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SBRT for High Risk Prostate Cancer (update)

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Posted 3/9/2017 5:57 PM (GMT -5)
It's an interesting experimental choice. The standard of care is the brachy boost, but this may have lower toxicity. We'll have to see how well it does when the doses are amped up higher than what Katz is giving. King's toxicity numbers are very good, even at the higher dose, and wider treatment field. With UCSF, Georgetown, and Arica Hirsch, we should have some decent numbers to look at for SBRT boost over the next few years.

/pcnrv.blogspot.com/2017/03/sbrt-for-high-risk-prostate-cancer.html
Posted 3/9/2017 6:11 PM (GMT -5)
What is the patient incentive to participate in these new methods ?
Posted 3/9/2017 6:15 PM (GMT -5)
Because it works.

Effective cancer control... lower side effects .... and greater treatment convenience...... lower cost.

It's called progress
Posted 3/9/2017 6:38 PM (GMT -5)

JNF said...
Because it works.

Effective cancer control... lower side effects .... and greater treatment convenience...... lower cost.

It's called progress

Greater convenience and lower cost were incentives for me to enroll in a trial ( see my signature for details) at Georgetown U Hospital.
Posted 3/9/2017 6:50 PM (GMT -5)
Allen--any thoughts on insurance approving this? I know a Gleason 9 who had initially selected SBRT for treatment (with King at UCLA), but his insurance didn't approve it. I don't know the specifics on why he wasn't approved, but do you think it would be more difficult to get insurance approval for SBRT if you're high risk?
Posted 3/9/2017 6:56 PM (GMT -5)
I meant before you know it works.
Posted 3/9/2017 7:33 PM (GMT -5)
Declaring "The standard of care is the brachy boost" is overstating the case.

It is certainly "a" standard of care option. NCCN lists several alternatives for even Very High Risk cancer. Many things factor into treatment decisions.

Encouraging a treatment option one believes in is fine. Maybe I'm misunderstanding, but so dogmatically stating it as "the" treatment seems a bit overly narrowly focused. Perhaps that wasn't the intent.

My humble opinion...
Posted 3/9/2017 9:02 PM (GMT -5)
Michael_T

Many insurance companies will pay if it's a clinical trial - they want to encourage that sort of thing. Sometimes it takes an appeal before they will. In this case, it's cheaper than the alternatives, so they have an incentive to approve it. But I've long ago stopped trying to figure out what they would approve and why or why not. I think it's decided by some clerk in a backroom who flips coins.

Redwing -

I agree. Brachy boost is a standard of care. I should have said it's the gold standard for oncological control.

Sheepguy-

For me, the incentive was that it was the only way I could get the treatment of my choice at the time.
Posted 3/9/2017 10:30 PM (GMT -5)
I was gonna say...if it works... it aint' experimental...as I continue to attempt to spread the "word" that every word has power and meaning...its kinda of like shoveling....against the tide...and is not for the kicked back don't shiv a get set...
Posted 3/10/2017 8:37 AM (GMT -5)
Hey, TA - Thanks to you and all the others who entered the trials. That's what made SBRT so easily available and easily covered by my insurance plan.

I'm a happy camper so far, even with a bit of radiation-enhanced enteritis.
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