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Radiation questions re Boost aand Prostox
Has anyone's experience with sbrt mri linac included boost to the dil as SOC?
2 lesions 43 34 bilateral psa 12 4/14 cores positive psa 12 psma pet confined
my direct experience:
RO recommendations with mridian viewray
1) 40 gray to whole prostate no boost
2) 36gray to margin 43gray to dil 40 to remainder of prostate
2 cyyberknife docs told me same as #2
Re: Prostox test
Has your RO told you what the options for radiation are if you score high risk?
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The MiraDx ProsTOX tests are for either SBRT or IMRT or both, One commentator remarked that at least for the SBRT group the interval between sessions might be extended. Instead of 4-5 visits daily (at one center), alternate days for < two full weeks is more typically. Possibly once weekly for 4-5 weeks could be considered.
It is unclear if this might reduce the delayed onset of urinary tract symptoms of 15% (vs,5%) incidence in the HIGH ProsTOX group. The delay can be several years. with >2 level in the RTOG score. The acute effects are about the same for SBRT and IMRT and are self resolving with/without symptomatic meds.
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2 ReactionsAlmost exactly one year ago I traveled to NYC for 5 day (M, Tu, Th, M, Tu) SBRT, 45 Gy total, on a MRIdian linac with boost to the dominant lesion. Prior to that, I consulted with arguably the most prominent clinician/academic at NYU, Cornell, and Maryland Proton Center. All 3 were very familiar with Prostox and at least one had even collected data in clinical trials. However, none recommended its use. Since all 3 agreed, I was comfortable omitting the test.
The consultations were in spring of 2024, so it's possible their opinions could have changed since then.