Latest MRI Guided Linac Radiotherapy aka Viewray

Terry G

Jzj, Imaging and guidance will continue to proved significant advantages in radiation treatment for prostate cancer. I simple can’t understand why more recently diagnosed guys chose only to talk to their urologist/surgeon. They do themselves a terrible disservice in my opinion.

__________________
Rising PSA:
11/13 1.95; 9/15 3.28; 10/16 5.94
TRUS 1/17
Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
DOB 7/21/47; good health; age 69 @ Dx
Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
Reduced ejaculate only side effect; everything works
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PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4

ASAdvocate

Terry, Maybe you need to read “Invasion of the Prostate Snatchers”.

Even Patrick Walsh, the most famous surgeon of his generation, recently denounced “greedy urologists” unnecessarily treating low risk men.

A man hears “You have cancer. I can cure you. Let’s get you on my surgery schedule”.

At that point, researching alternatives never occurs to them. A captive market.

CentralPaDude

They have the MRIdian system at my hospital, similar capability.

The combination of imaging and shaped beams gives some amazing control.

Terry G

@ASA…Thanks. Even with only three cores of Gleason six my Urologist wanted to schedule surgery the same day he reviewed my biopsy. The only other option presented was ‘seeds’. This Dr. enjoyed an excellent reputation and considered the best available at our local community hospital.

I can’t help but wonder how many men had unnecessary surgery. Most urologists practice general urology including men and women with prostate cancer only being a fraction of what they do on a daily bases. It was the information gained from this forum that saved me from making a very uninformed decision. I’m sure a lot of urologists are simply uninformed themselves and not driven by greed. I’m also sure we have far too many prostates “snatched” when other options would be far better for the patient. Terry

__________________
Rising PSA:
11/13 1.95; 9/15 3.28; 10/16 5.94
TRUS 1/17
Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
DOB 7/21/47; good health; age 69 @ Dx
Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
Reduced ejaculate only side effect; everything works
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4

jzj

Yes the MRIdian systems is the Viewray system. I think Viewray is the company name. MRIdian is the actual name of the system. Reports about side effects from anyone getting RT in the last 2 or 3 years seems to indicate very minimal chance of dealing with anything that significant, especially in younger, healthy patients with no pre-existing GU or GI issues.

The main problem is there's no reliable test/scan for micrometastases (yet.) Which would make the decision point a lot easier. It seems RT, due to all the advancements, is really turning out to have the highest chance of a cure in a variety of circumstances. But maybe a negative result for extracapsular extension on the latest PMSA PET scan technology is good enough to indicate RP is a "better" choice. Tough decision.

I'm a Systems Analyst and I can say from the tons of reading I've done, wrapping your head around surgery techniques and side effects is 10 times simpler/easier than understanding all the latest RT techniques. I can see how the average patient (and Urologist) can be drawn to the relative simplicity of surgery. Your average person's knee jerk reaction to a diagnosis in the majority of cases is going to be "just cut it out then."

__________________
Residing in Seattle, WA. At age 53: PSA 31.82 2/4/2022. 30 cc prostate size (avg to below avg). CT Bone Scan (w/ contrast): NEGATIVE. 3T mpMRI (w/ contrast): POSITIVE - One 2.1cm PIRADS-5 T2 DCE positive, and one 1.3cm PIRADS-4 T2 DCE negative lesion. Macroscopic extracapsular extension, seminal vesicle invasion & lymphadenopathy: NEGATIVE. Biopsy 8/12 standard core locations positive: 8 cores positive (5X 3+3, 2X 3+4, 1X 4+3) Additional 8 lesion targeted cores (4 each lesion). Lesion #1 4/4 cores positive (2X 3+3, 2X 3+4). Lesion #2 all cores benign. Total 12/20 cores positive, overall Gleason score described as 3+4 by Urologist. PMSA PET Scan results: NEGATIVE for capsule evasion.

DjinTonic

However, there are commercial tests for CTC (Circulating Tumor Cells). You may want to look at the literature on the correlation between CTC and metastatic PCa.

