Gleason7(3+4) - treatment options recommendation

I’ve seen it mentioned in forums, but know nothing about it. Can you share a link or something? Also is it covered by insurance?

@manojsmishra I had gleason 3+4 as well. 10.2 psa. Looked into removal and radiation. Not all radiation machines are alike in terms of radiation exposure to healthy tissue and therefore side effects. Google the Mirage study that compares built in mri radiation machines, such as the MRIdian or the Elekta, to other types of non mri radiation machines. 2 mm margins vs 3-5 mm margins DO have an impact in terms of side effects and toxicity and what you see with the MRI is what you can treat vs fused images.

I was not comfortable with the % of re-occurrence with prostate removal and potential side effects though others were. Once radiated, prostate removal later on becomes more difficult. That was a risk I was ok with.

Once I picked the radiation machine, the MRIdian, I spoke with 5 radiation oncologists from centers of excellence or those that were trained at centers of excellence and made my decision as to where I was going to be treated, which was in Florida. I completed 5 hypo-fractional treatment in February of 2023 with minimal urinary restrictions that cleared up quickly.

By the way, if you are in the New York city area, on Sunday, September 22 from 10:30am-2:00pm at the New York Academy of Medicine (1216 Fifth Avenue New York, NY 10029), there is an event featuring presenters from Weill Cornell Medicine, Columbia University Irving Medical Center, and Memorial Sloan Kettering Cancer Center, to explore critical prostate cancer topics.

Hello @bens1 - I am also recently diagnosed 3+4 in Florida and considering different options. Can you tell me where you went for your MRIdian treatment? My local RO only offers IMRT and trying to avoid 5 weeks of treatment. Thanks.

Hello @bens1 - I am also recently diagnosed 3+4 in Florida and considering different options. Can you tell me where you went for your MRIdian treatment? My local RO only offers IMRT and trying to avoid 5 weeks of treatment. Thanks.

Has the cancer spread beyond your prostate? If not IMRT is only one of multiple radiation treatments that you should be considering. Find yourself another radiation oncologist. If you have a mayo clinic in your neighborhood, you should definitely consider going there instead of the doctor you are seeing now.

If it has spread beyond the prostate, then a combination of IMRT and SBRT is frequently used and reduces the number of visits.

@daveinflorida

I spoke with 4 radiation oncologists in Florida (plus one in NY city) that had experience with the MRIdian.

I was treated by Dr. Kaitlin Christopherson at the Orlando Cancer center, which is part of the Orlando Health Hospital system. They have both the Mridian and Proton therapy available. The Mridian machine is in Ocoee and their Proton machine is in Downtown Orlando.

I also spoke with the Moffit cancer center, whose vice chairman told me that if I was interested in potentially utilizing the adaptive dynamic planning capability of the MRIdian that I should go some place else, which I did.

I also spoke with the Miami Cancer institute and chose them as a second choice for treatment with the MRIdian. They also had an on site hotel for convenience of treatment.

All the Florida radiation oncologists that I spoke with were trained and/or had practical experience at centers of excellence as well as the MRIdian machine.

Any more questions, please feel to ask or private message me if you need more details behind the nuts and bolts of the experience.

Thanks. I'm in Fort Lauderdale so Miami is close, although Orlando isn't that far. Is Miami Cancer Institute part of UM or Baptist Health? I like the idea of someplace that has both proton and MRIadian to compare.

PSMA shows no spread beyond the prostate, so I'm looking at all the options. RP is straight forward, it's the radiation treatments I'm having trouble with, there are too many! Definitely will speak to more ROs. Have been in contact with UFHPTI and Moffitt, and will contact UM and Mayo Jax. Am also considering focal treatments, but that's another ball of wax.

It is part of Baptist Health. I had Dr. Marcio Fagundez do a prostate consultation by telehealth. I am not sure if they have re-activated their Mridian as the original manufacturer, Viewray, went bankrupt. Another medical company started offering support using original Viewray employees, including software support at what I have heard was $1 Million per year. The Mridian had about 65 machines out there. Orlando Cancer center has re-activated their Mridian, months ago.

The only difference in my treatment suggestion by Dr. Fegundez, with my Gleason 3+4 and low Decipher score diagnosis, was because I had a 10.2 PSA, though my prostate cancer was confined to the prostate (left posterior mid-peripheral) and my prostate was not that enlarged at 48.9 cc's, Dr. Fagundez said he wanted to do short term ADT. I believe nccn.org recommends that for PSA's over 10 but Dr. Christopherson felt otherwise. So far, my PSA results every 3 months since May of 2023 seems to have supported Dr. Christopherson's decision.

You might also want to consider the Elekta Unity machine at the University of Florida. It is also an MRI guided real time machine that uses a stronger tesla, 1.5, than the Mridian but I am unfamiliar with the subtleties of the Elekta but I believe both support 5 hypo-fractional treatments. Here is their web site:
https://ufhealth.org/news/2022/uf-health-unveils-imaging-machine-one-42-world-tackle-difficult-cancers. (Thank you to @5galloncan for the link).

By the way, of the 5 RO's I spoke with, Dr. Fagundez was the only one that suggested ADT.

It is part of Baptist Health. I had Dr. Marcio Fagundez do a prostate consultation by telehealth. I am not sure if they have re-activated their Mridian as the original manufacturer, Viewray, went bankrupt. Another medical company started offering support using original Viewray employees, including software support at what I have heard was $1 Million per year. The Mridian had about 65 machines out there. Orlando Cancer center has re-activated their Mridian, months ago.

The only difference in my treatment suggestion by Dr. Fegundez, with my Gleason 3+4 and low Decipher score diagnosis, was because I had a 10.2 PSA, though my prostate cancer was confined to the prostate (left posterior mid-peripheral) and my prostate was not that enlarged at 48.9 cc's, Dr. Fagundez said he wanted to do short term ADT. I believe nccn.org recommends that for PSA's over 10 but Dr. Christopherson felt otherwise. So far, my PSA results every 3 months since May of 2023 seems to have supported Dr. Christopherson's decision.

You might also want to consider the Elekta Unity machine at the University of Florida. It is also an MRI guided real time machine that uses a stronger tesla, 1.5, than the Mridian but I am unfamiliar with the subtleties of the Elekta but I believe both support 5 hypo-fractional treatments. Here is their web site:
https://ufhealth.org/news/2022/uf-health-unveils-imaging-machine-one-42-world-tackle-difficult-cancers. (Thank you to @5galloncan for the link).

By the way, of the 5 RO's I spoke with, Dr. Fagundez was the only one that suggested ADT.