My AS is coming to an end. Moffitt recommended that I address my cancer. Leaning and heading towards SBRT at Moffitt. I live 3 hours away from there. Is there a big advantage to using MRI guided radiation? Is it only available with SBRT? Other wise I might consider radiation here locally.
SBRT VS CONVENTIONAL RADIATION - Prostate Cancer N...
SBRT VS CONVENTIONAL RADIATION
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twoodogs
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Sorry to hear that you are starting down the RT road, but good for you for asking questions and educating yourself.
MRI guided SBRT has a lower incidence and severity of acute GI and GU symptoms as it is more accurate than CT guided SBRT.
Having said that, I had my SBRT on a Varian Edge machine (CT). I also had a Barrigel spacer placed. This machine is crazy accurate....it can position you to within 0.1 mm and within .3 degrees of rotation. It monitors the fiducials in your prostate and automatically shuts off the beam if the position of the prostate is out of parameters. Additionally my RO was able to visualize the lesion and the urethra on CT, MRI and PSMA PET scans and gave a boost in radiation to the primary lesion while "steering" around the urethra to ensure it did not receive any radiation "hot-spots". Finally my RO was in the control room for all my treatments which is not always the case.
Check my profile for posts....but the short story is any minor GI/GU acute side effects resolved within 10 days....and I went on a two week SCUBA trip to Honduras 2 weeks after my final treatment.
So, for me......and I am 5 1/2 months post treatment....SBRT with the Varian Edge was a piece of cake.
Keep learning, then advocate for yourself.
Stay Strong Brother, we got this.
Thanks for the input trying to navigate this pretty much alone. Didn't have any luck with TA recommendation of Debra Freeman. I have a zoom meeting next week with DR. Grass at Moffit Not sure if there is anything to ask or just see what he recommends. I believe that I'm doing the right thing with SBRT would Dr. Freeman be better than Moffit I just don't know and not sure if I should pursue that route. I'm ready to get this over with.
See what the doc recommends and why. I missed your specifics as to age, PSAs, MRI, PSMA PET, or biopsy results. See what the doc says, come back and bounce it off the group.......but know that this is your informed decision to make, and once you have your treatment done don't look back and ask "what if". Be comfortable with, and informed enough about your treatment that you are not second guessing whatever outcomes there are.
Stay Strong Brother
One consideration about drive time is you are going to be expected to have a very full bladder when you go into the RT room. The RT techs will take a CT of your bladder and you won't be able to fool them. When I say full, I mean painfully full. This will get harder and harder to do as your RT sessions accrue -- at the end it will be very touch and go. If yours is not full enough, they say go drink a bunch of water and we'll swap your slot with someone else's slot. Furthermore, sometimes when you arrive with a full bladder, they will have to delay your RT session. It's a very fine line to arrive at and not overshoot -- if you wee you lose time. Sometimes they will call you and outright reschedule your RT session.
In a busy hospital, IMRT machines have multiple uses and are also subject to being down for maintenance or whatever reason.
Boy, is that an important point! My drive to the treatment center was about 35 miles and I had to very carefully time when to start drinking my water in the car so that I arrived with a full bladder but could still hold it. One time on the way there, we got stuck in traffic and that threw the whole schedule off. When we arrived I had to rush into the treatment center to pee and start all over again! They were very understanding, which I appreciated.
When my husband had IMRT at Sloan Kettering they would have you arrive 1 hour early and based on how they were running on schedule the front desk person would call him and tell him start drinking. The instructions were to empty his bladder first (as well as #2 if needed) and the drink 2 full cups of water. It worked well and for the most part never had any issues but he was running for the bathroom as soon as the radiation was finished. So perhaps try to get there early see if they are running on schedule, and try that routine with the drinking at the medical facility.
My RO......MIT, Harvard, Dana Farber...now at Kaiser here, advised that what matters most to him is that bladder filling is not lower than x% below the bladder volume on the planning day.......he is watching intestine location . About 14 sessions into the 28 session RT, he redid the planning based on new planning CT. Since all I hear about is 99% full bladder, is my guy nuts??? So, volume on planning day must be x% of full bladder , to allow acceptable intestine position, and then on session days should be fuller, or no more than x% below volume on planning day. Of course, more sessions equals lower dosage each day, so one bad day is not the same catastrophe as one bad day of 20 sessions, or the SBRT 5 session protocol.
For me, no fiducials, and he is using the numerous small calcifications within my prostate to help with more accurate targeting. and boosting to PIRADS 5 lesion area.
I'm drinking almost 1/2 gallon of water /liquids approx 1 hr before treatment, and still only a few "full" bladders. A real challenge for me to drink that much!
The advantage for MRI-targeting is very small, and vanishes with if the RO has little experience or doesn't contour precisely.
If you are anywhere near Tampa, Debra Freeman is one of the most experienced SBRT ROs in the world.
It's no farther than Moffitt so what makes the difference is the RO not the machine What is the difference thier accuracy and dosage ?
The toxicity difference (which is all the patient should care about) is minimal.
Have not had any luck contacting Dr. Freeman there are 2 cyperknife clinics and a dermatologist listed for her reach out to them all. Not sure how I would know to be treated by her or just her clinic. I've been a patient at Moffit for 5 years now and have a zoom with RO Dr. Grass next week Not sure what to even ask.
Sean Collins just moved to USF/Tampa General Hospital from Georgetown. He is great!
I was finally able to reach Dr. Freeman and have a Tele med with her next week. This site and your advice have changed my journey with prostate cancer I'm pursuing SBRT because of your posts have made me aware of that option. When I was diagnosed 5 years ago I was sent straight to a surgeon and thought that was the way it was going to go. I'm still a patient at Moffitt but with your statement that Dr. Freeman is one of the most experienced RO it will be hard not to go with her.
