Final decision on treatment: Viewray or Truebeam?

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.

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.

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.

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.

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.

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.

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.

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.