This doctor is amazing. We were lucky enough to have his care when he was still at Provision Care in Knoxville. It's been 5 years now and everything is going well.
Thanks for the video. Sounds like a friendly place. One question if you don't mind.. There's lots of confusion about whether the entire prostate gets the full dose or the cancer spots get high doses and rest of prostate gets less. Maybe it doesn't really matter but I would like to know in a low to intermediate situation with 2 spots.
Hi there! Thank you for the question. We passed it along to Dr. Gray and here is his answer: "Yes, the entire prostate receives “full” dose, and the amount of radiation we use has been tested over many years - allowing the dose to be increased - and better delivery systems have allowed us to avoid damage to the adjacent organs at risk of damage (mostly the rectum and bladder). Treating the entire prostate has been our standard because we have discovered that prostate cancer frequently involves more of the prostate than our biopsies or imaging suggests (we learned that from examining the removed prostate tissue after surgical treatment). Treating only part of the prostate is being explored in certain cases where we think the cancer is truly limited to just that one area. There is always the risk of missing some cancer, allowing it to grow back, and therefore we have to ensure that this won’t happen much. The promise of partial-prostate treatment is mostly the avoidance of some side effects and long-term risks (erectile dysfunction, rectal irritation, bladder irritation, etc.). We just don’t know yet if the tradeoff is worth it. So standard of care remains treating the entire prostate gland. However, we now know that we should put more emphasis on the areas of the gland where we KNOW the cancer exists, either through biopsy samples or imaging like MRI. It’s sort of like spraying a weed killer over most of the yard at a moderate intensity for the weeds you can’t see, but spraying a lot more on the weeds you CAN see. This makes sense logically, but we have to test such concepts in real human beings before doing things that might hurt more than they help….. and so some early evidence has confirmed this to be helpful, and more studies are underway. Meanwhile, I adopted a technique to do this site-specific dose intensification several years ago, primarily once I had access to very “steerable” radiation energy such as the “pencil-beam” scanning intensity-modulated proton system we have here. This system includes an image guided setup mechanism to make sure that the little areas I need to treat are EXACTLY where I think they are day to day, treatment to treatment (imagine trying to spray the concentrated level of weed killer without seeing EXACTLY where the weed patch sits in your yard….). If there are two or three spots by biopsy and/or imaging, I typically try to intensify dose to all of them, as long as I am convinced that this won’t increase your risk of harm. And yes, we are friendly…… it’s easy to be that way when you know you have the best equipment in the world!"
Thank you so much for that info! I am still in pursuit of treatment after a few more tests and doctor meetings. Knoxville is my preferred place! I am low Gleason 6 but the large spot is somewhat near the capsule and even bulging it out a little. If not for that we would probably just wait, Active Surv. And as you mentioned, the cancer could be worse than MRI and biopsies show. An art not a science.
I am currently receiving Proton Therapy @Provision in Franklin Tennessee.This facility has a goal to take care of every patient as if you were the Only patient.With 110 % of medical and spiritual care!This team is simply one word "Caring".So when you put a staff like this with the Nova 360 ,as Dr. Gray would say "WE GOT THIS",you feel so at ease with your situation! Thank you PROVISION PROTON for your Caring!
@@garywhitley5046 hello Gary I’m in the same situation as you these days and am exploring all options before doing some treatment I will regret. What treatment did you opt for? Hope your doing well!
I just got in touch with the Proton Therapy center in Miami Florida. I’m on the Gulf coast of Florida and we do not have any Proton Therapy centers on the Gulf Coast. This one in Miami is the only that uses IMPT. I want the least possibly side effects. My procedure is for salvage radiation. My prostate was removed 2 years ago. In two years after surgery PSA went .002 to .7. Had PSMA pet and the only place that had uptake was a lymph node near the aorta on my right side then had SBRT and another PSMA PET AND showed nothing anywhere in my body also had a Pelvic MRI and that showed nothing
Did you have IMPT or Conformal proton radiation. Some centers are pushing pencil beam. Is this really that much better than conformal for prostate treatment. More precise ? What were your side effects long term?
Hi Jaswinder. Thanks for the questions. Here is Dr. Gray's response: "We use intensity-modulated proton therapy (IMPT) here for all cases. In some circumstances it is not that much better than the older scattered beam technique, but I believe it will be proven to be clearly superior for most situations, particularly for lung cancers and other cancers in the larger and somewhat more complicated thoracic cavity. Even with prostate cancer it allows us to intensify the dose more precisely to the exact areas I select - based upon biopsy and imaging data. It will take a long time to prove the superiority of IMPT over scattered technique, and frankly, most of us in the proton community know that the scattered systems won’t be used much longer (and certainly are no longer being installed). The minimal concerns we have had with any downside of the scanning technique (such as the interplay effect in a moving target like a lung cancer that moves with respiration) has been effectively calculated and dealt with, IMO. Personally, I would have insisted upon a scanning beam (IMPT) for my treatment, but many proton centers are still using a scattered beam for prostate cancer treatment, and even this limits dose to other tissues better then x-ray techniques (IMRT). I’m doing great, thank you, but there’s always a chance for persistent side effects in any patient we treat - my job is to minimize that risk as much as possible. In my opinion, IMPT gives me (and my patients) an advantage. Every new proton center being built is 100% scanning beam, so the jury is effectively in on that debate."
Yes, proton therapy can be used to treat ovarian cancer. Since each diagnosis is unique, we encourage patients to call 1-833-6-PROTON to discuss specific details.
I had Proton Therapy for Prostate Cancer 20 months ago at Mayo Clinic. I could not be happier with the results of the treatment. William A Feldner DDS
Congrats!
This doctor is amazing. We were lucky enough to have his care when he was still at Provision Care in Knoxville. It's been 5 years now and everything is going well.