SBRT and MRI guided linacs are two different things. There are only two machines of the latter type, one made in the US the other in Europe. The company that makes and maintains the US one, has filed for bankruptcy and there are succession problems that are supposed to being addressed. I don't know if this is accurate, but it has the largest installed base in the US, so you will probably bump onto one of them if you decide to follow the MRI guided route. The European made may only have a handful of units deployed in the US, so your chances are limited.
My SBRT 5 Sessions was not MRI guided but the radiologist ar Christies UK have done thousands of treatments that's good enough for me
I had a look at the Christie's protocol once and it said empty bladder and laxative. It may be that they fill you up with water when you're there. Is that what you had?
Both empty micro enema for the rectum
That's interesting. I guess a full bladder is unachievable with the throughput they have. I failed 25% of my visits for RT and had to come back later in the morning, usually because I was just under the 200ml lower limit.
Full bladder empty bladder what's the difference, not aware of any definitive answer for which is best if at all, maybe opening a can of worms with this response but I'm being looked after my respected experienced professionals that's enough for me.
As I understand it, it's to protect the small bowel. As the bladder gets fuller, there is greater distance between the prostate and the very sensitive small bowel area. Also if the bladder is full, there is less bladder in the treatment area. Quite what difference it makes in practice is another question!
definitely having the correct bladder fullness was the most challenging put together a repeatable process that gets you there daily with the same amount of pee
This is correct. You need the same fullness as at your planning CT. They told me to have "a comfortably full bladder". The only time it was uncomfortable and difficult to moderate the fullness was when my appointment was delayed an hour.
I definitely support and thank Tall Allen's recommendation of RO Debra Freeman in Tampa. Went thru SBRT with her and Cyberknife 2 months ago. Nothing but good things to say about her. Definitely recomend her.
thanks for the input I'm having a hard time with everything i tried 3 different phone numbers no luck Im not sure where to call there are 4 offices for her. How would I know if i could be treated by her or just one of the clinics she owns?
Hi, the Cyberknife office you need to contact for Debra Freeman is at 621 Lumsden Professional Ct, Brandon, FL 33511. She is there every Wednesday. It's difficult to reach her but you can arrange an appt with Dr Freeman thru her Assistant Kilee. You can even have your first appt. Virtually by Zoom, etc. From my personal point of view, the fact that Dr. Freeman was very patient oriented, went above and beyond spending the time with me to have the correct/complete tests and diagnosis, gives you all the options that other Doctors didn't do with me and the fact that Cyberknife treatment is SBRT by robotic arm to attack the cancer from different precise angles made my decision to go with her. Good Luck to you.
Thanks for the info. At least I have the correct place and phone I called last week it just rang twice and went silent will try again tomorrow
2.5 years ago I had MRI guided SBRT at Sloan Kettering Prostate Center in New York City. Interestingly, I did not have a full bladder. Before treatment, I was administered an enema by a young nurse (poor thing) and off we went. As medical challenges go this was a pretty easy fix. Five treatments, not too much discomfort. The worst was actually after they inserted the fudicials. PSA went 8.5 down to .52 six months ago, last one a few days back was .95. I was warned about possible bounces. Hope that’s all this is.
My point being, most of these modalities will do the same thing with the same rates of success. It comes down to the technician, and the facility. The more experience they have, the higher the chances of an effective and positive outcome, in my humble opinion. But there are no guarantees… We all know that. Best of luck to you.
I've had a few consults with MSK and have a more meetings before I make my decision on treatment. What doctors did you work with at MSK? I'm seeing a combination of docs on LI and NYC. If I go the radiation route (where I'm leaning), can be HDR/EBRT, or SBRT/Hormone. Have telemed call this week with Dr. Gorovets to discuss brachytherapy.
Hello,
I had my treatment with Michael Zelefsky who has since moved over to NYU to head the prostate cancer wing there. When he departed I was advised to talk with Sean McBride. But since I am past treatment, I have been dealing with the PA in his office (same as where Zelefsky was). But I've heard really good things about Sean McBride.
Best of luck,
Thanks for the quick reply. I initially was looking to speak with him, but NYU is completely out of my network. I was told that Gorovets and a few others trained and worked under Zelefsky specific to brachytherapy. Not sure who would be perfoming the SBRT should I go that route.
I really do believe that if your insurance covers you at MSKCC, you're going to be in good hands. I found my experience there to be as good as possible considering the circumstances. Just avoid Mount Sinai. That place is the worst! I started out there and couldn't get out fast enough.
Funny that you mention avoiding Mt. Sinai. They've rescheduled my initial appointment with Dr. Tewari 3 times (now 2 months after my initial inquiry). They have only schedule time to meet with him (a surgeon) and no RO, which is counter to what I've experienced at MSK and a few other practices, who all scheduled me to see both a surgeon and a RO.
Avoid!! {{{Alarms going off, Sirens blaring}}}. If I've saved you from stepping foot in Tewari's office, than it is the best part of our conversation. If you need to see a surgeon go see Vincent Ladone at MSK (mskcc.org/cancer-care/docto....
As for Tewari, what an arrogant asshole. I've never felt more like a piece of meat being prepared for someone's profit motive, than I did in my one visit and biopsy with him. I have a friend who Tewari canceled the biopsy when my friend was already on the table. My friend fired him on the spot.
This seems to be a constant theme I'm hearing with Tewari!
I had Viewray Sbrt at ucla with Dr.Kishan September 2023. Cross country but continue your research and check it out. There’s a hotel connected to the med center that was a five minute walk to treatment. Made everything easier. The worst part was truly the anxiety, not the procedure. Best of luck.
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