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are gold fiducial markers and absolute necessity? protons

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Prostate Cancer
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Posted 2/4/2013 1:56 PM (GMT 0)
I was told they were!!! by chief of staff Loma Linda Hospital. He is a friend of a family friend.
He said the prostate can move 1/2 inch. the new IMRT/calypso programs lock onto the markers and move. and on another not it Appears the Proton treatment centers are adapting the Trimodal appraoch because of the increased percentage delay in psa. Most doctors I talk to are down on Proton? Probably its not what we do syndrome. most surgeons are down on anything else but cut it out. In fact they want to cut on an 80 year old friend??? no scrupples or compassion? My neighbor just had the early IMRT 20 years ago!!! he is amazing but uses flow max and has not had to resort to self cath! I am so upset I can't read anymore and My weight is plummeting. can't eat either, hey maybe cake and ice cream? so much for diabitus??? also the chief of staff and he was/is a urologist of fame in san diego. said seeds are just unnecessary with IMRT?? His name is Doctor Rich Conner. look him up.
Posted 2/4/2013 2:38 PM (GMT 0)
Berdoo,

Breyer's Carb Smart ice cream. It's mostly sweetened with sugar alcohols and has only 8g of carbs per cup.

To a man with a hammer the world looks like a nail. Surgeons recommend surgery; radiological oncologists push radiation; brachytherapists agitate for seeds. To some extent this may be self-interest -- trying to drum up business to make money -- but when they get prostate cancer the surgeons tend to seek surgery, radio oncologists seek radiation, and so forth. It fairer, I think, to call them all enthusiasts for their specialties. They have their biases. You have to make allowances.

I am sure there are other people here who can offer more details but here is my thought about the role of IMRT in a trimodal therapy. The treatment of the prostate itself is mostly the job of the seeds. The external beam radiation is to get anything that may have escaped locally into the surrounding tissues (the prostate bed). There are certain places that one wants to avoid radiating as much as possible (notably the bladder) but aside from that consideration, hitting "surrounding tissue" doesn't require pin-point precision.

As a follow-up to my surgery I had IMRT with daily ultrasounds to check on the position of my prostate bed. I didn't have markers.
Posted 2/4/2013 3:37 PM (GMT 0)
I had Calypso markers, which are a sort of "GPS" signal. I did it because I was told it was part of the process, but as you will see if you read my "journey" thread, you'll see that there were a couple of days that the system stopped my treatment because the markers moved a tiny bit. I like to think that damage was averted. The markers are the difference between IGRT and IMRT.

I investigated Proton, but my insurance would not pay the travel/lodging (there is not one near me) and would only pay the "agreed" price for standard IMRT. I would have to make up the difference and out-of-network penalties. That was not a viable financial choice for me, so IMRT won.

Posted 2/4/2013 4:45 PM (GMT 0)
In general the prostate can move a little, having the gold markers allows the therapist to get your prostate in the crosshairs prior to treatment. When you go through proton treatment, you drink water ( volume determined via CT scan ) and have a saline balloon inserted in your rectum. This holds the prostate still and reduces the volume of bladder and rectum tissue that receive radiation. You are aligned every day via low dose x-rays that look for those markers. So yes, they are needed, and are inserted with the help of ultra sound for guidance. Not a painful procedure. The whole treatment process was painless. Good Luck with your decision.

Regards,
Kris
Posted 2/4/2013 6:15 PM (GMT 0)
ah so, insurance pre-approval is the key! does medicare actually do a pre??? I never heard of that?
I had some stronger votes for robotic surgery at my diabitus class. if I qualify, I must get approval from cardio doc. also my stent instructions are no mri unless to a specific spec? another investigation. But MD Anderson asked that I not do a MRI here anyway. They have a high tech, with a coil??? gee another investigate required.
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