Would you treat a patient with XRT after local recurrence after prostate cryoablation?

We have a strong urologic local therapy program at Duke, and consequently, we see local recurrence after cryotherapy and HIFU. I can say that in my experience these patients tolerate radiation similarly as those who have not had previous prostate therapy, although based on what little data is available in literature I always counsel patients for the potential of greater urethral and cavernous nerve toxicity.

A few practical points:

1) I do require biopsy proof of recurrence, even in the setting of MRI or PET.

2) I generally don't change my typical curative intent dose, although I think it would be appropriate to use a more standard fractionation if there is concern re normal tissue toxicity. In my experience, patients have done very well w...

I agree with the previous posters. Tolerance to salvage XRT has been good but the cancers tend to be less sensitive to XRT (PSA failures more common). I ascribe this to hypoxia in surgical scars. I tend to add ADT and use more conventional fractionation.

I agree totally. We have treated many patients with conventional RT and SBRT over the years after focal therapy for prostate cancer. We treated patients after a variety of focal therapies. This speaks to the inappropriateness of focal therapy for a multi focal cancer.

We had tried publishing our results several years ago. But no single institution has enough data. A multi-institutional retrospective report would be a good idea. Our surgeons are not enthusiastic about operating after focal treatments

Yes. I have done so, and will continue to do so, having used both IMRT and SBRT in this circumstance. The toxicity and efficacy in this small cohort of post-cryo patients is completely indistinguishable from that, as observed in my larger rad onc prostate experience.

We have anecdotally observed somewhat higher acute urinary symptoms during radiotherapy after local recurrence following prostate cryo-ablation. There are about 8 reports in the literature, with relatively short follow-up comprising a small number of patients indicating possibly decreased tumor control outcomes and possibly slightly higher urinary related toxicities. The slightly decreased tumor control rates may actually be attributed to the general caution radiation oncologists have treated patients in this setting, and possibly related to somewhat lower radiation doses that end up being utilized.

While administering proper radiation dose levels would be important, it has been our practice to exercise caution when delivering brachytherapy...

Yes.

Same question, but with a recurrence after focal laser ablation (rather than after cryotherapy).