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Is SBRT with proton beam now a gold standard for prostate cancer?

Prostate Cancer | Last Active: Mar 12 9:45am | Replies (7)
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@toolbelt

I had photon SBRT with a focal boost the the dominant lesion and urethral steering to ensure my urethra did not receive more than the whole gland dose. I also am starting my 4th month (of 6) on Orgovyx. I am 68, fit, one 4+3, one 3+3, Decipher .84, PSA 7.6, PSMA PET showed confined to prostate. I had a Barrigel rectal spacer placed. I was treated on a Varian Edge linac.
For me this was the best treatment. I did not see proton therapy having enough of an advantage in my case to warrant my pursuing it.

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Replies to "I had photon SBRT with a focal boost the the dominant lesion and urethral steering to..."
brianjarvis | @brianjarvis | Mar 12 9:45am

Excellent that it’s worked out extremely well for you.

After being on active surveillance for 9 years, at 65y, I had 28 proton radiation treatments during April-May 2021 (with SpaceOAR Vue + 6 months of Eligard) for my 7(4+3) with PSA of 7.976. PSMA PET was not available back then, so we relied on MRI/bone/CT scans to confirm the disease was localized.

When I was evaluating treatment options (during 2017-2020 - compared to today, dated information), I considered photon SBRT. But, the 2 ROs I spoke to back then (one used Cyberknife, the other TruBeam), though they explained very well the accuracy of the technology, they could not explain to my satisfaction how they would avoid radiation scatter, that being a characteristic of photons (X-rays).

So, I wound up choosing proton, with its inherent Bragg-Peak characteristics. Of all the considerations and comparisons (including the fact that there was a proton center just a 40 minute drive away and that Medicare would pay fully for it), that Bragg-Peak characteristic was the major factor in my decision.

For me this was the best treatment. So far, it’s gone exactly as planned, hoped, and expected.

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