In the setting of prior salvage radiation therapy for rising PSA post prostatectomy, can there be any role of additional radiation therapy for isolated local recurrence in the bladder neck/prostate bed?

Topics: Radiation Oncology • Genitourinary Cancers

Does time interval from initial radiation therapy matter. Assume this is in the case of castrate resistant prostate cancer in which all other avenues have been exhausted and there is no evidence of disease outside of this area of local recurrence.

Answer from: Radiation Oncologist at Academic Institution

I have not run into this scenario. If it is visible on imaging (ultrasound +/- CT or MRI) I would explore the possibility of HDR, 13.5 Gy x 2. Careful consideration would need to be given to the location of the recurrence and anatomy. Technically it may be challenging due to scar tissue and the limi...

Answer from: Radiation Oncologist at Community Practice

We have a CyberKnife SBRT protocol for biopsy proven locally relapsed intact prostate post-radiotherapy, which actually works well, with 60% 5-years bRFS and low incidence of high grade GU and GI toxicity - 3,400cGy/5 fx w zero margin around the GTV (prostate + any suspected direct local extension o...

Answer from: Radiation Oncologist at Community Practice

I did it once with CyberKnife, 3400 cGy in 5 fractions. There was a good response, but recently more PSA relapse after couple years. There were no toxicity issues, though this series has 1 patient (n=1).

Comments

Radiation Oncologist at Mantik David W MD PhD
Focal laser ablation might also be considered. Dav...

Answer from: Radiation Oncologist at Community Practice

I have a patient who developed a palpable local recurrence after salvage XRT. We performed an ultrasound guided LDR I-125 implant which controlled him locally. Subsequently he developed a rising PSA which has responded to intermittent ADT for the past 20+ years.

Answer from: Radiation Oncologist at Community Practice

There is a paper reporting outcomes of 12 patients treated with 36 Gy/6 fx using SBRT techniques. 83% PSA response with 56% bRFS at 2 years. Toxicity was limited to acute grade 2 and late grade 1. https://www.ncbi.nlm.nih.gov/m/pubmed/30828565/ I treated one patient using these techniq...

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