My mentor Tall Allen already alluded to the potential difficulty of doing SBRT on top of prior radiiiton, depending on
locations already radiated. The odds are better than having additional radiation since 5 fractions at 8 Gy each is less total radiaiton than the 79 - 81 Gy you aldready had.
I can speak to the former that Jerry Redwing57 alluded to.
I too went to Dr. Fabio Almeida and had the F18 sodium that showed suspicious for Lymph Nodes and the C-11 Acetate that confirmed 3 micro LN's all contained within the pelvic girdle.
I tried to leverage the abscopal effect by having Provenge concurrent with SBRT.
prostate-cancer.org/abscopal-effect/ Provenge is 3 treatments every other weekend in my case with lukapharesis taking 3 hours and a good movie on Friday, a needle in each arm. The blood cells are then sent off site to be treated to learn how to combat Prostate cancer, same concept as a flu shot but repeated 3 times and using your own treated blood rather than a chicken donor. The infusion takes an hour on Monday, one needle.
To qualify for Provenge you need the two PSA increases at least 14 days apart so may want to get that approved before going onto ADT or what I did, Lupron since 3-28-13 and Zytiga since August 2014. Then don't have your PSA tested until after you have the Provenge/SBRT combo completed, to remain qualified for all 3 Provenge treatments.
Provenge as a monotherapy is difficult to measure its effectiveness since PSA does not necessarily go down even though in theory the Provenge is working and also in theory will make all future treatments more effective. When done with another treatment such as SBRT you can measure the combined effect.
I have only been on 4-month Lupron so cannot comment on differences between different frequencies. The side effects vary by individual and in my case I was one of the lucky ones who after abour 4 months had night sweats but slept through them. They only lasted a few months and I would not know I even had side effects except the wife commented on my sweaty pillow.
I had no noticeable side effects from the Provenge that ended Nov 3, 2014 nor the SBRT done in 5 fractions every other day that ended October 20, 2014.
MY PSA has always been relatively low but is now <0.01 twice in a row with Testosterone <3. I was originally thought to be lifetime Lupron but now am being told I can go onto intermittent hormonal therapy if my PSA remains <0.01 after I have been on Zytiga for 9 months. So that would be end of May, 2015. In anticipation of that I will change to 3-month Lupron New Years eve and then monthly therafter to wean down.
If you go onto Lupron you will likely also go onto Xgeva or Prolia. So get your dental work up to date before starting on this medication intended to avoid any adverse skeletal events such as bone compressions or bone fractures. The Xgeva is administered monthly and the Prolia is the same medication at a lower strength but in a 6-month shot. There is the potential for lockjaw like symptoms if you have any tooth extractions while on Xgeva or Prolia..
Also keep your cardiologist in the loop as Lupron can adversely effect your cadrio metrics and potentially cause weight gain. Since I am also on 500 Mg Metformin twice a day though not diabetic, its potential to cause weight loss has pretty much offset the potential for Lupron to cause weight gain.
I strongly recopmmend Dr Fabio Almeida who you already know and Dr Chris King at UCLA who did my SBRT. As an added bonus, Tall Allen lives in LA and I got to meet him several times in person in LA.
BTW, I see you lve in NM. Just drive through there from FL to San Jose for Christmas with my son and his family. What's with the 29 degrees and the snow? More convenient to Dr, Almeida and Dr King though.
LupronJim