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Reoccurrence after High Dose Rate Brachytherapy

cchqnetman's picture
Posts: 119
Joined: Sep 2012

I was treated with two 14 gray fractions of High Dose rate Brachytherapy in Feb and March of 2013.  Since then I have had a Stem Cell Transplant for Myelodysplastic Syndromes (MDS).  My PSA levels have been increasing lately (see values below).  The first one listed below was my nadir.  Has anyone had any experience with reoccurrence after HDR?  If this is reoccurrence does anyone have any thoughts on salvage therapy?


Would sure appreciate any thoughts or opinions.



3/5/14 0.976
3/31/14 1.44
6/11/14 1.35
6/14/14 1.1
8/9/14 1.33
2/10/15 1.26
8/3/15 1.04
9/3/15 1.1
2/4/16 2.29
2/11/16 2.74
2/15/16 2.44
1/11/17 7.41
1/12/17 8.07


Old Salt
Posts: 838
Joined: Aug 2014

Unfortunately, your Jan 2017 PSA results indicate that the cancer is recurring. To get better insight in your current situation, it would be useful to know what the original pathology was (Gleason scores etc.) Were any of the cancerous sites close to the edge of the prostate?

More in general, I recommend that you see a well-qualified medical oncologist and map a treatment strategy. I hope that he will recommend an appropriate scan to see if the cancer has spread beyond the prostate. If the latter has occurred, more radiation might not be useful, but this is up to the medical oncologist to say, obviously.

VascodaGama's picture
Posts: 3428
Joined: Nov 2010

The best guy to help you is the radiologist who treat you. He knows the protocol/planning of the RT done in 2013 so that he can verify if SRT could  be applied to the glang again. HDR brachy is sort of localized (similar to proton beam) so that sorounding tissues beyond target are not as affected as in EBRT. Surely the treatment for Myelodysplastic Syndrome which may have involved radiation of the whole body (or sort of chemo like therapy), could affect such a possibility but the grade of radiation in tissue is low. Radiologists are the best to consult.

Hormonal treatment is typically the sequential therapy after failed RT but removing the prostate is also a choice if one manages to find a surgeon to do surgery in affected RT tissues.
In any case, as commented by Old Salt you need to consider where cancer exists for defining a target. Is the bandit still whole in the gland or there are metastases at far places?
Diagnosing (previous data and additional image studies) is necessary to decide on anything.

I wonder your initial cancer status. The only post of yours I found has no details about you .(https://csn.cancer.org/node/249597)

Best wishes and luck in your continuing journey.


cchqnetman's picture
Posts: 119
Joined: Sep 2012

Thanks for the replies.  My original cancer was a T1C, Gleasson 7.  The doctor that did the HDR is no longer in the area.  Right now I have other issues with my MDS - decreasing Red Blood Cells, White Blood Cells, and Platelets.  I am about at the point where I want to get the MDS under control before I worry about the PCa.


Thanks again for the replies


Max Former Hodg...
Posts: 3705
Joined: May 2012


If you had a stem cell transplant you should still be in followup with a medical oncologist.  I recommend you see him at the first opportunity.  Relapsed PCa of any form is best managed by a medical oncologist, perhaps the same one who had the lead during your transplant.  Two years after chemo I tested during a routine follow-up as severely anemic, and had to go on IV iron.  The cause was never determined, despite a lot of testing, and resolved and never reoccured.  But it must be monitored.

Most guys agree that a urologist is NOT the best lead for PCa requiring second-line/salvage therapy, even if a urologist does need to be involved. A rare exception to this guidance would be if the urologist is cross-certified in medical oncology, but this is extremely rare.

MDS is a dangerous, rare disease that must be kept ahead of;  it can easily morph into leukemia.

I would not cast treatment as "either/or" for the two problems, but would get going on both.  As Vasco noted, the best curative treatment for you PCa will be radation-based. It is probably the only curative modality, since your case does not suggest surgery as a reasonable option.


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