Recurrence After Surgery

If you have experienced a recurrence following a prostatectomy, your salvage therapy and prognosis will be based on your pre-surgical Gleason score and PSA, the time between surgery and PSA rise, the velocity of PSA rise and doubling time, the amount of tissue left from the surgery and the location of the active cancer cells. While radiation always works best as an initial treatment, good results can be achieved in many salvage cases by increasing radiation doses using highly sophisticated DART equipment which incorporates all methods of 4D IG-IMRT. It is often desirable to combine salvage radiation with hormone treatment to take advantage of a supra-additive effect. (for example: 1+1 = 3 or 4)

Post-surgery recurrent patients require the most individualized treatment of all. It is imperative to design the salvage plan specifically to the current status of the patient, taking into consideration what treatment(-s) he has had in the past. Surgeries leave the prostate bed significantly devascularized – robbed of normal blood flow that brings critical oxygen to the cells which activate the killing power of radiation.

Success will depend on many factors … primary among these is the location of the recurrence, whether it is local (prostate bed, seminal vesicles, etc.) or distant (spine, lung, etc.)

As noted in the 2008 Duke University study, more and more men are experiencing failure of robotic or DaVinci surgical removal. In fact, close to half of the patients currently treated at Dattoli Cancer Center are those who have failed robotic surgery. Because the gland itself is often mangled by the attempt to remove it using robotic techniques, these men are not usually eligible for seed implant. However, full course 4D IG-IMRT with DART is being offered to these men with confidence of efficacy, depending on amount and location of positive cells, and rapidity of diagnosis of recurrence.

To recap, the problems with recurrence after prostatectomy are:

1. The target (the prostate and tumor) is no longer in place and this void becomes occupied by critical structures, particularly the bladder and rectum.
2. Because of this situation, only lower (suboptimal) doses can be achieved.
3. After surgery, the surgical bed is denuded of vessels (devascularized) and radiation works best in a vascularized, oxygenated region. In theory, even higher doses are necessary than when the prostate is intact.

Solution: Only the sophistication of DART can achieve the required higher dose levels. Hormones are commonly used to “sensitize” the radiation.

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