Second line treatments after radiotherapy

On the subject of follow-up treatments if it recurs after RT...

This will depend where the recurrence is.

Recurrence is most often outside of the area which was treated, i.e. it is a metastasis which wasn't known about at the time of the original treatment because it was too small to show on scans. In this case, radiotherapy in the form of SABR can often be used, providing they can plan paths for the thin beams which don't go through areas already treated, and avoiding organs which won't stand the beams. There's also a limit on the number of these they'll treat, generally up to 3 mets.

If recurrence happens in the prostate which happens less often (particularly for external beam radiotherapy which can't very easily miss a bit), a focal therapy might be suitable depending on extent and location. Salvage prostatectomy can be an option too, but you want that done by a surgeon who specialises in it - there is one at Guys and St.Thomas's. The current UK view is that you can't have RT in the same area you've already had it because you have already been given the max lifetime dose to that tissue. However, there is some thought now that if that was a long time ago, the body can withstand more, and that is being done in some countries. I was speaking with a leading UK oncologist, and she said we really need to get braver about doing this in the UK, so it might come along in the future.

To update all the great people on this forum who responded to my earlier posts, husband now has radiology appt BEFORE scheduled date for surgery - phew! Had to push for it though. He is leaning towards surgery now although will listen to what the radiologist says. This is partly due to the emotional toll of waiting and it being months before RT and the prospect of 3 years’ hormone therapy. We feel that he must be a viable candidate for surgery notwithstanding diagnosis, or surgeon would not have seen him. Accept likelihood of RT being needed later but surgery plus salvage RT feels like a two pronged attack whereas pathway on a recurrence after first line RT is less clear - although radiology appt may clarify.

My new question is what he should be asking about after care if he goes ahead with surgery i.e. as well as the incontinence and almost certain ED, presumably will still need to rehab penis etc just to feel a bit more like normal. Will the hospital provide rehab or support in this? He doesn’t care at the moment but I expect he will care afterwards. Also thinking about other issues like potential for lymphoedema. He is seeing specialist nurse before the op to talk about these things and the impact of surgery but only because he asked to.