Recurrence Risk After Radiation

Here are some information About treatment after a radiation failure

People who have radiation as their primary treatment have been told by doctors that surgery isn’t really an option if there’s a reoccurrence. Other options are not really mentioned..

This study shows that both salvage focal therapy (HIFU and cryotherapy) and salvage surgery were equally effective at extending the life of a patient that started off with radiation.

Those that had focal therapy had fewer perioperative complications.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2844900

I am in a somewhat similar situation. 64 (61 when diagnosed). I have 6 tumors: 2 are gleason 7 (3+4) with cribriform; 4 are gleason 6. I have a decipher of .72. My oncologist (Joseph Wagner - early robotic surgeon - over 4k successful) advise that both surgery and radiation were 'equipoise'. At his suggestion I met with a radiologists (trained at Weil/MSK). I had hoped that surgery would be the answer. But since one was the same as the other, I opted for radiation: - faster recovery, better odds at maintaining continence, better odds at maintaining intimacy. SBRT - 5 Treatments - 120 days of orgovyx. I just finished and my psa is undetectable. MRI later this week. I am no expert and Many Others on this site have very good information (Heavy Phil, Jeff Marci, and others) that helped me through the ramparts of my situation. Among the best notes of advice, I received from our cohorts: Exercise (very helpful), Get a Second Opinion (huge help), undestand that nearly every form of prostate cancer is treatable - maybe not curable, but treatable and a near-normal life is very possible. I have to say that in many ways we are lucky we have prostate cancer and not some other form that has far more grim prospects. So many kids and others have found cancer at much to early a point in their lives. My bet is you will be fine - you'll be anxious (rightfully) and annoyed at the side effects...and you will be okay once things are complete. Best of luck and watch for others with much better insight than me on this site to answer your questions. Go Easy - Jon

Forgot to mention, recurrence is more likely outside the remaining prostate tissue so SBRT could be used to treat other metastasis.

Memorial Sloan Kettering does have the Elekta unity which is a radiation machine that has a built in mri vs all other radiation machines that use fused images (except the Mridian). This means less toxicity and side effects. What the doctor can see he can treat. I was treated with the Mridian but the Elekta Unity has similar features. You might want to request the machine vs others that may be suggested to you.

@jeffmarc

Jeff, thanks for all you share and your generosity of time and efforts.

For cancer contained to the prostate and treated with radiation:

-Is it not as likely to recur in the prostate bed as outside the bed?
-Is the likely recurrence areas influenced by the cancer severity prior to initial treatment? Gleason 3+3 vs 3+4 vs 4+3 vs higher grades?

Thanks for any other thoughts and info you can provide on this subject. As I will likely have to make a treatment decision in the next few years.

Best Wishes

@bens1

Thanks for your input....I'm headed to MSK in early April for an appt with Dr. Ehdaie. Is the Elekta Unity an SBRT or is it a focal treatment? I tend to get confused with radiation that appears to be treating certain areas vs the entire gland. Would be interested in your age, diagnosis and overall experience with MriDian treatment if you would be so kind to share?

You might as well throw dice: there is NO definitive answer, only what treatments might cause lesser SE’s…maybe!
In your situation, many have opted for focal therapy such as TulsaPro.
It only treats the affected areas and leaves you with plenty of wiggle room to do EITHER surgery OR radiation if you get a recurrence.
The downside is periodic MRI’s and possible re-biopsies to see what’s going on. IMO, you are young enough to try to get some time from focal therapy (no one knows how much but it could be many years) before you have to pull the pin on life altering treatment. Best,
Phil

@charlesprestridge
The higher the Gleason score the higher, the chance of reoccurrence. There are, however, a lot of other issues that can cause it to rise. Other things found in the biopsy like intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE, and ECE can make the cancer much more aggressive And lead to faster reoccurrence.

If you have a Gleason score of 4+4 or lower the likelihood of SBRT radiation, to cancer confined to the prostate, working effectively for the long-term is pretty good, As long as you don’t have the above listed aggressive issues.

When you are ready to do something as the time to really evaluate, what’s going on, with your doctors? You definitely will need a biopsy before a final decision is made.

Urologist specialize in surgery so that is what they are most familiar and trusting with. Radiation Oncologists specialize in Radiation treatment so that is what they are most familiar and trusting with. Studies show equally successful, the difference being prep, recovery scenario, and side effects. A Medical Oncologists are generally neutral on mode but can help you figure out what's best for you.

Do your research, get second opinions, and be certain your decision is the right fit that you're comfortable with.