Thanks for your good coverage of the options. I completed SBRT at UVA last fall. Excellent results. Follow up PSA went from 11 to 1.2 in 6 months. No problems with incontinence or ED. Medicare covered everything.
Thank you for this comment. Would you mind sharing the name of your radiologist at UVA? I live in central Virginia and my urologist (whom I like very much) is at Virginia Urology in Richmond. I am considering radiation therapy and looking for an excellent radiologist with a good reputation. Keeping sexual function and not having urinary issues are very important to me.
I went to a RO who specialized in SBRT in search of a shorter treatment time. Due to the amount of cancer in my prostate, group grade, and aggressiveness of my cancer, he would only do IMRT. He said I had a 70 percent chance there was cancer in my seminal vessels. This was in the beginning of 2021, and PMSA scans were available in only a few medical centers and not covered by insurance. Maybe I got played so they could make more money off me, but a year after IMRT and 15 months of ADT, I'm cancer free.
Gleason 7, I had to ask my oncologist about SBRT. He said he’s done 15 of them. Not many. I wonder if I should be concerned or is the technology foolproof. Just got my Prostox results. I’m low risk, so full speed ahead SBRT.
My radiation oncologist at Mayo who was an author on studies promoting SBRT vs IMRT told me that data has come under question. The results were largely based on historical controls but early head to head comparison in the face of combined newer hormonal and chemotherapy treatments is trending toward IMRT being better. Need to watch for this data in the future.
I received IMRT for my prostate and one lymph node and after 6 months will receive SBRT to several mets on my pelvis. The 6 month separation is to allow things to heal and prevent damage to my rectum from too much radiation at once. This was the option agreed upon by 6 different radiology oncologists at a Kaiser affiliated facility in Denver.
Again, in France, a famous radiotherapist told they dont use SpaceOar in IMRT because in 20 or 40 RT sessions the gel doesnt stay in place. And they use SBRT only for salvage therapy (after brachytherapy for example) and still with no spacer 😢
thank you. used this to prep for my radiationtherapy exam. was having difficulty in understanding the differences. radiation therapy is very interesting indeed. thank you again, was very informative.
SBRT (plus Brachy HDR ) ( plus Space Oar) is a common intermediate risk Prostate Cancer treatment at the Centers of Excellence that seems to be replacing surgery. The wider margins (v surgery) can, simply put, kill more cancer. And side effects seem lesser than surgery. Suspicions that SRBT might result in greater toxicity than IMRT are apparently unfounded.
My medical oncologist says he doesn't recommend SBRT for my prostate cancer. My Gleason score is 3+5=8 and my PSA was 5.6, no metastasis and low volume. He told me it isn't considered "standard of care" at this time. He says there's not enough research yet to tell whether it's effective or not so he's recommending IMRT or Proton.
It would be nice if there was more information on the Hydrogel SpaceOARs ! Unfortunately for prostate cancer it is a matter of choosing your poison ! That is which side effects to choose ! You are doing an excellent job of educating prostate cancer patients ! Thanks very much !
Is there a cost comparison of IMRT vs SBRT when you add in SpaceOAR and Prostox In addition Patients who might benefit from nodal radiation are also not good candidates for SBRT
This is a technician question. Please cover biochemical recurrence after surgical radical prostatectomy, whether just radiation is appropriate. Gleason score was 7 (3+4) 20 YEARS AGO after surgery. After salvage radiation, 19 years after surgery the nadir was less than .02. But in the last 6 months the PSA has risen to .04 19.5 years after the prostatectomy. Where do I go from here? Patient is 79 years old with micro metastasis disease. PSMA SHOWED NOTHING after the PSA had risen to 0.45 18 years after surgery.
How beneficial can SBRT be for mCRPC (metastatic castration resistant prostate cancer) patients, such as me, having an extended period of time since their diagnosis?
