Looking for advice on Viewray MRI guided SBRT

[PSA_Pre]

Quick background: age 55, family history (father), had mpMRI and biopsy in 2020, G 3+4 cribriform, had focal TULSA in 2021 (roughly 1/3 of gland). Latest MRI shows two Priad 4 lesions (non-treated side), now embarking on the next leg of this adventure...

When doing TULSA, understood that I could probably expect to deal with more treatment in the future (just hoped it wouldn't be this soon). TULSA went well and I've been very pleased thus far, but now thinking I may just need to bite the bullet and treat the entire gland. Started this journey thinking that proton was the best technology for this but the latest advancements with the Viewray MRIdian platform seem to be best in class for my situation (at least for this brief moment in history?)

My research leading to TULSA convinced me that the practitioner is more important than the technology, especially with so many new emerging technologies. I've tried to gather information on which doctor/institution has performed the most treatments using Viewray MRidian - I know that Dr. Kishan at UCLA led the MIRAGE trial and they seem to be a high volume practice. But I would like to know who else is considered in this tier of provider? Does anyone have data on number of patients treated?

(I did see the chapter 11 filing. Based on the installed base around the world, I'm hoping that the relevant players in this ecosystem will figure out a way to continue to support this platform.)

Anyway, very glad I found this forum and thanks in advance for any insights!

[Tall_Allen]

TULSA-PRO doesn't work, even when the whole gland is treated by expert practitioners. There are lots of urologists out there who are misleading patients:

prostatecancer.news/2021/03...

Where are you located?

[PSA_Pre in reply to Tall_Allen]

I'm on the east coast, can travel anywhere but would be nice not to have to go all the way to LA. To be clear, I'm looking for the expert practitioners on the Viewray MRIdian SBRT. Somehow there doesn't seem to be as much information as I would have expected, particularly with centers of excellence in PCa? Most have a page or two online on MRI-guided SBRT but it's not clear which ones have the most critical mass.

I've read your postings on TULSA and agree with many of your points. I think for younger patients with lower risk localized PCa, TULSA is like an out of the money call option - there is a chance that it pays off and that you can kick the can far enough down the road for the trade off of QOL vs risk to make sense. For older or more advanced patients, I would not recommend buying out of the money call options as a retirement strategy.

[Tall_Allen in reply to PSA_Pre]

I think Weill Cornell has been using it.

Salvage after treatment usually has worse side effects.

[Concerned-wife]

yes Weill Cornell treated my husband with this. We thought the care there was excellent. Dr Nagar.

[Don_1213 in reply to Concerned-wife]

weillcornell.org/hnagar - looks excellent. I have to agree - the care by Columbia-Presbyterian/Weill-Cornell has been outstanding as I've experienced it. I've slowly transferred my care to MD's at CPWC.. and have no complaints about access or skills exhibited.

[BL2023]

I think you’ve got the best recommendation for the east coast. Good luck to you.