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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.

rockin2047 | @rockin2047 | Jun 8, 2023
In reply to @mperloe "ViewRay is photon. The issue also has to do with how many beams. MRIdian has up..." + (show)
@mperloe

ViewRay is photon. The issue also has to do with how many beams. MRIdian has up to 18 beams, energy divided into 18 paths. Photon has all the energy through only two paths. As a result there are more skin burns with proton. Proton also adds 5 mm margins around tumors, MRIdian adds 3mm so less normal tissue is exposed with MRIdian. Adaptive radiotherapy and automatic gating significantly lower the risk of side effects with MRIdian which is about 50% less than other CT guided radiotherapy. There are no well designed randomized studies comparing proton with photon. No evidence that 45 proton sessions will do better than 5 with MRI-Linac.

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I think you intended to say "Proton has all the energy through only two paths." What I want to know is whether the Photon radiation is controlled by MRIdian so that it does not escape outside of the prostate when the beams are turned ON? From what I've read, Photons (xrays) pass right thru tissue and don't stop until they leave the body. What is your understanding as to what is going on when treatment is being applied ?

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mperloe | @mperloe | Jun 8, 2023
In reply to @jb2buckwater "Great summary. Although I chose 5 treatment proton at Mayo Rochester where they use Hitachi kit,..." + (show)
@jb2buckwater

Great summary. Although I chose 5 treatment proton at Mayo Rochester where they use Hitachi kit, the statement, "There are no well designed randomized studies comparing proton with photon" is consistent with all I have read and been told by urologists and radiologists. The one statement made by those perfming the procedure that I question is whether Radical Prostectomy is still the "Gold Standard". Photon and Proton have been shown to have equal long term outcomes.

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I think men are finding better information regarding the risks of surgery that occur immediately. They are learning about penile shortening, ED and incontinence. The advances in RT have been non stop. ROs are learning how to reduce side effects. Hopefully we will soon see adaptive radiotherapy and automatic gating which will improve safety and side effects profiles to all delivery systems.

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jb2buckwater | @jb2buckwater | Jun 8, 2023
In reply to @mperloe "ViewRay is photon. The issue also has to do with how many beams. MRIdian has up..." + (show)
@mperloe

ViewRay is photon. The issue also has to do with how many beams. MRIdian has up to 18 beams, energy divided into 18 paths. Photon has all the energy through only two paths. As a result there are more skin burns with proton. Proton also adds 5 mm margins around tumors, MRIdian adds 3mm so less normal tissue is exposed with MRIdian. Adaptive radiotherapy and automatic gating significantly lower the risk of side effects with MRIdian which is about 50% less than other CT guided radiotherapy. There are no well designed randomized studies comparing proton with photon. No evidence that 45 proton sessions will do better than 5 with MRI-Linac.

Jump to this post

Great summary. Although I chose 5 treatment proton at Mayo Rochester where they use Hitachi kit, the statement, "There are no well designed randomized studies comparing proton with photon" is consistent with all I have read and been told by urologists and radiologists. The one statement made by those perfming the procedure that I question is whether Radical Prostectomy is still the "Gold Standard". Photon and Proton have been shown to have equal long term outcomes.

REPLY
1 reply
bens1 | @bens1 | Jun 8, 2023
In reply to @rockin2047 "Am glad to read about your experience with ViewRay's MRIdian SBRT. I am considering using this..." + (show)
@rockin2047

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?

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rockin2047: one of the great benefits of the Mridian is real time MRI mapping and dynamic mapping capabilities. I had an MRI and a CAT scan used for preliminary mapping. They were used as a guideline for the initial set up and the real time Mri in the Mridian was used to finalize the mapping. They did not have to use the dynamic planning capabilities of the Mridian as my body did not move internally or externally in a way that required it but it was there if needed. In other types of cancer, where the organs move more, the dynamic planning capabilities of the MRIDian become more important.

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mperloe | @mperloe | Jun 7, 2023

I had a PET scan but mapping was MRI and CT.

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mperloe | @mperloe | Jun 7, 2023

ViewRay is photon. The issue also has to do with how many beams. MRIdian has up to 18 beams, energy divided into 18 paths. Photon has all the energy through only two paths. As a result there are more skin burns with proton. Proton also adds 5 mm margins around tumors, MRIdian adds 3mm so less normal tissue is exposed with MRIdian. Adaptive radiotherapy and automatic gating significantly lower the risk of side effects with MRIdian which is about 50% less than other CT guided radiotherapy. There are no well designed randomized studies comparing proton with photon. No evidence that 45 proton sessions will do better than 5 with MRI-Linac.

REPLY
2 replies
rockin2047 | @rockin2047 | Jun 7, 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

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?

REPLY
1 reply
mikewo | @mikewo | Jun 4, 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.

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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.

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mikewo | @mikewo | Jun 4, 2023
In reply to @jb2buckwater "Bl2023, I received proton Beam SBRT at Mayo Clinic Rochester. Not certain whether ViewRay or TrueBeam..." + (show)
@jb2buckwater

Bl2023, I received proton Beam SBRT at Mayo Clinic Rochester. Not certain whether ViewRay or TrueBeam offer both Proton and Photon Beam options. The Proton Beam provides a radiation which enters the Prostate but does not exitafter performing its function. Photons enter and then exit which means they may have a higher chance of negatively impacying healthy cells outside the Prostate. This treatment required that I make the trip from Portland, OR to Minnesota for treatment... well worth the effort.
Best wishes for a successful outcome regardless of treatment choice.

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I did my 5-day Proton treatment at Mayo Phoenix and other than the one 5-inch tan circle on each hip I would never know anything was even done to me. PS the weather is great here in Phoenix in the fall and the Arizona Fall League baseball season is great baseball . Talking Stick ballpark is three exits away on the 101 for entertainment in the afternoon and evenings.

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bl2023 | @bl2023 | Jun 3, 2023
In reply to @drj "I went the same Viewray route as you but I'm one year behind you. My UCLA..." + (show)
@drj

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.

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Thanks and continued good health.

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