RadioTherapy Skill Levels

[OldTiredSailor]

I have put off having salvage radiation therapy for over six-years now. But my Post- RP (August 2018) PSA level has doubled from 0.09 in June '23 to 0.19 in June '24, and doubled again to 0.40 in December 2024. A visit with a radiation oncologist at Moffitt Cancer Center on December 16 confirmed that I need to get going on my radiation therapy (RT) early next year.

The Moffitt radiation guy in response to my question told me that there was probably little difference in the quality of RT treatment I would receive at a center of excellence such as Moffit (2 hour drive each way for me) and my local RT provider (10-minute drive each way). He said there appeared to be nothing unusual about my recurrence and any RT provider would do a fine job. He did say that the PSAM/PET scan he ordered might change that opinion but for now getting treated close to home was probably a good choice.

He felt the same way about the PSMA/PET scan but did say I could have my local imaging facility send him the images for a 2nd opinion.

He is recommending 64 Gy to the prostate bed and pelvic lymph nodes (pending the scan). I would have 32-treatments Monday thru Friday.

Any thoughts about a Center of Excellence -vs-local provider for post-RP RT?

[Tall_Allen]

An experienced local provider is fine.

[Justfor_]

They claim: "The pilot makes the flight, not the plane" . Marketing sophistries.

The indisputable fact is that the management of the more recent plane (hence, more money invested onto it) appoint their best pilots to fly it.

Back to earth: Go with the more recent/expensive linac.

[Derf4223]

You might be overthinking this. Every second of dithering lets the PCA grow exponentially.

[NanoMRI]

I passed on centers of excellence for salvage RT w/o ADT to my prostate bed; 39 sessions of 70.2 Gy. We missed more than some. Pre salvage RT PSA 0.11 - post treatment nadir 0.075. I think it is important to note a center of excellence would also have missed my cancer that had already spread beyond the prostate bed. I came to view "precision targeting" with some doubt; when you get your tattoos and are then aligned on the platform, you may understand what I mean.

[j-o-h-n]

Time to flip a coin.......

Good Luck, Good Health and Good Humor.

j-o-h-n