The treatment of prostate cancer local recidive

If there is a renewed increase in PSA after treatment of a prostate carcinoma, appropriate clarifications or examinations, such as MRI and PSMA PET/CT, must be performed in order to distinguish whether it is a local recidive in the box or the prostate itself or a distant recidive in the form of metastases. More than 50% of recidives are local recidives.

In case of local recidive, a variety of treatment alternatives (surgery, conventional radiation, cyberknife, cryotherapy, focused ultrasound (HIFU), brachytherapy) are available. Systemic therapy (anti-hormonal therapy) is preferred when patients are not candidates for invasive surgery due to poor general health or do not consent to invasive surgery. The risks of invasive therapy, such as bleeding, urethral strictures, fistulas, incontinence, and impotence, must be considered and weighed. The indication must be examined very critically, especially in elderly or multimorbid patients.

Cyberknife for the treatment of prostate cancer recidive.

In this article, the possibilities of Cyberknife therapy for prostate cancer recidieves are discussed with our cooperation partners. Also, a patient treated for a recurrent prostate tumor a few years ago describes his personal experience with this therapy and how he fared afterwards.

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Cyberknife radiosurgery is a very effective and safe therapy alternative to the previously known therapy options. With the highest precision, small tumors that can be sharply delineated by imaging are treated with a high dose in a single outpatient session. Risk structures such as the urethra, urinary bladder or rectum can usually be spared well with this technique.

High-resolution imaging (PSMA PET/CT and MRI) and precisely placed gold markers for tumor tracking are the basic requirements for effective and safe cyberknife treatment of local recurrence. Without appropriate imaging, an exact target volume definition cannot be guaranteed. Here, close cooperation with highly specialized partners in radiological diagnostics is important. At the Cyberknife Center Munich this is given with corresponding experts on the campus.

For the application of the gold markers, a small intervention is necessary, which is performed on an outpatient basis under local anesthesia within the framework of therapy planning with our partners in urology shortly before the actual treatment. This procedure is comparable to taking a sample from the prostate and has few complications.

Possible complications depend on the size and localization of the recurrence. Basically, the same side effects and risks are to be discussed as described under the item “Prostate carcinoma”, only the probability of occurrence is lower due to the significantly smaller irradiation volume.

To check the success of the therapy, the PSA value is checked 3 months after therapy, and PSA and MRI checks are performed 6 months after therapy.

The exact procedure and individual questions will be discussed in detail with our experts in our consultation hours.