UCLA SBRT and ENI

[Fozzworth]

2-Part question.

1) Does anybody have experience with UCLA's ViewRay machine? I have a True Beam 1 mile from my house but I am interested in flying to LA to be treated by UCLA- Dr. Luca Valle who works with Dr. Amar Kishan and they use MRI-guided SBRT.

2) I have to make a decision for Elective Nodal Irradiation. Decipher is 0.40 and PMSA Pet scan was negative for spreading and thus the Pc is localized but my original pathology of 4+3 was upgraded by a Johns Hopkins 2nd opinion to 4+5. Not sure how two pathologists can disagree on 3 v 5 but I don't want to treat the nodes if I don't have to.

Thanks!

[Tall_Allen]

You mistake metastases that are too small (<5 mm) to see for "localized." The decision to treat the pelvic lymph nodes should be made on the basis of risk if they don't show up on imaging. That is what was done in the POP-RT trial:

prostatecancer.news/2021/08...

Johns Hopkins have the best prostate pathologists in the world. They are the gold standard. Your original pathologist probably categorized some of the Gleason pattern 5 as pattern 4 - Gleason grading takes lots of experience. With your PNI and your clinical recurrence, whole pelvic treatment is required.