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Radiation Oncology • Genitourinary Cancers
What dose/fractionation would you recommend for a prostate patient who previously received 1 of 5 planned fractions SBRT in 2020?
I have a gentleman in his 70s with multiple medical comorbidities who now presents with a high volume, Gleason 8 prostate cancer, PSA 29.5. PSMA PET/CT shows uptake only in the prostate gland.
He had a low volume, Gleason 3+4=7 prostate cancer, PSA 5.7, diagnosed in late 2019. He elected to undergo SBRT at another facility out of state and received 1 of 5 planned fractions (7.25 Gy) before being hospitalized with severe COVID with a prolonged recovery. He was lost to follow-up for several years and now presents to me with the above history.
He is not a surgical candidate and has started long-term ADT with his urologist. What dose/fractionation would you recommend?
Answer from: Radiation Oncologist at Community Practice
He now falls into a high-risk disease category. Unfortunately, there's no clear-cut answer to this question—it ultimately comes down to clinical judgment.
In my opinion, it would be reasonable to switch to a moderately hypofractionated regimen (e.g., 70 Gy in 28 fractions), include elective p...
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Answer from: Radiation Oncologist at Academic Institution
Tough case and a reminder of all the continuing fallout from the pandemic. My TL;DR is it's fine to deliver full dose and basically ignore the prior RT delivering as conformal and safe a plan as you can this time around. A couple more wordy thoughts:1. What's the benefit?For a man with ver...