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MRIdian Viewray Experience
Making a decision related to which radiation machine one uses seems to be something that does not get a lot of discussion by urologists and radiation oncologists in terms of the differences, other than their success with the machine they use. I chose the MRIdian Viewray. There are multiple choices with different capability and toxicity risks.
I had my first treatment, out of 5, on January 31. I had spaceoar gel inserted. The machine is both a radiation and MRI built into one unit. They can see healthy tissue and the cancer in real time and adjust accordingly using the machines dynamic mapping capability, if necessary. They used 2 mm margins based on a recent randomized trial called Mirage. The machine turns off automatically if your internals move and the radiation goes outside the mapped out area. No pain or real side effects after the first treatment. Second treatment is on Friday. My prostate cancer is contained within the prostate and I am almost 70 with Gleason 3+4 on one core and 3+3 on another. Psa was 10.2.
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My SBRT treatment at Mayo used 3mm margins. The prep was placement of 4 gold seed fiducial markers and the SpaceOAR via a transperineal approach all while I was under general anesthesia in an OR. It was pretty much a non-event although I can't imagine doing it under just local anesthesia in a doctors office. The "ink markers" you are referring to are applied on the external skin in three areas during the "simulation" which is when they take precise imaging and measurements to plan the radiation targeting (about 7-10 days before your first radiation treatment). I was offered stickers or permanent tattoos. Since I'm a daily lap swimmer, I opted for the permanent tattoos which are three very small dots about the size of a small freckle where nobody is going to see them anyway. This was just a very minor skin prick. So back to the fiducial markers and SpaceOAR-- my RO feels that even with the MRI imaging/tracking, these fixed markers make the process much more precise. And the SpaceOAR, some say it's not needed with the MRI tracking but he's yet to have a single bowel issues arise from radiation when the device was used. Enough said for me. Others will have different experiences and treatment plans but this was mine. Hardest part for me was just the waiting. Best wishes! Reach out if you want to chat.
Thank you for your comments on your SBRT treatment at Mayo. Did you have the MRIdian Viewray treatment or something else? If so, was it at Mayo in Rochester, FLA or Arizona? How are you doing now with side effects, etc.?? Thank you.
Mayo JAX. I don't know what device was used but I don't believe it was MRIdian Viewray. Half way through, no issues. Also doing 6 months of Orgovyx due to high-risk on the genomics test.
Thank you for the reply and glad to hear you are not having any issues. You tolerating the Orgovyx ok? I am curious how it compares to Lupron injections as far as side effects go?
Take care.
Haven't been on it long. Takes about a week to kick in from a SE perspective. Manageable though, especially with a solid exercise regimen. Orgovyx studies shows less SE's and quicker T recovery after stopping compared to Lupron. Less than have that CV SEs than Lurpron as well which was important to me with my CAD history. The fact that it's a daily oral med was a big draw for me. If I develop any SEs I just can't deal with, I can stop taking it. If I get a single 6 month dose injection of Lurpon, I can't undo that. I've seen others post about their Orgovyx experience so check them out as well.
According to the Viewray MRIdian website Mayo does not offer it at any of their sites. For SBRT (Stereotactic Body Radiation Therapy) Mayo uses it as their primary RT option (I think). Did you have only one tumor they treated which required the 4 fiducial markers? Since I have three tumors will I need 12 fiducial markers?? Is the idea to place the markers "around" the tumor or place them "inside" the tumor? It sounds like you received Proton Beam SBRT over 5 treatments at Mayo. The stated margins for PB SBRT are 4-6mm from what I've read about. MRIdian on the other hand has it down to 2mm. The SpaceOAR after a few months gets absorbed by the body. Gee, now that you have 4 fiducial markers inside you the police will be able to identify you if you go wandering off....just like your friend's dog!! At this time my Decipher test score is 0.37 (Low Risk) and am trying to decide on using Active Surveillance or 5 MRIdian treatments. The next PSA test will be in a week and am hoping it will remain at 3. So far have you had any blood in either your urine or semen? I am glad to hear you exercise. I have been working out 3 days/week and walking a mile each time. Thanks, will await your reply.
I had a single 1 cm tumor grade 4+3, right side only. Decipher was .69. My RO specifically told me he used a 3mm margin for my targeting plan using Photon Beam SBRT. From my understanding, the fiducial markers are used to better track the whole gland in preparation for and during treatment. They already know the location of the tumor(s) relative to the gland itself. It's like knowing where your house is but needing to zoom out to see your house relative to your neighborhood. Although I've heard that some ROs boost radiation dosing in the tumor regions, mine doesn't prescribe to that theory. As he explained to me, the planning is meticulous to help ensure the prostatic urethra and bladder bulb don't get too "hot." The SpaceOAR moves the rectum far enough away so that's protect by the additional spacing. With the markers now in place, I believe my wife can now locate me with the the iPhone "Find your Phone" app...
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1 ReactionAlso, just a follow on note, Mayo did offer numerous treatment options including Tulsu Pro and surgery. However, after a few months of in-depth research and multiple "second" expert opinions, I settled on SBRT as MY best treatment option. I emphasize MY because everyone has their own decision path. I believe that's the only way you'll feel confident in your decision, FWIW. Best wishes!
The only side effects I have from my 5-session proton treatment at Mayo Phoenix are two approximate five-inch tan circles, one on each hip where the radiation went in. I even wondered if they actually gave me the higher dose of radiation.
Am trying to narrow down my options between MRIdian versus CyberKnife which both use Photon beams. Is there anything you know about the CyberKnife procedure which is not as good as MRIdian? Their website https://cyberknife.com/wp-content/uploads/Prostate-cancer-treatment-information-guide-31.pdf says it
"continually tracks, automatically adapts and synchronizes treatment delivery with movement of the
prostate in real-time throughout the entire treatment session. This helps ensure
the radiation dose is delivered precisely to the target — maximizing treatment
effectiveness while minimizing dose to surrounding tissues which can help reduce
the incidence of side effects." They also claim that their margins are down to 1.35mm (better than MRIdian?). Does it look to you that CyberKnife is using a diagnostic-quality MRI or some sort of fused images??