Stanford or USCF for HDR brachytherapy

[Seat15c]

I've consulted with both specialists, and here's my situation: I'm Gleason 7 with a Decipher score of 0.25. Out of 18 biopsy cores, nine are positive—eight of which are 3+3, and one is 3+4. My PET scan results are clear, showing that the cancer is still confined to the prostate, with a PSA of 8.

Both specialists have advised that I’m a candidate for monotherapy and would not require ADT (androgen deprivation therapy). I'm now considering which center might have better outcomes for my situation, especially ones that specialize in this type of treatment. I'm weighing options between Stanford and UCSF and would appreciate any insights on which might offer the best care.

[Muggs1]

I heard UCSF was good but I went to Dr Chang at UCLA. His mentor, Dr Demanes, started at UCSF but no longer there.

[Nodrogear]

Sorry don't know what mono therapy is. Brachytherapy I had in2015 and was 'clear' then till 2021 when PSA read 5.8 then climbed back to 13 after a year. Have now had two doses of ADT over the past year. After 6months reading was 0.05 now 0.01 last month. Side effects have been mainly hot flushes, itchy skin and very bad sleep pattern. Loss of libido has been complete sadly!

[Seat15c in reply to Nodrogear]

You had a relapse? Did they find out where the cancer is? Was it still IN the prostate?

[cscmetsfacil]

If you have an opportunity to get some sort of radiation (RT) monotherapy, you are lucky. I assume you live in the Bay Area. I am in Walnut Creek and use UCSF as my main treatment source as well as John Muir Health where there is a brand new cancer pavilion with state of the art RT equipment. You have several good options to explore that vary in the degree of invasiveness and likely side effects. I had Brachy as primary therapy for my GL 8, 7+ years ago. since then other options have emerged that are even less invasive. Top of the list for me would be focal radiation with something like Cyberknife at UCSF where you should consult with the master of this technique, Mac Roach. There is also Tulsa Pro (ultrasound) ablation, cryogenic therapy, proton, etc. that you might explore.

I'm not as familiar with Stanford docs, but know people who use them. UCSF is terrific. You are correct that whatever treatment you choose needs to be set up by an expert, and Dr. Roach is world renown, as is there Brachy practitioner. The goal of all these techniques is to get an ablative (killing) dose of radiation where it is needed with minimum exposure of surrounding tissues, which cyberknife-type SBRT focal radiation does very well. Treatments like ultrasound ablation have the advantage that they don't use radiation and don't start adding to the limited amount of radiation you can get over time.

The best way to get feedback on treatments and hear about options, real experiences,, etc is to join a prostate cancer support group, like the one I am in at the Cancer Support Community in Walnut Creek. Our Localized PCa group meets monthly, next on Nov 21. We do screening intakes to make sure members area appropriate for groups (some folks are so devastated by a diagnosis or other life situations that they need other support). Meetings are Hybrid so you can Zoom in, though in-person attendance once a month is the way to go, if possible. You will learn a ton. Lots of other classes, activities and groups too - all free to cancer patients and their families. To register, go to cancer support.net and look for a button that says, "New to CSC? Start Here." That button will take you to a couple of information forms and you will do your intake interview with me, so we can talk more in depth.

Please know that you are doing the right thing by researching options and reaching out for advice. You are not alone in dealing with these tough decisions or climbing a steep learning curve. These groups have kept me going and growing for 7 years now and I can't imagine facing cancer without this sort of support. Sending you best wishes!

[Tall_Allen]

Joe Hsu at UCSF.

[MackworthGuy]

I was/am with Stanford but pretty easily got a 2nd opinion from Dr. Hsu when I reached out to him. In choosing between the two for treatment I’d think both are top notch and the bigger factor is your comfort with the care team and their personal experience with your chosen treatment.

If doing IMRT, note the stories here of having to time fluid intake etc. and going everyday for weeks and think about if that makes travel less advantageous for one of the places.

[Jprostate]

I had Brachytherapy in April 2023 by Dr Steven Kurtzman from the Bay Area. For what it’s worth my psa was 10.7 and the last 3 tests at 6 month intervals measured between 0.12 to 0.19. He has done over 5000 of these procedures

Wishing you a heathy outcome

Jprostate

[RainState in reply to Jprostate]

You mean LDR Brachytherapy, right? What have your side effects been? I'm thinking of doing the same thing.