My oncologist informed me today that Kaiser offers SBRT, but advised against having this treatment due to my young age (57 is not young to me), good health (I have cancer so saying I'm in good health is a misnomer to me) and it's toxic. However the following site suggest that SBRT is one of the better options.
I also inquired if Kaiser offer HDBT but he didn't respond to that question so I asked again(in contact with my Dr. via Kaiser's website). I'm hoping he'll advise soon if Kaiser offers HDBT too.
If anyone out there had SBRT or HDBT or considering having one of these treatments, it would be great to hear form you. Even if you're not considering either of these please chime in.
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anthonyq
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I considered both and decided on SBRT. That was 8 years ago when I was 57. Your oncologist doesn't have a clue- which is understandable - it's not his field. You should only talk to specialists about their own specialty.
I have an appointment tomorrow morning with my oncologist to discuss SBRT. I've been in consultation with 2 oncologist and 1 urologist at Kaiser. All have been very supportive. This particular oncologist is focus on just LDBT and I've previously canceled a scheduled LDBT due to my fling with considering ADT. I'm coming to this meeting with the questions you've provided in a previous discussion we had. I have questions of SBRT, HD and LD Bracky Therapies. Since Kaiser does offer SBRT the questions I'll pose I'll share the response with everyone.
I've also checked with UCLA and they advised if Kaiser doesn't offer HDBT I can than request Kaiser to give me a referral to see the doctors at UCLA and my insurance will cover it. This includes consultation which alone is anywhere between $300 to $900 (what a range).
I'm the same age you were when you had SBRT and since Kaiser offers it I have one foot in the door, but want to find out also what UCLA's HDBT team can do. Just curious, what made you decide to go with SBRT over HDBT, did you have any side effects and if so what were they and how long did they last? Moreover, how have you felt since having the procedure? Are there any regrets?
I also like to thank you for your advice. I'm not out of the woods by no stretch of the imagination, but you've provided valuable advice. One thing for certain I'm more knowledgeable feel a lot better and looking forward to tomorrow's meeting.
I think both are excellent, and had a hard time deciding between them. They were designed to be radiobiologically identical. One places the highly radioactive source within the prostate and the X-rays emit outwards in all directions. The other stars from a large number of outside points and only reach a cancer-killing effect at the points in which the beams converge in the prostate. Bot have very low toxicity outside of the prostate - the dose/volume histograms, which show the amount of radiation absorbed by organs near the prostate are pretty much identical. Both are extremely hypofractionated - which we now know has greater prostate cancer killing power and lower healthy cell killing power (because of the reduced total dose) than conventional fractionation. They both have a very low amount of ED - 70-80% of men retain potency. They both have near certain probability of reducing or eliminating ejaculate. Since I was able to be treated at UCLA, I had the pick of the pioneers of each therapy (Demanes and King).
HDRBT involved 2 overnight hospital stays (they've since reduced it so the two treatments can be done without an overnight stay). It also involved anesthesia and is intrusive. SBRT took only five 5-10 minute treatments. Dr King does not require any bowel prep or special diets because he uses a very fast machine. (Some machines take 45 minutes to an hour for each treatment and involve bowel prep and low-gas diets). SBRT also costs a lot less than HDR-BT, so if you pay a co-pay, that is a consideration. In the end, I chose SBRT because it was easier and cheaper.
I have had some fairly mild irritative side effects along the way, but they were transient, as is most often the case. Currently, I have no side effects, no ED whatever, but also no ejaculate. I am very pleased with my choice. I'm pretty sure I would have been equally pleased with HDR-BT.
One thing you should be aware of is that Dr. Demanes has retired. Dr. Chang has taken over his practice at UCLA. Dr Kamrava, who trained under Demanes for many years, has moved over to Cedars-Sinai. I would prefer Kamrava to Chang because he has more experience, although I'm sure both do excellent work.
Allen ...... What type of SBRT equipment took only 10 minutes for PCa per session? Any comments on that type of machine versus Viewray MRlinac? use of fiducials and SpaceOAR comparison?
Kaiser SCAL Sunset has an excellent radiation department and I know the director, Dr Goy because he treated me. I assume you are SCAL because you mentioned UCLA which is in SCAL.
Kaiser sunset Radiation oncology has the philosophy that they do not want to give a pinpointed treatment because there is a risk that an area near it will be missed, and cannot be followed up again with another treatment because it will overlap the area already radiated. The tend to enlarge the treatment area to avoid this problem.
I had a left pubic bone treated because of a bone met, but they treated R and L + prostate fossa area. Analysis after getting more knowledge over the years, I did not need the Right pubic or the prostate fossa area treated. There was a happy median decision I should have taken and said "just treat the spot and a go a little larger to cover margin of error". Radiation has a cumulative side effect over the years, so too much radiation and too frequent takes its toll on bones.
You are in good hands at that department, but I would start thinking about your future with Kaiser. At your young age, (yes you are young), your cancer may be aggressive but I hope it is not aggressive. Watch out for future recurrence after treatment . Kaiser does not like referring people out for edgy treatments when standard treatments are available at Kaiser. Long term, you may have to go on medicare disability and sign up for a PPO (not HMO) so you can go to any cancer center you want, including UCLA. There is the attraction of the Kaiser HMO with zero cost, and 5 star ratings, but I would give that up to have the flexibility of a PPO, even if you have to pay a little money monthly and pay copays for treatment. Copays can be covered by a an additional Medicare supplemental plan.
Thanks for that. I'm curious to know if you had low dose (seeds) or high dose brachy? Also what was your diagnosis and how long ago did you have the surgery?
I am a Gleason 8 warrior. Had immediate surgery in Jan 2002, not seeds, although seeds were probably a good option but was unaware of that option. I did not have a Forum like this to give me other ideas. Cancer appeared to be contained to surgical margins but later PSAs detected it biochemically recurring and doubling every 8 weeks. Kept it down with various drug therapy and later with new and recently approved drugs. I danced my way through my cancer for exercise with ballroom dance competitions, and I got very good at that sport. I think dancing helped me feel better in general. 2012 did pelvic external beam radiation at Kaiser with Dr Goy as I described before. Did same pelvic bone again in 2012 at Stanford because it came back again and caused a very painful fracture. If I was not in pain, I probably would have resorted to surgery to remove that bone, but I was in a lot of pain, in a wheelchair, and wanted relief. After radiation, I was out of the wheelchair and walking again, and started lite social dancing again on Saturday nights. Hope my story enlightens you.
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