There is a myth that there are no 2nd chances after radiation, IMRT or Brachytherapy. Many on this forum have stated that they chose surgery because if it faled there was always radiaton to fall back on.
This is not true! First for any salvage technique to work the reoccurrance must be local, approximately 25%-30% of all reoccurrances are local in either surgery or radiation; the rest are systemic and cannot be salvaged with any technique.
For failed radiation salvage surgery is difficult and should only be done by an expert surgeon, even then the results and side affects are not good. Cryosurgery and HIUF are also salvage therapies for radiation, these have good cure rates, but again the side affects are not good.
The best salvage therapy for failed radiation is HDR Brachytherapy. These are temporary implanted radioactive rods that can be precisely placed, even the seminal vessels and uretha can be treated.
The side affects are better than either cryo or HIUF and cure is in the 80% range at 5 years.
So if anyone says that there are no 2nd chances in radiation, they are dead wrong.
For Brachytherapy only patients a 2nd seeding with a different isotope can also be done; but it appears that HDR Brachytherapy is becoming the best therapy for failed radiation that is local.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.