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Salvage treatment after initially had radiation.

User
Posted 27 Dec 2022 at 18:53

Have you had salvage SBRT for a BCR (recurrence)….I had EBRT in 2004-5. Had 6 months of ADT (firmagon). Would like to find out your experience of salvage SBRT after radiation failed.

Thanks.

User
Posted 28 Dec 2022 at 02:20

The problem is that in subjecting your Prostate to further radiation regardless of type, there is a need to avoid the original paths along which the radiation was directed. This is what I was told by one of the top UK hospitals when I was in a rather similar situation to you. This UK hospital then referred me to the leading UK hospital for Focal Therapy in the UK. The preferred method for further treating significant tumours confined to the Prostate would be by HIFU where the probe could be positioned to focus on it. Had this not been possible, Cryotherapy, which is more widely known in the USA, would have been the second choice. I was not offered SBRT and was told it was not an option. That is not to say that somebody with a previously radiated Prostate would necessarily be refused SBRT.

In the event, due to the failed RT I had 2008, I had HIFU in 2015 and repeat HIFU in December 2021. The three PSA tests I have had this year have all recorded 0.02 which is the lowest ever. (Best after original RT was 0.05).

Should a tumour grow in my Prostate again, I was told that the only treatment they would consider doing would be Prostatectomy with it highly likely that I would be permanently incontinent. The alternative would be to resume HT which I have tried to avoid, last experiencing that in 2008. So I am hoping the good results from the HIFU will continue.

Nano knife, (Irreversible Electroporation), is another Focal Treatment but in its infancy in the UK and FLA (Focal Laser Ablation) in the USA. Oncologists tend to use the treatment they are familiar and happy with.

Edited by member 28 Dec 2022 at 02:41  | Reason: additional comment

Barry
User
Posted 28 Dec 2022 at 10:43

W , different situation, I had surgery in 2014, salvage RT in 2017. Following a second BCR and a PSMA scan this year I had SABR treatment to a pelvic lymph node tumor in August this year, I had one blood test too early but it had halted the rise. Next test in three weeks time. No side effects to report. 

Would a PSMA scan be on the cards, the source of the cancer may not be in the prostate or bed. 

I think it is Guys hospital that specialises in salvage treatments.

Thanks Chris 

User
Posted 28 Dec 2022 at 12:08
Chris, W gives his country as USA and states he had PSMA in NYC.
Barry
User
Posted 28 Dec 2022 at 12:52

Barry,

Thanks for your thoughtful response! 

One of the top places (Yale) medical hospital told me that he didn’t think that HIFU

would be effective. He had copies of my MRI and biopsy report. Possibly either the location of the tumor or that it was “intraductal”…

With focal therapy I was told by one of the top places that after failed radiation that there is a chance of getting a rectal fiducial. The other possibility that you mentioned was cryotherapy which if not successful it could be repeated. There is medicare coverage for cryotherapy but it also doesn’t sound appealing.

I inquired about having a RP but the top urologist at Memorial Sloan Kettering in NYC doesn’t recommend it. 

I had 6 months of firmagon (ADT) earlier in the year. I suspect that this is the kind of schedule i could be on! It is one choice that i may need to live through…

Bill

 

User
Posted 30 Dec 2022 at 02:32

There used to be a relatively small chance of an anal fissure after HIFU or indeed other procedures but this is much less likely nowadays. The surgeon who did my HIFU is on record as having done the HIFU procedure over 900 times without one instance but she is a leading exponent of the treatment.

Treatment and techniques are continually being updated and mostly with good effect. There is now an alternative way of ablating the Prostate by ultrasound for example. This is done with the probe been fed inside the Prostate via the urethra rather than the rectum. We are moving to a situation whereby all possible treatments can rarely be available, even in a large hospital and it becomes even more demanding to choose what might be best for an individual. Also, expertise in administering new or modified treatment can be rare. As there has not been any particular form of treatment that it is so overwhelmingly  better than alternatives, it may well be best to use the well used procedures your local practitioners are familiar with. It can also come down to what treatments a man is suitable for and perhaps push at the envelope for by participating in trials.

Edited by member 30 Dec 2022 at 14:05  | Reason: clarification

Barry
 
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