Treatment options- SBRT

What are your husbands numbers?

Also at UCLA is the well regarded HDR Brachytherapy program. I'm an alum, four years out.

SBRT mimics the high dose, short duration radiation protocol of HDR Brachytherapy. The track record on HDR is longer (see Demanes and others), but SBRT studies with fairly long term follow up are now available (see King and Katz and others). SBRT is the less invasive choice, but for someone of a relatively young age thinking many years down the road and with your concerns maybe HDR is worth consideration.

Had a phone consult with Dr. King about SBRT. He had my folder. This was around the 8th month mark after diagnosis. Good guy. Never rushed. Familiar with my case. Spoke for 45 minutes. No charge.

After going over different scererios of my case, his parting words to me were, “David, this needs treatment. I don’t care what you do. Just do something soon”. I’ll never forget the emotion in his voice. I think he picked up on, during our conversation, my hesitation to do anything at all.

I believe you are on the right track Leah. And right on time.

Overall the risk of a radiation induced secondary cancer following radiation for PCa is thought to be about the same as the risk of dying from PCa surgery. about 1%. A recent Scandinavian study of more than 350 men found the incidence after 10 years to be just 0.3%. This is much less than the incidence of dying from PCa surgery.

With the modern technology the risk is so low as to not be seriously considered. Plus it takes many years for the very rare case to show up. A secondary cancer to surrounding areas like the bowel or bladder within 10 years would not be caused by the initial radiation.

Leah,

I think a lot of guys in here (me included) would have done SBRT if it had been available and had a longer track record--which it now has. SBRT is certainly a mainstream treatment nowadays, and I don't know of anyone on this forum who went that route who is unhappy with their outcome.

I've heard great things about Dr. King, most recently at an Orange County support group meeting, so you're certainly in the best hands. Can't comment about post-radiation cancer susceptibility, but you might discuss Radiation Fibrosis Syndrome. I have no stats about it, and given the shorter duration of SBRT it might not be as much of an issue, but it doin't hoit to ask.

Best of luck to both of you!

Who knows what will come in 10-20-30 years but we do know what comes along right now as SE's

SBRT is a GREAT option. I am almost 71 and was 69 when I had SBRT. Yes, I have a few minor SE's but all of the important stuff still works. I get erections that are usable, I can pee when I want to or not pee when I don't want to. I have taken several different drugs for short term increased SE's but was then able to put them aside.

At your husbands age, be very thoughtful and consider the SE's. He has some options, thoroughly investigate them and choose based upon today not 30 years from now.

Roger

Did you have your consult with Dr Scholz yet? (And in the event that you haven't and you're going to be there tomorrow in the am, I will say hello since I'm having my six-month follow-up with Dr. Lam...)

SBRT causing secondary cancers?

I don't think this is a question we will know the answer to during our typical lifespans. There just hasn't been enough (any?) qualified research to give us an answer yet, and by the time SBRT is "old" enough to have the data, there will be several newer treatments to consider. I think we all need to make the best decisions we can with the information available, and I think you're doing an admirable job of that so far.

That's exactly the same way I started seeing Dr Lam...he had an opening sooner. And over the years, I've developed the best relationship with him that I've had with any doctor. I know you've also seen Dr King at UCLA, who's also fantastic. You've assembled a very good team!

Leah77 said...

One of the main concerns we have is the risk of secondary malignancy from the radiation- 10, 20 or even 30 years from now. My husband is young... in his mid 40's.
Dr. King did not seem to have a very solid answer to that question. Otherwise, SBRT sounds like it would be a no brainer as a treatment option over the RALP...

Secondary is a concern, but a minor one. That's why Dr. King, who is as good as you'll find, had no solid answer. No one does, and any %'s you hear or read are just wishful dreaming. Every treatment has some risk. I wish I could have had SBRT, and from King. It is an excellent choice, with no absolute lifetime guarantees...about anything.

Just do it.....

JNF...sorry to interject my contact into this post thread.Im new on this site and not too skilled at how to contact other members. I had recently posted my situation and one of the replies i received suggested that i contact you because you are apparently from the Atlanta area and i live in Gainesville, Georgia. I have had PC since July ,2015 and have been on AS since then.I have been seeing a Urol at Emory since mid 2016. Due to my PSA continuing to rise to over 10 he has finally recommended i start radiation therapy.He turned me over to one of his Rad Oncs who went over my case in detail and recommended EBRT..28 sessions I told him i was leaning toward SBRT if i start any kind of treatment...I am 79 and may well not start treatment, but im at a point where i want/need to make a more definite decision since He said he didnt rec SBRT but didnt give me any reason that made sense. I think he recommended what he does. Ironically, back in Dec 2017 i met with another Emory RO who recommended SBRT in my case. he is now in the Proton Therapy Ctr or i might go and see him.
Anyway i am scheduled for a fusion target biopsy in mid April.That was at my suggestion, not my Urol's. I had a 2nd op from Natl Cancer Inst of my last MRI and the reviewer who is highly regarded did NOT find a PIRADS 5 new lesion which had never shown up on any of the 3 prior Multi Par MRIs. I asked my Urol about that and he said his reviewers are as good as the NCI guy. So I am trying to get an Oncotype PC Assay before the biopsy date to see what it indicates and then decide whether or not to proceed with the biopsy or not. I definitely wont decide to staRT treatment without the biopsy and the genomic test . May even get a 2nd from JH of the biopsy like i did initially with my 2 random biopsies.
I am starting to look for a new Urol and Rad Onc...preferably people who concentrate on PC. Do you know of any you would recommend? I have looked all over the internet and found 3 or 4 ROs who specialize in SBRT. There is a doc named Chad Leavitt at Piedmont who seems heavily experienced. I just plan to move away from Emory handling my case as i have been underwhelmed with how it has been handled so far. Thank you for any helpful recs you can provide.