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Should I have Recurrence Post SBRT, what are my options?
Prostate Cancer | Last Active: Apr 6 7:32am | Replies (7)Comment receiving replies
So as I’ve read more it’s now my understanding that given my profile the majority of the time when recurrence occurs it is outside of the prostate.
Assuming that is accurate the radiation treatment for spread is essentially the same as if I would have had surgery initially.
If this is true correct then the treatment flexibility with surgery really only applies with localized recurrence……do i understand that correctly ?
Replies to "So as I’ve read more it’s now my understanding that given my profile the majority of..."
@broderbund1 @brianjarvis summed it all up perfectly. But surgery or SBRT for localized cases (all the cancer is INSIDE the gland) can still fail: cells can escape into the body during removal or undetected rogue cells outside the gland (farther away than the lethal zone of the radiation) can live in a lymph gland.
After living with this disease since 2019 I have come to understand that there are no absolutes, no ‘odds’ you can reliably go by.
Each and every case is unique unto itself and surgeons/RO’s can only give you percentages based on whatever study they like best.
Thousands of men have suffered BCR after ‘successful’ RARPS with negative margins, clear lymph glands, no EPE and unremarkable surgical pathologies.
Likewise, an equal number have undergone BCR after SBRT or EBRT when the cancer was deemed ‘localized’.
After a while, the endless calculations of success vs failure can drive you insane…truly!!
Know the facts, ALWAYS have a Plan B and then go with your gut - the inner you knows the answer. I got good advice from someone on this forum via a snippet I found online during my search for answers 7 years ago: the correct answer is usually the hardest thing to do, never the easiest. In my case that was surgery because I truly did NOT want it! But it was the best decision because I got 5 years undetectable and then got a second chance to treat it again.
YOUR case is completely different from mine - much, much less widespread or aggressive so I am NOT suggesting surgery in any way.
But DO have a Plan B, and then you can forget about all these little side distractions that aren’t worth your time or worry. Best,
Phil
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@broderbund1 I think that the recurrence profile is different for surgery vs radiation,
In one of Dr. Kwon’s presentation’s (https://youtu.be/Q2joD360_pI), he indicates different recurrence patterns for surgery vs radiation.
He talks about recurrence following prostatectomy starting about timestamp 3:10.
He talks about recurrence following radiation starting about timestamp 5:20.
Treatment for localized recurrence following primary surgery (in the prostate bed) is not very flexible - almost always radiation.
Treatment for localized recurrence following primary radiation (in the prostate) can include any treatment that is targetable - focal therapy (like cryo), brachytherapy, SBRT, and sometimes even proton radiation. It depends on the nature of the recurrence. (With any type of salvage re-radiation, the concern is with how much re-radiation rectal tissue is getting,)