How do you approach a patient with a radiographically proven recurrence in the prostate bed after prostatectomy?

Topics: Radiation Oncology • Genitourinary Cancers • Prostate Cancer

If a patient who has undergone radical prostatectomy many years previously presents with biochemical failure and is found to have a nodule in the prostate bed on MRI, would you boost this area to a higher dose? What dose would you use? Would you treat the pelvic lymphatics?

Answer from: Radiation Oncologist at Academic Institution

We have been getting earlier referrals for salvage RT, so these types of cases have become less common for us to see. We would probably offer RT assuming there is no evidence of distant disease (we have begun using fluciclovine PETs selectively to see if it help with patient selection or alters trea...

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Radiation Oncologist at Lafayette Radiation Center
Would you base ADT duration on repeat Bx? What if ...

Answer from: Radiation Oncologist at Academic Institution

I agree with @Stanley Liauw's comments. I would typically recommend concurrent ADT and cover the entire prostate bed to 66-70 Gy while simultaneously boosting the nodular recurrence to 72-76 Gy as limited by normal tissue constraints. Of course, the decision to treat aggressively would be determined...

Answer from: Radiation Oncologist at Academic Institution

What rectal constraint do you use for those getting prostate nodule boost to ~76Gy?

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Radiation Oncologist at Vanderbilt-Ingram Cancer Center
Consider using constraints similar to what you wou...

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