Final decision on treatment: Viewray or Truebeam?

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.

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.

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.

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 used to live and work in Ventura, which I miss very much. Thanks for the info and continued good health.

I chose OHSU (Oregon Health Science University) based on hope. The place provides excellent treatment with hope. Hopefulness seems to add to my "living with cancer" abilities.

PS. I failed to tell you where I got the excellent care, sorry. It was at UCLA in Westwood. I live in Oxnard andWestwood is an 1-1.5 hours from my house. The quality of care clearly compensates for the frequent and long drive. Good luck

I have had Prostrate surgery and ADT with lupron and Erleada for Gleason 9 aggressive, castration resistant, advanced cancer and I have found the care to be excellent, all preformed by experienced physicians who are also professors at the medical school. They have given me care for 2 years. The hospital however is a teaching hospital so a class of very young medical students may visit you and observe delicate procedures and the modest men have to adjust to that. Good Luck. This is a very important decision for you.