Radiation Oncologist Search

I am planning for salvage radiation as I am facing recurrence.My psa is going upward from a nadir of 0.09 which I had after starting Avodart about two years back. At present it is 0.15(still on Avodart).Please guide me to some top radiation oncologists.Regards and Good Luck.

Nearest big city? Why are you taking Avodart? It shrinks the prostate, but you had yours removed.

No, you don't double it. That myth stems from the fact that when a man has prostate cancer and BPH and he takes Avodart, his PSA drops on average by about half. That's because Avodart is good at reducing the PSA from BPH, but not so good at reducing the PSA from prostate cancer. It bears no relevance at all to you, since you don't have a prostate and you don't have BPH, obviously. Neither does taking Avodart have any benefit at all for most men in your situation. Recent clinical trials have proved it to be useless in your situation.

But your present PSA at 0.16 is high nonetheless, and along with your EPE is a danger sign. If money is no object, have your prostate sent out for a Decipher test.

Honestly, salvage radiation can be done by any competent RO with experience, so you might as well get it done locally if you decide to get it. I prefer arc machines with image guidance.

- Allen

1. That was an early trial. When they did a randomized placebo-controlled trial, they found no added benefit. So that pretty much settled the controversy.Here's the most current/best data:

IADT, dutasteride, and the AVIAS trial — not the result some would want to hear

There may be sub-groups, possibly yourself, who it works for. But on the average, it did nothing. The changes in your PSA were minor. I'd be reluctant to use terms like "shot up" to describe movement from 0.16 to 0.20 - there are normal variations in PSA, and PSADT is not a constant or even validated for values under 0.2.

The manufacturer doesn't mention these or any uses of Avodart for which it is not FDA approved. You were taking it "off label" so you can't expect to find anything useful on the label.

2. SpaceOAR is usually a waste of money as far as I can tell. It's use with salvage is even more questionable - its only use, if there is any, is to put more space between the rectum and prostate. What would be the point if there is no prostate? Here's my article about it:
SpaceOAR hydrogel decreases rectal radiation dose, but is it worthwhile?

3. The benefit of adding ADT with salvage RT seems to depend on a number of factors. Here's an article about it:
Combining ADT and salvage radiation therapy improves outcomes

4. Only if there's a reason to suspect nodes are involved. With your low Gleason score and initial PSA, I wouldn't think so, unless you had enlarged nodes on a CT scan.

5. Here's an article about hypofractionated salvage radiation. Since then, there's been another clinical trial at USC: NCT02446366
Can salvage radiation therapy be safely and effectively completed in less time?

6. There is no evidence to suggest that chemo is useful before mets are evident.

- Allen

That's why I said, "if money is no object." Decipher costs around $4,000. It is very good at detecting those cancers that will not metastasize in the next 5 years (I think they are quoting 10-yr probabilities now, but that is less well validated). However, it is not as good at predicting which cancers will progress in that time frame. So it can help rule out treatment, but it may not be able to help with the decision to rule it in. There are nomograms (like CAPRA-S or Stephenson) that may aid judgment and don't cost anything. In the end, it is up to you and your RO's judgment.