In the DC area, Georgetown has a good radiation oncology department. I'm sure Johns Hopkins can do a good job too. It's about
35 treatments over 7 weeks, so he really wants a place close to home. Even a long drive can be problematic toward the end of treatments when he has to pee urgently. In fact, I think this is one of those jobs where getting "the best" really doesn't matter as much as it does for surgery. This is a common procedure and there are many skilled ROs capable of doing a very good job.
Here are some questions to ask when interviewing ROs (not all of them may apply, depending on his situation):
Questions for a Salvage Radiation Interview.
1. How many patients have you treated with adjuvant/salvage radiation?
2. How has your practice of salvage treatment changed, if at all?
3. What is the probability that I need salvage treatment? Do you calculate that from a nomogram?
4. Do you think I should get a Decipher test to find my probability of metastasis in the next 5/10years? Do you know if my insurance covers it? What do you think about
their PORTOS score?
5. How large a dose do you propose for the prostate bed? (should be near 70 Gy)
6. Do I need pre-treatment, concurrent or adjuvant ADT?
b. What's the evidence that it's useful?
c. For how long?
7. How do you decide whether to treat the pelvic lymph nodes?
a. If so, at what dose? (50 Gy)
b. How do you plan to prevent bowel toxicity?
c. How will you account for the separate movement of that area and the prostate bed?
8. What do you think of doing this in fewer treatments (hypofractionation)?
9. What kind of machine do you use? (e.g., RapidArc, Tomotherapy, Vero, etc.) Why do you prefer that one?
10. What is the actual treatment time for each treatment? (faster is better)
11. What kind of image guidance do you propose? fiducials in the prostate bed? Using the fixed bones only? Soft tissue?
12. How will inter- and intra-fractional motion be compensated for?
13. What measures do you propose to spare the bladder and rectum? (ask about
treatment margins and dose constraints)
14. What side effects can I reasonably expect, and how do we handle them?(discuss in detail!)
15. What probability of a cure can I reasonably expect, given my stats? Is there a nomogram you use to come up with that?
16. How will we monitor my progress afterwards, both oncological and quality of life?
17. 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: 0.1,no lasting urinary, rectal or sexual SEsmy PC blog