Repeat radio therapy to the Prostate?

Bri

It's rare that cancer returns in the target area of the radiotherapy, although not impossible.

You really need a PET scan to find where it is, and if it's far enough away and not too widespread, you might be able to have Cyberknife or one of the other highly targeted RT treatments, without exceeding max dose to any body tissues.

Sometimes, brachytherapy can be offered as a secondary RT treatment, again, depending heavily on the circumstances and previous treatment doses.

Edited by member 14 Feb 2020 at 16:41  | Reason: Not specified

Next week I am starting repeat radiotherapy for recurrent prostate cancer. It's very similar in intent to Cyber Knife but is known as SABR - Stereotactical Ablative Radiotherapy. When my oncologist suggested this I mentioned maximum dose to the prostate but she said that the lymph node involvement was in an area just above the prostate and, therefore, could be done. 

As Andy says it is rare that the cancer returns in the target area of the prostate. In my case the nodes are above the prostate (or what's left of it) and the original radiotherapy had evidently destroyed the cancer at which it was aimed. There is no trace of cancer in my prostate.

It kind of indicates that the cancer had already escaped and set up shop in these nodes at the time of my original treatment although I don't know this for sure. They must be very small and very slow growing. They showed up as tiny green dots on the PET scan and were undetectable on MRI and CT scans.

Edited by member 14 Feb 2020 at 21:56  | Reason: Not specified

RapidArc is Varian's brand name for VMAT (Volumetric modulated arc radiotherapy).

This is EBRT treatment using a continuous sweep, combined with intensity modulation and dynamic beam shaping.

I think most main centres have been doing VMAT for a while, but obviously earlier treatment are less likely to be.

20 fractions (usually at 2.9 or 3Gy but sometimes at 3.2Gy) was a trial but is becoming more common now.

It doesn’t have anything to do with PSA or staging, simply onco preference I think.

NICE recommendation is that men should have 20f at 3.0Gy unless they are not able to have hyperfractionated RT in which case they should have 37f at 2Gy

I agree about the 20 sessions versus the 37 sessions in terms of travel time Bob. My journey was a 70 miles round trip so if I had had 37 sessions it would have been nearly 2,600 miles! 1,400 was enough.

Hi Bob - 9 sessions this time. It's a specialized form of RT called Stereotactical Ablative Radiotherapy (SABR for short) and is delivered over 9 sessions. It's aimed specifically at the affected lymph nodes. The stereo bit comes from the fact that very narrow beams are fired at the node from different angles meeting in the middle. 

Done first week now so 6 more to do. Asked them today if each node gets a blast each day but no - week one they attack one node, then move to another and finish with node number 3.

Not sure what happens if you have more or less than 3!

Thanks Lyn.  I should clarify that if I'd chosen prostate only EBRT I would have had 20 fractions.  It's only 37 because there's a question mark over spread to lymph nodes and so I've chosen to have the wider area covered.  Though the thought of the shorter course was tempting it was the knowledge that should it crop up in my lymph nodes later, further EBRT would not be an option that led me to go for the 37. 

Edited by member 21 Feb 2020 at 18:45  | Reason: Not specified