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MRI-Guided SBRT vs Proton Therapy (5-fraction)

Prostate Cancer | Last Active: Feb 24 6:35am | Replies (15)
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@chaimkugel

Thanks SeaSuite for your thoughtful response. Glad to hear you are doing well!
Either treatment seems like a good option, so I am concerning myself with the QOL side effects and the location of my G7 right up on the capsule, next to the bladder. The MR-guided SBRT has a margin of 2mm (to Proton's 3mm) and it accounts for realtime movement and automatically gating (shuts off) if off target. Also, MR-guided SBRT's urethral-sparing techniques have demonstrated significantly low rates of acute genitourinary toxicity in trials. Additionally, while proton therapy lowers the dose at several rectal DVH points compared to photons, in turn, photons limit the high dose to the bladder slightly better than protons. And the proximity of my G7 to my bladder leaves me seriously considering the MR-guided SBRT now because of high degree of focus and control. For the reasons you mentioned, there is not clear data out there that makes proton a decisive choice, particularly with the location of my PCa.

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Replies to "Thanks SeaSuite for your thoughtful response. Glad to hear you are doing well! Either treatment seems..."
seasuite | @seasuite | Feb 19 12:29pm

@chaimkugel I also closely evaluated the position of my core 16 L1 - Left Posterior Apex Peripheral Zone that was 4+3; the other 5 cores with prostatic adenocarcinoma, 3+4, were all located in adjacent zones (the remaining 10 cores showed no cancer). You can then speak to ROs who, typically, don't delve into PCa position conversations without prompting. I found it highly useful to consult with a retired urologist friend who spoke to me under 'cone of silence' in addition to several other ROs and urologists who gave formal opinions largely representative of their institutions.

As has been mentioned, the Decipher Grid is one of the best predictive tools available and a PSMA PET can provide an additional layer of reassurance. As far as future treatments, that hopefully will never be needed, I am confident that with AI driven and other advancements, what we have available in 10 years will make the current offerings 'primitive'.

Best of luck to you! It was certainly reassuring to know that I did my best to evaluate alternatives.

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