Would you consider re-irradiation for a prostate local failure for a patient who initially received standard fractionation with a focal SIB to 95 Gy, or a SBRT boost with cyberknife after EBRT?

In general, I am not an advocate of re-irradiation for prostate cancer, and I am especially not an advocate of re-irradiation in settings where very high dose boosts have been delivered previously, such as focal SIB, SBRT, or brachytherapy. In this situation, you have demonstrated pretty conclusivel...

This scenario is not specific enough to generate an acceptable answer, in my opinion.

Did this hypothetical local recurrence happen in the 95 Gy PTV zone or, did it relapse intraprostatic but not in the 95 Gy zone?

Relapse "in" PTV 95? - Probably not

Relapse "outside" PTV 95? - Much more likely to be ...

No

There are a couple of investigations and considerations I make when reirradiating in the setting of previous radiation, including high doses:

1. I always get a PSMA PET in this setting and if there’s an in-field recurrence or edge-of-field recurrence, I order an MRI to characterize the disease in the ...