Husband diagnosed with 3+4 - Mpmri says it’s contained in anterior…2 out of 12 positive…both in anterior region.
Looking at MRI guided SBRT. Concerned about prep. Doc is saying that barriergel spacer is required. And a catheter during rad planning. For all cases.
I thought mri guided was better targeted so we were surprised. Seems invasive. Also saw research that catheter was useless because the urethra moves after removal.
We are seeking another opinion but wondering if others can speak to standard practice. Like at UCLA?
Thanks!
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Don’t know where you’re being seen. I was treated with MRI SBRT by Dr. Amar Kishan at UCLA and did not require SpaceOar or any catheterization. I understand that has changed somewhat since my treatment in 2020 in that some men may require SpaceOar now. Different circumstances probably require different protocols even at the same institution and by the same physician though.
thanks so much for your reply. We are looking at Jefferson in Philly.
Doc says new barrigel is state of the art. And that the urethra disappears on the mri so need a catheter. In all cases.
So, this is the only system in Philly for MRI based Sbrt. Looking at MD Anderson Cooper in NJ. They do not use catheters and only use spacer in some cases.
This is never easy but seems like Jefferson makes it tougher.
Do you know how they mapped the urethra without a catheter?
Nothing specific was mentioned in regard to the urethra. The only prep I had was full bladder for each treatment. I don’t have any side effects to speak of either. It’s been 2 years, I was one of the first MRI SBRT patients at UCLA, things could have changed in that time.
Jefferson is also requiring an enema before each treatment. So many requirements. I wish we lived closer to CA. Checking in with Cornell Weil now and MD Anderson Cooper.
I think the prep procedure you're referring to is what I went thru for IMRT and they called it Simulation. In my case, the oncologist used a syringe with contrast material and injected it into my urethra then a nurse put a clamp around my penis shaft to make sure it didn't leak out. I was on my back on a CT scan table. This is also when they put the small spot tattoos on my hips and pubic area to use for alignment when doing radiation. For the radiation treatments, I was not required an enema or a balloon in the rectum. They only wanted me to have a full bladder. I did have the SpaceOAR gel but it doesn't do any good.
Try a consult with Amar Kishan at UCLA (tell them you're currently visiting relatives in California if they ask). He doesn't use catheters or SpaceOAR (unless the patient insists) with SBRT on Viewray.
The Viewray magnets are of low field strength (0.35 Tesla) as compared to high field Elekta Unity (1.5 Tesla). As such, any enhancement to the imaging is in favour to the precision of the procedure.
It is, but as of a European make it is more deployed in Europe and Australia. There is only a handful of units in the US where, understandably, Viewray shows a wider installed market. My post was not meant to divert you from one to the other but to vote for your Philly center people.
yes…but hesitant to go with a doc who uses them all the time or frequently as it would seem the team is not used to contouring without it. Yet the MSK guy looks like one of the top docs on the east coast.
By all means. There is only one constraint with Elekta: The bore size. In order to achieve the high field intensity they kept it tight. Overweight and obese men will not fit in it. Waist size of 115cm (45 inches) is the upper limit, if memory serves.
The catheter doesn’t make sense. I had viewray SBRT at UCLA with space oar, which wasn’t required. The only prep needed was an enema for both spaceoar and MRI
Actually procedure prep requires enema and full bladder every other day, for 5 treatments
Doc says the urethra “disappears” on the mri. We shared research that points to the catheter being useless as the urethra shifts after removal. He say it’s standard procedure and he can give an anti anxiety drug. We like this doc overall, he’s done it a lot and the system is well regarded. Hard to find mri based. We are getting another opinion or two.,
They want the catheter for planning only. I've had one for 7 days, so I'd say a catheter for a short time during the planning visit would not be a big deal..obvious question to them is "why do you requre and others don't" Same with SpaceOAR, which would be the worse of the two personally for me!! SpaceOar is not all positives !!
Since you are considering facilities in NYC I would suggest Memorial Sloan Kettering Cancer Center. I had SBRT in 2016 and was treated by the head of RO, Dr Michael Zelefsky. I was very pleased with how my treatment was handled and continue to have my PSA drop and have no side effects to speak of. I don't recall all the specifics although I do recall having a SpaceOar placed. I would suggest reaching out to them. Good luck.
My husband is 8 weeks out from SBRT with the Cyberknife system in NC. What you describe is exactly the procedure his RO used. SpaceOAR and fiduciary implanted a week before treatment started. Catheter during the planning / simulation only. Enema before each of 5 treatments and planning Full bladder during treatment. He has had no bowel or bladder issues so far, just fatigue. Good luck!
thanks so much and glad he is doing well. Sounds like standard SBRT with seeds…we are looking at MRI based. Harder to find and usually requires less prep. New though, so we are finding that systems vary in how they handle.
I just had MRI guided SBRT with Dr Kishan at UCLA in August and I thought that I might want to use the SpaceOAR gel, but Dr Kishan didn't feel it was necessary and there's a small risk of infection, not to mention that it's painful. There was never any mention of using a catheter either. Definitely talk to Dr Kishan if it's an option for you.
same here. Just finished my view ray treatment with Dr Kishan. No catheter during planning, but did have the space oar. The only side effects I had was some urinary retention which was quickly resolved with flowmax, otherwise I feel as I did before treatment which is good
Before I decided on UCLA, I consulted with UCSF and Stanford. Neither facility required a catheter for the planning phase. UCSF and Stanford use the standard SBRT protocol, fiducials, and CAT scanning for targeting. Decided on UCLA because no fiducials necessary, and almost real-time MRI used during treatment for targeting
If close enough take a look at MEDSTAR GEROGETOWN DR. Shawn Collins I just finished up there. Great people. Dr. Collins has video on MedStar web sight that should help answer questions. Their phone number is 202-444-3062 that will get you to his executive assistant and they should be able to help you out from there worth the call.
I agree with those who are saying that if you're going to NYC do a consultation at Memorial Sloan Kettering (where I did LDR brachytherapy). Even if you don't ultimately do it there, you'll get the perspective from a top institution which routinely performs these treatments -- and pioneers them -- to compare with what you've been told.
My gel placement did not take. There are two schools of thought on the use of the gel spacer. I am on hold now for my radiation treatment. I did tell my medical team we are not doing another gel placement. They agreed.
I was treated by Michael Zelefsky at Sloan-Kettering New York City for a very similar diagnosis. He did insist on space oar but no catheter. five treatments on the LINAC and done. Can’t say enough good things about Sloan Kettering.
So far MSK, UCLA, Cornell Weil, and MD Anderson Cooper don’t use catheters and use spacers selectively. Not sure why Jefferson is an outlier here. We will ask although we didn’t get anywhere last time we questioned it.
had SBRT (cyberknife) with Dr Haas at NYU. also insisted on spaceoar (related to the location of my lesion) but a catheter was not used or even discussed. 5 days of treatment, strict diet with fleet enema each morning...
I would pass on Jefferson if I were you. In all of my research prior to treatment no one proposing radiation treatments talked about a catheter. I would also make sure that your SBRT is MRI guided. That’s an important feature because technicians can observe the position of the markers and correct in real time.
it is mri guided. They’ve had the Linac for two years and doc says he’s done it many times and has a great rad team. Frustrating as they are the best local option other than MD Anderson Cooper. We have a consult with them in a couple of weeks.
No, all I had to do in the planing is get the gold fiducious put in all under anesthesia never knew it happened no pain no side effects no nothing from that then a week later had a MRI and a CT scan done and then after that scheduled for the five SBRT treatments and it was all done. Watch the video online give them call to get straight answers.
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