Thanks for the kind words, Picc.
Spratt worked with Zelefsky at MSK for many years, and co-authored many radiation studies with him. That would be great training for anyone. Coincidentally, his buddy, Zach Zumsteg, just landed at Cedars in LA working for Howard Sandler who used to head up radiation oncology at UMich. Howard Sandler is fantastic, brilliant, and a hell of a guy - Michigan's loss is LA's gain. Michigan also recently lost Daniel Hamstra to Texas. He treated compiler, and he has been very helpful to me in explaining some of the many studies he has done. It's an incestuous industry.
My feeling is that it's not about
feelings, or shouldn't be. It's about
who can do the best job. But salvage radiation is, unfortunately, fairly common practice because the RP failure rate is about
30%. So a lot of places have the experience, equipment and expertise to do it equally well. Because of that the 35 trips back and forth become an important consideration. It's not easy to drive far when you have to pee urgently, and that will happen.
Below are the questions I use when I go on interviews with patients. I'll reprint the ones that apply to you below:
Questions for a Salvage Radiation Interview.
1. How large a dose do you propose for the prostate bed? (should be near 70 Gy)
2 Do I need pretreatment, concurrent or adjuvant ADT?
b. What's the evidence that it's useful?
c. For how long?
3. What do you think of doing this in fewer treatments (hypofractionation)?
4. What kind of machine do you use? (e.g., RapidArc, Tomotherapy, Vero, etc.) Why do you prefer that one?
5. What is the actual treatment time for each treatment? (faster is better)
6. What kind of image guidance do you propose? fiducials in the prostate bed? Using the fixed bones only? Soft tissue?
7. How will inter- and intra-fractional motion be compensated for?
8. What measures do you propose to spare the bladder and rectum? (discussion of margins and dose constraints)
9. What side effects can I reasonably expect, when, and how do we handle them? (discuss in detail!)
10. What probability of a cure can I reasonably expect, given my stats? Is there a nomogram you use to come up with that?
11. How will we monitor my progress afterwards, both oncological and quality of life?
12. How many patients have you treated with adjuvant/salvage radiation?
13. How has your practice of salvage treatment changed, if at all?
14. What's the best way for us to communicate if I have a question or issue?
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results
•SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.2,no lasting urinary, rectal or sexual SEsmy PC blog