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Recurrence after brachytherapy - looking for the best option

Posted by andy54 @andy54, 1 day ago

Looks like prostate cancer recurrence is now suspected but not yet confirmed.
My original diagnosis - G7 4+3 PSA7.6 in May 2019. Treated with low dose Brachytherapy and 4 months of ADT (Lupron). PSA levels dropped to undetectable and stayed that way for a couple of years before increasing to current level of 2.3. PSA doubling time is around 13 months. Have had three annual PSMA PET scans with the most recent in March 2025. The first two were negative. The last scan has a small focus of mild uptake in the left seminal vesicle (SUV 3.8) which is indeterminate. No sign of mets anywhere else.
Obviously I'm now considering next steps. I'll be talking with my RO next Monday. He will almost certainly suggest ADT. I'm not totally against it, but would prefer other options with lower side effects, and with a higher potential of long term remission. I've been researching the use of SBRT as a treatment for recurrence, where there are only a few mets that need treatment, but don't know if SBRT of this area is advisable after Brachytherapy. If the recurrence was within the prostate then cryotherapy might be an option.
Any other options that I might want to consider?

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heavyphil | @heavyphil | 21 hours ago

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

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1 reply
andy54 | @andy54 | 20 hours ago
In reply to @heavyphil "Hey Andy, sorry to hear of your present situation. I do agree with you that radiation..." + (show)
@heavyphil

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

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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.

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