So, today I visited the center in Reading, PA where they have been using Viewray Linac since 2019.
The RadOnc I met with seemed very knowledgeable and spent a lot of time. Good bedside manner. He too discussed pros and cons of various options. He also ruled out Brachy or SBRT due to prostate size and past retention issues. He seemed ok with either a 5 or 9 week course of therapy whereas Fox said not less than 8. He did seem to be a bigger proponent of Spaceoar, having treated 300+ patients using it. He also said it was optional. (First doc said SpaceOar bad idea with large prostate). He was balanced in his surgery vs radiation estimate, a bit more optimistic about radiation than I sensed from first RadOnc. Felt either is an excellent option.
He did state that while surgery obviously addresses the BPH issue that once things settled, my prostate size would almost certainly be reduced so it is likely to have positive effect in that regard.
Concerning long term effects, he said minimal likelihood of incontinence but increased likelihood of other uro or gastro issues. Damn, no easy choices with this disease.
The Reading oncologists tend to treat all sorts of cancers, the Fox Chase ones tend to be more specialized (ex. Urogenital). That's a big consideration. It would be closer to go to Reading which is also a consideration albeit, lesser.
In terms of the Viewray. They do have the original .35T but he feels the image quality is more than sufficient for prostate. He was very honest in noting that there is no proven efficacy benefit over other Linacs. The biggest pluses seem to be the confidence that comes from real time imaging and that you do not need invasive marker placement. You do not get the CT exposure since it is MRI but, he felt the imaging CT exposure from other Linacs is minimal and a non-issue.
While I keep trying to convince myself otherwise, my very last and least desirable choice of surgery may yet wind up being the best choice. :-(. Due to related issues, I can't do Brachy or the 5 session radiation but instead would need to do the full 8-9 weeks. When you work for a big consulting firm, whose sole focus is how many billable hours you have, I am not even certain I could pull off an 8-9 week course of therapy and still be employed at the end.
I did ask about Liproca to reduce prostate size. Outside of a trial, I have not found a doc willing to try that.
Obviously SBRT would have been ideal, 5 days and done. For conventional fractionated, both RadOncs indicated that AEs would likely start around week 2-3 with some possibility of needing a catheter, also talked about bowel issues. Yeah, that could be rough if it starts up when you have 6-7 weeks of treatment with worsening symptoms in front of you. As if to warn me, as I got home I had an unexpected sudden and unpleasant bowel movement (just made it!!!). Then again, I have to consider 7 weeks of misery vs 20 years of misery.
Both talked about salvage therapy in event if recurrence. Sounds like surgery wins there although one must weigh that against low likelihood of recurrence for intermediate favorable. One thing I was not aware of that Foxchase shared is that should you later get bladder or rectal cancer that radiation is no longer an option if you have had RT for prostate.
I could do one more round of consults at Penn but, I really doubt I will hear anything different. It could be useful but may simply be delaying a decision.
Not as dissapointing as last week as I mostly heard what I thought I would.
Perhaps I should look into some alternative therapies. You know, bleach and very bright light or something.
Argh, this sucks!
For my prior update, see: healthunlocked.com/prostate...