Questions about radiation for prostate cancer: Can I drive myself?

Hi, can you recommend a doctor from Mayo in Rochester please. Thanks, Mike

Gently,
Thank you for your response.
were you treated by Percy Lee or some other Radiation oncologist from City of Hope?
How long ago you were treated?

Hello everyone,
I started this thread, and have weaved my way through tons of information on prostate cancer treatments. At the time of posting, I was interested in radiation treatment. After more research, I felt that the MRIdian treatment was the way to go, and still feel that way as far as radiation goes. There are a couple of down sides. First, the company that made the MRIdian machine went out of business and many of the facilities that offered the procedure no longer do. Secondly, it is radiation. I like the idea that it's guided in real time with MRI. Makes me feel that this would be a very accurate method for aiming at the cancer. I believe that it uses Photons not Protons and is only a few treatments (please correct me if I wrong). With all of this said, I am now leaning towards the Tulsa Pro procedure. No radiation, no cutting, MRI guided, computer controlled, side effects are not common. Don't have to worry about the effects of radiation down the road. Partial ablation or full ablation as required. It can also treat symptoms of BPH. BUT, it appears that it's not covered by Medicare, though I'm not certain of that. Most of my online searching has lead me to believe that it's not covered, but I did find a few sites that mentioned temporary medicare numbers that can be used to get it covered. Also, I've read that it will be covered come the 1st. of next year. At $30k to $40k that's a big deal for me. UCLA does the Tulsa procedure, and initially they told me that traditional Medicare would cover it. But that was coming from the person that sets up appointments. Since then I have emailed back and forth a few times with different people in their department, and they will not confirm nor deny whether it will be covered, so I'm skeptical. They won't be able to tell me until after I have had a consultation, and I can't even schedule a consultation until after I have had an MRI, which is scheduled the 8th. of next month. Speaking of tests, I did get my Petscan test results back, it showed no cancer outside of my prostate. While that's no guarantee, it is good news. Oh, and Radnet, who also has a site where they perform the Tulsa Procedure, wrote to say that Medicare would only pay if the procedure is done in a hospital. Not sure how trust worthy that info. is either. My issue is waiting. Waiting for UCLA to schedule a consultation, then waiting to see if Medicare will cover it. I'm definitely willing to wait if it's covered, but if not, and I have to pay out of pocket anyway, I might as well go somewhere else that doesn't have such a long wait. Speaking of waiting, I spoke with my original Urologist about waiting, he said 6 months should be fine, but when I mentioned that I may want to wait until the first of next year, he said I had better speak with the UCLA doctors. Sorry for the rant, it helps to discuss this with others that are or have gone through it. I'm glad to be a part of this group.

Most likely you will.
You do have 2 prep issues.
1. A self administered enema 60 minutes before treatment.
2. Then drinking a bottle of water about 20 min before tmt.
Empty colon and full bladder.

My experience was with Proton treatment 5 doses over 8 days.
Stayed by the hospital during the week and drove home - 2 hrs- for the weekend.
No issues with driving

Avall, having to make that exact choice, we decided on City of Hope. Dr. Rossi doesn't think the five is a good choice. The difference would have been 28 treatments for a total of 58GY with a spacebar procedure. City of Hope is 5 treatments for a total of 40GY. The treatments are every other day so MWF and then TTh.
City of Hope is so much easier, but the genuine advantage is in the 2mm margin that they radiate around the prostate. With proton it is 3mm.
Opinions about the effectiveness of the total amount of radiation don't have enough evidence either way. Rossi suggests that 8GY a day could be more damaging in the final anaylsis. Damage from radiation treatment is sometimes not apparent for several years after treatment.
I drive 258 miles to the Lennar City of Hope Cancer Center, but would drive the extra 55. It's the MRI guidance during treatment and the lower GY total that were convincing.
If you haven't spoken with Rossi, you might want to have a zoom appointment. He has the most extensive experience. And there may be a deciding factor in the specifics of your cancer.
Ten minutes.
Best luck with your choice. I'm guessing you be at City of Hope.

I just got my PSMA PET/CT scan. No metastasis even though I had 2 cores 4+5, luckily.
Is there a benefit of proton therapy over MRdian 5 treatments in terms of the outcome and safety for my situation?
City of Hope Irvine has MRdian machine 10 miles from my house and UCLA is about 55 miles.
San Diego for Proton Treatment is 75miles .

Elekta makes the Unity, another MR-Guided SBRT (MSK, for one, uses the Unity). Here is a good article on the technology with a bit of a side-by-side on the two machines: "MRI-LINAC: A transformative technology in radiation oncology" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911688/

I totally enjoyed your comments along with a few others. My husband will be starting his Proton Beam therapy in the next few weeks. I gave him the information that you posted about having a change of clothing in the car. I'm visually impaired so I can't help him out with the driving. After reading your comments, I smiled for the first time since he was diagnosed. Thank you for that!

Dear Paulcalif,
I was in my late 60's when I had the 25 External Beam Radiation Treatments. I could have driven myself, but I was most grateful that my wife drove. The reason for that was due to all the water I was drinking everyday to make my bladder as large as possible to push tissue away from the radiation beam as much as possible. I literally was bursting out while in the car, going up the elevator, and rushing in to the waiting room, waving to the receptionists and thank goodness rushing into an empty restroom to use the facility. At the time, it, an empty restroom, was one of the most beautiful sights I could have imagined!!! The Technicians and Staff were very compassionate and said, "Don't worry about it, we clean up "spills" all the time." So I started bringing a bag with a change of clothes, a towel and wipes to run in with, just in case I had an accident or the restroom was in use. To date I am glad I filled up so much on water, I wish I had eaten more vegetables and kept my intestines and bowels cleaner with a little more "fasting" during that 25 day period of treatment. I hope your treatments go well, you drink lots of water and if you do have a "spill" your sense of humor carries you through to greater health and wellness. God Bless,

The Proton at Loma Linda even though pioneers is long in the tooth. It’s older tech. If I was going to do Proton San Diego would probably do better. After doing research more I felt the MRI tracking of the prostate at 4-8x a second was superior. Proton isn’t as accurate as it is sold to be and is easily deflected by calcifications, it has lateral scatter and in studies I read MRLinac SBRT was superior in saving OAR especially the nerve bundle. Then add to that 5 treatments in a row compared to I believe they said 39. The very low side effects from MRLinac and I was tested as low risk to side effects from SBRT at UCLA. Plus I like the UCLA institution, they were way more pro active, on the ball and communicative. It was the right choice for me. Everything is on track and my life is better than it was before treatment. I feel great and according to my doctor who is the chair of RO at UCLA I should not expect to have any side effects or reoccurrence. 90-95%. I’m happy I didn’t have to go for 39 days was definitely a factor but a bigger factor was I believe in the tech, being able to adjust the treatment on the fly and the gating and tracking of the MRLinac MRidian machine in which they can see all the soft tissues, colon bladder and prostate during the actual treatment. It was super easy (I didn’t need ADT) and it couldn’t possibly have gone better.