With all due respect every video about prostate cancer treatment needs to address incontinence and especially erectile dysfunction in DEPTH. I have found that urologists just mention it but pass over it as if it's irrelevant. It's not.
you have to do your own research and your results are unknown and drs will take a wait and see approach to what will be. let’s face it. the only people who know what’s going on with us are Us and our higher power. don’t matter what they
Can't seem to find information about where Prostox is used? I'd be interested in that type of testing before deciding on IRMT or SBRT. Is it a blood test or done through biopsy samples?
Does the Prostocks test predict if you are too sensitive to get a brachytherapy(burns of the urethra sphincter in my case is a risk, because of an Apex location of the cancer)?
I'm guessing it is because the margins are tighter along the prostate border with SBRT (in part to reduce toxicity to neighboring tissue). IMRT may be set to a wider margin to address cancer that may very well have spread across the prostate border (and this is much more likely in higher Gleason scores...even if PSMA and other scans do not provide evidence of spread).
With reduced margins with MRI-Linac, 15 separate beams and automatic gating, assuming a PET scan shows disease limited to the prostate, is SBRT going to join HDR brachy as SOC for GL8 and GL9 men
If PSMA PET could rule out ECE (at this point it cannot) I do believe modern SBRT would be the modality of choice for PC radiation. For organ-confined disease.
Moving forward with SBRT. Preparing for spaceoar. But have questions about local positively reviewed radiologist vs larger metropolitan top center hospital. How best to decide which facility, Dr., technician?
Great job! Thank you for all that you do. Two Questions: Can do a brief segment of Volumetric Modulated Arc Therapy (VMAT)? I understand that SBRT is stronger radiation dosage per session thus requiring less time than VMAT, but are these the only differences? I am very curious of Dr. Scholz’ views on VMAT. 3 years ago when I started my prostate cancer journey I was receiving combination therapy: ADT along with radiation therapy, i.e., Volumetric Modulated Arc Therapy (VMAT). The new PSMA PET-CT SCAN revealed that my cancer has metastasized. Thus I will be receiving SBRT for targeted external beam therapy, while continuing an adjusted ADT (Lupron and Erleada) So of course, my curiosity grown as to the different types of radiation treatments.
It is difficult for me to accept the notion that ethical physicians would literally make treatment recommendations based on the financial benefit to the physician or institution, rather than the impact on the patient. That notion is very sad and distressing to me.
I sat on the quality assurance committee of a 1000+ bed major eastern hospital referral center. We and our staff scrutinized every single then-current patient record for any evidence of issues such as you describe. During my tenure, we found only 3 questionable cases prompting the obtaining of additional records, including private office records. Two were promptly resolved and one was a proved documentation error without malpractice. I strongly urge all pts. to be treated at major medical centers such as ours and not at small clinics or privately owned facilities where independent oversight may be lacking.
This has been recommended to me as well for high risk, localized but some protrusion. Would like to hear what the opinions might be. I've had three different opinions and none match up. Becoming very Leary.
I had a gleason 9 score and wasn't willing to do hormone therapy so that was my best option. I'm 4 months out just had my first follow-up and am now waiting for my PSA result.
Thanks for your good coverage of the options. I completed SBRT at UVA last fall. Excellent results. Follow up PSA went from 11 to 1.2 in 6 months. No problems with incontinence or ED. Medicare covered everything.
👍✨️
Did you have to take ADT?
Thank you for this comment. Would you mind sharing the name of your radiologist at UVA? I live in central Virginia and my urologist (whom I like very much) is at Virginia Urology in Richmond. I am considering radiation therapy and looking for an excellent radiologist with a good reputation. Keeping sexual function and not having urinary issues are very important to me.
I went to a RO who specialized in SBRT in search of a shorter treatment time. Due to the amount of cancer in my prostate, group grade, and aggressiveness of my cancer, he would only do IMRT. He said I had a 70 percent chance there was cancer in my seminal vessels. This was in the beginning of 2021, and PMSA scans were available in only a few medical centers and not covered by insurance. Maybe I got played so they could make more money off me, but a year after IMRT and 15 months of ADT, I'm cancer free.
How long cancer free?
Which gleason score did you have?
