New club member...i think. From Diagnosis to SBRT.

E.noont,
At the time of my treatment SpaceOAR was still a pretty new idea and the data suggested it might not be worth the expense. Two years ago Cleveland Clinic (CCI) had only done a relatively few trials with it although I believe CCI uses SpaceOAR routinely today. The normal protocol of an endorectal balloon was used for me. It’s my layman’s understanding that the balloon has two purposes. One is to use it to fix the position of the prostate and the second is to thin the rectal wall allowing the radiation to pass through with less damage. It seems intuitive to me that SpaceOAR can help fix the position of the prostate while moving the rectum out of the radiation field. The balloon was used during simulation as well as each of the five fractions. I did have a catheter during simulation but not during the radiation fractions. I did maintain a full bladder during treatments. SBRT due to the higher doses of radiation with each fraction must be more precisely delivered than EBRT (conventional beam radiation) to avoid collateral damage to other organs. Possibly like comparing smart bombs to carpet bombing. Smart bombs don’t fly if the weather is not perfect.

My urologist was ready to schedule an open RP following my biopsy even though I only had a small mount of Gleason 6 in three of twelve cores. I credit this forum, the people on it, and the Dr.’s at CCI for providing me with information to make a better informed decision. My biopsy results suggested I was a good candidate for AI and I strongly considered that. However, with three total joint replacements I did not wish to incur the infection risks on my new joints of repeating biopsies. The Partin tables data showed that my cancer was very likely fully contained and that any RT would be equally curative. I liked EBRT over BT since I didn’t want to limit contact with my grandchildren. The metropolitan Pittsburgh area does not have anyone currently doing SBRT for PCa; however, Cleveland Clinic does routinely do it. So off to Cleveland we went and it proved an excellent fit and choice.

My treatment and side effects so far have been unremarkable. I was able to maintain my normal routine including aggressive spinning (cycling) classes, lap swimming etc. I did have some mild burning when urinating following my third fraction that lasted about 7-10 days. Although I did have a script for Flowmax I didn’t take it since it was never an issue and it resolved. I never had any issues with bowel or sexual function during or following treatment. I did have a PSA bounce that was a little unnerving; but, my RA says at this point following RT it happens to 25-30% of guys and not an issue. Allen Edel’s site has information also suggesting bounces are good. So far so good. I wish you the same.

Hello e.noont - you sound like you are headed in the right direction. My husband had SBRT at a similar age as you with very similar biopsy reports and was and still is a health/exercise nut. All things went well. You are in good hands. Best of luck.

Somehow, I missed this thread before today. Just read it from start until now.

I’ve participated in many forums over several years, and think that this is one of, if not THE, most thorough, intelligent, and supportive threads on the journey to a treatment decision.

Best wishes to e.noont for continued good health, and thanks to all those who counseled him.

I just had my first post-SBRT PSA test on Monday, and then a visit to the RO yesterday. My last PSA in July, before treatment started in August, was 4.77. Yesterday's result was 1.48. The staff and I were jokingly making bets at the blood draw on Monday as to what the new number would be, and I was just hoping for about a 2.5. None of us guessed it would be below 2.0. I've read that a slow PSA decline is usually associated with a better long-term "non-recurrence" outcome, but my RO says that this has not been his experience and he is extremely pleased with these initial results. He's even had one patient that dropped from 16 to less than 1 at the three-month mark. The DRE check indicates that the SpaceOAR is completely dissolved/absorbed and the prostate feels "rock solid normal," whatever that means. My only side effect so far is about a 50 percent reduction in ejaculate. The RO says that 100 percent of his PC patients experience about that same level of reduced ejaculate. His expectations are that I should reach nadir at about 30 months and we're looking to go below 0.5. A quarter of his patients experience bounce at around 18 months, which I guess is a common timeline for prostate/PSA bounce. Well, the next test is early March. Hopefully it continues a trend downward.

As stated before, I offer this summary of my experience to give others an idea of just one of the many ways to manage this disease. I hope it's helpful.

Great report!

I received my six month post-SBRT PSA results today and I'm now at 1.14. It was good to have a second result that establishes a downward trend. I check in with the URO on Monday. Should be a short visit. Other than reduced ejaculate, still no side effects. Is it too much to hope for a 0.? number at the nine month mark?

I agree with ASAdvocate this is a great thread and has a lot of excellent information regarding SBRT as an alternative to surgery for low risk guys who seek treatment and have no urinary issues. Just to add my two cents as someone on another forum noted I maybe the poster child for PSA bounce. My last PSA was 0.3 and I maybe through the bounce phase. Everything continues to work w/o an issue.

👍👍👍 I agree with your RO's advice to keep on keeping on.

Well, I had my 18 month PSA test this past week and it was 0.94, which is up from my 12 month test of 0.77.
I have my annual visit with the URO next week and don't expect much as my urinary and bowel functions are normal. I'm actually not surprised with the bounce since I feel that my levels dropped pretty fast during the first twelve months. My RO says that about 25% of his patients bounce and I'm right at that post-treatment timeline for it to start. I can remember Tall Allen saying to "embrace the bounce" as it's usually associated with lower levels of recurrence down the line.

I'm now two years out from completion of SBRT for my 3+4 prostate cancer. I had a blood draw yesterday and this morning in my patient portal I learned that my PSA is now down to 0.68.

I have had absolutely no side effects from the radiation. All body functions normal and in good working order.

Since my original post describing my PC journey has had over 12,000 views, I'll continue to update my journey on the forum.

This past week was my 30 month post-SBRT visit with my Uro. PSA is now at 0.53. A digital exam was performed and the Uro described my prostate as "flat". I'm still enjoying no side effects from the treatment and the doctor feels I've probably reached nadir.

This forum and its participants has been an incredible aid in helping me along this journey.

E. Thanks for posting your journey since I believe it helps others who maybe just starting on their own journey. SBRT is safe, effective, and convenient compared to most other treatments. My treatment actually turned out to save my insurance provided $10K less than IMRT. One size doesn’t fit all for PCa; however, most low and intermediate risk would benefit from at least investigating SBRT. Terry

Nicely done! Keep on going and thanks for sharing since I think it's important for new guys to hear how many of us doing really well.