recommendations for SF Bay Area SRT / ADT

Dr. roach is among the best. I have heard him speak at seminars and he is leading edge. If you are choosing insurance, I assume you are on an individual plan and have to choose provider networks, correct? Timing of treatment will be important for deductible and co-pay reasons. I suggest you get as much of the treatment as possible within one calendar year, probably 2021.

As to the treatment, SRT is external beam radiation that usually uses photon based IMRT. Doseage is generally in the 65-70 gy range and takes 40 or so fractions, one fraction a day five days each week. So about two and a half months. The RO will determine whether the pelvic lymph nodes are radiated.

As to the ADT, the main drug will be an antagonist like Lupron, Eligard or Firmagon. These act to turn off the gonadal production of testosterone, which feeds the cancer. These are done by injection and are time released and can choose from one month to six month effectiveness. Often, the first shot starts a month before the radiation to make the PCa more radio sensitive. It will have to be determined whether you need ADT just for the radiation or a little longer. Often this is 6-9 months, but can go longer based on your risk assessment.

You may also have some scans to look for where the cancer might be. If it is found outside the radiation zone, then you may not even have radiation as it won’t be curative. So, it all starts with an assessment by a top RO that is a specialist in salvage treatment.

Jeff - Your PSA is still pretty low at 0.018, may be a while. I think you will find that there a number of good facilities near you using the same equipment and their RO’s went to the same schools. You can still go to UCF for evaluation and recommendations but select a center that is closer for the actual treatments. Stanford is fine I am sure.

From my experience, ART/SRT is a big time waster for 10 minute treatments over 35-40 days. I chose a center 15 minutes from my house vs. traveling 1.5 hours to Mayo then back 1.5 hours. My RO was trained at Mayo so never felt I was lacking for expertise and the technicians were great. Just parked in the lot and walked in and waited my turn. Then went to Home Depot or food store afterwards to continues my errands and life in general. Some people feel differently though.

Can’t help much with private insurance in CA, the price of 35-40 treatments is huge ($50K?) so good insurance is very helpful unless you have lots of money. High deductible plans may make some sense. You know the places where you want to go so try to get coverage that includes as many as you can and keep the drive reasonable.

ps: Mack Roach went to medical school at Stanford and did a residency there from what I just read. Small world.