Proton beam question

Not in Knoxville, but if you contact the facility they will probably have a support group and you could attend. Good place to get your questions answered. Good luck if you decide on proton treatment.
Regards,
Kris

So you are considering treatment and are interested in Proton beam therapy. Does that mean you are no longer going to continue AS? You look to be stable, unless I am miss reading your signature.

I would first suggest that you inquire with your insurance coverage to determine whether it will reimburse for the treatment. I assume you are on Medicare, correct? I know in the past few years many, if not all insurance companies have stopped paying for Proton Therapy (some never did) due to the significantly greater cost than Photon therapy and no evidence of improved outcomes or reduced side effects. I understand that Medicare reduced the reimbursements significantly in 2015 for many Proton uses, but I don't know the effect on PCa. The facility you are interested in should be able to provide useful information. I was just on the Provision Center for Proton Therapy website. That is the Knoxville center. The coverage information was very general and not specific to PCa. I suggest you call their business center and find out the coverage facts as well as calling your insurance company/Medicare.

You look like an excellent candidate for HDR brachytherapy or SBRT/Cyberknife. With HDR you may have only one or two procedures and SBRT is usually done in 5 or 6 fractions. Proton is often up to 44 fractions over 8 weeks or so.

Why not brachytherapy? Why is it you don't think you are a candidate? Have you consulted both a LDR HDR brachytherapy specialist? In my opinion the meetings are a must to make an informed treatment decision. Get the information from the expert to determine and confirm whether the treatment protocol is best for you.

Based on the limited information in your signature, you appear to be an excellent candidate for HDR brachytherapy mono-therapy. Check the website www.ctmc.com by Dr. Jeffrey Demanes the HDR pioneer. For LDR permanent seeds look at www.prostrcision.com by the seed pioneer Dr. Frank Critz, here in Atlanta. Both sites provide excellent information and long term results. LDR has some issues and limitation with prostate size and sometimes the pubic bone formation. HDR is much more flexible and do not have such limitations.

As Yoda would probably have said..."don't think...know...". It is our job to get the facts, not wonder about them. Good luck and let us know how to help,

Jack

Again, I suggest you actually have the consult and find out for sure what your options are. What does it hurt to get the assessment from the expert?

I am not aware of situations where brachytherapy would be bad but that external beam would not. What specifically is the reason for the poor flow?

You are in an enviable position to be deliberate and thorough in your investigation to determine the absolute very best treatment methods. In your shoes I would be having consults with an expert in each possible area. Having been on this forum for several years I have never heard anyone complain that they had too many consultations with expert practitioners. I was blessed to have a principal urologist that would not take me as a patient until I had several other consultations. In just a few weeks I had met with two radiation oncologists (one HDR and one LDR seeds) two surgeons (open and robo) and two medical oncologists. When I was finished I had the knowledge and confidence to decide on a treatment path with no wondering or second thoughts. This helped me immensely and I always suggest that others follow a similar research routine.

Best wishes. I hope you can safely stay on AS. I was not able to and had to pursue aggressive treatment. Thankfully it went well and I have no lasting side effects from the radiation treatments I had.

Thanks.