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Final decision on treatment: Viewray or Truebeam?

Posted by bl2023 @bl2023, May 29, 2023

Final decision on treatment: Viewray at UCLA or Truebeam at Kaiser
Well, after getting the word this last January 24 that I had G7(4+3), 3 lesions rt side, 1 lesion left side, and a Decipher low risk of 0.26, and rabbit holes of research and education, I’m close to deciding. I have to thank you on this and other forums for giving me your experience and insights. It’s really amazing to be able to talk to guys about their most personal details and struggles you’ve dealt with and I’m very grateful.

So. I’d like to hear from any and all that have any insights on their experiences with the above treatment options: Viewray vs. Truebeam. Bring it on.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Moderator
Colleen Young, Connect Director | @colleenyoung | 3 days ago
In reply to @itsaquarter23 "I'm also thinking about doing MR-Linac. It's now been more than a year since you've had..." + (show)
@itsaquarter23

I'm also thinking about doing MR-Linac. It's now been more than a year since you've had your treatment at UCLA. May I ask, how would you describe the short and long-term side effects? Also, any recurrence? I live in Portland, Oregon, and Providence Hospital here in Portland offers MR-Linac for prostate cancer. I'd prefer to be treated here in Portland, but the hospital isn't a center of excellence. It's just a community hospital. Do you think I'd be better off going to UCLA for the MR-Linac treatment? I'd appreciate any insights you can share. Hope you're doing well!

Jump to this post

@itsaquarter23, I'm tagging @mperloe to make sure he sees your post and questions about his experience.

@itsaquarter23, did you make your decision about where to get treatment in the meantime?

REPLY
Beachcomber20 | @itsaquarter23 | Nov 7 10:36am
In reply to @mperloe "I was 69 when my GL4+3 was discovered. I traveled from Atlanta to UCLA to get..." + (show)
@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.

Jump to this post

I'm also thinking about doing MR-Linac. It's now been more than a year since you've had your treatment at UCLA. May I ask, how would you describe the short and long-term side effects? Also, any recurrence? I live in Portland, Oregon, and Providence Hospital here in Portland offers MR-Linac for prostate cancer. I'd prefer to be treated here in Portland, but the hospital isn't a center of excellence. It's just a community hospital. Do you think I'd be better off going to UCLA for the MR-Linac treatment? I'd appreciate any insights you can share. Hope you're doing well!

REPLY
1 reply
bens1 | @bens1 | Apr 18 7:04am

I found a few hospitals that are listed online as still using Mridian but I have not called them to confirm:
UCLA Health Jonsson Comprehensive Cancer Center
UCLA Health
Hoag
New York-Presbyterian David Koch Center
Henry Ford Health
Baptist Health Miami Cancer Institute

REPLY
kaspar | @kaspar | Oct 3, 2023

ViewRay has 1/2 the immediate side effects compared to Varian according to UCLA and they have both.
MRIdian for me, finished in March and went straight back to work 5 treatments in a row, no SpaceOar. No ED or incontinence, everything is excellent and 0 changes to QOL.
Small bother side effects for 2-4 weeks.

REPLY
jc76 | @jc76 | Jun 12, 2023

My Decipher test came back as low risk. However two different radiologist/oncologist both stated the curative radiation therapy was warranted. I am in my 4th week of a 6 week M-F treatment plan for pencil Proton Radiation.

I agreed with radiation treatment. My bone scan was negative and my pet scan was negative. I was told cancer confined to prostrate. For me curing cancer not letting it grow was much better mentally than worrying about it growing outside of prostrate. The wait and see option was never presented to me even though my Decipher was "low risk." They did say my Decipher contradicted the biopsies which the worse ones were 4+3=7.

This Mayo Clinic Connect is a great source of information. I am glad that Mayo Clinic set it up. What I see though is still the disagreements withing oncologist/radiologist about photon and proton. I hope more studies are done to help patients have the information to make decisions. And maybe someday there will be a scientific consensus among radiologist/oncologist of what is best for patient cure and not personal opinions and bias.

I keep reading about Meridian and others having proton but only 5 treatments. I have a ICD/Pacemaker so the physics department at my Proton provider recommended pencil beam.

Wish I knew more about Pencil Beam. My question and maybe some of you know is when you get Pencil Beam does one beam come down or is there a multitude of beams? If entire prostrate is being treated how do you get pencil beam to all? When you say pencil beam you think it is a single beam the size of a pencil. That would seem like there would have to be hundreds of pencil beams.

REPLY
vp3 | @vp3 | Jun 12, 2023

Starting MRIdian next week at Dana Farber/Brigham & Womens in Boston.
5 treatments over 2 weeks.
Any experiences with this type tratment?

REPLY
mperloe | @mperloe | Jun 11, 2023

GL 4+3 is intermediate unfavorable which gets the PET ordered or should. Not sure what you mean by Gleason 20??

I was part of a PSMA PET study at UCLA and chose to push for it.

REPLY
rockin2047 | @rockin2047 | Jun 11, 2023
In reply to @mperloe "PSA was 0.3 when PET was positive. It is CT so yes the resolution is much..." + (show)
@mperloe

PSA was 0.3 when PET was positive. It is CT so yes the resolution is much greater with MRI, but the PET is far more sensitive because the radioactive tracer binds to PSMA on the cancer cells surface.

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Do you recall what your Gleason number was? Perhaps 20 or higher which caused a PET to be done for you?

REPLY
mperloe | @mperloe | Jun 11, 2023

PSA was 0.3 when PET was positive. It is CT so yes the resolution is much greater with MRI, but the PET is far more sensitive because the radioactive tracer binds to PSMA on the cancer cells surface.

REPLY
1 reply
rockin2047 | @rockin2047 | Jun 11, 2023
In reply to @mperloe "I was 69 when my GL4+3 was discovered. I traveled from Atlanta to UCLA to get..." + (show)
@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.

Jump to this post

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?

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