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Posted 8/14/2013 2:07 PM (GMT 0)
sure, understood. And even with top guys and everything else going for you (age, health etc) ther ear estill no guarantees. But that said, there are top guys all over the country and it does help to stack the odds in your own favor when selecting a practitioner, regardless of discipline, who is an expert and who works in a major center of excellence. Unfortunately this sometimes requires travel time which can be a drag, but in my opinion, well worth the "one shot" we have.
Posted 8/14/2013 2:17 PM (GMT 0)
I agree. If the surgeon is in your insurance network and/or you can afford it, by all means choose a top gun.

But many guys don't have that luxury. I could have myself chosen Dr. Patel in Florida as he was in my insurance network. Florida's distance from me was my X factor, so I chose a surgeon 2 hours away.

But none the less, there are many factors in choosing a doctor right for you.
Posted 8/15/2013 11:58 PM (GMT 0)
Update:  Thank you all for your quick and VERY informative advise and posting.  Night before last I attended a Prostate Cancer support group at my local hospital.  Told my story and shared my results and numbers.  I was surprised to find out 4 of the 12 attendees had their treatment at Loma Linda although they we older in age and Medicare covered the procedure.  I think age factor had played a part because no one there had had the robotic procedure performed.  All other were treated with the different radiation methods.

It was a clear vote as with this site.  SLOW DOWN and get a second opinion.  I was referred and have faxed all my forms and release paper work out to a service called "thesecondopinion" located in San Francisco.  They have a web site.  I will follow up with them and also make sure my slides are read again.  I had to laugh, of course I let the wife call and cancel my surgery and the nurse was extremely rude and said "well when is he going to have the surgery done I need to put a date down".  After being told I was researching and such she again and again asked to which my wife said he will get back with you.  Good  Lord.

Anyway Thanks again for all the replies and please keep em coming if you haven't posted or think of something else.  I certainly will keep you all informed and believe me won't hesitate a minute to post a question here.

Ric

Posted 8/16/2013 12:18 AM (GMT 0)
REDOC, last year I had a surgery date scheduled since I was trying to fit into a busy hospital schedule and I didn't feel comfortable waiting. But as I researched I was having second thoughts about going the surgery route for my particular diagnosis and I was stressing about being a late cancellation. The folks here did a wonderful job of talking me out of my guilt (I'm a catholic school graduate and feel guilty for pretty much everything) and putting things in perspective.

I felt so much better afterwards and it sounds like you feel the same. Even if you continue to go with surgery, you'll be better prepared and informed, which can only help you. Best of luck and let us help with any additional questions and concerns.

Michael
Posted 8/17/2013 3:14 AM (GMT 0)
Thanx for the reply.  Yes I was thinking the same about the late cancellation but then we are talking about (1) a major (some say not) surgery and (2) It is us they will be performing it on.  I'll keep burning up my printer and reading excellent forums like this.  Who knows might still go that way but not at the moment.  The man upstairs might even have changed my mind and told me to slow down at do some research.

Thank You again and Gold Bless.

Ric

Posted 8/17/2013 10:50 AM (GMT 0)
Ric, I applaud your courage to cancel. Yes, this is a big deal and you want to be confident. Keep doing your homework and you will know when and what is right.

Jim
Posted 9/4/2013 2:09 AM (GMT 0)

UPDATE:

I met with a Radiation Oncologist this week from South Sacramento Cancer Center and have decided (or at least for now) to go with RapidArc Therapy.  Kaiser will not cover the Loma Linda Proton Therapy but they will cover this Non-Kaiser Provider.  Sooo I thinking this is about as close as it gets.  I have chosen not to have the "Golden Seeds" placement as he was pretty convincing that they can pretty much zero in on the area every treatment without having them put in.

Any thoughts out there?  Seems less evasive then surgery and the success rate I've been reading about seem very high and low side effects.  Well back to reading.

Any thoughts folks??

Posted 9/4/2013 5:00 AM (GMT 0)
I am so glad you're getting out there and talking to specialists. UCDavis does CyberKnife - I suggest you check it out - 5 treatments and you're done. They will place fiducials though.

What does the RO intend to use to track your prostate motion if he is not using fiducials? Some use an intrarectal balloon to stabilize it. Tomotherapy automatically tracks with wasted X-rays. Any system that doesn't immobilize the prostate or track its motion (called "image guidance" or IGRT) is going to give you extra toxicity=side effects - rectal, urinary and sexual. Ideally, you want to track motion both between treatments and during the treatments.
Posted 9/4/2013 5:30 AM (GMT 0)
I think but I will check if I did not want the "tracing" seeds they do a CT-scan prior to each treatment.  I was told most men with my low numbers choose this procedure with the CT-scan with no or minimal side affects.  And they use a On-Board Imager or something? 

Thanks, Ric

Posted 9/4/2013 5:35 AM (GMT 0)
There are always side effects to any treatment. However, side effects are minimized when motion is tracked. That way they can irradiate the prostate and nothing else. I was treated on a RapidArc machine, but I did have the fiducials placed. Why would you not want the fiducials (the tracing seeds)?
Posted 9/4/2013 11:05 AM (GMT 0)
I don' t know anything about 'golden seeds' or 'tracing seeds', but I do carry around the 'permanent seeds' from my ldr brachy. I could not be happier with both the results of this treatment and the very minimal side effects.
Posted 9/4/2013 11:22 AM (GMT 0)
The gold seeds used as locating markers ("fiducial markers") are no big deal. They're inactive, they carry no radiation. Implanting them was like a biopsy with only 3 pokes, very easy. Typical minor side effects, and same risks of a biopsy I suppose. Once placed, you'll never know you have them.

