Thanks for all of the great info so far gents! I've been dealing with an elder care issue for part of this weekend so I apologize for not being near a keyboard as a result.
InTheShop, yes I'm considering SBRT. HDR-BT is basically the first iteration of hypofractionated prostate cancer treatment, which is what SBRT is modeled on. SBRT, or "cyberknife" as it is affectionately called, still uses photons for treatment, as opposed to PBRT which uses protons. I'm an engineer so the theoretical aspects of protons interest me. I do like the less invasive aspects of SBRT or SRT, but the limitations of photon based RT and the damage to surrounding tissue always concern me. HDR BT, while a bit more invasive, does not introduce as much radiation since it does not pass through other tissue. At least this is my current assessment.
There are certainly trade-offs no matter which option we choose, it's really "the best of the worst" when it comes to choosing any one treatment plan.
NativeMD, glad to share in our mutual introduction to HW!
I'm glad you are well on the road to recovery. I've also heard the same info from urologists (surgeons) about
longer term secondary cancer risks, and this was indeed true many years ago prior to the advent of much more targeted RT options. More recent 10-20 year stats for more targeted RT shows very little statistical differences in bladder or rectal cancer rates for RT patients as opposed to general population cancer stats. At least this is what my research has shown me over the past few years.
Fox Chase is one of the few centers in the Northeast known for HDR BT and for RT in general. FCCC was the first to do HDR BT in the Northeast region actually. FCCC has been doing HDR BT, IMRT, IGRT, SRT, SBRT for many years now. Dr. Horwitz, Chair of RO, is who I've been speaking with. Anyone in the northeast and in particular, in the Philly metro area who is looking for a center that has good prostate cancer experience, here's a link:
Here's a link to Dr. Horwitz:
WorksOut and DCD55 thanks for all of the info and links, I will check them all out and let you guys know what I find. I'm not opposed to traveling anywhere if it's the right thing to do, the way I look at my situation is, once and done, and I want it done right by those who have done it so many times it's almost second nature.
Horwitz at FCCC has been doing HDR monotherapy since Y2K, and has several hundred under his belt from what info I have gathered - waiting on actual stats to be delivered to me now to be sure. Basically FCCC moved from LDR to HDR in Y2K and only does LDR under certain specific cases where HDR is not a good match. I'll get more info on stats and share them with you all here. FCCC has an entire dedicated suite only for HDR BT, which has MRI, ultrasound and CT dedicated all in the same small space specific to HDR BT procedures. I saw the suite when I last visited - so they have made the investment over time. More to come as I learn more. Scheduling for HDR-BT is 3-4 months out at FCCC right now - to give at least a possinle indicator of the volume.
Paul65, thanks for chiming in! I had my fusion biopsy at NIH just last May, with Dr. Pinto, who trained the entire staff at JH on the fusion software and procedure. If you have any questions, I have firsthand experience with the fusion biopsy procedure.
WorksOut, specific to FCCC HDR-BT, it was two procedures, seven days apart, two fraction RT treatments each day - so four total fractions over a seven day stretch. I believe there were other fractions available - but this is what FCCC recommended for my specific case data.
Dewayne and WorksOut, thanks for the HDR specific treatment experience data. This is what I'm looking for most of all, folks who have had HDR-BT and their outcomes and experiences. So thanks again.
Keep the great info coming! I will keep sharing what I learn under this thread as well.
Diagnosed at 42, 11/13, PSA 5.8, DRE negative, GS 6, 1 of 12 cores positive, <5%. MRI guided biopsy at Johns Hopkins. Active surveillance chosen.
NIH T3 endo-rectal MRI 11/14, PSA 6.5, fusion MRI guided biopsy 5/15. 6/18 cores positive for G6. DRE negative.
Consults at NIH, JH, Penn, Fox Chase. Pursuing HBR BT tentatively scheduled for 2/16.