Input on Treatment

[Mike404]

After my MRI showed a PIRADS 5 lesion, my biopsy came back with a Gleason 4+3 in 5/13 cores. PSA measures 7.5, but would be 15 without my daily Finasteride. ECE was suspected, but my PSMA PET confirmed no spread outside the prostate. That’s a relief. Graded as unfavorable intermediate. 

I‘ve decided on MRIdian with Dr Kishan at UCLA. Awaiting results from a genetic test whether I do five or twenty rounds. I also have an option to join a trial on just two fractions. I’m also a candidate for SpaceOAR, which I may do. The PET scan confirms there is no cancer in the area that might be protected by the gel, and I’ve read studies that suggest the Neurovascular Bundle can also be protected by the gel. Sedation is an option for insertion.

I do have to have six months of ADT, but Orgovyx is an option to bring T levels back sooner. Dr Kishan is willing to irradiate the chest to prevent “breast growth”.

I feel very comfortable with Dr Kishan as a leading expert and also with the advanced ViewRay technology. I’d love to hear from others about their experience at UCLA or with ViewRay. Also thoughts on the SpaceOAR and ADT options. Finally, has anyone seen studies or other information on the two treatment SBRT option. Thanks.

[Tall_Allen]

I'm a big fan of Dr. Kishan's. You're in good hands.

I didn't think he did SpaceOAR with Viewray. He said it was unnecessary. It doesn't spare neurovascular bundles, just the rectum, and that is only when fiducials are placed. Why have an invasive procedure if there is no benefit?

The 2-dose SBRT is very experimental. I found 5 doses to be easy peasy, so I don't see the advantage.

I don't think you'll need breast radiation. Gynecomastia is rare in men getting a GnRH agonist (like Lupron) or a GnRH antagonist (like Orgovyx). It mostly occurs in men only using an anti-androgen (like Casodex).

[Yearofthecow in reply to Tall_Allen]

I will be going in for treatment with Dr. Kishan starting September 1, and we discussed SpaceOar. He indicated to me that since my Medicare covers that, he anecdotally believes that the hydrogel will reduce radiation to the rectal area, and he recommended to me. Perhaps because I told him because I have hemorrhoids, which don't bother me, or bleed, but he thought it would be a worthwhile thing to do since my insurance covers it, which I think was part of his recommendation for it.

I will be going through a 5 dose treatment for favorable intermediate

[conbio in reply to Tall_Allen]

Would agree on avoiding the chest radiation. I had some worries - 12 months into 18 month Lupron regime - but the more research I did and the more medical folks I talked with - it appeared unnecessary. So far so good. Why irradiate yourself if you don't really need it? Best of luck - sounds like you have a good plan.

[Jpl506]

Dr. Kishan did my treatment just over 2 years ago. 5 fractions on the ViewRay (I was one of the first treated on it) for very high risk. I was a breeze except for the full bladder, I slept in the machine most days. No SpaceOAR, it isn’t necessary with MRI guided. I was on enhanced ADT (Lupron + Apalutimide) for 25 months, just completed April 30. I exercised a ton and drank a lot of coffee. Otherwise it wasn’t a big deal. My T is back in the low normal range and my PSA undetectable, I sure hope it stays this way.

[Yearofthecow in reply to Jpl506]

Dr. Kishan will treat me with ViewRay in September on the ViewRay, and he recommended it for me since my insurance covers it, and he believe it will reduce any possible radiation dose to the rectal area

I will be going through a 5 dose treatment plan for it, every other day

I suspect his recommendations depends on one's insurance coverage along with other factors. For instance, I have hemorrhoids, which don't bother me, but suspect that may have weighed into his recommendation.

Also, in technology, two years is a long time, and he may have changed his views on SpaceOar in that time

[Jpl506 in reply to Yearofthecow]

There is nothing my insurance wouldn’t cover but I’m very happy you found a treatment that eases your mind.

[Yearofthecow in reply to Jpl506]

Glad your treatment is looking great, and wish you continued success also.

I wasn’t endorsing SpaceOar, one way or another, only going to have it done because Dr. Kishan recommended it in MY case, and speculation why that might be.

Treatment is such an individual situation, and a physician may recommend one protocol for one patient, and a different protocol for another patient.

One size does not fit all with what we are dealing with.

Take care jpl

[1Ubspaine]

Your diagnosis is very similar to mine and your treatment plan is as well.I was a patient of an excellent RO at UTSouthwestern in Dallas-Dr. Garant.

She suggested a genetic test, then 5 treatments, Spaceoar, 6 months of ADT.

I completed the last ADT treatment 3/1/22.

I am pleased with my decision and treatment. The only complication was I became very sick upon my first ADT shot and spent a few days in bed. After the other shots it was usually a 24 hour reaction. My RO stated this was unusual, but then a nurse later said it happened a fair amount. Certainly no reason to second guess the treatment.

Carry on, best to you.

[tsim]

MR guided LINAC is quite an advancement, you're fortunate to have it available.

[BL2023]

I have a consult scheduled for May 23, 2023 with Dr.Kishan re Viewray mridian Sbrt. I’m uir with G7(4+3). How are you doing (SE’s) and would you recommend him and the Ucla team? Thanks

[Mike404]

yes, for sure. High volume center, so don’t expect a lot of handholding. They were mostly accommodating with my requests, though not so much on ADT. I started on Orgovyx, but eventually moved to Lupron (only option they had). I should have stayed on Orgovyx.

I had some bowel urgency the first day after SBRT completion. Some occasional urinary burning first few months, but mostly nocturia. I started having to get up 2-3 times a night, but just started sleeping through the night. A few ADT side effects, which are cumulative (fatigue, sexual, muscles and weight). I try to exercise a lot, which helps.

[BL2023]

Thanks, Mike. Continued good health to you. Please keep us updated.

[Mike404]

A quick update. I completed the five rounds in September with SpaceOAR. As I mentioned, limited side effects. Finished ADT in March. PSA and T were essentially undetectable up till now. The most recent test this week sees my T back up to 286 and my PSA at 0.07. So far so good!