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Radiation Oncology • Genitourinary Cancers • Prostate Cancer • Medical Oncology • NCI-CCC Tumor Board Question • UCSF • NCI-CCC GU Tumor Board Question • Nuclear Medicine
For persistent PSA elevation after prostatectomy, would you recommend salvage radiation if pathologically negative nodes, but regional and non-regional lymphadenopathy on PSMA PET?
Specifically, would you offer salvage radiation to a patient who underwent a prostatectomy with PLND and had a post-op PSA of 12 with pathology revealing adenocarcinoma 4+3+5, pT3a N0, and positive margins? PSMA PET revealed regional and non-regional nodes up to the cervical chain.
Answer from: Radiation Oncologist at Academic Institution
While based on classical staging methods, it appears that he would fulfill the criteria for salvage RT with a persistent PSA, it sounds like this patient has M1a disease by advanced imaging (possibly at presentation). I think that it is very unlikely that he would gain any meaningful benefit from ad...
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Answer from: Medical Oncologist at Academic Institution
Unfortunately, this is patient more in line with LATITUDE than any of the standard SRT studies. The role in this case of further focal therapy with both regional and non-regional nodes is less clear.This patient is an outstanding candidate for intensified AR suppression. Should there have been only ...