Dr Zelefsky

I talked with someone at Dr Zelefaky's office a couple of months ago and was told that when I completed my biopsy and current PSA I could call the office and they would send me forms to authorize access to my medical records. A PA in the office would review the records and decide if I am a candidate for salvage brachytherapy. Today I called to let them know I would be having the PSA and biopsy soon and wanted to get the ball rolling. She said she would email the forms. When I explained my understanding of the next steps she said I had been told incorrectly.
They do not let patients know over the phone or in an email if they have been accepted in the treatment program.
I would need to make an appointment with Dr Zelefsky to discuss that in person. I explained that I would be flying in from NC and would like to avoid a $1000 expense only to be told in person that I don't qualify. She said she understood but that is the procedure. Obviously the main consideration is it confined to the prostate. It was in February when I had the PSMA but is that current enough? If my PSA doubles, the MO wants another PSMA but that'll take 2-3 months to schedule. Will Dr Zelefsky want another PSMA too? My guess is he will.

Dr Polascik, the Duke urologist, specializes in cryotherapy. He lectures all over the country and has written numerous papers on it. When I mentioned in our first visit that I was interested in salvage treatment and was strongly considering brachytherapy, he said that it had fallen out of favor. I didn't want to argue with him because he's arrogant and thinks cryotherapy is better. Thats understandable since he is an expert in that procedure. I do think cryotherapy does have merit for salvage treatment.

I dont feel like I've looked at these two treatments in depth. All I've read is some reports that I found googling the procedures. They both seem to have similar efficacy and side effects. Both doctors are expert in their area of specialization. I wish I knew more.

There is a new procedure that Dr Zelefsky is using called MR-LINAC. Does anyone have any information to share about this procedure? Can it be used in salvage treatment for some who had primary radiation treatment?

Post Edited (hrpufnstuf) : 8/13/2024 1:11:59 PM (GMT-8)

HR - The question of salvage radiation after primary radiation treatment seems to rely on the location of the problem area. A RO would look at previous treatment plan and current imaging to make that decision. The general rule is/was you can not radiate the same area twice so it can be a close call.

Obviously cryotherapy does not have that limitation but it has to be able to get to the problem so that might have its own set of problems.

It is unusual to have a recurrence in the radiated prostate as far as I known. Does your PSMA scan clearly show recurrence in the radiated prostate? Did you have radiation to lymph nodes? Your biopsy results would not normally require that and it is a more likely recurrence location as far as I understand it.

Just throwing some stuff out there for you.

HR, as I recall Linac machine company Elekta integrated MRI with the Linac a decade, or so, ago in their technology competition with Varian and their Rapid Arc. My RO used Elekta Linacs when I was treated, but this was before the Elekta Unity was commercially available.

HR, the Elekta Unity (Linac plus MRI) was launched in 2018. When I was being treated in 2010, their machine lined me up with CT scanning, rather than the more traditional static X-Ray scan for placement. At the time my RO explained that in a few years the CT would be replaced by the MRI. So he was well aware of the development at the time. Interestingly, Elekta was founded by the doc that developed GammaKnife technology that he started researching in the 1940’s in Sweden. They are also the dominant producer of interstitial/brachytherapy machines in addition to Linac/SBRT machines.

You can probably go on their website and look for practitioners using the Unity Linac. It would be interesting to see where they are as the machine is about double the cost of the standard Linac. Looks like a $10-12 million investment to install the Elekta Unity Linac.

Tudpock18 said...
Just a thought re the appointment with Dr. Z...you might try the office again to see if another associate has a different (i.e. the original) understanding of the process. If not, after explaining the $1000 trip, perhaps they could set up a video visit? Since all they are doing is looking at your records and telling you what added tests you need I can't imagine the real value of an in-person visit just to determine whether or not they will accept you. You also might try asking to speak with the doc on the phone or via email to discuss the situation. For them to insist on your spending $1000 just to determine if they will accept you under these circumstances seems a little nuts.

Jim

I asked all of those questions. They don't do virtual consults, no phone calls to the doctor, no emails. The person I talked with yesterday, Clara, is the primary administrative person. My earlier call was with someone who was filling in for Clara during lunch. Clara seemed very knowledgeable but put me on hold to consult with someone to see if there might be a workaround to my in-person visit. Unfortunately there is not.

HR, you could contact the radiotherapy center I used here in Atlanta. You are a few hours drive and an inexpensive overnight stay that can reduce your travel cost. Founded by Dale McCord, who was a HDR brachytherapy pioneer in the southeast. His son, Mark McCord is a renowned RO, consistently getting the Top Doctors recognition in Atlanta. I used another of their associates for my radiation combination. I have referred several men to them, and all had very positive results. Several were from well outside the Atlanta area. My understanding is that they have used tele-visits for initial assessments and information. The clinic is Atlanta Oncology Associates and the closest location for you is Alpharetta on Atlanta’s Northside. Phone is 770-255-7500. The center is associated with Northside Hospital Cancer Institute, a designated cancer center of excellence. My RO was Craig Wilkerson now in Macon. I knew Dale fairly well and have met Mark several times. All highly regarded and no-nonsense. I think they would be worth a call to see if they can help you either directly or with a referral to a specialist they might know that you haven’t yet found.

How about asking for an old-fashioned letter to inform you whether you are in or out.

I did not have a good experience with Dr. Polascik.