How many sessions would salvage radiation be
Thanks for the video. Sounds like a friendly place. One question if you don't mind.. There's lots of confusion about whether the entire prostate gets the full dose or the cancer spots get high doses and rest of prostate gets less. Maybe it doesn't really matter but I would like to know in a low to intermediate situation with 2 spots.
Hi there! Thank you for the question. We passed it along to Dr. Gray and here is his answer:
"Yes, the entire prostate receives “full” dose, and the amount of radiation we use has been tested over many years - allowing the dose to be increased - and better delivery systems have allowed us to avoid damage to the adjacent organs at risk of damage (mostly the rectum and bladder). Treating the entire prostate has been our standard because we have discovered that prostate cancer frequently involves more of the prostate than our biopsies or imaging suggests (we learned that from examining the removed prostate tissue after surgical treatment). Treating only part of the prostate is being explored in certain cases where we think the cancer is truly limited to just that one area. There is always the risk of missing some cancer, allowing it to grow back, and therefore we have to ensure that this won’t happen much. The promise of partial-prostate treatment is mostly the avoidance of some side effects and long-term risks (erectile dysfunction, rectal irritation, bladder irritation, etc.). We just don’t know yet if the tradeoff is worth it. So standard of care remains treating the entire prostate gland.
However, we now know that we should put more emphasis on the areas of the gland where we KNOW the cancer exists, either through biopsy samples or imaging like MRI. It’s sort of like spraying a weed killer over most of the yard at a moderate intensity for the weeds you can’t see, but spraying a lot more on the weeds you CAN see. This makes sense logically, but we have to test such concepts in real human beings before doing things that might hurt more than they help….. and so some early evidence has confirmed this to be helpful, and more studies are underway. Meanwhile, I adopted a technique to do this site-specific dose intensification several years ago, primarily once I had access to very “steerable” radiation energy such as the “pencil-beam” scanning intensity-modulated proton system we have here. This system includes an image guided setup mechanism to make sure that the little areas I need to treat are EXACTLY where I think they are day to day, treatment to treatment (imagine trying to spray the concentrated level of weed killer without seeing EXACTLY where the weed patch sits in your yard….).
If there are two or three spots by biopsy and/or imaging, I typically try to intensify dose to all of them, as long as I am convinced that this won’t increase your risk of harm.
And yes, we are friendly…… it’s easy to be that way when you know you have the best equipment in the world!"
Thank you so much for that info! I am still in pursuit of treatment after a few more tests and doctor meetings. Knoxville is my preferred place! I am low Gleason 6 but the large spot is somewhat near the capsule and even bulging it out a little. If not for that we would probably just wait, Active Surv. And as you mentioned, the cancer could be worse than MRI and biopsies show. An art not a science.
@@garywhitley5046 You're welcome, Gary. Please feel free to contact us at 1-833-6-PROTON if you'd like more information.
I am currently receiving Proton Therapy @Provision in Franklin Tennessee.This facility has a goal to take care of every patient as if you were the Only patient.With 110 % of medical and spiritual care!This team is simply one word "Caring".So when you put a staff like this with the Nova 360 ,as Dr. Gray would say "WE GOT THIS",you feel so at ease with your situation! Thank you PROVISION PROTON for your Caring!
@@garywhitley5046 hello Gary I’m in the same situation as you these days and am exploring all options before doing some treatment I will regret. What treatment did you opt for? Hope your doing well!
I just got in touch with the Proton Therapy center in Miami Florida. I’m on the Gulf coast of Florida and we do not have any Proton Therapy centers on the Gulf Coast. This one in Miami is the only that uses IMPT. I want the least possibly side effects. My procedure is for salvage radiation. My prostate was removed 2 years ago. In two years after surgery PSA went .002 to .7. Had PSMA pet and the only place that had uptake was a lymph node near the aorta on my right side then had SBRT and another PSMA PET AND showed nothing anywhere in my body also had a Pelvic MRI and that showed nothing
Did you have IMPT or Conformal proton radiation. Some centers are pushing pencil beam. Is this really that much better than conformal for prostate treatment. More precise ? What were your side effects long term?
Hi Jaswinder. Thanks for the questions. Here is Dr. Gray's response:
"We use intensity-modulated proton therapy (IMPT) here for all cases. In some circumstances it is not that much better than the older scattered beam technique, but I believe it will be proven to be clearly superior for most situations, particularly for lung cancers and other cancers in the larger and somewhat more complicated thoracic cavity. Even with prostate cancer it allows us to intensify the dose more precisely to the exact areas I select - based upon biopsy and imaging data. It will take a long time to prove the superiority of IMPT over scattered technique, and frankly, most of us in the proton community know that the scattered systems won’t be used much longer (and certainly are no longer being installed). The minimal concerns we have had with any downside of the scanning technique (such as the interplay effect in a moving target like a lung cancer that moves with respiration) has been effectively calculated and dealt with, IMO.
Personally, I would have insisted upon a scanning beam (IMPT) for my treatment, but many proton centers are still using a scattered beam for prostate cancer treatment, and even this limits dose to other tissues better then x-ray techniques (IMRT). I’m doing great, thank you, but there’s always a chance for persistent side effects in any patient we treat - my job is to minimize that risk as much as possible. In my opinion, IMPT gives me (and my patients) an advantage. Every new proton center being built is 100% scanning beam, so the jury is effectively in on that debate."
Hello doctor Gray Love You video keep up the good work, and stay healthy Kenard
Do u treat Ovarian cancer tumors?
Please let me know thank you so much
Yes, proton therapy can be used to treat ovarian cancer. Since each diagnosis is unique, we encourage patients to call 1-833-6-PROTON to discuss specific details.
Did proton therapy be helpful for Glioblastoma cancer...How much success rate