MRI guided SBRT

Are the MRI guided SBRT treatment devices (as opposed to those with CT and need for markers) such as 'Viewray' , worth the inconvenience and cost of travelling out of state for a few weeks to centers that carry them? I know RO's experience is critical, but let's assume same level of RO expertise. I am GS(3+4) and been told one treatment method is with SBRT.

Chad…Although I can’t comment on the effectiveness of CT guided; the placement of the markers was no big deal. If you have SpaceOAR the markers are typically placed at the same time. I would favor going with the best practitioner and team you can find.

We live about 2.5 hours travel time from Cleveland Clinic where I was treated and all of my followup has been by virtual visit. I find it very effective and efficient. Keep us posted on your experience. Terry

Chad…At the time of my treatment Cleveland Clinic used an endorectal balloon at simulation and for each fraction treatment. The idea was the balloon thinned the rectum wall and pinned the prostate into a fixed position. The thinner wall limited radiation damage according to CCI. I understand that recently SpaceOAR is more common. Also, it appears slightly higher volumes of radiation maybe given today. It’s a balance between eliminating the cancer while limiting side effects.

When my wife and I had our sit down with the SBRT team at CCI we were so impressed and at ease that all the treatment details were left up to the professionals. As we went through the treatment process we came to realize it really was a team effort. I did ask about SpaceOAR and they said their experience was limited at that time and we simply went with the balloon. I had no bowel issues prior, during or following treatment. The urinary issues were mild and very temporary.

I have a friend diagnosed at the same time I was. Our diagnosis was similar and very low risk. He elected AS while I elected aggressive treatment. My friends PSA continued to climb and finally one of his subsequent biopsies showed some pattern 4 and he followed his urologist’s recommendation and had his prostate removed. The pathology results suggested both ADT and radiation. He tolerated the ADT well; however, his urinary function and climacturia have been significant since and two weeks ago he had an AUS installed. I know that a lot of guys do very well following surgery and many of them contribute to this site; however, we also become biased based on our own experiences. I know I have a bias towards RT and it maybe since I’ve had a good results while a friend has had poor results from his choice. Following treatment we’re each only data points of one. I just wish more recently diagnosed men would make informed choices and explore the treatment options. I applaud you for doing that.

Thanks for all the responses. I have another issue I have come across that have casted doubt on the suitability of radiation (specifically SBRT) for me. A couple of ROs I have talked to a couple of weeks ago, tell me that because of my 'Moderate' existing urinary symptoms (IPSS score 15)', I have to be careful about LT radiation effect, especially SBRT. If anything, they recommend IMRT 28 sessions. I have a weak flow and urgency which I hope to be addressed as part of a treatment, if possible. The ROs say I should not rule out surgery as it may better relieve my moderate urinary symptoms, that is if prostate related. Surgery may have the added benefit of the surgeon fixing any bladder neck or urethra obstruction that could be the result of the weak urinary flow. Their argument is my best LT (2+ years out) outcome as far as urinary symptom relief would be a bit better that a return to baseline before the treatment with worsened short term symptoms. I may even have a 10%-20% chance of 'permanent' worsening of symptom. I am not taking any alpha blockers but I think most radiation patients start on those as well and it could be effective.
So, in short I am still undecided and think may be surgery will work better in terms of simultaneous LUTS relief as well.