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prostatectomy vs radiation?

Prostate Cancer | Last Active: Jul 17 7:48pm | Replies (52)

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Profile picture for northoftheborder @northoftheborder

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.

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Replies to "I got that from Dr. Walsh's book, IIRC. He (or one of his co-authors) wrote that..."

For someone with a HIGH ProsTox test, suggestive of higher risk delayed urinary tract symptoms [15 vs 5%] the interval between sessions may be prolonged. Instead of 5 visits over two weeks (alternate days) maybe the 5 sessions can be provided over 5 weeks. The third party compensation may be the same regardless of time. I saw US$27K for SBRT and US$37K for IMRT. Moderate IMRT of 20 sessions was just as good 37 to 40. I know Medicare 'A' went to a DRG payment schedule for inpatient care. That is the institution prospective compensation. Physician visits are paid through Medicare 'B' and may still be a la carte fee for service?