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Prostrecision (Radiological Clinics of Georgia) Any opinions?

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Posted 8/18/2013 2:49 AM (GMT 0)
 

Have received some info in the mail on Prostrecision treatments at Radiological Clinics of GA and have scheduled a consult.

It appears they do seeding first followed by IMRT Beam Treatments.  They mention they have a database of 12,000 patients and state they have a cure rate higher than surgery.  They say that cancer leakage at the Apex is cause for concern because most positive margins from surgery happen at the Apex and that is where 70% of prostate cancer resides in patients.  Seeding and Beam radiation can get to the Apex region better than surgery  or so they say.

My urologist does do seeding treatments and does not recommend for me because of the harmful side effects that radiation can cause longer term.  He is my age of 49 and said it would be a difficult decision but he personally would go for surgery over radiation based on my stats. 

I mentioned this group out of Atlanta and he was not impressed with their claims.  Just wanted to know if anyone had treatment there and what was their experiences both short term and long term.

Thanks

 

Posted 8/18/2013 7:56 AM (GMT 0)
I think your doctor is right that ProstRCision provides high rates of SEs with no additional benefit, especially for low risk men like you.

In the Lawton et al 8-year study of combined LDR brachy+IMRT (like ProstRCision):
• late grade>3 genitourinary and/or gastrointestinal toxicity was 15%. There were two grade 4 toxicities, both bladder necrosis.
• 42% of patients complained of grade 3 impotence (no erections) at 8 years.
• biochemical failure was 18% after 8 yrs.

www.ncbi.nlm.nih.gov/pubmed/22330999

Compare this to Katz's 6 year results with SBRT:
• late grade≥3 genitourinary or gastrointestinal toxicity was 0
• 75% of previously potent men remained potent
• Only 3% of low risk men had biochemical failure after 5 yrs

Or Compare to Demanes's 8 year results with HDR brachy:
• late grade≥3 genitourinary was 3%, gastrointestinal toxicity was ≤1%
• 80% of previously potent men remained potent
• Only 3% of low risk men had biochemical failure after 8 yrs
Posted 8/18/2013 11:56 AM (GMT 0)
I consulted with them, finding them to be thorough in their contact and follow up methods. They give a lot of good information, and of course they portray their process in the best possible light.

The most useful thing was their fairly direct assessment of success with my specific factors, based on their big database of cases.

The bummer was that out of 14,000 guys in the database (the number I recall they stated), they located just 56 with my specific numbers, 56 like me that had used their services. Based on that, their projection of "cure" by a pretty stringent definition of recurrence was 60%. While that's pretty good, and a little better than the coin toss I see in many studies, they were pretty low key about it. We agreed that wasn't a real exciting projection, and that other treatment modalities have similar probabilities.

All in all, a positive and professional discussion with them. I didn't go with them, so can't offer anything further, but that's my experience with them.
Posted 8/18/2013 12:07 PM (GMT 0)
I am in Atlanta and closely investigated them. I had two consults and attended one of theri evening meetings. In fact my wife used one of their rad oncs for some tricky breast cancer radiation. This was her second bout and the first also used radiation. Overall he experience was very good and she really likes the rad onc. He does not do prostate cancer work.

I met with them and studied the procedure and reported results. The founder, Dr Frank Critz is older and does very little work. I have a client who used them two years ago and a business partner who used them ten years ago. Both report good treatment, minimal side effects, and good cancer control as both continue to be undectible. Two years ago Northsie Hospital bought the group and they heavily advertise them.

In the end I chose HDR brachytherapy for its superior dose conformity, better cancer control, and less side effects. My med onc said "seeds are last century, HDR is 21st century". I felt RCOG was far too commercial and I had some concerns about some aspects of the practice. With your concern about radiation I suggest you more strongly investigate HDR brachytherapy. There are two excellent centers in Atlanta and I would be happy to provide the information. One I used, I would strongly recommend and I can provide information about another group that a high risk friend used and is very pleased.
Posted 8/18/2013 2:02 PM (GMT 0)
Thanks JNF.  Yes I would like to know the groups and doctors you used for the HDR radiation in Atlanta.

I am travelling to Nashville with my wife tomorrow to meet with Dr Joseph Smith and then have a consult with Dr. Crist at RCOG on Friday.

Thanks also for the info you sent me by Email on positive margins at the Apex after surgery.  I have just added some additional questions to my list when I meet with Dr Smith concerning this issue.  

Thanks again

 

Posted 8/18/2013 2:29 PM (GMT 0)
I agree with JNF re the fact that it's a good idea to investigate HDR brachy as an alternative. However, I respectfully disagree with JNF's doctor's characterization of LDR brachy (as would Dattoli, Chicago Prostate Center, Seattle Prostate Insitute, Grimm, et al, etc). In fact my brachtherapist characterized HDR brachy as "promising but without long term evidence". But I personally would not think to disparage either option. I think there is a place for both protocols and might suggest either depending on the individual patient's circumstances.

And TA, as I'm sure you know,the Lawton study is in conflict with others that show much better results for the IMRT/brachy combo, e.g. Dattoli who shows 89% BCR free results for intermediate patients after 16 years.

My best advice for kdienv is to continue to do what he is doing, i.e. investigate multiple options for his treatment. I know he was originally set on surgery but I continue to think that one of the radiation options might make good sense for his case.

Jim

P. S. I have to smile a bit at the irony of radiation guys semi-debating which radiation protocol might be best in light of the fact that not too many years ago on this site ANY of the radiation options would have been scoffed at.
Posted 8/18/2013 5:07 PM (GMT 0)

Jim said...
And TA, as I'm sure you know,the Lawton study is in conflict with others that show much better results for the IMRT/brachy combo, e.g. Dattoli who shows 89% BCR free results for intermediate patients after 16 years.

My point is that kdeinv is low risk. Combo therapy may be a good idea for high or even debatably for intermediate risk, but is certainly overkill for low risk. Monotherapies, especially the hypofractionated ones (HDR and SBRT), for low risk have better oncological outcomes and certainly lower risk of side effects.

I quite agree that in the hands of artists like Grimm or Taira, LDR brachy does as good as HDR. However, HDR doesn't seem to have as steep a learning curve, but does require some very high-tech equipment and techniques, which was JNF's point. Experience with LDR can help make up for the precision placement one gets with HDR.

- Allen
Posted 8/18/2013 6:10 PM (GMT 0)
Allen....agreed!

Jim
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