New Member is Western PA. Comsidering SBRT. Looking for info, recommendations, alternatives.

Newly diagnosed in Western PA. The major medical provider in Pittsburgh appears to have SBRT available; however, I don't find any recent posts concerning that treatment option on HW. SBRT therapy appears to be used mostly on upper body and lung cancers in our area. My Urologist suggested I would do well with AS, RP, EBRT, or SEEDS. He had no knowledge of SBRT or HDBT. SBRT appears to be a better choice for my wife and I. I'm hoping that some members of HW can provide a local recommendation.

Gave your thread a title to help members with information find your questions. Welcome to the forum! -- PeterDisAbelard, Moderator

Post Edited By Moderator (PeterDisAbelard.) : 3/8/2017 9:52:16 AM (GMT-7)

Welcome Terry,

SBRT can be a great treatment direction and we have several men on the forum who have successfully used it. Of note is TallAllen who used SBRT more than six years ago. I am sure he will add to the conversation and can share published long term treatment results.

Next step is to go speak with the radiation oncologists in each of the treatment specialties; including brachytherapy ( both seeds and High Dose Rate), SBRT, and external beam. Few radiation oncologists do all of these so you will need multiple meetings. You urologist is not the spokesperson for other specialties. You must see the radiation oncologists.

As you can see from my signature I used HDR Brachytherapy and have done wonderfully. For excellent information on HDR I direct you to www.cetmc.com. This is the website of Fr. Jeffrey Demanes, the "father" of HDR having used it since 1981. He is also the head of the department at the UCLA Medical Center.

Let us know all your questions. And another suggestion is to review the "sticky" thread at the top of the page providing information for the newly diagnosed. I also urge you to have a second opinion of your biopsy slides read by either Bostwick Labs or Epstein at Johns Hopkins. They are the only true PCa slide specialists.

The machine or Platform isn't specific to the cancer. Look for Radiation Oncologists and clinics by using Google to search an area or City and Prostate Cancer treatment. You should find urologists, radiation oncologists, clinics, hospitals etc. then you can drill down from there. You urologist should have referrals as well.using the area.

If you are on traditional Medicare and a Supplement then you do not have any network issue with Cleveland Clinic. If you use a Medicare Advantage Plan simply call the service number on your membership card and you can get an answer in minutes. They can also provide you with the specific providers in your network for you to consider.

Terry - I also suggest that you look into the centers listed on AccuRay's CyberKnife site. While the listings may not tell you which centers are using the CK for prostate cancer, a call to each will tell. It is also possible that if you call the first, they may know which of all the others are using CK for prostate cancer.

As a patient, I can tell you a bit about CyberKnife. I can't say much about my specific results, as I just completed my treatment in late November 2016. I go for my first "official" PSA test and consult in early April. I can tell you that my pathology was just a hair worse than yours (3 cores G3+3, 1 core G3+4) and by early January (about 5 weeks after treatment) my PSA had already dropped from 5.7 down to 4.7. I made it through the treatment just fine, with some intestinal after-effects still, though.

I won't go deeply into the experience until you find out if SBRT is an option for you. It is convenient (5 treatments over a 2-week period). Treatment is painless. Some of the prep procedures are a bit uncomfortable, but these are only performed one time. After-effects will vary for each patient. Mine are related to another condition I have, so you may never have any side or after effects.

I think SBRT could be a good option for you but I have to ask. . . with only a couple of cores of G3+3=6, do you really have to rush into active treatment? You may qualify for one of the active surveillance programs and be able to put off treatment and side effects for a long time.

Not close to Western PA, but you can come to the 'swamp' for highly experienced SBRT/CyberKnife treatment at Georgetown U Hospital. (see my signature for some background).

PS: It looks like you are a good candidate for Active Surveillance...

Hello Terry.
Just this past Monday, Cleveland Clinic opened their new Taussig Cancer Center (400,000 sq ft., $300MM). I know from experience that UPMC and CC don't like each other in terms of insurance plans, so I wish luck with that. Their radiation doctors are very smart people and easy to talk to. They consult as a group and seem to know what each is up to...comforting and impressive. With the new construction comes another Varian machine to perform, among other things, SBRT for PCa. A new 6 degree comfort couch is attached which had the doctors giddy with anticipation. Beyond that, this May, they will be doing the SBRT procedure with an attached ultrasound (parineal). The theory here is to eliminate the need to implant markers for the desired accuracy. Dr.s Stephans has done ~120 SBRTs. Dr. Tendelkar has done about 30. They have three physisists who have been there since they began SBRT. Jay Ciezki is their LDRBT guy. I would recommend you speak with him if you go there (jaw dropping intelligence). Terry, FWIW, your numbers are good and I just know your going to be well!

Sheepguy, excellent point about the need for expertise and experience of our practitioners. This goes for all the various procedures we seek as patients.

SBRT is essentially IMRT/IGRT but using fewer but more intense radiation fractions. With both methods accuracy of the radiation delivery is paramount. But it is with most all external beam radiation methods in all parts of the body. The prostate is difficult as it is surrounded by other organs that prefer not to be radiated.

And as you point out, just having the machine is not enough. You must have the doctors and technical staff that have the experience and expertise to use it properly and draw patients to the facility.

Terry, you fortunately have a lot of effective radiation treatment options. All present excellent cancer control with very little side effects for most men.

I would be basing my choice on the practitioners' expertise and experience. For example, I am biased toward HDR brachytherapy. But if my choice was between a HDRBT team that has done 30 versus a permanent seed team that has done 1,000 I would be likely use the seeds.

Same with IMRT versus SBRT. However, I am sure that at a place like CC that the people doing the SBRT already have thousands of IMRT experiences. And the two are similar in delivery requirements. So with what you are saying I might be more in line with IMRT at UPMC, but would be very confident with SBRT at CC.