How do you manage a seminal vesicle recurrence after prostate brachytherapy?  

Finding more of these in the PSMA era. Have managed a few patients with SBRT +/- ADT adjusting dose based on overlapping OAR if needed.

We have run into this issue with several patients at Beaumont (now Corewell) over the years and have had excellent results with salvage HDR brachytherapy. General Logic of Our Approach to ManagementMy standard approach to these cases is to obtain imaging workup with both MRI and PSMA to clarify...

HDR brachytherapy. Get an MRI, confirm the SV recurrence with biopsy, and make sure no metastatic disease (PSMA scan).

I've used multifraction HDR (13.5 Gy x 2) with 4-5 catheters with good success for these presentations. If possible fuse PSMA PET and/or MP MRI to HDR treatment planning CT to ensure appropriate coverage of recurrent area, being mindful of urethral, bladder/bladder neck, and rectal OAR, and any over...