Thoughts on treatment options?

There a lot more radiation options for you today that I had for example in 2013 and 2021. Personally I chose high-dosage Cyberknife (twice) because of the short treatment (5 days versus 28+ spread out over a number of weeks for other technologies.); and the fact that the 5yr-10-yr life expectancies were just as good if not better than other technologies. In addition to the 5 days on the table, I had an MRI the prior week, which they use to map out their radiation plan; and they also needed to plant gold fiducial markers in the prostate (done under anesthesia, easy in-and-out procedure. )Those gold markers are used for positional tracking by the Cyberknife while you're on the table and are with you for life (no issues). Anyway, that's just my experience....I avoid recommendations since I'm not a doctor. Good luck !!

@lagnafinc Thank you for the information and the related suggestion(s). I'm not at all familiar with the "cyberknife" approach, and have no idea whether its something that either my urologist or oncologist would recommend? I just have to be patient for another couple of days, until I can meet with both, and know their respective thoughts on things. However, in the meantime, I will certainly begin looking into it, and I greatly appreciate your sharing your thoughts.

@toomany
Cyberknife is just SBRT radiation. It’s been used for over 18 years, clinical trials started in 2007. I know people that have had it 15 years ago, he’s never had a recurrence.. My brother had five sessions of it at UCSF, He’s doing fine three years later. I know almost as many people that have had that as have had IMRT radiation.

Cyberknife is just a technology, not an approach; it's a brand name for a specific technology to administer SBRT using high-dosage radiation. Developed at Stanford, been FDA approved since 2001. Among other things the Stanford developers were able to determine that the prostate is capable of receiving higher dosages of radiation than other parts of the body....which allows it to do what it does in only 5 days at higher doses.

Word of caution: many urologists/oncologists have their own, very expensive radiation machines in their own clinics. As you might guess, that's what they typically recommend...so hopefully the people you are seeing are independent and not necessarily referring you to a source of their own income. Get multiple opinions...I think I had six when I first started.

Cyberknife is just a technology, not an approach; it's a brand name for a specific technology to administer SBRT using high-dosage radiation. Developed at Stanford, been FDA approved since 2001. Among other things the Stanford developers were able to determine that the prostate is capable of receiving higher dosages of radiation than other parts of the body....which allows it to do what it does in only 5 days at higher doses.

Word of caution: many urologists/oncologists have their own, very expensive radiation machines in their own clinics. As you might guess, that's what they typically recommend...so hopefully the people you are seeing are independent and not necessarily referring you to a source of their own income. Get multiple opinions...I think I had six when I first started.

@lagnafinc Given its shorter application time (i.e., under two-weeks), SBRT would certainly have some obvious appeal, but I'll need to look into whether short-term, higher-dose SBRT is even advised for someone (like me), who has already had long-term, lower-dose IMRT.

@toomany That is the key question! If you’ve reached your ‘ lifetime maximum’ of radiation in an area that has recurrence, SBRT could be questionable. You can’t keep hitting an area with radiation and not suffer consequences.
However, anything outside this area is very successfully treated with SBRT; it is more of a ‘spot’ treatment, rather than a ‘blanket’ tx.
But never say never; today’s machines/software can do amazing things so talk to your RO for the best info.
Phil

@heavyphil Thank you for your posting, Phil. You've taken the words right outta my mouth on this one. I was not previously familiar with shorter-term SBRT, and I'm not sure that my original treatment facility in 2018 offers it. However, given my serious disdain for the thought of spending another 7-8 weeks away from home again for something like IMRT, and, the fact that the hottest area on my recent PSMA-PET scan was notably isolated to a single seminal vesicle, localized (targeted) SBRT, just might be the right answer. So whether my RO recommends it or not tomorrow, I certainly will be questioning him about it. Thanks again for reinforcing my mental database.

@toomany It is absolutely possible to have only one SBRT treatment to a met. My husband has had a single zap to mets on his spine at Mayo Rochester several times over the years. Your RO will know if this would be possible and effective for you.