SMART - MRI Guided Adaptive Radiation Therapy

What would be useful would be to see what your biopsy showed, You could post the biopsy here and people could comment about things that may be an issue. Some things in a biopsy are problematic if you have radiation.

You don’t mention what your Gleason score was, your PSA before treatment. How old you are. All of these can be factors in how soon a reoccurrence might or might not happen.

Did you have a decipher score to see what your chance of reoccurrences is.

Did you have genetic testing? Is there cancer in your family breast cancer, prostate cancer pancreatic cancer All of those can be signs that you have genetic issues.

tip1958, looks like were interested.

May I ask where you had this treatment at? I am strongly leaning toward this considering multiple facilities. If you would rather private message me, please do.
Thanks!

@tjp1958

I too had that same type of machine finishing my 5 treatments in February of 2023 and felt very lucky with my choice. They used the Mridian for me.

Did they use the Mridian or the Elekta Unity for you? Also, did they use spaceoar? Finally, I agree with @jeffmarc. Sometimes its helpful to see whether a particular machine or treatment may be applicable to the details behind your or somebody else's cancer biopsy results.

@jeffmarc
Age 67. Extremely active.
On Active surveillance since 2020.
2025 Biopsy results attached.
Gleason score 3+4 w potential extra prostatic extension raising NCCN risk to unfavorable intermediate.
Progression of cancer continued to worsen in each annual mris and biopsy.
Psa increased from 3ish in 2020 to 6 in 2025.
Decipher .88 - high risk.
Polaris 3.2 - low risk
PET - no outside spread
Hope this helps!
I’m no expert, but happy to share if helpful.

Also -
Machine was MRI Linac and no oar spacers due to close proximity of cancer lesions to the rectum.

And no ADT, though recommended by Decipher and Medical Oncologist, because I have slight AFIB controlled by heart medication, so they didn’t do ADT.

@4rbest
Dana Farber Cancer Institute in Boston coupled with Mass General

Ambry Genextic testing showed no abnormality and no family history of breast cancer or or other cancers.

Best of luck with your treatment - I completed my (5) MRI guided SBRT two months ago in Portland, OR. Barrigel instead of Spaceoar. No ADT and doing well. PSA has already dropped from 10.1 to 3.7. Also 67 years old and active with intermediate decipher plus other complications. Was ADT prescribed for you?

@tjp1958
It definitely looks like the cancer has spread beyond the prostate. I would imagine that if they’re doing MRI guided radiation, they would’ve hit the area that looked like it had spread to. You could ask the RO If that did happen just to confirm that they did cover that area and you Have “clean margins” as far as radiation is concerned.

That would be the only thing I would be concerned with. You are all 3+4 or less And nothing else that is looked for to be possible to escape radiation is in your biopsy.

Overall, it looks real good.

AI Overview
In a prostate cancer biopsy report, "tumor extends into loose fibroconnective tissue at the end of the core" means the cancer has likely spread beyond the prostate gland's boundaries. This is also known as extraprostatic extension (EPE) or extracapsular extension.

Here is a breakdown of the key terms:
Loose fibroconnective tissue: The tissue just outside the prostate. A pathologist views this material at the end of the biopsy sample, which marks the outer edge of the prostate.

Extends into loose fibroconnective tissue: The cancer cells are seen invading this tissue, which suggests they have broken through the prostate capsule and spread beyond the gland.