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Experience With Recurrence Post SBRT
Still trying to understand my options here should I have recurrence post SBRT. This is the only thing potentially holding me back on radiation vs surgery. I’m 59….3 (3+4’s) with 10%, 10% 5% pattern. Artera AI score of 2%, 3.5 psa and .065 psad.
Based on what I’ve read chance of recurrence post SBRT for me is approximately 10% but that 10% is Biochemical Recurrence which doesn’t necessarily indicate cancer is present ( although it does in most cases). So of the 10% ( or let’s say 10 men out of 100) 4 or 5 men would have localized recurrence and 1 to 2 would have metastasized. The other 3 may be due to inflammation or cancer to small to even detect.
Interested to hear from those who have experienced localized recurrence post SBRT and how effective the treatment has been the second time around. Not sure I’ve really received a definitive answer from the RO’s on how easily treatable localized recurrence is post sBRT.
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I did not have SBRT, but my good friend did, at Sloan Kettering.
His RO told him that if treatment ever failed they would ‘do seeds’.
He was not specific about HDR/LDR brachytherapy but that would assume there was no spread outside the gland if BCR occurred.
Phil
I've had it all - Prostatectomy, EBRT, SBRT.
Now more metastases where they say is either too far north or too far south to zap.
Told me ADT till I die
Seeds are permanent (interstitial radiotherapy). It is the original form of brachytherapy. I think it would be useful if
the clinicians adopted.... LDR-B 'low' dose brachytherapy AND HDR-B for the short lived temporary 'high' dose form. If you consider time + dose the LDR-B provides the optimal dose without the additional effects on the healthy tissue outside the gland which limits EBRT dose. MSK uses CT guided implanting of permanent seeds.
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 ?
Not myself - I had 28 sessions of proton radiation + 6 months of ADT - but, I’ve had two acquaintances who had recurrence following SBRT. In both cases, recurrence was a single localized spot.
Both of them were treated with SBRT for the salvage treatment for a couple of reasons:
1. Having had SBRT before, they were familiar and comfortable with it.
2. Because recurrence was a single spot, they wanted a treatment that was very targetable. (They could’ve chosen focal therapy or brachy - both being very targetable - but, because of #1 above, they stayed with SBRT,)
In both cases, their PSA plummeted following treatment. The last I heard - a couple of years ago - they were still doing fine.
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Hug
3 Reactions@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,)