Need help deciding which radiation treatment system i should go with.

I was 3+4 with a high Decipher score. Underwent 39 sessions of VMAT with the TrueBeam after having fiducials and SpaceOAR inserted. That was 2 years ago and I am now in remission. I had a single day a few months ago with some blood accompanying a bowel movement, but nothing since. No other side effects (I had ED before the treatment and still have it, though treatments suggested here have helped greatly with that).

On the other hand, I have a friend who was also treated using a TrueBeam linac at a different location. He had fewer sessions and did not have the SpaceOAR. He has suffered greatly from radiation proctitis and has undergone numerous procedures to stop his rectal bleeding.

If you choose the TrueBeam option, I would strongly encourage you to have a spacer implanted. Good luck.

@bens1
Hi, could you pls share additional details. 5 session totalling to how much radiation Gy ? Trying to understand if MR Linac can deliver upto 70gy... also did you have any after effects (in days/weeks/months). The difference between 3-5mm and 2mm of MR Linac can make a difference in saving healthy tissues around..

...The optimal dose of radiation without the extra-glandular side effects is Interstitial Radiotherapy (a/k/a permanent seeds/ 'Low' Dose Radiotherapy,/LDR brachytherapy, Low dose is a misnomer. It is low dose over weeks or months which makes it higher than the others. Time is the relevant dose factor. All external beam radiotherapy [EBRT] must be suboptimal because the various beams converge inside after passing through healthy tissue at various angles. Fiducials, spacers are attempts to minimize the unavoidable risk of side effects by the converging sub-optimal rays. When I asked the surgeon about 'Seeds' he laughed and said "Find someone to do it." I did. All of the factors in your case can be discussed with clinicians that have done 6-10 thousand procedures. Go to the Prostate Cancer Research Institute (PCRI.org) and look up videos on brachytherapy, etc. The outpatient procedure is about 30 minutes.

@thmssllvn I've done exhaustive research, I'm 4+3, Brachytherapy has by far the best cure rates for intermediate risk patients, with lower side effects.

I am 1 month out from 5-dose SBRT for Gleason 4+5 done with Viewray MRIdian. I did have a rectal spacer and have few residual side effects (bladder and bowel irritability mostly resolved after first 2-3 weeks). ADT planned for 12–18 mos per RO has side effects that I am learning to manage, but an acceptable trade off for the anticipated long term benefit.

@sbd

I do not remember offhand how much Radiation was used per session.

I can tell you that I was warned ahead of time that after the third session, I might have some urine restriction, which I did, but was prepared with Flomax ahead of time, just in case.

I carried around a hospital urine bottle for a few weeks thereafter because when I needed to go I could not hold it for very long. That urine bottle did come in handy a few times.

I too chose the Mridian machine for the reasons you stated, the smaller millimeters. If it was today, I would choose the same machine or maybe the Elekta Unity, which also has a built-in Mri and similar capabilities. I did have spaceoar.

Overall, I have had very few side effects since I was treated in February 2023. Overtime, I did find out that erections were not as firm as they used to be. Rectally, I never had any issues either.

I’ve just started pretreatment simulation at Mayo Rochester for 3+3/6 with psa 19.5
1) Had fiducial markers placed with hydrogel spacer also
2) discussed with RO of spacing SBRT 5 treatments over 5 weeks to minimize treatment side effects and have scheduled that
3) pretreatment image at each appt
4)Discussed all available options,: proton radiation, brachytherapy, HDR brachytherapy and MRIdian he said no significant side effect difference and believes the 5 treatment SBRT is the way to go!
First treatment 2nd week November!

I also had a Decipher and a Pristox test to give a glimpse into aggressiveness of cancer and susceptibility to GU issues with Radiation treatment. PD

@packman7 5 treatments over 5 weeks sounds really good to me. I’ve read a few studies showing that longer time intervals between SBRT treatments really diminish overall SE’s…Best
Phil

Thanks, RO quoted a Canadian study that still had same efficacy and diminished SE!!!PD