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I now will need to decide on SBRT or Brachytherapy
My original post is here:
https://connect.mayoclinic.org/discussion/received-the-news-on-halloween-i-have-prostate-cancer-need-advice/
To do a quick summary:
I was diagnosed with 2 cores of Gleason 6, 1 core of Gleason 3+4=7 (40% of the core, G4=10%). Two lesions; one on each side. One abuts the capsule. Dr. Jonathan Epstein did a 2nd opinion on the slides and came back with exactly the same diagnosis, even down to the percentages. Decipher score is 0.57. PSMA shows cancer is confined within prostate.
We met with Dr Kishan, UCLA, yesterday. A young doctor with an assistant came in first and reviewed my current status. My IPSS score is 3. No issues with bowel. I do have to take a 1/3 of Viagra pill each time.
Dr Kishan came in soon after. He is a very pleasant doctor to talk to. He is very patient and confident that his SBRT method can provide good survival and control of the side-effect issues. None of these are 100% of course, but close. Sextual side-effect is a lot higher.
He puts me in Unfavorable Intermediate state because of my bi-lateral lesions; one abuts the capsule, and my Decipher score (0.57), therefore Active Surveillance is out. Even all forms of Focal therapy available in UCLA are not recommended in my case.
He points to my Decipher report, 10 year metathesis rate of 2.7%. I could add 6 months of hormone therapy after SBRT and reduce that rate by 1.3%. I asked what would he do, he said he will not elect to have hormone, but he offers it just for those patients with less risk tolerance. I think I am going to decline the hormone.
I asked about Brachytherapy by Dr Chang, UCLA. He said SBRT has slightly less side-effect than Brachytherapy. But either treatment will provide equal survival rate in my case. If I schedule whichever treatment more than 6 months after diagnosis, I will need to get a new MRI. So, I am planning on a March or April timeline.
I did a swab for Prostox at the clinic and now await for the result. If I am sensitive to high dose treatment, I will have to do low dose such as IMRT.
I still have an appointment with a surgeon, and later with Dr Chang on Brachytherapy. I will likely choose between SBRT and Brachytherapy. I will be doing a lot of research on short term, and long term side-effect of both radiation treatment. Any feedback on either treatment is highly appreciated.
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@climateguy LOL - not really skeptical, in fact it’s a great story…just that we’ve all been told to compare apples to apples so it’s surprising to see an expert not doing the same, right?
BTW, my first consult about radiation was with Dr Nagar at Weil Cornell; a fairly young guy, he’d been trained extensively in brachytherapy. However, he only spoke about the MRIdian Linac and how great it was.
He’s no longer at Cornell, but he does lecture so maybe Youtube or Google him; I wonder if he’s back in the brachy game now that the ‘boost’ procedure has become mainstream…Best,
Phil
@heavyphil I like the sound of MRI Linac. I think it is Zelefsky who has a video up showing how during the administration of the radiation beam, if the MRI detects that the prostate has moved so the radiated margin will be beyond whatever limit they set, the beam is automatically shut off.
Zelefsky said he was astonished when he first used MRI during the procedure as he saw the prostate move, in an extreme case, as much as 5 cm. MRI Linac sounds like the only EBRT anyone would want.
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1 ReactionWe kept the appointment with UCLA surgeon and saw him yesterday. One number he cited would affirm my decision to go with Radiation; the recurrence rate for surgery is something like 20-30%. Dr Kishan said Radiation recurrence would be around 10%.
My Prostox result came as low risk for high dose radiation. My appointment with Dr Chang for HDR Brachytherapy is still 2 weeks away.
I am still debating between SBRT and HDR Brachytherapy. It may come down to convenience since both treatment yield very similar results.
@frank1956, given a choice between SBRT or HDR Brachytherapy, which treatment would I choose?
Of course it's not a simple decision. There's so much information to digest and there are a ton of personal factors to consider. It's definitely not a one-size-fits-all-cases decision.
Fortunately, as you already mentioned, I believe both have statistically similar outcomes.
