Proton Salvage Radiation in NJ

[JoelB]

Currently 75 yr. old – Diagnosed 7/2006 Gleason 7 (4-3) PSA 3.9 -- RP 9/2006 Stage pT2c N0 Mx

Reoccurrence 8/2010 and 5 Docs recommended Salvage Radiation – After 5 months PSA still at 0.2 – Reluctant to radiate because of history of Ulcerated Colitis - Charles Myers put me on his Growth Arrestment Program, first with Avodart then he added Bicalutamide – That worked for the past 7 years – Myers retired in November 2017. - In the past 4 months PSA went from 0.49 to 1.31 while I continued Myers’ program.

4/2018 Axumin PET/CT at PCMI in Wall, NJ using their new Digital GE MI scanner – The scan picked up metastatic disease in one lymph node 3.7 x 6.6 mm – the scan also picked up suspicious uptake in the prostate bed and distal reanastomosis site which I think is the urethra

I put radiation off for almost 8 years but think I must reconsider Salvage Radiation. One of the options I am investigating is Proton Therapy. Can anyone recommend a Radiation Oncologist in central NJ who does Proton Therapy?

[Tall_Allen]

Salvage proton radiation is highly experimental. I think you should only do it as part of a clinical trial.

[JoelB in reply to Tall_Allen]

Thank you for your feedback.

[AlanMeyer]

Hello Joel,

As Tall_Allen says, proton beam radiation is not customary for salvage radiation. It has been used in the past almost exclusively for tightly focused radiation of small cancers in sensitive areas, originally for eye and brain tumors. I don't know how good it would be for treating a significant area around the prostate. I agree with Allen. You should only consider it as part of a clinical trial where much thought has been given to how to use it properly.

Also, as I understand it, the equipment needed to generate, accelerate, and aim proton beams costs $150 million and up. You're not going to find it at any old radiation oncology practice. It's only available at big centers where big money can be attracted (often from big investors who are expecting big payoffs from big fees extracted from little patients.)

You said that 5 doctors have recommended salvage radiation. That's a lot of doctors. It's starting to sound like a consensus, isn't it? If you haven't seen a radiation oncologist, you should, and you should tell him about your concerns regarding colitis or other problems. See what he or she says about it. Get a second opinion from another rad onc if the first one doesn't satisfy you that he's paying attention to your problem. Ask what they would radiate, how they would target the beams to hit all the cancer and protect all of your sensitive areas. Get a list of questions together before you go to see one.

As with everything else in cancer, be sure you've got a good doctor. Here's the NCI list of designated cancer centers:

cancer.gov/research/nci-rol...

Best of luck.

Alan

[JoelB in reply to AlanMeyer]

Alan Thank you for your insight.

The 5 doctors (urologist, medical oncologist & 3 radiation oncologist) that recommend salvage radiations was in 2010 when I was first diagnosed with biochemical reoccurrence after a RP in 2006.

The 6th doctor I spoke to was Charles Myers (medical oncologist) who did not believe I need immediate salvage radiation. For 7+ years Myers was able to manage my PSA level and avoid both Lupron & radiation. In my last meeting with Myers he expressed concern that the treatment was no longer working and I would be a candidate for a PET/CT within the next 12 months.

After Myers retired in November 2017 I have been under the treatment of Ana Ferrari a medical oncologist with the Rutgers Cancer Institute of NJ. The Rutgers Cancer Institute is a NCI designated cancer center.

I got my AXUMIN PET/CT results back on 4/17, I met with my Medical Oncologist yesterday and I have an appointment with a Radiation Oncologist at Rutgers Cancer Institute on 4/23.

Right now, I am in investigational mode. Looking at all options.

Thanks again for your help

[wat380bjw in reply to JoelB]

Good morning. Does Centra state in Freehold have proton? I am sure there is a center in Somerset that offers it. I had my radiation done at Fox Chase in Philly.

[Hberg08]

The nearest Proton treatment centers would be Somerset, NJ & Proton treatment center in Baltimore, MD. affiliated with University of Maryland 410-369-5200.

My husband was diagnosed back in 2005 - had HIFU treatment in Germany in 2008. Was diagnosed again in October 2017. Friends in Arizona had Proton treatments 10yrs and another 15yrs ago - both doing very well. My husband will be starting treatments in May he is 78. I would suggest check Proton Treatment Center, Baltimore on line, or call 410-369-5200. Not all insurance comp Pay...we had delayes & issues with Kaiser-they do not pay! Medicare covers 80%. The Baltimore PROTON center charges the same for Proton as for traditional radiation treatment. I wish you all the best -

Good Luck....EV

[j-o-h-n]

Central N.J. - It's not the end of the earth... try Michael J. Zelefsky, MD

Radiation Oncologist at Memorial Sloan Kettering Cancer Center at 68th Street and York Avenue (Manhattan). They provide low cost parking close to the hospital with free van service to and from. I in no way am related to the doctor but was once treated by him ( Salvage Radiation 39 sessions). I know it would be a PITA to travel to NYC for 39 session (daily - Mon to Fri) but I would do it.

His bio: (212-639-6802)

As a recognized expert in the field of radiation therapy, I am Chief of Memorial Sloan Kettering’s Brachytherapy Service. Brachytherapy, which we use to treat many types of cancer, is the delivery of radiation using seeds implanted directly in a tumor.

Our prostate brachytherapy program, which I have helped develop and enhance since joining the staff in 1990, is known for its depth of experience and cutting-edge approach in treating men with prostate cancer. For patients with advanced or aggressive prostate cancer, I have significant expertise using high-dose-rate brachytherapy and temporary brachytherapy, in which patients receive several high-dose treatments either as a boost or as the sole treatment. I also have experience using brachytherapy in patients whose tumor has recurred after external-beam radiation therapy or seed implant, as well as expertise using image-guided stereotactic radiosurgery for areas of metastases (spread) such as bone or lymph nodes.

In addition, I was instrumental in pioneering the use of IMRT (intensity-modulated radiation therapy, which is computer-guided delivery of high doses of radiation directly to the tumor) and IGRT (image-guided radiotherapy, radiation beams targeted precisely to the tumor) for treating men with prostate cancer.

**** BE AWARE RADIATION MAY CAUSE PROBLEMS IN OTHER AREAS OF YOU BODY.****

Good Luck and Good Health.

j-o-h-n Friday 04/20/2018 6:25 PM EDT