In the setting of prior salvage radiation therapy for rising PSA post prostatectomy, can there be any role of additional radiation therapy for isolated local recurrence in the bladder neck/prostate bed?  

I have not run into this scenario. If it is visible on imaging (ultrasound +/- CT or MRI) I would explore the possibility of HDR, 13.5 Gy x 2. Careful consideration would need to be given to the location of the recurrence and anatomy. Technically it may be challenging due to scar tissue and the limi...

We have a CyberKnife SBRT protocol for biopsy proven locally relapsed intact prostate post-radiotherapy, which actually works well, with 60% 5-years bRFS and low incidence of high grade GU and GI toxicity - 3,400cGy/5 fx w zero margin around the GTV (prostate + any suspected direct local extension o...

I did it once with CyberKnife,  3400 cGy in 5 fractions. There was a good response, but recently more PSA relapse after couple years. There were no toxicity issues, though this series has 1 patient (n=1).

I have a patient who developed a palpable local recurrence after salvage XRT. We performed an ultrasound guided LDR I-125 implant which controlled him locally. Subsequently he developed a rising PSA which has responded to intermittent ADT for the past 20+ years.

There is a paper reporting outcomes of 12 patients treated with 36 Gy/6 fx using SBRT techniques. 83% PSA response with 56% bRFS at 2 years. Toxicity was limited to acute grade 2  and late grade 1.  https://www.ncbi.nlm.nih.gov/m/pubmed/30828565/ I treated one patient using these techniq...