That would be me. Had it done 2 1/2 yrs ago by Dr. King (the originator) at UCLA. No lasting SEs - the ones I had were irritative, mild and transient. No ED, thank God. Little ejaculate at orgasm :-(
ASTRO endorsed SBRT for PC a few weeks ago based on the presentation of 5-yr results among 1,100 men (below). NCCN is considering an endorsement in June.
I asked Michael Steinberg, the Chairman of Radiation Oncology at UCLA the following question:Given that the alpha/beta ratio of prostate cancer now seems to be about 1.5, is there any reason to still do IMRT rather than SBRT as primary therapy?
His answer:Yes. A radiation oncologist doing IMRT will make twice as much money compared to SBRT. They will be slow to adopt it.
I went for it because SBRT and HDR mono have the combination of the highest reported cure rates (around 95% for low risk) and the best sexual preservation (around 80%).
On the West Coast, there's Dr. Meier at Swedish Medical Center in Seattle, Drs. Mack Roach III and Dr. Gottscaulk at UCSF, Dr. Fuller in San Diego, and several others.
Here's a link to Dr. Katz's 6 year report:Stereotactic body radiotherapy for localized prostate cancer: disease control and quality of life at 6 years
Here's what was presented at ASTRO in November:
SBRT presentation at ASTRO said...
Title: Five-year Biochemical Control Rates for Stereotactic Body Radiotherapy for Organ Confined Prostate Cancer: A Multi-institutional Pooled Analysis
Authors: Alan Katz MD JD, Deborah Freeman MD, Irving Kaplan MD, Donald Fuller MD, Giampaolo Bolzicco MD, Sean Collins MD, Robert Meier MD, Jason Wang PhD, Michael Steinberg MD, Christopher King MD PhD
Purpose: To report the 5-year biochemical relapse-free survival (bRFS) rates from a pooled multi-institutional dataset of a large number of localized prostate cancer patients treated with stereotactic body radiotherapy (SBRT).
Materials and Methods: The outcome data from 1101 patients with localized adenocarcinoma of the prostate were pooled from 8 institutions. Patients were treated between 2003 and 2011. The distribution by stage was 92% T1-2a and 8% T2b-3. The distribution by Gleason score (GS) was 72% Gleason 6, 20% Gleason 7 and 8% Gleason 8-10. The distribution by risk was 59% low-, 30% intermediate- and 11% high-risk. Median baseline PSA was 5.4 ng/ml; 88% of PSAs were < 10 ng/ml, 10% were 10-20 ng/ml and 2% were > 20 ng/ml. All patients had CyberKnife SBRT as the radiotherapeutic modality. The median dose was 36.25 Gy (35-40 Gy range) delivered either with 4 or 5 fractions; this is equivalent to a range of 90-112 Gy in conventional fractionation, assuming an alpha/beta ratio of 1.5 Gy. In most cases, the PTV was the GTV expanded by 5mm, 3mm posteriorly. This was created by expanding the CTV from the GTV by 3 mm, 1 mm posteriorly; the PTV was the CTV plus 2 mm to account for errors in target definition and delivery. Androgen deprivation therapy was given to 146 (14%) patients. Biochemical relapse, defined as a rise > 2 ng/ml above nadir, was determined in a total of 49 failures. Of the 49, 9 had resolution of the rise (i.e. the >2 ng/ml rise was a large bounce). However, outcome analyses were performed on all 49 cases; no cases were excluded.
Results: The median follow-up for all 1101 cases was 36 months (range 1 to 66). For all patients, the biochemical relapse-free actuarial survival (bRFS) rate at 5 years was 93%. The 5-year actuarial bRFS rates for Gleason score < 6, Gleason score 7 and Gleason score > 8 were 95%, 83% and 78%, respectively (p=0.001). The 5-year actuarial bRFS rates for iPSA <4, iPSA 4-10, iPSA 10-20, and iPSA > 20 were 96%, 94%, 82% and 73%, respectively (p=0.001). The 5-year actuarial bRFS rates for low-, intermediate- and high-risk patients were 95%, 90%, and 80%, respectively (p<0.001). No difference in bRFS was observed with the use of androgen deprivation (p=0.76). A PSA bounce of > 0.20 ng/ml was observed in 16% of the patients at a median of 36 months (range 6-60). The median bounce magnitude was 0.50 ng/ml (range 0.2-5.29). For the 335 cases with a minimum of 4 years of follow-up (median 53 month), the 5-year bRFS rates for low- and intermediate-risk cases were 97% and 89%, respectively.
Conclusion: With a large cohort of patients treated with stereotactic body radiotherapy, with a reasonably long followup period, excellent efficacy was demonstrated at 5 years. For high risk cases, the results are preliminary, given the small number of cases treated. However, for low and intermediate risk cases, these results compare favorably with other modalities. These results support a low alpha beta ratio for prostate cancer.