Brachytherapy vs Cyberknife opting out for surgery

@mauk

I recently posted my experience but maybe it will help you as I too had a 3+4 Gleason.

I was 69 when I had 5 radiation treatments with the MRIdian linac which had a built in MRI so the margins of radiation exposure to healthy tissue, which impacts side effects and quality of life, outside the prostate, were 2 mm instead of 3-5 mm for most other radiation machines. The Elekta Unity is the only other machine that I know of that has a built in MRI. What they see, in real time, they can treat.

My side effects were limited to a slight reduction in urination after my third treatment, which Flomax took care of overnight. I had no pain, no bleeding in the rectum and was still able to have erections and orgasms shortly thereafter.

That was in February in 2023 and before treatment I had a PSA of 11.2 and a Gleason of 3+4: Low risk decipher. I did have spaceoar. Still all good today. I would do it the same way today except maybe a different type of biopsy.

Multiple opinions from centers of excellence or those trained at centers of excellence was also helpful.

Mack Roach UCSF RT physician believes they are equally effective. Your Gleason numbers are ideal for these forms of radiation therapy per Dr. Roach

I just opted out of surgery and into SMART Stereotactic MRI guided adaptive radiation therapy at Dana Farber. I researched the heck out of it and have 3+4, PSA of 4.5, but several cores invaded. Seems like best approach for me anyway. I considered downtime, side effects, cure rate. All weighed well for me. Glad to discuss further if you like.

@tjp1958 Please yes,

I have my initial consult with Tony Wong @ UCSF-Any suggestions

https://www.google.com/gasearch?q=mri%20guided%20adaptive%20stereotactic%20radiotherapy%20for%20prostate%20cancer&source=sh/x/gs/m2/5
See if this opens for you. It is a short intro. We can start there. I’ll send a couple of thoughts tomorrow. Feel free to ask any pointed questions. I am no expert. I have only been researching this as a Lehman and was very impressed and made the turn.

@tjp1958 and @mauk, please note that the link opens a AI-generated answer. Google's AI tool called Gemini, scrapes all content on the Internet to provide these summaries.

AI tools do not replace human judgment or oversight. Any text, image or video generated by AI should be viewed as a starting point (like @tjp1958 said). It is not verified factual information. It may contain inaccuracies, biases and other problems. Fact check and review for accuracy, relevance, and unbiased balance. I recommend clicking the little link icon to also see the original sources.

Here is the study description directly from Dana Farber.
- A Master Protocol of Stereotactic Magnetic Resonance Guided Adaptive Radiation Therapy (SMART) https://www.dana-farber.org/clinical-trials/19-353

With AI become more present in our world, we have also updated the Community Guidelines to offer guidance about using AI and conversations on Mayo Clinic Connect. See the section called "Guidance about the use of AI." https://connect.mayoclinic.org/blog/about-connect/tab/community-guidelines/#ch-tab-navigation

@tjp1958, are you enrolled in the study? Have you started treatment?

SMART IS considered standard of care today. There is no clinical trial and it didn’t need enrollment. I am having MRI Planning/Contour (First step) done in August and treatments begin in Sep.
The link they sent is impossible for the layman to understand (or at least me!) hence me providing you a summary. Please feel free to review as much as you can on line and then chat on this blog with me if I can provide one non medical persons perspective as to my individual situation.

Many ROs will recommend a combo external beam radiation plan + one high dose brachytherapy "boost" procedure either before or after the external beam sessions. I had 5 weeks IMRT followed by one half day HDR "boost" session