I just finished my, "one and done" with Dr. Hsu; thank you Tall_Allen for the recommendation. Things couldn't have gone better. The procedure was done at Mt. Zion. A covid test was required prior to the procedure. Because of my distance travelling, they set-up the test for the day before; and the results were in before 6AM the next morning. The entire staff was very professional and helpful. When I told Dr. Hsu that memebers of this group refer to this one day procedure as "One and done", he and his staff laughed and repeated it several times. My RO in Northern Nevada has been pushing heavily for sspace oar. I asked Dr. Hsu if it was needed and he said he didn't think so. When I told this to the other RO he said he would need to further radiate the gland and there was likely to be rectum damage without SO, as part of his 5-7 weeks of EBRT. He then placed markers, without anaesthetic, even though Dr. Hsu had intentionally left his in. I go back to Reno next Monday (a 2 1/2 hour drive each way) for a CT scan to determine if the markers are correct. I've contacted Dr. Hsu for more input on the Space Oar and possibly for a recommendation for another RO. I live in a small rural No. Cali county and there are no ROs near, accepting patients, so I'm not sure what can be done. I would like some advice on whether I'm making too big of a deal about this or not.
Thanks, John
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Smallfall
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I agree with you to find another RO if possible. He should not have inserted more fiducials - what is the point of that other than to bill insurance for it? I agree with Dr Hsu about Space OAR - it is unnecessary (another money grubbing tactic of your RO):
An RO I highly respect never uses it because it compresses the prostate. He believes that ROs who like it are just lazy - there is no substitute for the painstaking work of accurate contouring. That is what protects the rectum.
Wasn't the external beam radiation plan done along with the HDR brachy plan? If not, maybe UCSF can do the plan, and your local RO can just execute it? And why is it 5-7 weeks? it is usually only 4-5 weeks when brachy is part of the plan.
Thank you for answering the questions I have about the current EBRT plan. Much if the info I have about this has come from this forum and I trust much of the information I have gotten, and verified here. The idea of UCSF doing the plan is a good one, possibly Dr. Hsu will suggest or approve that.
Actually, one-and-done in the HDR-BT world means one Brachy session instead of two. About five years ago, two HDR sessions one week apart was the norm. Now it's more common to have one HDR session. Fiducials for follow-up IMRT are placed in either case.
Ideally the SpaceOar would have been placed during the Brachy procedure, it gives you about 15mm separation, which is a mile in radiation mapping. You don't have anything to lose except radiation proctitus of the colon from excessive radiation. I had SO along with HDR-BT with no SE's at all (see profile). You might ask your EBRT MO if he would insert it, but you would likely need a lower anethestic block.
Dr. Hsu didn't need SO with HDR, and said he didn't think I needed it with the follow-up radiation. I trust Dr.Hsu more than the guy with SO advertisements on all of his walls.
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Making a decision! 
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ECE and CRIBRIFORM FOUND IN PATH REVIEW OF MSK BIOPSY BY UCSF
