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 availa...

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 res...

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 cont...

Yes.

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