Top Dr.s for LDR brachytherapy or SBRT

[MauiJef]

Hello everyone,

I got my results on 2/28/23 , 3+4 in 3 areas. I've consulted with Dr. Dorff at City of Hope and she recommended surgery over radiation, her preference with prostate cancer. She recommended Dr. Lau if I go the surgery route.

I met with Dr. Kishan at UCLA, when they had MRIdian, and he thought I'd be a good candidate with either SBRT or surgery. They all agreed I can do AS so that's what I've been doing, until this week. I had another PSA and I j umped from 3.97 to 6.2 and my Dr. thinks it's time to make a decision.

I'm leaning towards either LDR brachy or SBRT. I was hoping for help in finding the top Dr's in these areas. I'm in So Cal but can travel. Trying to find someone with a tremendous amount of work, and success, under their belt has been tough.

Beside Dr. Kishan, is there anyone else I should consider for SBRT?

For brachy, I've come across Dr. Steven Kurtzman and Dr. Ankit Agarwal from western radiation oncology, that look good, but can't find anyone to talk to that have used them.

Has anyone had brachy from UCLA or City of Hope and can recommend someone there?

I truly appreciate any and all suggestions.

Have a great day. Apologies for rambling, but I was hoping I could be on AS for longer than this and it's been a gut punch , again.

[Tall_Allen]

I love Tanya Dorff but she has no specific expertise in either surgery or radiation.

Amar Kishan now has Viewray MRIdian operational again.

IDK why you prefer LDR Brachy to HDR Brachy? HDR has fewer side effects. Mitch Kamrava at Cedars-Sinai is my preference if you want HDR-BT.

Tim Wilson at St. Johns would be my choice for prostatectomy.

[leach234 in reply to Tall_Allen]

Dr. Thomas Ahlering and Dr. David Lee at UCI (if you live in Orange County) and Dr. Robert Reiter at UCLA are excellent robotic surgeons. Dr. Tim Wilson is good too.

[MauiJef in reply to leach234]

Thank you

[Seat15c in reply to Tall_Allen]

I thought HDBT was for high risk and had more side effects? Source was interview from PCRI

[Tall_Allen in reply to Seat15c]

Nope. Don't believe everything you hear at PCRI- when their peers aren't there to challenge them, doctors will say anything to patients.

pubmed.ncbi.nlm.nih.gov/147...

prostatecancer.news/2016/08...

[Seat15c in reply to Tall_Allen]

Thank you wow HDRBT sounds like a great option!

[MauiJef in reply to Tall_Allen]

Tall_Allen appreciate your feedback. I thought HDR was for advanced PC, so I need to look into that as well. Thank you

[mchale]

my two cents go with Dr. Kishan Mridian MRI guided radiation, real time Imaging and gating that shuts down radiation when the target goes out of margin set points. The target area +2 mm margin MRI guided versus CT guided is +4 mm margin much less side effects. Look up the MIRAGE trial WITH DR. KISHAN

[MauiJef in reply to mchale]

Appreciate your input....

[PopCubby]

I had somewhat similar diagnosis as you, but was 70 when first diagnosed, and am on the East coast. I was on AS for 3 years when my PSA jumped from just over 4 to close to 7. Had another biopsy and was initially Gleeson 8, and seriously considered surgery. Went to Hopkins, Penn, and Fox Chase in Philly. Hopkins and Fox Chase reread my slides and concluded I was really Gleeson 7, not 8 so I started looking into radiation.

I decided on 2 treatments of HDR Brachytherapy a week apart at Fox Chase. It's coming up on 3 years and my last PSA was undetectable. I did not do any ADT.

I am happy with my decision. Side effects are minimal. Fox Chase no longer does LDR Brachytherapy. Not sure why that is. My Dr. was Eric Horwitz. He suggested SBRT as an alternate, but said he favored the HDR Brachytherapy so I went with it.

Good luck on your decision.

[MauiJef in reply to PopCubby]

Pop, thank you for your advice and I'm glad that you're doing well...

[SonomaGuy]

I"m curious about your rate of increase on the PSA? Was it a year? 2, 3, 4? That is something to consider. 6.2 is not that high. Also, I've been on AS for 4 years and the lead PC doctor at UCSF said to me he doesn't worry about PSA until it hits 10. Before radical treatment, I would have another MRI and/or biopsy.

[MauiJef]

Sonoma,

My PSA rise

9/2020 3.4

9/2022 4.91

10/2022 5.7

7/2023. 5.28

2/2024 4.91

9/2024 6.2

I have another PSA this Friday as my last one I didn't refrain from cycling or sex prior to the test so we are retesting Friday just to see if that last one was a blip.....

My Dr. isn't saying I need to do something ASAP but he is concerned....