Did IMRT 5 days a week for 9 weeks. Got used to going to the radiation center so it went by pretty quick.
Gleason 7, I had to ask my oncologist about SBRT. He said he’s done 15 of them. Not many. I wonder if I should be concerned or is the technology foolproof.
Just got my Prostox results. I’m low risk, so full speed ahead SBRT.
My radiation oncologist at Mayo who was an author on studies promoting SBRT vs IMRT told me that data has come under question. The results were largely based on historical controls but early head to head comparison in the face of combined newer hormonal and chemotherapy treatments is trending toward IMRT being better. Need to watch for this data in the future.
Which studies?
I received IMRT for my prostate and one lymph node and after 6 months will receive SBRT to several mets on my pelvis. The 6 month separation is to allow things to heal and prevent damage to my rectum from too much radiation at once. This was the option agreed upon by 6 different radiology oncologists at a Kaiser affiliated facility in Denver.
May I ask which Denver area facility you used?
Again, in France, a famous radiotherapist told they dont use SpaceOar in IMRT because in 20 or 40 RT sessions the gel doesnt stay in place. And they use SBRT only for salvage therapy (after brachytherapy for example) and still with no spacer 😢
Just heard something similar after a consultation with a radiation oncologist with 18 years in the practice.
thank you. used this to prep for my radiationtherapy exam. was having difficulty in understanding the differences. radiation therapy is very interesting indeed. thank you again, was very informative.
SBRT (plus Brachy HDR ) ( plus Space Oar) is a common intermediate risk Prostate Cancer treatment at the Centers of Excellence that seems to be replacing surgery. The wider margins (v surgery) can, simply put, kill more cancer. And side effects seem lesser than surgery.
Suspicions that SRBT might result in greater toxicity than IMRT are apparently unfounded.
What is Brady hdr?
HDR (High Dose Rate) Brachytherapy@@perfectly22smith38
@@perfectly22smith38 Brady therapy is seed implants (low dose). Brady HDR is the similar technique using high dose radiation and leaving no seeds
My only concern, at 63 year old, is that radiation can have ED effect 3-5 years after treatment.
My medical oncologist says he doesn't recommend SBRT for my prostate cancer. My Gleason score is 3+5=8 and my PSA was 5.6, no metastasis and low volume. He told me it isn't considered "standard of care" at this time. He says there's not enough research yet to tell whether it's effective or not so he's recommending IMRT or Proton.
It would be nice if there was more information on the Hydrogel SpaceOARs ! Unfortunately for prostate cancer it is a matter of choosing your poison !
That is which side effects to choose ! You are doing an excellent job of educating prostate cancer patients ! Thanks very much !
I got the barigel implant ...prior to radiation
Got SpaceOAR which was a fairly painless procedure. Didn’t really know it was there. No major bowel problems occurred after the radiation treatments.
Does anyone know why you cannot get a Prostox test in New York state?
Is there a cost comparison of IMRT vs SBRT when you add in SpaceOAR and Prostox
In addition Patients who might benefit from nodal radiation are also not good candidates for SBRT
This is a technician question. Please cover biochemical recurrence after surgical radical prostatectomy, whether just radiation is appropriate. Gleason score was 7 (3+4) 20 YEARS AGO after surgery. After salvage radiation, 19 years after surgery the nadir was less than .02. But in the last 6 months the PSA has risen to .04 19.5 years after the prostatectomy. Where do I go from here? Patient is 79 years old with micro metastasis disease. PSMA SHOWED NOTHING after the PSA had risen to 0.45 18 years after surgery.
How beneficial can SBRT be for mCRPC (metastatic castration resistant prostate cancer) patients, such as me, having an extended period of time since their diagnosis?
With all due respect every video about prostate cancer treatment needs to address incontinence and especially erectile dysfunction in DEPTH. I have found that urologists just mention it but pass over it as if it's irrelevant. It's not.
you have to do your own research and your results are unknown and drs will take a wait and see approach to what will be. let’s face it. the only people who know what’s going on with us are Us and our higher power. don’t matter what they
Can't seem to find information about where Prostox is used? I'd be interested in that type of testing before deciding on IRMT or SBRT. Is it a blood test or done through biopsy samples?
