selecting best radiation oncologist- ... - Advanced Prostate...

Advanced Prostate Cancer
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selecting best radiation oncologist- how important is this?

we all know that it’s important to select the best surgeon when contemplating surgery, but does this apply to ROs as well? for salvage therapy?

if both centers are using same technique & using same amount of radiation etc. how important is the skill of the RO?

i’m sorry if this is an ignorant question, but my understanding of how radiation works is limited.

thanks in advance.

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My opinion is that experience counts, but the learning curve is not nearly as steep as for surgery. Here are questions to ask:

pcnrv.blogspot.com/2017/12/...

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thanks for your response. experience as in years practiced? the one we're leaning toward is younger but seems very impressive (tendulkar), the other one probably has more experience in the field though (comprehensive cancer center).

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Tendulkar is great!

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Oh wouldn’t it be nice to talk to the Gastroenterologist who scopes the colon of a guy who underwent IMRT. Therein lies the big difference- skill in killing prostate cancer while little or no scarring of the colon and rectum. Good lick.

GD

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IMHO - Besides the person doing the treatment (who will typically not be the MD for external beam radiation treatment - it will be a radiation technician) another thing of importance is in planning the treatment and the machine it's being done on.

Newer machines are better than older machines. They have more capabilities to deliver the correct dose to the correct spot while avoiding damage to other innocent tissue. The planning involves looking at what is desired for the best outcome and putting that into the computer that plans the actual scans. The technician running the machine is responsible for target identification for each treatment, and making sure you're in the correct position as was set during the planning session.

In my case - a good friend was the technician for many of my treatments. It was good having someone I trust at the controls, I knew everything possible to make the treatment a success was being done.

The equipment being used was the current state of the art, a Varian EDGE (which can also be used for SBRT), with image-guided targeting - a 3D "Cone" x-ray was taken at the beginning of every session. The x-ray not only accurately shows the prostate, it shows the position of the other organs and that allows the software to plot an exposure to avoid them. The actual exposure is done as the LINAC head is moving around the patient - in an arc (hence "Rapid-Arc" is the name of the treatment used) and reshapes the beam (conformal beam) and varies the power of it (intensity modulation) to avoid harming other organs while concentrating the radiation on the target.

This is new equipment - the one I was treated on is almost brand new in a brand new cancer treatment center. There are other great machines now being made that provide equal accuracy and targeting. The machine I was treated on is claimed to have a rate of side-effects at least as good as proton therapy. My experience - with only very minor side-effects - doesn't make me doubt that.

OK - on to the choice of a radiation oncologist - mine was head of this cancer center. Fairly young (I'd guess early 40's) very bright, very easy to talk to and most important to me - totally willing to communicate. I could email him whenever I had a question or idea, and his typical response time was about 3-4 hours. He was happy to discuss with me exactly what we were doing as far as treatment, and even how the machine does it (I mentioned to him that I am a retired engineer - and he thought I'd be interested - and he's right.) I sent him some studies I saw on the web, and he would comment on them - what might be missing from the studies, how patient selection can slant results, or what was good about the studies and applicable for my disease. He also is very current on what state of the art treatments are and the results that can be expected. Nothing I asked seemed to come as a surprise. Easy communications with an intelligent and caring oncologist is what I looked for, and I am satisfied he was an excellent choice.

I saw the list of questions - but in a center like this that isn't just prostates - there are lots of different ongoing treatments. They treat 3-5 prostates a day. The followup by the radiation-oncologist is visits for 5 years after treatment.

If you want to discuss if further - friend me - and we can chat a bit.

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wow wow wow! thank you so much for your thoughtful post. so informative. so greatly appreciated. i may have more questions for you, but i'm not sure how to friend someone on here. will try to figure out! thanks again & again!

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I needed someone I like, trust, and respect, but also someone willing to be as aggressive as I want and believe I need. I have certain advantages I wanted to play to, and I needed an R O who would play along but also had the experience and know-how, with an excellent team of techs and other staff, to get the job done with the least chance of hurting me and/or making me poop myself forever, into a bag. Finally, when it ultimately fails and I die anyway, I need the feeling we gave it our very best shot. I believe I got that. To me it was very important, as important as when I chose the surgeon for the RP, who was excellent, as was my pathology report but I was still in BCR in three months, which I expected but ..... we had to give it our best shot, which I will always do, right to the end. I owe it to the nice people who love me.

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yes this is what we're thinking too- that it's just as important as surgeon selection bc this is his one & only precious life. give it all we've got w/the best of the best, no regrets. thank you for your input!

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Imho it’s very important to choose an RO who has treated hundreds of prostate patients. I had bad rectal scarring after SRT using a local community RO for 38 sessions of IMRT . When I had a colonoscopy to determine the source of bleeding it discovered a mess in my lower rectum. Looked like a mini war zone!

When I needed radiation to pelvic lymph nodes I went to Sarasota for Dr Dattoli who treats nothing but prostate cancer because of the complexity of designing a plan and treating this area of the body which is much more extensive than the little prostate. No complications after FIFTY sessions of IMRT!

Always seek the best you can find even if it means travel/ relocating to have it done. I did the same with RP when I flew to Johns Hopkins.

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it's funny that you mention dattoli bc we've had several people mention that center to us recently. did you have to relocate to be treated there? were you torn between ROs before making the choice?

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We're relocating to Sarasota from April 28 to July 1 - or longer - to be treated by Dr. Dattoli. I used HomeAway, but the clinic has a list of suggestions. We were definitely torn about which RO to use. My husband consulted Dr. Kwon in late January. Dr. Kwon made a recommendation. And we had a choice at JH as well. We finally chose Dattoli for quite a few reasons, one of them the DART, another the fact that the clinic treats only prostate cancer, yet another Dattoli's and Kaminski's partnership. And there were a few other reasons like the integrative approach. We're happy so far. Keeping fingers crossed.

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Pwallace

My wife and I rented a condo in Sarasota; nice place to be in fourth quarter and fairly cheap.

I wasn’t torn as I communicated with other guys on who led me to him, and after one hour phone interview I was convinced. Plus the fact that he only treats PCa and started out at MSKCC was enough for me. He’s very thorough and dedicated to his patients. He treats you holistically not just with RT. They reply to your email or phone questions very quickly and work with your local provider and Rx seamlessly. His staff have been with him for decades. Quite a testimony!

The only negative I have now is that he hadn’t adopted SBRT yet when I spoke to his head nurse about 4 months ago.

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I remember many years ago that Dr. Strum advised finding a radiation "artist". That advice unnerved me a little.

Experience is essential, but in many fields, we know that there are individuals with twenty years experience who are no more competent than they were at two years.

Even so, how does one set about finding an artist?

-Patrick

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yes dr. scholz in marina del rey was the same way, he talked about the artistry of dr. demanes often (brachy). makes my head spin.

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Dattoli only treats PCa : that’s an artist!

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Wanna good Fryer? See Dr. Michael Zelefsky at Memorial Sloan Kettering c.c. in New York City. Their microwave ovens are top notch.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/08/2019 2:48 PM EST

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It counts for a lot to get a good rad onc. Also, it is vital that their scan imaging is precise as the imaging guides the treatment, especially for salvage.

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