Salvage Radiation Therepy- Provider that important?

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James C.
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Date Joined Aug 2007
Total Posts : 4462
   Posted 8/29/2010 2:01 PM (GMT -6)   
If one is planning SRT, does it make any difference where or who does it, as long as they are an accrediated facility, such as a normal hospital radiology department, clinic or such? You know, the places in every town that radiation is dispensed? We see people being told all the time to select the best surgeon, hospital, brady guy, HT specalist, etc. but not really much is said about how critical it is to be so selective in choosing the place and persons who will do SRT.
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 110 gms., margins clear
3 Years: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/29/2010 2:18 PM (GMT -6)   
James, unless someone is living in a major urban area, with multiple sites/choices, I think its limited to where you live and how many treatments. Here in Upstate SC, there is only one place to have savlage radiation. Sure, with time/money, one could go to Charlotte, Atlanta, Columbia, or Charleston. But considering that most SRT runs 30-40 treatments, and they are daily treatments spread up to 8 weeks, it would be difficult for most people to have it done outside their immediate area.

Where I went, they have x amount of Radiation Oncologists, and they all work for the same clinic. I used one of their choices 10 years back, and this time, interviewed 3 more of their doctors before choosing one.

I wouldn't think most people live in areas of multiple choices, could be wrong though.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 8/29/2010 2:24 PM (GMT -6)   
James, I don't have an answer for you but it is an interesting question that I just had to deal with. I could have had SRT 15 minutes from home at a regional hospital, but decised to err on the side of caution and I am having it done at Dana Farber. It is over 2 hours one way by train and bus. Is it worth the time and expense? I probably will never know. It does make me feel better knowing that I am being treated at a top notch facility. I will follow this tread closely. BB
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 8/29/2010 2:54 PM (GMT -6)   
I am wrestling wiith this very question, and in fact I'll even refine the question. So far, I am not in need of SRT, but that could easily change. If it does, I want to have a plan in place. Part of that plan is in place: I will make an appointment with Dr. Hussein a top-notch medical oncologist at Umich., about 2 hours from my house.
 
But, if I need srt, supposedly the best place is at Umich. But our local hospital is a major mid-Michigan regional medical center. Supposedly they have a top-notch radiation department. According to a doctor friend of mine, he would stay local because they have the exact same equipment at Umich and the radiation docs are very good.
 
So, my refined question: assuming the equipment is the same, do I stay here? In other words, assuming a good vs. a top-notch radiation expert with the same equipment, is it a big difference? I really would like to stay 10 minutes away rather than 2 hours away. If I did go to Ann Arbor (Umich) I would probably look at renting a place and just come home for long weekends. I would have to be convinced that it is worth it, medically-speaking.
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. Next PSA late Sept.

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 8/29/2010 3:30 PM (GMT -6)   
I agree with Mel. My regional facility has new equipment and a brand new facility. The doctors were well regarded locally. My main concern was with the experience and expertise of the docs and techs. I took the same approach as with surgery. If they are doing very many procedures for PCa recurrence the they must be better than a smaller facility doing fewer radiation treatments for PCa.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 8/29/2010 3:36 PM (GMT -6)   
Hi James,

I was quite concerned with this question prior to my treatment. There are four providers in the immediate area. Two hospitals and two private practices. I interviewed all of them. There are two aspects to the treatment. the technology used and the radiation oncologist/planner's experience. Here is my short list of things to ask.

1. Who does the radiation planning?
2. What is their experience in doing the planning?
3. What is the machine to be used?
4. How often is the machine calibrated?
5. Who does the calibration?
6. When was the last calibration on the machine to be used on me?
7. What is the radiation doctor's track record with patients in terms of side effects and disease remission.

As it turned out my radiation oncologist writes programs for radiation treatment for others as well as his own use. He has something of a reputation in this arena and owns a company that provides the software for the machines. I felt then and now that I was in good hands.

I also made an inquiry to Cyberknife about their machine. At the time they had two doctors on staff who answered questions and both agreed that it would not have been the right treatment for me since there was evidence of spread to the nodes.

Best of luck to you.
Don
Diagnosed 04/10/08 Age 58
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
PSA:
02/08 21.5
07/08 0.82
10/08 .642
09/09 0.32
03/10 0.32
06/10 0.32
07/10 0.10

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4226
   Posted 8/29/2010 3:47 PM (GMT -6)   
Just like surgeons some radiation oncologists have much better track records in reducing side affects. It's difficult to locate these on your own. As long as the radiation oncologist was recommended by your oncologist or surgeon and has the latest equipment and has experience treating reoccurrances you should be OK.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 8/29/2010 6:18 PM (GMT -6)   
Another aspect that I didin't get across is whose experience is more critical, the doc or the tech's. I know the docs plan the radiation and such, but how much do they have to do with the actual radiating and the patient, once the plan is developed and you are lying on that table the first time? Do these guys really need much specialised knowledge to lay out what 'may' be a standard radiation scan of a pelvic area. I am beginning to suspect the actual critical point would be the person who actually lines you up and pushes the buttons each time. How specialized are these docs in their 'plan' and experience neded? Or maybe they just use a cookie cutter approach for us?

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3742
   Posted 8/29/2010 7:31 PM (GMT -6)   
What really makes this difficult, this field of treatment is changing rapidly...New, more powerful, faster, more accurate beam radiation machines are being installed at a hospital or treatment center near you...Of course, NOBODY knows the finer details of operating these machines until they gain some experience. Do YOU want to be the provider of that experience?? I'm sure they make many dry runs on artificial targets before the first human is placed on the table, but still...

On the other hand, this new equipment offers never before achieved improvements in beam targeting and dose accuracy which SHOULD markedly improve treatment outcomes.. it will be years before we know..In the meantime, insurers are starting to balk at the costs of providing these cutting edge treatments...

So I would be looking for a Radiation Oncologist who specializes in treating prostate cancer and has done many patients successfully...Ask your other doctors who THEY recommend..Because of the TIME involved, traveling to a distant "center of excellence" can turn out to be prohibitively expensive for many people...You can enter these doctors names in Google and find their history and background. I was shocked when I poked around a little investigating an R-doc I really liked and trusted. (he had treated my daughter) Turns out he had four red flags, administrative actions, taken against him, including one from the DEA..he had practiced in 5 different states...

Another one, Dr Reggie Westmacott, was trained and practiced as a surgeon and Urologist..he suffered a nasty bicycle accident which ended his career as a surgeon. So he went back to school and now practices as a Radiation Oncologist in Denver, treating prostate and other urinary cancers. His unusual background makes him an excellent R-doc... So James, just dig, dig dig until you find the man you are looking for..
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..
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