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← Return to prostatectomy vs radiation?
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The history of the SBRT approval in 5 sessions by Medicare is new to me. I do know that UCSF Mack ROACH had mentioned he does it in four visits. (via PCRI.org YouTube video). One center of excellence in NYC is or has reduced SBRT to two sessions in an investigatory protocol. Roach said he was salaried by California and used the amount he thought necessary independent of personal gain. Incidentally, recent studies have shown that fewer IMRT visits are as equi-effective as more sessions over a longer period of time. Unfortunately there is likely less payment for the institution using the revised study. SBRT produces the least remuneration.
MiraDx has a PROSTox test ( mouth swab, 2 week turn around ) can categorize the risk of delayed urinary tract symptoms. They occur in several months to years later in up to 15% of those who test HIGH. The background rate is 5%. The test can calculate the risk for either SBRT or IMRT or both. Short term self resolving side effects with or without symptomatic medications are about the same for either technique. The SPACEOAR protects the bowels from the radiation effects. It should be emphasized that the skill of the physician is equally important. One commentator said the latest iteration is called SpaceOarVUE implying it was an improved version?
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I got that from Dr. Walsh's book, IIRC. He (or one of his co-authors) wrote that SBRT can be delivered in more visits and smaller fractions to try to reduce side effects, but it's tricky because the Medicare fee schedule will cover only 5 sessions of SBRT.
If anyone thinks that sounds dubious, I can try to look up the refence and see if I'm remembering correctly.
In any case, I did have my 60 gy of SBRT to the prostate spread out over 20 fractions here in Ontario and still developed mild radiation cystitis (occasionally annoying) and proctitis (barely notice it except for a bit of tingling or "buzzing" after eating spicy food).
Personally, I don't mind the radiation spread: it means the radiation would have killed cancer cells near the prostate as well as those in it, giving me a much better chance (in my layperson's opinion) of long-term remission for my aggressive, stage 4b PCa. A bit of urinary-tract irritation seems like a very small price to pay.