All that said, given what I know about your Gleason 7 case, I'd choose HDR Brachytherapy monotherapy -- mostly because I like that it's a focal therapy that directly radiates the cancer inside the prostate with temporarily-inserted pellets. https://www.youtube.com/watch
To put my opinion in context, I had both SBRT and HDR Brachytherapy with Dr. Chang at UCLA in March2023.
I'm not suggesting you need both treatments. Just saying I can compare 'em based on my experience.
A little background: I was diagnosed with Gleason 9, Stage 2 PCa in Dec2022. Confined to prostate (see attached PSMA PET scan), my treatment plan covered the prostate, seminal vesicles, and local lymph nodes. And ADT (Orgovyx) for a year, starting about 2 months before beginning treatment.
Not sure what info you'd like, so I'll just shotgun some thoughts:
1. UCLA is excellent for treating prostate cancer. And Dr. Chang's UCLA team is terrific!
2. My HDR/Bt was an out-patient treatment. I arrived at 6 am and was discharged at 2 pm. Two days later I drove home 3 hours; that is, allow at least a day for recovery.
3. Take the pain meds they offer before the Afterloader is removed. It's tolerable but very painful; thankfully, the pain disappeared almost immediately.
4. After I was discharged, during the ride to my hotel, surprisingly I had no pain and just a little discomfort that resolved within a day.
5. Not surprisingly, there was no pain or discomfort during SBRT treatments. Just some mild fatigue afterwards, especially the last two treatments.
6. Confirm your treatment location in advance and plan accordingly. My HDR Brachytherapy treatment was at a UCLA location in Santa Monica. SBRT was at UCLA in Westwood.
7. If possible, especially for SBRT, stay in one of the UCLA housing options in Westwood. It's an expense, yes, but you don't want to risk missing an appointment due to unexpected traffic jams. Also, it's much more convenient if you're housing is nearby in case your appointment is delayed/re-scheduled.
8. They're booked solid for SBRT... unexpected issues can cause delays in treatment. Of my five SBRT treatments, only one started on time. And one was re-scheduled to a later time. Most started at least 20 minutes late. Bring something to read and/or digital entertainment with headphones.
9. Pre-treatment protocols for SBRT include a self-administered enema and "full-enough" bladder, which can have unfortunate consequences if you're stuck in traffic.
10. Travel much? https://www.amazon.com/dp/B000NV878S
Sorry for the long post. Hope that helps. Best wishes.
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2 Reactions@retiredboomer71 Your post is very valuable to me. Your HDR Brachytherapy could be a boost to SBRT. My intermediate cancer requires one monotherapy. For HDR Brachy, it would be 2 treatments, one week apart. For SBRT it will be the same 5 treatments as yours. I will just need one of them.
I have visited few UCLA facilities in Santa Monica. There are also hotels near by and we stayed in one before. In another time, we simply called Uber to take us home. My wife no longer drives. We live 20 miles away, but traffic on freeway could take up to 90 minutes.
For SBRT option I will plan to stay in a hotel around Westwood as you suggested. At least the night before treatment, so no mishaps.
I have a list of questions for Dr Chang in order to compare both treatment modality. I found that UCLA doctors will not discount other treatment types just to convince patients to choose theirs. They all know each other and often refer patients to one another. When I asked the doctors whom I saw already, their answer is always that the treatments UCLA offers are all equally good. In the end, I need to pick the one I feel most comfortable.
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3 ReactionsIf I were you I would ask about three pronged treatment plan as follows:
6 months Orgovyx AST
5 weeks daily IMRT treatments
One high dose brachytherapy boost
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1 ReactionNever heard of prostox test. What exactly does this swab detect?
@imbimbo
Test predicts which patients with prostate cancer are most likely to develop long-term side effects from radiation therapy
https://www.uclahealth.org/news/release/test-predicts-which-patients-with-prostate-cancer-are-most
If your test result shows high, SBRT is not suitable for you then. But low dose treatment such as IMRT can be done, says my doctor.