable intermittent pc.
So seven years-
I joke w my Doc by qouting a Mark Twain adage about a guy who said after being tarred and feathered and rode out of town on a rail-
"You know
If it wasn't for the honor of it-
I justa soon passed the whole thing up!"