Would you offer salvage prostate reirradiation with a rising PSA but negative biopsies?

Quick answer is No. I would NOT give re-irradiation with a negative prostate biopsy.

Salvage RT (SBRT or brachy) can have toxicity, sometimes severe. There must be a good justification to give it and a negative biopsy to me is a contraindication assuming the biopsy was performed correctly.

No. Salvage re-irradiation, like any re-irradiation can have significant toxicities. We have had a re-irradiation program since 2001. MRI can be very useful as a screening tool. The positive predictive value of MRI after radiation is very good. After LDR, the imaging is less clear due to seeds causi...

I agree with the above and in fact, even in the setting of a suspicious MRI or positive PSMA scan, in my opinion, it would be imperative to have the patient undergo a prostate biopsy before moving forward with salvage re-radiation, given the added toxicities associated with such procedures. The mere...

As mentioned previously, you should NEVER offer re-irradiation to the prostate without confirming this is the ONLY site of recurrence, a rising PSA after radiation therapy statistically speaking signifies micro/macro metastatic disease, local recurrences alone (if RT was done appropriately) are not ...

I am hoping to continue the discussion in the setting of a negative biopsy but with PSMA PET showing avidity in the prostate only as I would consider salvage RT (SBRT or LDR BT) in the setting of bF (meeting ASTRO and/or Phoenix guidelines), negative biopsies, and positive PSMA PET showing avidity i...

No