Djin

__________________
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
Dry; ED OK with sildenafil
Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.023 (4 yr. 6 mo.)

ASAdvocate

QUOTE=jzj;5515832]Yes the MRIdian systems is the Viewray system. I think Viewray is the company name. MRIdian is the actual name of the system. Reports about side effects from anyone getting RT in the last 2 or 3 years seems to indicate very minimal chance of dealing with anything that significant, especially in younger, healthy patients with no pre-existing GU or GI issues.

The main problem is there's no reliable test/scan for micrometastases (yet.) Which would make the decision point a lot easier. It seems RT, due to all the advancements, is really turning out to have the highest chance of a cure in a variety of circumstances. But maybe a negative result for extracapsular extension on the latest PMSA PET scan technology is good enough to indicate RP is a "better" choice. Tough decision.

I'm a Systems Analyst and I can say from the tons of reading I've done, wrapping your head around surgery techniques and side effects is 10 times simpler/easier than understanding all the latest RT techniques. I can see how the average patient (and Urologist) can be drawn to the relative simplicity of surgery. Your average person's knee jerk reaction to a diagnosis in the majority of cases is going to be "just cut it out then."[/QUOTE]

[
If that were true, then an overwhelming majority of men would be choosing surgery. However, the latest results from the National Cancer Institute’s 400,000 man SEER prostate cancer database show that only 32 percent of newly diagnosed men are choosing surgery. That is slightly less than radiation.

IADT3since2000

Hi ASAdvocate and all tuned into this thread. You posted (#8) in part:

[QUOTE=ASAdvocate;5515835]... It seems RT, due to all the advancements, is really turning out to have the highest chance of a cure in a variety of circumstances. But maybe a negative result for extracapsular extension on the latest PMSA PET scan technology is good enough to indicate RP is a "better" choice. Tough decision....[/QUOTE

I'm thinking a negative result for extracapsular extension and negative for any other metastatic spots would considerably lower the risk for ineffectiveness of surgery and make it a reasonable option, but I can't think of a reason why it would be a "better" choice than radiation after that negative PET scan, unless there were extenuating circumstances where radiation, pre PSMA PET scan, was judged the better of two risky choices (such as an extremely enlarged prostate, chronic inflammatory prostatitis, and a few other circumstances where radiation is not usually a very good choice).

It could be that advanced scanning that can spot very small metastases will enable some patients to be confidently and effectively be treated by surgery for high-risk disease if they so choose, which would be an improvement over the past few years where surgery was fading as a wise option for higher-risk cases. I hope that happens, and I believe that it will.

On the other hand, I'm anticipating, visualizing, that wide-spread use of advanced scanning for high-risk patients will almost certainly find, for a large proportion of higher-risk cases, that there are very small metastases in the pelvis (and perhaps elsewhere beyond the pelvis), and that finding will rule out surgery as a wise choice though preserving the radiation option.

Are you seeing this the same way?

Jim

CentralPaDude

This is more of an excuse to share an anecdote, but both Scott Kelly and Mark Kelly, the twin astronauts, had PCa. They elected surgery to keep their radiation dose down, to avoid hitting their max allowable lifetime dosing through that and space flight.

ASAdvocate

Hi Jim, You are attributing quotes to me that somebody else wrote.

Unless somebody has an enormous prostate or a mental state that demands “cut it out, now”, I would never suggest surgery as having any advantage over radiation.

IADT3since2000

Hi ASAdvocate, the quotation is from your post, #8 (not #18 as I had posted - correcting now). The quoted part is actually thought provoking.

Jim

ASAdvocate

Yes, you are using the quote form jzj that I replied in rebuttal to.

Not important. We live and learn from all these exchanges.

__________________
In Active Surveillance program at Johns Hopkins since July 2009.

Seven biopsies from 2009 to 2021. Three were were positive with 5% Gleason(3+3) found.

Ramon7070

Exactly what happened to me. If I knew then what I know now…