The best part about having them is that the x-ray machine's on-board imager takes 2 quick low-dose x-rays to let the technicians line you up accurately. It accounts for movement of the prostate from day to day, and lets them use smaller exposure margins. It's also a good deal faster than lining people up through images. I had many days when my treatment was delayed by prior patients for that reason; they struggled to locate on tumors with imaging. My RapidArc sessions ran like clockwork, ten minutes from start to finish every time.

If you select primary radiation therapy with a machine like the Varian Trilogy with RapidArc, it seems to me completely worth it to have these fiducial markers implanted.
Posted 9/4/2013 3:46 PM (GMT 0)
While I'm one of the less technical guys here, it sure makes sense to have them IMO. They spent about 10 minutes each session lining me up with those to make sure everything went properly. That's my non-medical professional two cents.

PS When I started my IMRT they didn't mention the fiducial markers, so I asked when they would be implanted. Turns out they did during my brachy, so I was never aware of it being done.
Posted 9/4/2013 10:54 PM (GMT 0)
Hey Redwing57  (like that name being a Redwings Fan)

"The best part about having them is that the x-ray machine's on-board imager takes 2 quick low-dose x-rays to let the technicians line you up accurately."  I thought that was what the CT scan did prior to treatment?  The seeds were just an extra step that the used back before they had the "newest" technology to pin point the prostate.  The Dr. just told me is the use the CT the seed plant was a over kill.  Do it if you want to but he saw no reason for it.  ????????  Back to the web for more research I guess.  Any more thoughts on this.  I go back Monday and will drill em more then.

"No biggy kinda like a biopsy"  That S.B. was no fun.

Thanxs All / Still Reading

Ric

Posted 9/5/2013 3:01 AM (GMT 0)
4D IG-IMRT DART, no markers needed, supposed to adjust in real time to changes in prostate positioning due to movement, by computer generated imaging. I was told the gold markers are older technology.
As far as your treatment decision, take your time, get other consultations. do not jump in for expediency. There is no going back once you have treatment. All have risks, some permanent
Posted 9/5/2013 3:16 AM (GMT 0)
Thanx Fauntleroy.  Was thinking around those lines.  But will make sure Monday when I go for a appointment.  Errr Monday after a Lions game....won't be in  a real good mood or probably feeling that great...........

Thanks Again will post Monday..........

Posted 9/5/2013 3:21 AM (GMT 0)
Isn't that just the EXACT couch positioning system? I had both that and the cone beam CTs at the start of each treatment. But the fiducials (or RF transponders) are necessary to track the motion within each treatment. I'm thinking that that RO's feeling is that RapidArc is so fast that not a lot of motion can occur during the treatment. With IMRT and only 2 Gy per fraction, he may be right that intrafractional motion is less important. With SBRT and up to 8 Gy per fraction, it is critical.
Posted 9/5/2013 3:34 AM (GMT 0)
Thanks Tall Allen.  I printed your comments out also.  Going to have a lot of questions and clarification come Monday.
Posted 9/5/2013 4:31 AM (GMT 0)
You have not mentioned whether you get your Kaiser insurance through your employer.

If so, you may want to load up on a premium plan during open enrollment that does not require evidence of insurability, and thereby have even better insurance coverage, or even switch your group insurance carrier to someone who does pay for thee procedure you decide on.

If I read it correctly, it's the proton therapy that Kaiser is not covering but other options are covered by Kaiser. So there may be no need to switch carriers but you can still go with a higher end plan.

I applaud you for slowing down.

If I were lucky enough to have your metrics, I would choose either proactive surveillance or short term hormonal therapy in order to defer it until after the wedding in February so as to have minimal side effects for the big event.

Good luck whatever you decide.

LupronJim
Posted 9/5/2013 11:38 AM (GMT 0)
REDOC, I hear ya about the biopsies, they aren't any fun. Placing the fiducial markers was just less bad I guess. People's tolerance seems to vary a lot for those procedures.

Fauntleroy, I'm not familiar with the tech you mention. It sounds interesting, and may be good, but I'd do some research on it first.

I had a CT scan on the machine with its onboard imager just once a week. They did it to check my internal geometry to make sure it was still within tolerances for the treatment plan (mainly verifying bladder filling, bowel condition, prostate size). So, I suspect it can do a decent job of seeing internal soft tissues.

The fiducial markers let them use simple, quick x-rays to locate the prostate. They charged the insurance extra for every CT scan, and it took somewhat longer than the targeting x-rays did. The radiation technicians that do the actual test, alignment, and delivery are capable people, but it seems pretty foolproof for them to just get the dots on the targets. Aligning to a fuzzy image seems significantly more difficult, but they probably have good software to help with that.

Another consideration might be how much additional radiation a CT scan delivers compared to simple targeting x-rays. Of course, during treatments the machine delivers ferocious amounts of x-rays to the target tissues, but imaging exposes the entire pelvic area. The doses for imaging are probably pretty low anyway, just don't know.

Much to consider....

Oh, and go Redwings!! We lived in southeast Michigan for over 30 years, and our son was on the Joe Louis Arena video team for the home games. So, we're big fans :)
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