No SBRT at Stanford

Well, I can't offer too many specifics, as I am in Illinois, but SBRT is "alive and well, nearing mainstream use" here. No insurance issues at all for me.

I know we have had a number of California members who have had SBRT, some going back even 5 or 6 years, and I haven't heard of much in the way of insurance issues. There have also been a few G7 members (myself, included) who have had SBRT. Lots of G6, and even some higher grades were treated under a few clinical trials. Tall Allen, himself an SBRT patient, can probably fill in names and studies for you to review.

I also found that many doctors prefer to offer what they "do" and downplay alternatives, and we have to be good at ferreting out the full story so we can make our own decisions.

Both SBRT and HDRBT are very effective with little side effects. There is no information to show that one is any better then the other. I had HDRBT more than 6 years ago and am glad I did.

Your quest for a great practitioner is the most important element in my opinion. If you find a great HDRBT situation I would take that over a less experienced SBRT practitioner and vice versa.

I wouldn't shy away from the HDRBT doc with 400 procedures in the last 4 years. I would learn more about the situation. Is he using HDRBT for treatments other than PCA? If so, how many HDRBT procedures has he done in all? What other work are they doing? How is the center rated? Remember the most experienced HDRBT doc, Jeffrey Demanes, has performed HDRBT procedures for several different cancers; PCa being just more than half of the total. Some of the other HDRBT work that is done is just as tricky as PCa can be so look at the totality of the practice, not just the PCa work.

Regarding insurance reimbursement, simply inquire with your insurer. All their covered procedures are written in their manual and is available to you.

I guess that when Dr King left Stanford he took his SBRT expertise with him. Dr Bouy moved from Fox Chase a few years ago where he did seeds. I'm sure Gottschalk can do a good job for you. Kaiser N Ca offers it too, I hear. If you want HDR, I'd go to UCSF for that too - they've been doing it much longer. It may take a couple of tries, but almost all insurance covers it these days. I had no problem 7 years ago on my Anthem Blue Cross plan. But the ways of insurance companies are dark and mysterious.

I contacted UCSF two weeks ago to schedule an appointment with Dr. Gottschalk. They entered me into their database and have received all my records from Stanford. I've yet to receive an appointment even after I called them last Friday. Does anyone know if it typically takes UCSF this long to schedule new patients consults? I'm getting a little stressed since it's been about 2 months since my Dx. Maybe I should call Dr. King at UCLA. What do you guys think?

I finally had my consultation with Dr. Gottschalk at UCSF yesterday. He's very knowledgeable and really took the time to explain and answer all my questions. He started the SBRT program at UCSF in 2003 and has performed over 400 prostate procedures, although he indicated that he had lost track of the exact number. His SBRT treatment plan consists of 4 visits (every other day), delivering 9.5Gy each visit, which he said was designed to mimic HDRB. He is familiar with the insurance issue with SBRT and indicated that most insurance plans would not cover SBRT with patient having GS7 or more than 4 positive cores. He also said that one way to get around the insurance issue was to do a 12 day (consecutive days) treatment plan delivering 4.3Gy each day, which he could code as IMRT, which most insurance plans cover. Has anyone, particularly Tall Allen, ever heard of this 12 day SBRT treatment plan? I don't think I would want to deal with the inconveniences that come with SBRT over 12 consecutive days but just wondering if anyone has heard of it? He says he's done it about 12 times.

One question for those who have had SBRT, does the radiation leave any scarring on the skin where it enters the body? Perhaps my ignorance leads me to think of it as similar to a laser beam.

Thanks as always for your feedback and advice.

I suggest you go through the process of trying to get insurance approval first. It hasn't been a problem for the many men in my support groups in Southern California. Hypofractionated IMRT outcomes have been very good.

johncc,
I finished SBRT/CyberKnife at Winthrop Hospital's NYC location on 26 May 2017.
5 days. Zero side effects. Absolutely no scaring of skin.

Because I was Gleason 9, Winthrop thought my traditional Medicare Insurance would not pay and required me to pay them $5000 in advance. Medicare has actually paid and once all the medical bills have been processed by the system, I might get that money back.

Apotter said...
My husband is doing AS for his Gleason 6 for now but if he ever gets to a 7 in future biopsies he will do SBRT at Mayo in Phoenix. After doing our due diligence with urology and RO's that is the recommendation we got from MAYO...we met with a Dr Vargas who was amazing in talking us through all that is out there..

Hi Apotter, I have been on AS for eight years, and have the same inclination to go with SBRT if treatment is ever indicated. My threshold for what it would take for me to move off AS seems to increase with time, as the years roll on, and I read more and more posts from men unhappy with their awful side effects from treatment (usually surgery).

Can you add a signature with your husband's clinical history? That is very helpful for members when they respond to you.

Your original comment makes no sense as Stanford advertises on their website

https://stanfordhealthcare.org/medical-clinics/radiation-oncology.html

that they perform Cyberknife surgery and are among the leaders in doing so. Cyberknife is just another name for SBRT. Perhaps this is where the miscommunication happened. Either that or you ended up with a doctor that didn't properly refer you over to the other doctors at Stanford that perform this function.

Still seems odd, though, as if you look at Dr. Buyyounouski 's scholarly articles
http://scholar.google.com/citations?user=mjDKAAoAAAAJ&hl=en
it includes at least three where he has done clinical studies on the use of SBRT.

Post Edited (GaryLK) : 9/7/2017 1:32:33 PM (GMT-6)