It's a mouth swab process...
I'm in Canada and spaceoar is not available here. I am going to receive 5 sessions of SBRT in about 6 weeks. I did ask about spaceoar.
Does the Prostocks test predict if you are too sensitive to get a brachytherapy(burns of the urethra sphincter in my case is a risk, because of an Apex location of the cancer)?
In my area sbrt is popular but not recommended for gleason scores over 7. Why might be the reason?
I'm guessing it is because the margins are tighter along the prostate border with SBRT (in part to reduce toxicity to neighboring tissue). IMRT may be set to a wider margin to address cancer that may very well have spread across the prostate border (and this is much more likely in higher Gleason scores...even if PSMA and other scans do not provide evidence of spread).
Proton beam toxicity vs imrt and sbrt?
Unfortunately prostox not available in ny
With reduced margins with MRI-Linac, 15 separate beams and automatic gating, assuming a PET scan shows disease limited to the prostate, is SBRT going to join HDR brachy as SOC for GL8 and GL9 men
If PSMA PET could rule out ECE (at this point it cannot) I do believe modern SBRT would be the modality of choice for PC radiation. For organ-confined disease.
@@robertmonroe3678 It depends on the size of the lesion. Mine certainly showed up And we extended to hit the seminal vesicles.
Fantastic video! Thanks for sharing this great information!
Moving forward with SBRT.
Preparing for spaceoar.
But have questions about local positively reviewed radiologist vs larger metropolitan top center hospital. How best to decide which facility, Dr., technician?
How much does it cost a foreigner to undergo the SBRT
Great job! Thank you for all that you do.
Two Questions:
Can do a brief segment of Volumetric Modulated Arc Therapy (VMAT)?
I understand that SBRT is stronger radiation dosage per session thus requiring less time than VMAT, but are these the only differences?
I am very curious of Dr. Scholz’ views on VMAT.
3 years ago when I started my prostate cancer journey I was receiving combination therapy: ADT along with radiation therapy, i.e., Volumetric Modulated Arc Therapy (VMAT). The new PSMA PET-CT SCAN revealed that my cancer has metastasized. Thus I will be receiving SBRT for targeted external beam therapy, while continuing an adjusted ADT (Lupron and Erleada)
So of course, my curiosity grown as to the different types of radiation treatments.
It is difficult for me to accept the notion that ethical physicians would literally make treatment recommendations based on the financial benefit to the physician or institution, rather than the impact on the patient. That notion is very sad and distressing to me.
Realty is often not pleasant
Apparently the lower profit or income is a big reason why Brachytherapy is not popular or as available in the USA
I sat on the quality assurance committee of a 1000+ bed major eastern hospital referral center. We and our staff scrutinized every single then-current patient record for any evidence of issues such as you describe. During my tenure, we found only 3 questionable cases prompting the obtaining of additional records, including private office records. Two were promptly resolved and one was a proved documentation error without malpractice. I strongly urge all pts. to be treated at major medical centers such as ours and not at small clinics or privately owned facilities where independent oversight may be lacking.
Ty 😊🙏
Very concerning to suggest treatment based on unproven assays. Please seek a consult from a radonc independently before making any decisions.
Radiation oncologist is the one recommending radiation treatment, it's like asking devil which method of torturing do you prefer.
WHAT IS PROS TOX?
My doctor has recommended for both IMRT & SBRT. Is this a normal process also?
This has been recommended to me as well for high risk, localized but some protrusion. Would like to hear what the opinions might be. I've had three different opinions and none match up. Becoming very Leary.
I had a gleason 9 score and wasn't willing to do hormone therapy so that was my best option. I'm 4 months out just had my first follow-up and am now waiting for my PSA result.
@@darylmcfarley9650 very interested in your PSA results after treatment. I am in the decision making stage now.
@@darylmcfarley9650 And the verdict?