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bl2023 (@bl2023)

Final decision on treatment: Viewray or Truebeam?

Prostate Cancer | Last Active: Oct 3, 2023 | Replies (33)

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@mperloe

I was 69 when my GL4+3 was discovered. I traveled from Atlanta to UCLA to get a PET scan which showed involvement just outside the gland in the seminal vesicle which didn't show up on MRI or CT scan. After speaking with a number of urologic oncologists and radiation oncologists I learned about ViewRay's MRIdian SBRT with Dr. Kishan at UCLA. I opted for this route as I was able to avoid fiducials and SpaceOAR. MRIdian offered automatic gating which shut off the beam should the rectum or bladder enter the beams path or the prostate move outside the treatment path. Neither proton or Truebeam offered that. While providers of proton therapy champion the Bragg effect, clinical trials have not shown proton superior to photon therapy or that it is associated with fewer side effects. Proton has just two beams vs 15 with MRIdian. This results in a higher risk of skin burns with proton treatment. In that the MIRAGE studies show a 40-60% reduction in early radiation side effects with MRIdian SBRT. And I never understood why someone would want to do 45 sessions when they can do just as well and possibly better with 5.

Dr. Kishan and the entire UCLA team made this an easy 2 weeks for 5 treatment sessions. I am now 2.5 years out from treatment and my PSA is undetectable.

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Replies to "I was 69 when my GL4+3 was discovered. I traveled from Atlanta to UCLA to get..."

Proton Beam is also now offered at 5 sessions. My understanding is that there are studies of 2 session treatments and perhaps even one a done approaches.

Any info re 2 vs 5 sessions for Viewray/Sbrt?

I went the same Viewray route as you but I'm one year behind you. My UCLA radiation oncologist, Dr. Reddy, employed the hydrogel spacer because my large prostate was pressed against the prostate (the pre-/post hydrogel images were dramatic.) I suffered zero colorectal post-radiation effects as a result. Five treatments (around 30 minutes) in 10 days was an amazing process. Excellent staff.
My gleason 9 disease has responded well by all markers and tests.
Good luck.

See my comment below about my 5 proton treatments at Mayo Phoenix. Other than my five inch tan circles on my hips where the radiation entered, I would not even know anything was done. I did have the SpaceOar Gel inserted. I still wonder if they did give me the correct dose as I expected at least some side effects.

Am glad to read about your experience with ViewRay's MRIdian SBRT. I am considering using this 5 treatment option as well. My understanding is it combines a high tech MRI with proton radiation. However, jackm9005 just replied to me saying "I recently had my consultation and was told that protons are not delivered using the Mridian ViewRay, only photons. Has something to do with the magnets in the MRI and protons." So, what did you receive protons or photons? The clear definition I found was "The key difference between the two in terms of radiation therapy: Like an x-ray, photon beams will pass through the body and have an exit point, whereas protons can be stopped in tissue without a significant amount exiting the body." Who wants to have an exit dose of photons passing right thru the prostate and beyond? Hopefully you will tell me you had protons.
What did they use to map you, an MRI scan, a CT scan or a PET scan?
If I have two GL 3+3 and a GL 3+4 do you think all three could be zapped in 5 treatments?

Your case is interesting. On the one hand you say "to get a PET scan which showed involvement just outside the gland in the seminal vesicle which didn't show up on MRI or CT scan." However, on the site health dot costhelper dot com it says "PET scans do not show images as detailed as those produced by a CT scan or MRI, but can show chemical activity and blood flow as other scans cannot." So was the involvement detected as a result of the chemical activity/ blood flow only? Please say what your PSA was at that time. I've read that there are 2 things that would require a PET scan: a PSA blood level of 20 or higher or a Gleason grade of 7 (3+4) or higher puts you at higher risk of metastatic prostate cancer. So was your PET scan because of a Gleason 7 and/or a PSA of 20 or higher or both?"
My PSA is only 3 but have one Gleason 7 (3+4) along with a Decipher Low Risk of 0.37. Thus I wonder if a PET might be done since my Gleason is a 7. Any thoughts?