SBRT versus IMRT for BCR after prostatectomy

What you are having recommended seems very strange. The normal technique is to do the 35 IMRT sessions. That’s done to the lymph nodes and the prostate bed. I had that done 12 years ago at 65 and know many people that have had the exact same thing done. None of them have had SBRT under the same conditions.

There is no SBRT equivalent. There are studies of doing SBRT instead of IMRT but they have not been proven to be successful. I think this is an experiment you may not want to be involved in. Did they tell you it’s a clinical trial?

Normally, they want to do salvage radiation when your PSA hits .2. I had a prostatectomy and it took 3 1/2 years before mine hit .2 at which point I had 8+ weeks of salvage radiation. I was not on ADT until my PSA hit .2, if I had been, my PSA would almost definitely have remained undetectable.

These PSMA pet tests you are getting are a real problem. When the PSA is as low as yours is, they frequently can’t be anything seen in the pet test. The PSA is too low. They usually want it to be at least .5 or .7 before doing a pet test. The other problem is the PSMA Pet test cannot see Metastasis smaller than 2.5 mm and the UCSF radiologist says even 5 mm is hard to see. So I’m a little concerned about what you’re hearing about what’s going to be found, or not found. If you just started Orgovyx Then it is very likely your PSA will drop to undetectable and the scan will show nothing.

It sounds like your oncologist has a much better feel for what to do than whoever else you’re talking to. Waiting until your PSA hits .2 and then doing the salvage radiation is what is usually done? If they just put you on Orgovyx Then your PSA will probably become undetectable, Nothing will be found so they will want to do radiation. That is a very strange way of doing this.

At this point, it might make sense to go to a center of excellence and get a third opinion.

An MRI can show metastasis if they already know where they may be. It’s just that that’s not the standard way to find them and it really needs to be a very sensitive MRI to see what’s truly going on.

I wish you luck.

@jeffmarc
They picked up three spots on my ribs. Since for cancer it picks up on the psma that the cancer produces, By giving me adt, if cancer, the psma will be gone and the new scan will not show the spots. If the spots remain it is something else
The place recommending the SBRT is a center of excellence, Sloane. I also have pudendal neuralgia issues being hypersensitive with penal pain, rectal sphincter pain and tenemus currently. When it gets bad I cannot sit and if I cough it sends pain down my legs. The pain resonates through the whole pelvic area.

@jeffmarc
They picked up three spots on my ribs. Since for cancer it picks up on the psma that the cancer produces, By giving me adt, if cancer, the psma will be gone and the new scan will not show the spots. If the spots remain it is something else
The place recommending the SBRT is a center of excellence, Sloane. I also have pudendal neuralgia issues being hypersensitive with penal pain, rectal sphincter pain and tenemus currently. When it gets bad I cannot sit and if I cough it sends pain down my legs. The pain resonates through the whole pelvic area.

@pamperme
SBRT has not been a standard of care for salvage radiation. If you consider doing it, please make sure to ask the doctor if it is standard of care or is this a clinical trial? I have never heard of anybody getting SBRT in this situation.

If they just want to do it to zap metastasis on your ribs, that’s a totally different story.

What you are having recommended seems very strange. The normal technique is to do the 35 IMRT sessions. That’s done to the lymph nodes and the prostate bed. I had that done 12 years ago at 65 and know many people that have had the exact same thing done. None of them have had SBRT under the same conditions.

There is no SBRT equivalent. There are studies of doing SBRT instead of IMRT but they have not been proven to be successful. I think this is an experiment you may not want to be involved in. Did they tell you it’s a clinical trial?

Normally, they want to do salvage radiation when your PSA hits .2. I had a prostatectomy and it took 3 1/2 years before mine hit .2 at which point I had 8+ weeks of salvage radiation. I was not on ADT until my PSA hit .2, if I had been, my PSA would almost definitely have remained undetectable.

These PSMA pet tests you are getting are a real problem. When the PSA is as low as yours is, they frequently can’t be anything seen in the pet test. The PSA is too low. They usually want it to be at least .5 or .7 before doing a pet test. The other problem is the PSMA Pet test cannot see Metastasis smaller than 2.5 mm and the UCSF radiologist says even 5 mm is hard to see. So I’m a little concerned about what you’re hearing about what’s going to be found, or not found. If you just started Orgovyx Then it is very likely your PSA will drop to undetectable and the scan will show nothing.

It sounds like your oncologist has a much better feel for what to do than whoever else you’re talking to. Waiting until your PSA hits .2 and then doing the salvage radiation is what is usually done? If they just put you on Orgovyx Then your PSA will probably become undetectable, Nothing will be found so they will want to do radiation. That is a very strange way of doing this.

At this point, it might make sense to go to a center of excellence and get a third opinion.

An MRI can show metastasis if they already know where they may be. It’s just that that’s not the standard way to find them and it really needs to be a very sensitive MRI to see what’s truly going on.

I wish you luck.

@jeffmarc hi Jeff I read your posts etc a lot they are always very informative. To me your a pro in this field after 12 years. If I may, how do you view or by what you know… Photon vs. VMAT and brachy . Haven’t started yet and I’m very scared because of what I read about side effects. I’ve been trying to get approved for proton my RO says he will make sure I’m very well taken care of with the VMAT, says not a huge difference.. but it’s not what I hear from patients that swear by proton. I can’t put it off to long I know but I really need to explore. My RO will even give me a letter for insurance to approve proton.. if I want. I’ve already talked to insurance they need letter and justification and I’ve been evaluated - all records- by Emory Proton Center -Atlanta.
Proton not available here in Puerto Rico and I lived in Atlanta over 12 years .. PSA dropped .02 after 1 Lupron at 5 weeks etc it’s all I have had done but switching to Orgovyx - possible dangerous allergy to Lupron. So on the fence thanks for listening

@islander2025
I’m sorry to tell you, but I have not ever heard of anybody having VMAT radiation for prostate cancer. Technically, it sounds like a really good thing. Proton is a good choice too. Gives a smaller chance of getting radiation to other nearby organs.

I have had prostate cancer for 16 years. I attend nine online advanced prostate cancer meetings every month and VMAT has not been discussed. It has been discussed in a couple of different conferences. I have been at. UCSF discussed it in a radiation conference they did last year. You might be able to find information about it on their website, They have the videos of their conferences available.