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Next step is aRT, but where?

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Prostate Cancer
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Posted 7/5/2015 10:02 PM (GMT 0)
Since my Decipher test has me as high risk and I have a positive node, aRT is the next step for me. So the question is to have the radiation at MD Anderson in Houston or locally at a smallish hospital. If I commit to MD Anderson, I'm going to stay in Houston at the Rotary House for seven weeks or so since it is a 4.5 hour drive from our domicile. That's like about $6,000 bucks for the hotel room alone. While we can afford that, I wonder if I would have the same results at a smaller facility? How critical is the reputation of the facility? Is there an advantage of having that done at a world-class facility? I have a buddy that had RT locally a few years and he is very positive about his experience.
Posted 7/5/2015 10:29 PM (GMT 0)
It's the skill and expertise of the RO, not the facility.
Posted 7/5/2015 10:44 PM (GMT 0)
You may want interview and discuss with a local and see what they have to offer. I am in Houston and know the reputation of MDA. I received my second opinion from MDA but decided with a local group to perform my surgery. However like Andrew said above, it is the expertise of the RO that matters.
Posted 7/6/2015 2:45 AM (GMT 0)
Determine the make and model of the LINAC the treatment center plans on using to administer the radiation..The newest equipment (less than 5 years old) is light-years ahead of what they were using 10 or 12 years ago...If it's not AT LEAST a Varian RapidArc then I would be looking for a treatment center equipped with this or perhaps even newer machinery...The big advantage with the newest equipment, the R.O. can administer the highest dose while sparing nearby healthy tissue serious damage..

The LINACs by themselves can do nothing..The R.O. skills must equal the capabilities of the equipment he is using....
Posted 7/6/2015 3:23 AM (GMT 0)
Modern and well-maintained equipment is key.

Great RO to design a good plan is essential.

Experienced and stable staff (techs) are critical. Best plan with best gear poorly executed is useless.

My insurance would not pay the travel / lodging to MDA since I had local facilities that were in network.

I can't suggest mine, as the RO has since retired, and the great staff all left en masse when the new guy showed up, and "took control". The girls who were staff are now senior at some prestigious university hospitals.

Get current info on any facility. Last year could be another world.
Posted 7/6/2015 6:33 AM (GMT 0)
Just as 142 says, its a combination of facilities, RO and techs. Although I live in Hawaii. I had mine done at MD Anderson in Houston. They were great. Since I didn't want to stay on campus, I stayed at a nearby hotel called ZAZA. It was great and they provided me with free drop off and pick up every day. Highly recommend the hotel and doesn't cost much more than Rotary. I had my computer set up in the hotel and so when I got back I could work remotely. Feel free to contact me if you want more details.
Posted 7/6/2015 1:16 PM (GMT 0)
Thank you everybody for the helpful comments and suggestions! One of the two nearby small towns near us does have a fairly new machine, I think my local urologist mentioned it was installed a couple of years ago. I might just set up an appointment with the local RO my local doc was recommending and at least chat with her.
Posted 7/6/2015 8:27 PM (GMT 0)
With your positive node, the challenge is a bit more complicated than with primary RT. They have to simultaneously treat two areas that can move independently of one another. Excellent image guidance becomes more important. It is a challenge for both the RO and the machine. My latest favorite machine is Vero, which they use at UT Southwestern in Dallas. However, you don't have to have that machine - just a good strategy for dealing with conformality and movement. As you interview local ROs, ask them what their strategy is for dealing with that, and what their experience has been in situations like yours. Simultaneous nodal radiation isn't all that common, so make sure you find an RO experienced at it.

- Allen
Posted 7/6/2015 9:04 PM (GMT 0)
I did not realize the positive node was a complication. Maybe I should plan on MD Anderson then since they are more likely to have dealt with a variety of situations routinely that a small town RO hasn't seen or seen frequently. Thank you Allen.
Posted 7/6/2015 9:25 PM (GMT 0)
If you decide to stay with MDA Houston, look in to this website. I stayed there for a month in my own coach, but now they have rentals. They have a free shuttle to and from MDA and just exploring there website, it even looks like they have shuttles to the grocery store and other places. They are just down the street from the Med. Center and it is gated and safe. Most of the people I met, were there for Medical reasons and it was a very friendly caring atmosphere.

southmainrv.com/rates.php
Posted 7/6/2015 9:30 PM (GMT 0)
Wow! We have a 40' coach, I had no idea there was an RV park that close to MD Anderson - this might just be the ticket :-)
Posted 7/6/2015 9:44 PM (GMT 0)
Just got off the phone with South Main RV Park and I'm stoked about staying in our own RV and I'll bring Sarah the corgi doggie for company. yeah Whoo-hoo!
Posted 7/7/2015 2:59 AM (GMT 0)
John

My whole demeanor changed in the last two or three posts on your thread. I read you thread this morning before going to work. I was reminded of what my surgeon communicated to me before my SRT. He said: "hey stupid go to the world class cancer center, not the neighborhood generalist- it's your stinking life!" I chose not to post this morning. But the new idea of bringing the RV and Corgi made that idea even more acceptable. I finished SRT at MDA in mid May. Seven weeks no results until mid August. Could not have been easier. RO stated I had better than 80% chance of success. They know what they are doing- period. So if you come let me know and let's have a play date with our Corgis. I have had my new dog four weeks. She is three year old retired show dog. Trying to get second Corgi from rescue now.
Good luck. David
Posted 7/7/2015 5:32 AM (GMT 0)
John
In Rochester, there are care centers that allow you to stay rent free while you are receiving radiation at the Mayo. Some of these places have waiting lists and I know of one individual who stayed there during the last 4-5 weeks of his radiation treatments.
I'm guessing MD Anderson has some similar centers that might be worth looking in to.
Good luck!
Posted 7/7/2015 12:36 PM (GMT 0)

Octorobo said...
..They know what they are doing- period. So if you come let me know and let's have a play date with our Corgis. I have had my new dog four weeks. She is three year old retired show dog. Trying to get second Corgi from rescue now.
Good luck. David


I am convinced the reason I was immediately continent post surgery was due to the skill of my surgeon at MDA (he's done over 2,000 RARPs) - they are truly a world class facility.

Hey, how about that! Our last Corgi which suddenly passed away last fall (she was 12), was also a retired show dog and loved to play fetch (she was obsessed with it). Our nine year-old Corgi (we've only had her a few months could care less about fetch.

Gunner34 said...
John
In Rochester, there are care centers that allow you to stay rent free while you are receiving radiation at the Mayo. Some of these places have waiting lists and I know of one individual who stayed there during the last 4-5 weeks of his radiation treatments.
I'm guessing MD Anderson has some similar centers that might be worth looking in to.
Good luck!


We were at an RV park in Rochester several years ago and most if not all of the campers were there for Mayo. At any rate, the thought of living in our coach with the doggie in Houston is a winner.
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