Third SBRT Opinion Worth It?

psychometric,
without wisdom or experience (I'm not even a guy) I'll say MR Linac is worth the trip. It's a five day treatment 40gy per fraction with a closer margin than Cyberknife. And my inexperienced opinion says that your tumor is appropriate. https://www.mdanderson.org/research/departments-labs-institutes/programs-centers/image-guided-cancer-therapy-program/resources.html

UCSF does cyberknife regularly. My brother with a 4+3 had five sessions and no side effects two years later. If you’re concerned about SBRT causing problems, you could get the MRI guided SBRT like the MRIdian To reduce the chance of side effects.

If you do have surgery. It gives the option of having radiation after. Much harder to do if you do radiation first.

I’m 54, similar stats: 3+4 and 0.68. I chose RARP over radiation after talking to 9 doctors who all told me the same thing for a man of my age and that severity of cancer.

This is to say that you should absolutely talk to a variety of doctors in urology, radiation oncology and medical oncology to discuss the pros and cons. Radiation early can cause problems in later life and isn’t to be what any physician I talked to recommended.

This is your life and you are your own best advocate for it. The choice is yours, but talking to doctors and getting a fuller picture will benefit you greatly.

All 5 fractions add up to 40Gy.
Stay Strong Brother.

@toolbelt, yes, thanks for catching that.

I also had SBRT, 40 gy in 5 sessions. A few side effects but nothing major. If that's the direction you're leaning it couldn't hurt to make the trip. Does Anderson do telemedicine?

It’s always worth the trip to get better care and the Linac certainly is that.
But perhaps this weak stream issue should be addressed first? SBRT (cyberknife) even with gel spacers delivers high doses of radiation and the bladder can become inflamed, swell and cause decreased flow or blockage( happened to my friend who was given Finasteride and did fine). So the RO’s, while understandably concerned, don’t address the WHY of your situation.
Do you have BPH? Congenital bladder condition?
There are quite a few stories on this forum of men who had TURP’s or HOLEPS or Green Light Laser therapy PRIOR to any cancer treatment because of these pre-existing bladder conditions.
So before you make that trip, you might want to look into that; you DO have time as your biopsy shows intermediate grade cancer ( a few months, not years!) and urgency ( no pun intended) is not an issue. Best,
Phil

The initial visit has to be in person, and they say to allow for 3-5 days to see the entire team in case any of the doctors require additional tests. The timing works out well because I'll be on spring break.

At 59, now 60, your numbers were very similar to mine. When I was thinking about options, my urologist naturally recommended RARP "as soon as possible" but also left open referrals to Mayo-Rochester and the U of Iowa (COE), as well as local ROs. When I spoke to my RO, he opined that six mos. of Eligard, combined with five courses of SBRT (TruBeam STX). My PSA was 14.7 as we started and my most recent followup in December showed a PSA of 0.08. Minimal side effects and my testosterone is coming back without issue.

I don't know why the ROs recommended against SBRT Cyberknife, unless the site of your tumor creates certain issues. However, since you seem to have time to consider options, I think a trip to MD Anderson or Mayo may be worth the time and money before you decide on a treatment plan.

Best of luck, brother. You got this and we're here for you.

The surgeon who did my biopsy has remarked several times that my prostate isn't very large (I don't know the exact dimensions). He also did a cystoscopy last Friday and didn't see anything major. He wrote me a prescription for overactive bladder but I haven't had a chance to pick it up. I probably drink too much coffee/tea, and I run, so I drink a lot of fluids in general, which I'm sure contributes to the frequency issues. I've been on Flomax several times in the past and am currently on Silodosin. I've seen maybe minor improvements at best.

I have about a month until the appointment in Houston. It is probably worth cutting down on (or out...ack!) caffeine and trying the bladder medicine to see if the issues improve drastically.