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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.

mperloe | @mperloe | Jun 3, 2023

Welcome to the ViewRay alumni. It would be great if we all could speak out to help alleviate fears and get people to screen earlier.

REPLY
drj | @drj | Jun 3, 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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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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1 reply
bl2023 | @bl2023 | Jun 2, 2023
In reply to @mperloe "I doubt we will see one and done. A single brachy session was not as effective..." + (show)
@mperloe

I doubt we will see one and done. A single brachy session was not as effective as two. Skins burns may be an issue with proton 2 or 5 SBRT. The FORT trial is considering 2 vs 5 sessions of ViewRay MRIdian.

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Dr. Mark, what do you think snd what have you heard about the FORT 2 vs 5 Sbrt treatment? Greater risks with fewer treatments but higher doses?

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bl2023 | @bl2023 | Jun 2, 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

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

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mperloe | @mperloe | Jun 2, 2023
In reply to @jb2buckwater "Proton Beam is also now offered at 5 sessions. My understanding is that there are studies..." + (show)
@jb2buckwater

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.

Jump to this post

I doubt we will see one and done. A single brachy session was not as effective as two. Skins burns may be an issue with proton 2 or 5 SBRT. The FORT trial is considering 2 vs 5 sessions of ViewRay MRIdian.

REPLY
1 reply
bens1 | @bens1 | Jun 2, 2023

Finished my MRIdian treatment in Orlando Cancer Center in February. 5 Treatments with spaceoar. NY Presbyterian/Cornell Weill is doing a 1 treatment vs 5 clinical trial. 2 mm healthy tissue exposure vs 3-6 with Proton. Real time mapping with the built in MRI and dynamic mapping, if needed. Built in MRI is a big deal. It is more accurate than fusing images from other sources. Some urine restriction side effect but all good now. Looked at Proton at first as well. If Proton Therapy had a built in MRI and auto shutoff, I might have leaned in its direction.

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mperloe | @mperloe | Jun 1, 2023

Dr. Rossi at California Proton stayed that complications are higher with proton SBRT.

We do not have data from ongoing clinical trials that proton 45 sessions is safer or more effective than SBRT 5 sessions with photon. The MIRAGE study shows reduced side effects with MRI guidance, reduced margins and gating. The soon to be completed studies compares photon IMRT with proton IMRT. It is important to separate marketing hype from well designed clinical studies.

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jb2buckwater | @jb2buckwater | Jun 1, 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

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.

REPLY
1 reply
mperloe | @mperloe | May 31, 2023

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.

REPLY
6 replies
jb2buckwater | @jb2buckwater | May 31, 2023

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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