How do you decide WHERE to go for treatment?

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SkeeterZX22v
Regular Member


Date Joined Apr 2011
Total Posts : 240
   Posted 6/22/2011 4:40 PM (GMT -6)   
I am recently diagnosed as my signature indicates, and as I have previously posted, my treatment of choice is proton therapy at Indiana University. Right now I am still in insurance appeals trying to get approved. I am hopeful that I will be approved (based on a couple of fellows who went before with the same coverage--approved on appeal). However, if I don't get approved, I have to go somewhere else for conventional radiation treatment (i.e. IMRT). I have made a personal decision that I will not do surgery.

I am in a position in life that I can basically travel anywhere in the country for consultation and possible treatment (recently retired, not wealthy but sufficient retirement income to live on and health insurance provided as part of retirement program). How do I learn about the quality of radiation programs at various hospitals? Do I just assume that the "big name" places (MD Anderson, Vanderbilt, Duke, etc.) are better? Or is there some objective information somewhere that I can access to take a look?

Here in central Ky MD Anderson is kind of like THE PLACE to go if you have cancer of any type. Is it overkill to go there for "simple" prostate cancer? Am I overreacting in wanting the best possible high quality treatment for my PCa? Or is this something any "shade tree" radiation oncologist with an imrt machine can handle?

It is really starting to wear me down. Can anyone help?

Steve
Age 61, psa 4.6, 30 days cipro, psa 4.3, biopsy 4/28/11, 2 of 12 cores positive, Gleason 6
T1c
Central Ky

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 6/22/2011 4:58 PM (GMT -6)   
Skeeter, I don't know how helpful that I can be. I didn't do a lot of reseach. When I had BCR and needed salvage radiation, I decided to go to a national prostate cancer center of excellence. In central CT there were 3 close by, Dana Farber, Yale and MSK. I would have gone to MSK (highest rated for PCa) except that it would have been a 3+ hour one way trip. I chose Dana Farber because it was still very highly rated but only a 90 min drive. Would I have gotten the same level of treatment locally? Perhaps, but I didn't want to leave anything to chance. BB
Dx Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4)
Robotic RP March 2009
Path Report: T2c, G8, organ confined, neg margins, lymph nodes - tumor vol 9%
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT/SRT .01, < .01
End ADT3 5/11 PSA < .01

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 6/22/2011 5:06 PM (GMT -6)   
Google US News & World report best hospitals. It will give you the highest rated hospitals for PCa.
Dx Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4)
Robotic RP March 2009
Path Report: T2c, G8, organ confined, neg margins, lymph nodes - tumor vol 9%
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT/SRT .01, < .01
End ADT3 5/11 PSA < .01

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/22/2011 5:28 PM (GMT -6)   
Steve,

Most would agree that if you have access to a MD Anderson facility in your area, that would be a good choice. Hopefully, your original primary treatment choice will be ultimately approved by your insurance carrier. Hope it works out for you.

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 margin
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, 2/11 1.24, 4/11 3.81, 6/11 5.8
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 6/22/2011 6:15 PM (GMT -6)   
Steve, with your stats have you considered either permanent or HDR brachytherapy?  I'm not exactly sure why a T1c, G6, 2/12 with low PSA would make a decision for IMRT over brachy but maybe I'm missing something...
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

SkeeterZX22v
Regular Member


Date Joined Apr 2011
Total Posts : 240
   Posted 6/22/2011 6:29 PM (GMT -6)   
Tudpock18 said...
Steve, with your stats have you considered either permanent or HDR brachytherapy? I'm not exactly sure why a T1c, G6, 2/12 with low PSA would make a decision for IMRT over brachy but maybe I'm missing something...


Tudpock (Jim)


Jim,

A fair question. I have a history of mild urinary problems that caused both my urologist and my radiation oncologist to believe I was at risk for urinary side effects if I went with brachytherapy. Until they advised against it, I was strongly considering HDR brachytherapy. That is why now I am leaning so strongly toward some form of external beam radiation (proton or photon).

Steve
Age 61, psa 4.6, 30 days cipro, psa 4.3, biopsy 4/28/11, 2 of 12 cores positive, Gleason 6
T1c
Central Ky

Going for brachy
Regular Member


Date Joined Apr 2011
Total Posts : 201
   Posted 6/22/2011 6:53 PM (GMT -6)   
I had exactly the same diagnosis as yours. I decided to go for brachytherapy. Because I considered it to be the best bet. For a while I was thinking about proton therapy. But after exhaustive study decided against it. 
__________________________________________________________________________
Age 70
Resident of DE, USA
PSA 3.4 January 2011
Biopsy Feb 2011 Gleason 3 + 3 T1C 2 out of 12 one 5% other 10%
Treatment option: Brachytherapy in the next 5 or 6 weeks
Volume study 5/3/11 49 cc

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3886
   Posted 6/22/2011 7:39 PM (GMT -6)   
I had the HDR brachytherapy because it results in less urinary problems. Due to my risk profile I also had IMRT and HT. With all of it I had minor urinary issues.

Here in Atlanta we are blessed to have extremely good PCa practioneers. The pioneer of permanent seeds and combined IMRT called Prostrcision is here, two centers that specialize in HDR brachytherapy (one of which I used), a urology specialty clinic patterned after Mayo and Cleveland Clinics (with the Home Depot founders money behind them) that is pioneering the Nanoknife procedure, and, a cancer center of excellence, Winship at Emory University.

You should look at the possibilities here. It is only about four hours away and the summers are great. Let me know and I will give you the details, contacts, and referrals.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011

Dan0
Regular Member


Date Joined Jun 2011
Total Posts : 163
   Posted 6/22/2011 9:06 PM (GMT -6)   
Skeeter,
Sorry you have to come here but glad you did. The men here will try to help as best they can I am sure.

my thoughts : you have a low risk Gleason score so assuming it is accurate you have time to make a well processed decision.
It can only help to have the slides read and diagnosis confirmed by a different pathologist. There are many referenced on this forum, take your pick.
There is no "right or wrong" decisions, only personal ones. Your numbers suggest a favorable outcome whatever you do.
As far as facilities go, I have no experience or preference since I have yet to be treated in any manner. There is nothing simple about PC and G6 is especially so IMO. G6 is in between options to me, so I certainly can relate. Whatever you do, involve your family and close friends as much as possible, and if you're a believer then include Him as well.

I will end with this, be thorough, be patient, and then be at peace.

Dan0
May 2010 PSA 6.9 up from 3 May 2009
July 2010 PSA 3 after anitbiotics
August bx, 1-12 cores PC 5% volume G6
Saturation bx March 2011, 31 cores all neg..
now....confused
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