SBRT alternative

[MauiJef]

So I've been trying to decide on what treatment I wanted to do and finally decided that I'd go with SBRT. Well unfortunately the MRIdian SBRT is going away at the end of the month. I reached out to Dr. Kishan to verify and this was the response

"Unfortunately that is likely correct. We will be doing triggered imaging with beam hold on our CT machine instead, which is very similar to the MRI tracking."

Now based on Dr. Kishan's Mirage trial, as I understood it, the CT method wasn't near as good.

From the mirage trial

"Conclusions and relevance: In this randomized clinical trial, compared with CT-guidance, MRI-guided SBRT significantly reduced both moderate acute physician-scored toxic effects and decrements in patient-reported quality of life. Longer-term follow-up will confirm whether these notable benefits persist."

So I'm thinking I do not want to go with this treatment. So for those of you who know more than me, any suggestions on an alternate to SBRT? Any thoughts on IMRT, Brachytherapy?

I have 2 cores of 3+4 , PSA is 5ish

Appreciate any feedback

[Tall_Allen]

I talked to him. They will still provide SBRT with fiducials on their VMAT linac, which is what I had.

[MauiJef in reply to Tall_Allen]

Thanks TA, is that different than what they told me? Their response to me "We will be doing triggered imaging with beam hold on our CT machine instead, which is very similar to the MRI tracking."

Just curious...thanks again

[Tall_Allen in reply to MauiJef]

Before MRIdian, they have always done SBRT with fiducials for intra-fractional tracking. I know they are considering increasing the number of triggering images they use. I had 4 (each half arc) when I was treated - they are considering 6 or 8 and reducing margins. I'm not sure adding more and reducing margins is a net benefit.

[Wifey21]

IsI have read through your previous posts and am interested in why you have not considered brachytherapy? I am aware you are in the US and that this treatment doesn't appear so popular there despite its good rate of success. We live in the UK and so don't have the insurance company issues that you have (I have 3 brothers in the US so am VERY aware of the insurance company shenanigans).

My husband was diagnosed 14 months ago with 7 out of 24 cores positive, 50 percent in one, 6mm tumour, stage T1. He is a fit 73 year old with no prostate enlargement. Only symptom he had was a bit of restricted flow first thing in the morning. He had full range of options given to him including AS, but after much reading + help from folk on this site, opted for LD brachytherapy. He had 75 seeds implanted in January. He had no SpaceOAR as it would have cost us as not funded on the NHS because he is fit (£6k to pay for it ourselves!!).

9 months on & about to have next 3 monthly check. Only side effect as a result of the treatment is VERY occasional slightly slow flow during the day (he is weaning off Tamulosin). SpaceOAR would have been a waste of money. His PSA was 1.6 at 6 months (he was 6.6 and rising at decision point). he expects further drop at this next review.

I know he's not as young as you but his decision was based on the specialist's comment that he could have another 20+ years ahead of him so the issue of side effects was very important. He's very pleased he chose this treatment.

I read somewhere on here of an opinion that brachytherapy isn't so popular in the States as the insurance companies don't get so much profit. Long Allen or others may be better informed on this. We have the NHS which our current government is idealogically opposed to but which in our experience has been A1 in its provision. Don't discount Long Allen and others like him.

[Tristag in reply to Wifey21]

Costly, but you might look at Proton beam radiation. That’s what I did 5years ago

[MauiJef in reply to Wifey21]

Wifey, thanks for your reply, and yes I have considered doing brachytherapy....still weighing the options

[cancerfox]

Don't underestimate the side effects of brachytherapy in your deliberations. A few days after I had LD brachytherapy I felt like I had been run over by a truck, and I still have bowel and bladder changes two years out. 🦊

[MauiJef in reply to cancerfox]

Thank you for the info, sorry to hear about your lingering issues

[CarverD]

If my results are indicative HDRBrachy may be a good choice for you if you are a candidate. I had mine done 3 years ago and have no complaints. Current PSA is .609 and side effects are pretty much nonexistent. Best of luck to you!

[MauiJef in reply to CarverD]

Carver...thank you

[Mpaddler]

You should take PROSTOX test to see if higher dose RT is suitable for you. Dr. Kishan had me take before he would recommend SBRT. About 10% of population does better with IMRT.

I live Maui. IMRT offered at PCI @ Maui Memorial. Not highly targeted and no SBRT for prostate cancer. Consulted TCCoH Oahu. They can do SBRT but seemed to really try to sway me to brachy. UCLA seems best option. Awaiting referral approval to have SBRT there.

[MauiJef in reply to Mpaddler]

Aloha Mpaddler, Thank you for the info, i hope you hear from ucla soon. Good luck

[NotDFL]

'Conventional' SBRT has been used successfully on thousands of patients and long-term results are available. The doc (who I will gratefully acknowledge) has done over one thousand himself (Georgetown University Medical Center).

[MauiJef in reply to NotDFL]

NotDFL, thank you