Stuck between deciding on IMRT CONDENSED and SBRT with 4 months ORGOVXY- Have Jan 12th date to make decision for UCLA (meet with Dr. Kishan)

[JWS13]

I will give you the facts as I know them and who recommends each therapy:

1. I live near UCLA so convenience is not a factor ,however 20 IMRT treatments is more than 5 SBRT Treatments.

2. Dr. Howard Sandler, (Cedars -Sinai) -RO, Dr. Rana McKAY -UCSD -MO , Dr. Mark Botnick -(Cedars Sinai) -RO , Dr. Tim Wilson UROLOGIST (St. Johns) , All emphatically recommend IMRT , with no Spaceoar ( to make sure my EPE is covered) , and with 4 month's of ORGOVXY .

Their main premise is that IMRT has the longer term DATA re: "BCFR" (failure rate) and for the time being holds up better. Also less probable toxicity.

3 Dr. Mark Sholz -PO and Dr. Daniel Shasha - MSK-RO- recommend SBRT. They both think that both IMRT and SBRT are basically the same if given by a "Center of Excellence" and are not concerned with the data but rather "why waste the time & effort " and "get this behind you"

4. I have researched the "Biochemical failure rate " and for 5 years both treatments are in the 80-90% percentile. Only IMRT has data for 10 years at 80 % or so. Both have basically same toxicity rate. ( this may not be exactly right as my head is "full")

5. Have defibrillator so will be getting "old" CT protocol. with IMRT 15 minutes w "comfortably "full bladder , (don't think you need a fleet enema for each of the 20 treatments). With SBRT a bit more complicated , 45 minutes -hour being "still ' w full bladder.

Tall-Allen please weigh in here... Need as much input as possible as soon as possible. Thank you all. All responses welcome and encouraged.

68- Gleason 7 ( 4+3) , EPE indicated in left posterior, PSMA Pet ( all lesions in capsule -bilateral) .

[Tall_Allen]

Kishan, and previously Chris King, has been running SBRT for high risk for many years.

prostatecancer.news/2016/08...

Brachy boost therapy is the tried-and-true. SBRT is the new kid on the block. Hypofractionated IMRT has more published data than SBRT.

My computer now is better than computers 10 years ago. So, my feeling is that newer technology is usually better. But you may feel differently. Choose whatever you feel comfortable with.

You are wrong that SBRT lasts an hour - each of the 5 treatments lasts 5-10 minutes on a VMAT linac (which is what you would be treated on regardless of whether you choose IMRT, SBRT, or brachy boost).

I have no idea why you are asking MOs and Urologists about it - they know less than I do.

[JWS13 in reply to Tall_Allen]

Is the VMAT linac WITHOUT MRI and for CT treatments ?? The failure rate in the article with SBRT only states about 60% non failure rate , is that the "2016" rate as discussed in the article . Isn't there a higher non failure rate recently with SBRT at UCLA... and are you classifying me as "high risk" due to the EPE ? even though I generally fall in "unfavorable internediate risk"...would a decipher clarify this more?

Of importance you made no comment regarding IMRT , is the 5 and 10 year failure rate for IMRT Condensed monotherapy as high as Brachy or in the 80-90% range?

as always thanks TA.

[Tall_Allen in reply to JWS13]

The VMAT linac uses CT and X-rays for image guidance-no MRI. All treatments at Cedars and UCLA that you would get, brachy boost, SBRT, or IMRT use exactly the same linac - TrueBeam with RapidArc. They only differ in the amount of radiation delivered in each session. And SBRT uses intrafractional tracking

They are all about the same success rates with modern dosages and techniques. You cannot decide based on that.

EPE (Stage T3a) makes you "high risk" no matter what Decipher says. You are not intermediate risk.

[Tall_Allen in reply to Tall_Allen]

I think you should ask Mitch Kamrava at Cedars-Sinai about HDR brachy boost therapy.

[JWS13 in reply to Tall_Allen]

TA ...Can you tell me what the IMRT Condensed Monotherapy (20 treatments) 5 year and 10 year failure rate is with 4 months ADT ?

[Tall_Allen in reply to JWS13]

Here ya go:

ascopubs.org/doi/10.1200/JC...

[jjpeabody]

I consulted with both Dr. Sandler and Kishan with my 4+3=7, ECE, PNI. Dr, Sandler, and Kishan, I felt were both totally trustworthy, I mean extremely. Dr. Kishan gave me a swab test (re Garuda trial, ask Kishan) to determine if I could tolerate the higher intensity of SBRT, I failed the test and that was that and he recommended IMRT for me. Tall_Allen referred me to Dr. Sandler (elected president of ASTRO in 2023 I believe, radiation oncology part maybe not sure) and have never met a better doctor in every respect. If you weigh what each of them tell you, you'll have your answer. Good luck JWS13

[JWS13]

thanks

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[Jancapper]

As far as I understand it, there is no external beam therapy that can accomplish the same as HDBT. All external beam therapy still has to pass through normal healthy tissue to reach the target. HDBT is able to achieve unparalleled BED because the radiation is emitted from the target organ itself. Additionally, if any movement should occur, the catheters move with the prostate thereby eliminating errors caused by movement. There are many peer reviewed published papers detailing the benefits of HDBT + IMRT + ADT.