RISING PSA AFTER HDR-BT

In September 2017, I had HDR-BT monotherapy 2400 cGY treatment delivered in two fractions of 1200 cGY. Five years later, a biopsy was done because of rising PSA which is now 3.9 ng/mL. Biopsy revealed residual cancer cells in the left apex lateral and medial prostate measuring 1mm and 3mm respectively. A shot of Lupron and salvage external RT daily for 8 weeks is being considered. I am worried about how this may affect surrounding tissues and overall outcome since I have had HDR-BT earlier. Any thoughts?

Lanky, Although I have no personal experience that I can share your case is interesting to me and a learning experience for me and others. I wonder what information regarding Gleason grade that they can identify from your post treatment biopsy? I also wonder if Epstein can be of help? Wishing you a very successful outcome. Terry

Sorry to hear this. (And for what's it worth, I think this is a very unusual situation you're in.) It's not uncommon to pair HDR-brachy with external radiation as a primary treatment. Several guys (including me) have had that combo. In your case, you're having a five-year gap between the treatments. I would expect that your external radiation would take into account that you previously had brachy--that would be something I would want to get a good sense of from the RO. I would also think it's likely that the radiation would target some of the area beyond the prostate in case any PCa cells are lurking nearby.

Wishing you good luck with the next steps!

Terry's Cellar said...
Lanky, Although I have no personal experience that I can share your case is interesting to me and a learning experience for me and others. I wonder what information regarding Gleason grade that they can identify from your post treatment biopsy? I also wonder if Epstein can be of help? Wishing you a very successful outcome. Terry

Gleason grading after radiation seems to be an elusive endeavor. I agree Epstein could be of help here.
On the surface this appears to be a failed HDR-BR within the prostate. But you need to know the source of most of that PSA before you start more treatment. Get your PSA history to Epstein as well. The timing of Nadir and subsequent rise may offer another clue to the source of PSA.
Good luck in your treatment lanky.

Ten years ago I had daVinci surgery, and two years later I had IMRT/IGRT salvage therapy (72 grays). My PSA just became detectable (0.02 ng/ml) and my oncology urologist mentioned that in the future focal radiation can be applied. I too fear additional radiation might create problems. With that said I heard UCLA has been using faocal HIFU for salvage therapy with good results.

As a 'triple play' guy as well (see my 'resume'), I concur with the hypothesis that the HDR-Brachy did not kill all the cancer in your prostate. Because it appears that one area of your prostate didn't get the required dose at the time (2017), I would hope that a second radiation regimen optimized for that area will not cause excessive side effects.
It's my hope that the proposed radiation therapy, combined with ADT, will eradicate your cancer for good.
I do wonder however why 40 IMRT sessions are required. There have been several trials that show that a shorter course with higher intensity per session has the same outcome. Not only is this more convenient, but it is also much less costly.
I would also ask whether SBRT could do the job. Your current provider may not have that technology in its 'toolbox', but there are many facilities that do.

Like Mumbo, I also think that a PSMA scan prior to treatment is an excellent idea. Just today my rad oncologist told me that that is what they currently do at Georgetown U Medical Center when the PSA rises significantly after radiation therapy.

Post Edited (Sr Sailor) : 10/11/2022 9:27:56 PM (GMT-7)

Possibly, your Dosimetry Report from HDR-BT done in September 2017 will have some details about the constraints applied to the surrounding organs. That information may be valuable in your EBRT planning.

Also, I second the PET PSMA suggestions.