Topics:
Radiation Oncology • Genitourinary Cancers
Would you offer salvage radiation in a patient s/p radical prostatectomy with imaging showing local recurrence as well as oligometastatic disease in the pelvis?
Would you treat the entire pelvis vs local recurrence? How would you approach the oligometastatic lesion? Would your treatment recommendation change if the patient did not have radiographic evidence of local recurrence in the prostate bed? Assume the patient is initiating combined androgen suppression with GNRH-inhibitor and novel oral androgen-signaling inhibitor.
Answer from: Radiation Oncologist at Academic Institution
For oligonodal regional recurrence, I would treat the entire pelvic nodes and fossa and consider enrollment on RTOG 3506. If oligomet is to pelvic bone, I have rarely treated fossa/nodes/pelvic bone lesion (PET identified) in those wanting to be very aggressive and understanding the lack of data the...
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Answer from: Radiation Oncologist at Academic Institution
I agree with @Neil B. Desai. If the patient is N1M0, I will treat the pelvic nodes and the fossa. If the patient has confirmed distant metastases, I prefer to only treat gross disease and would not typically go after imaging-negative fossa or elective lymph nodes.
I completely ag...
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Radiation Oncologist at Community Health Network
PSMA scan is 98% specific on pelvic ln in prostate...
PSMA scan is 98% specific on pelvic ln in prostate...
Radiation Oncologist at UC San Diego
PSMA PET—with a particular tracer, a given p...
PSMA PET—with a particular tracer, a given p...
Answer from: Radiation Oncologist at Academic Institution
I agree with the sentiments above and will comment specifically about oligonodal recurrence alone. I'd treat the entire pelvis, SIB the pelvic lymph node, and treat local recurrence if present supported by recent OLIGOPELVIS GETUG P07 data. The phase II trial examined the role of pelvic radioth...
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Radiation Oncologist at Fort Belvoir Community Hospital
This is becoming an increasingly prevalent scenari...
This is becoming an increasingly prevalent scenari...
Radiation Oncologist at UC Irvine Health/Chao Family Comprehensive Cancer Center
I don't think there's a clear answer. For those wi...
I don't think there's a clear answer. For those wi...
Radiation Oncologist at Yale
I agree overall with this paradigm but I struggle ...
I agree overall with this paradigm but I struggle ...
Radiation Oncologist at Vanderbilt-Ingram Cancer Center
For N+ patients at either initial diagnosis or rec...
For N+ patients at either initial diagnosis or rec...
Answer from: Radiation Oncologist at Academic Institution
For a patient with PSMA/MRI local recurrence + distant metastasis - I have a discussion with patients and if they want to be aggressive, given our understanding of oligometastatic prostate cancer, I would treat fossa, nodes, and metastasis simultaneously along with generally 2 years of ADT.If no evi...