Recurrence after brachytherapy - looking for the best option

Hey Andy, sorry to hear of your present situation. I do agree with you that radiation might not be advisable, but you should definitely seek out the best RO you can to see if this is the actual case….you never know.
As others - and I - have oft repeated: surgery after radiation is not a good idea. BUT, it can be done by a skilled surgeon. Evidently, you have cells resistant to low dose brachy, and they did not die off after treatment. So prostatectomy, while challenging, might still be your best option; also lymph nodes could be removed to check for spread.
Again, it is essential that you find a surgeon who does this salvage surgery regularly and not just an excellent prostate surgeon - it’s a whole different ballgame and you don’t want the SE’s of the surgery to make you miserable.
Perhaps others on the forum can guide you to a center of excellence/surgeon who performs this procedure. Best,
Phil

Thanks Phil, you make excellent points. I am hoping to not go down the surgical path but it would be foolish to not consider it as an option.

@andy54, any update? What treatment option did you decide to pursue?

Hi Colleen, met with my Radiation Oncologist Monday - next step is an MRI to confirm the PSMA scan. He believes treatment with SBRT is definitely a way forward, will also be discussing use of proton radiation. Once the MRI results are in there will be another round of discussions before making a choice

Great news, Andy. Hope it works out!
Phil

Hi Andy, did you have any IDC-P present or Cribriform in your pathology report ? Asking because my husband has exact same numbers as you and we are gathering data about possible treatments etc. Thanks so much in advance.

No IDC-P or Cribiform - Two of the four cores (out of 12) that had cancer present had evidence of perineural invasion, but nothing else. My initial biopsy report was G7 4+3 but MD Anderson's second opinion downgraded it to G7 3+4 (months after treatment of course). With G7 4+3 the recommendation was 12 months of ADT with Protons or 4 months ADT with Brachytherapy. The downgrade would have skipped the ADT requirement for both treatments.

Follow up to the original post - have had a 3T MRI done which confirmed the results of the PSMA scan. Apparently the seminal vesicle with the "hot" spot is very thin and long, which is going to make safe use of proton treatment challenging, according to the Proton RO. Next step is a trans-perineal biopsy with emphasis on getting a sample from the seminal vesicle. Once done the severity of the tumor can be determined which might help direct the decision making. Am also considering a Decipher test (the more information the better).

If I can't go down the additional radiation route I suspect I'll head to a center of excellence for a second opinion on alternatives. The Proton RO seems to think salvage prostatectomy might be a consideration, but, as discussed earlier with heavyphil, getting the right surgeon for that might be challenging