@climateguy

As a layman, trying to make the best decision possible, I knew that all randomized trials had their strengths and their weaknesses in terms of design. For me, the mirage trial was one of those components in my decision-making process and since February 2023 when I was treated, what I saw in the trial turned out to be true.

In Dr Patrick Walsh‘s book, he discusses biases, and there are many of them in the medical community regardless of one’s experience. Those biases are unintentional but real. I’ve run into those many times.

I had researched the Mridian machine in several ways, including talking to the president of the manufacturer at the time who was also able to give me feedback from hospitals that were using it.

I spoke with six Radiation oncologists specifically about the machine versus Proton Therapy, which was the other choice, I had narrowed myself down to. Those included Radiation oncologists who were either trained or worked at Cornell Weill, Memorial Sloan-Kettering, MD Andersen, Moffitt Cancer Center, Miami Cancer Center and of course, where I was treated at the Orlando Cancer Center, all with substantive experience related to what I wanted.

I have not researched Dr. Roach, and everybody obviously has to make their own decision, but I felt that the expertise in the oncologists experience with the machine and within the industry, and by the way with Proton, as doctors of centers of excellence with every day extensive experience, was enough for me to make my decision for the Mridian machine. The only other machine I would’ve considered would be the Electra unity, another Radiation machine that has a built-in MRI, but slightly different features than the Mridian. If the Proton Therapy machines had a built-in MRI, I might’ve chosen that machine.

Finally, a not so scientific note, I am seeing that hospitals are either refusing or leaning people towards other forms of radiation machines because the popularity of the Mridian machine and the Electra unity, as they are trying to be saved and used for those people with cancer who’s organs move more than the organs of people who have prostate cancer. That seems to be more of an administrative decision related to how many people they need to put through a radiation machine at any given time. I consider this to be one of many biases that are out there again , that are unintentional but applicable, especially since many oncologist take the position that the outcomes are the same no matter what choice you make. One oncologist who happened to also be the second in command of a large well-known cancer hospital surprised me by saying “if you want to use the real time dynamic planning capabilities of the Mridian Machine, then you should try another hospital.“ that was back in the beginning of January 2023 and it seems that that has expanded in some ways to other hospitals. What he should’ve said to me is we don’t normally use it for Prostate Cancer in our hospital but we will in your case and if we have to use that dynamic capability, we will use it.

The Internal debate as you mentioned was not an easy one and nothing is black and white in any of these decisions, whether they involve experts or patients. All we can do is the best we can to collect and correlate the information from as many sources as we can. Good luck.