Connect
MRIdian Viewray Experience
Making a decision related to which radiation machine one uses seems to be something that does not get a lot of discussion by urologists and radiation oncologists in terms of the differences, other than their success with the machine they use. I chose the MRIdian Viewray. There are multiple choices with different capability and toxicity risks.
I had my first treatment, out of 5, on January 31. I had spaceoar gel inserted. The machine is both a radiation and MRI built into one unit. They can see healthy tissue and the cancer in real time and adjust accordingly using the machines dynamic mapping capability, if necessary. They used 2 mm margins based on a recent randomized trial called Mirage. The machine turns off automatically if your internals move and the radiation goes outside the mapped out area. No pain or real side effects after the first treatment. Second treatment is on Friday. My prostate cancer is contained within the prostate and I am almost 70 with Gleason 3+4 on one core and 3+3 on another. Psa was 10.2.
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
I had my third MRIdian treatment today. No change in the process or prep.Did a workout and some errands afterward. By the end of the day my urinary flow was more restricted. No pain. I did feel tired but not sleepy and had chills. I have Flomax ready. When I spoke to my RO today, she said that 90% of her prostate patients take Flomax. I do not know how that number works with the multiple types of radiation machines she uses at the Orlando Health Cancer Center. I also don’t know how that number changes given they just just officially adjusted the margins on the MRIdian from 3 mm to 2mm a week or so ago.
I had the 3rd and 4th MRIdian sessions last week with my last one coming up on Tuesday. No real change other than I was glad I had the Flomax. My urine flow was really restrictive, enough so, that I took it before I went to bed (.4 mg) and by morning, I was flowing again. I was happy my RO had preemptively prescribed it. I was told about 6 months before the radiation effects would be maximized to bring my PSA down to the lowest level from the treatments so that a PSA blood test makes sense. Not sure if I am comfortable with that but will look into it.
I also found that there is a set of biases related to these radiation machines. What will insurance pay for? What machine requires more labor than another? What the institution has available vs traveling to a better choice institution, if one can? All the RO's I spoke with claim the outcomes are the same with some "minor" differences in toxicity. Are there any administrative restrictions from using one machine vs another (ie scheduling, labor available...)?
Thanks for posting again… I have my consultation later today with a RO who uses the MRIdian … I will be asking many questions.. I hope I get unbiased answers.. I have heard the same regarding PSA level reduction after radiation treatments.. It seems each if the SBRT options have similar prep times… MRIdian does not require fiducial markers and maybe can even avoid SpaceOar.. I’ll see what he says… So how often will you be getting PSA levels tested?? Thanks again for posting your “journey” and hope you have an excellent outcome…
dale1k:
Good luck with the consult. Medicare paid for my multiple consults. I also asked for the Decipher test as sort of a backup to the pathologist, the urologist and the RO. The mapping time was also key (in my layman's mind). The MRIdian, as discussed, allows mapping in real time without image fusion each time I had a treatment so I "felt" a little safe. They were looking at any movement each time on the MRIdian. Also, my thought was I have one shot with this healthy tissue side affect stuff. Since they were putting me out, I would rather have the extra half inch space between the rectum and the prostate. As they were in there anyway, let them put the fiducial markers in was my reaction, as a backup.
My RO told me 60 days before the PSA check and I "get" that the radiation has to play itself out to lower the PSA. I may get my PSA checked sooner through my GP as I will be due for a blood test shortly anyway . Maybe it is lower than the 10.2 I had. By the way, I read that there is an initial trial for a PSE blood test which is a PSA/Gene oriented test for Prostate cancer with 94% accuracy.
Well, my consultation with the RO was a huge disappointment.. Despite the fact they were one of the first cancer centers to get the ViewRay MRIdian and a NCCN member institution, they rarely use it for prostate cancer... Of course I pressed them on the reason why... Their answer was that the set-up was too time consuming and that they could do only 8 to 10 prostate patients a day as opposed to the ~30 patients they treat for other cancers.. So it's a matter of efficiency and "thru-put" as he put it .. They use the Varian TrueBeam Edge to treat the vast majority of their prostate cancer patients.. So it seems I will have to check MRIdian locations out of state or select the Cyberknife or Varian machine for treatment...
dale1k:
Sorry they did that to you and you have to travel outside your area.
I had a similar consult scenario at another cancer institute in Fl. They would use the MRIdian machine but would not use its dynamic planning capabilities, under any circumstances. If I wanted that, the RO and Vice Chairman said, go someplace else.
I hope others read our discussion so that they understand that looking at multiple options and sources, if possible, that work best for "you", as a patient, makes a difference. Transparency on this stuff should be discussed much more by the professional and by patient advocacy.
Even though Mayo does not have the MRIdian, I applaud them for encouraging the exchange of information on their connect web site.
Lets keep talking about your next steps. If Florida or New York are a choice you are considering, let me know.
I’ll check what is available in Florida… I have a condo in North Naples that normally I would be at this time of year… I know where you went is not far from Orlando.. I’m not sure if there are any providers closer… I will say that I was most impressed with the consultation I had earlier with a RO provider here(St Louis area) that happens to use the Cyberknife … The technology of the machine is theoretically not as “good” as the ViewRay(fiducial markers and SpaceOar is used as a standard)but he listened to me and took my other health issues into consideration before recommending his treatment option.. No pushing ADT like the others.. Worst case I could go with him if timing works and starting over with a ViewRay provider in Florida doesn’t work out for me.. Wish me luck..
dale1k: One of the RO's I spoke with was a Dr. Fagundes at the Miami Cancer Center and they have the MRIdian. They have a Hotel right next to the Cancer center. He and the Miami Cancer Institute was actually my first choice until I found my RO at Orlando Health near where I live. Good luck!
Thanks, I will contact them.. I also saw that there is one in Ft Myers and Tampa as well… Did you have any contact with either of those?? I’m asking since you also had a bad experience with a consultation that was similar to mine… Thanks and I hope you are feeling well since you are done with your treatments..
Good luck and hope all goes well for you.. I have to ask.. Did they place any fiducial markers and or use SpaceOar prior to starting your treatment ???