The Complete Guide to SBRT for Prostate Cancer | Amar Kishan, MD, UCLA
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- Опубліковано 15 чер 2024
- Amar Kishan, MD is an Associate Professor, the Vice-Chair of Clinical and Translational Research, and Chief of the Genitourinary Oncology Service for the Department of Radiation Oncology at the David Geffen School of Medicine at UCLA. In this talk from our 2022 Prostate Cancer Patient Conference, Dr. Kishan discusses the latest in SBRT for prostate cancer including the use of real-time MRI imaging and the use of genomics to predict which patients may be at risk of severe side effects from radiation treatment. To see Dr. Kishan's faculty profile page, visit: www.uclahealth.org/providers/....
To watch Day 1 of our 2022 Prostate Cancer Patient Conference, visit: • Radiation, Advanced Tr...
Day 1 includes: "Active Surveillance" | Matthew Cooperberg, MD, MPH, "Incontinence & ED Medical/Surgical Treatments" | Jeffrey Brady, MD, and "Prostate Treatments & Imaging" | Eugene Kwon, MD.
To see Day 2, visit: • Radiation, Advanced Tr...
Day 2 includes: "Side Effects of Radiation Therapy" | Amar Kishan, MD, "Advanced Treatment & Side Effects" | Nicholas J. Vogelzang, MD, "2022 Update - Bring it on! 8th Annual Moyad and Scholz Free for All! Any Question on Any Aspect of Prostate Cancer!" | Mark Moyad, MD & Mark Scholz, MD
Don’t know your stage? Take the quiz: Visit www.prostatecancerstaging.org
To learn more about prostate cancer visit www.pcri.org
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Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website or call our free helpline at 1 (800) 641-7274 with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
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#ProstateCancer #Prostate #AmarKishanMD
I paid $500 out of pocket for the genetic Prostox test. Came in low risk. Will do SBRT.
FYI: I have prostate cancer with a psa of 10. Initial biopsies came back with 1 positive out of 12. Subsequent biopsy with fusion found more positive results. All of it in a very small area of the prostate. I decided I wanted brachytherapy but my doctor advised me that my prostate size of 50 ruled me out as a candidate for brachytherapy according National Cancer Institute guideline. After that I began a search for a local radiologist. The brachy doctor was 2 hours away and that ruled out regular low dose radiation. 6 months ago, while I was looking for a local radiologist, I decided to stop taking my 100 mcg tablets of levothyroxin to see if my psa would go down while I was making arrangements for radiation therapy. Last week I went for my 3 fiducial markers. As a matter of routine procedure, the ultrasound measured my prostate size, as it did before during biopsies. Lo and behold, my prostate size shrunk from 50 to 32. Can you believe that? All of you urologists that are reading this, you better ask your patients before ruling out brachytherapy if they are on levothyroxin. Had I know that I could have reduced my prostate and then had the brachytherapy, I most certainly would have. This is something that should be verified in a clinical study. This could be a significant finding if a controlled group experienced the same reduction in the size of their prostates. This if for real. I am staying off my levothyroxin now and forever. My prostate has been steadily growing over the years as noted in yearly physicals with the old method of rubber gloves. Even if your patients dont have cancer but have urinary problems related to BPH, they may see benefits of regaining a normal sized prostate after stopping levothyroxin. My PSA did not decrease as I had hoped though. PLEASE SHARE THIS COMMENT WITH OTHER COLLEAGUES.
Great talk. Thanks to everyone responsible for the production!
Great, clear, not boring!
Excellent presentation. Great teaching skills!
Excellent, succinct but thorough presentation, giving much food for thought.
Thank you so much. It was like a repeat of what my Doc said earlier today. I now have a better understanding and feel more confident going forward.
Hey, that is my oncologist! He is amazing!
Very good video. One slight clarification, not that you made a mistake or anything, SBRT is NOT always IMRT. In many cases it is IMRT but not all. It doesn’t have to be. For example, Cyberknife SBRT with the Iris is not considered intensity modulation and therefore not IMRT. Just wanted to make that point in case anyone was confused or had that question.
Now I understand why my doctor is doing a genetic profile, thanks for the excellent presentation.
Great video. Facts help patients make good choices. Thank you
Many thanks! Articulate and so instructive for me as I am embarking on treatment options.
Very nice presentation. The combination of real-time MRI with an SBRT instrument looks very promising.
I always worry about how long it takes to for insurance companies to acknowledge the efficacy of treatments. Ones known to be effective and saving lives in Europe are often labeled "experimental" here in the USA, and not covered.
With reference to the PACE-B abstract as presented at ESTRO 2021, cumulative incidence rates of G2+ GI toxicity at 2 years were 10% for standard-of-care and 12.2% for SBRT (using the CTCAE score). Using the RTOG score, G2+ GI toxicity showed 7.5% for standard-of-care and 11.5% for SBRT. How do you explain that?
27:30 Radiogenomics is the most interesting topic in this talk
It is a great video, but I am not sure that it focuses on any contrast between SBRT with photon radiation, and Proton Therapy radiation treatment, which is the choice which I am looking at. I would very much like to know this comparison.
I’ve had 44 radiation treatments 5 days a week. Then 1 more on my spine. Plus lupron. But then 4 spots showed up on my spine. So then I had 9 Chemo sessions. Now I’m on Abiraterone and lupron and in remission for 9 months. Lots of different options.
I sill can't believe that I shruked my prostate cancer with herbal supplements from DR. Osaka on youtube channel, who I came across actually couldn't believe it at first because it sounded impossible to me knowing how far I have gone just to get rid of it. All thanks to you sir Dr. Osaka
My heart goes out to you Tom. I’m hoping the remission holds.
Hi Tom - I’ve had 35 sessions over seven weeks, plus Lupron and abiraterone. Good luck.
I was diagnosed with high risk prostate cancer (Gleason 3+5=8, PSA 7) and I'm wondering if SBRT is an option for me. I read previously that it's only for low/medium risk patients.
Dr. Kishan.....I am at 6 weeks from completing 5 cyber knife treatments. I have exhibited only short term urinary issues....weak flow- straining which were thankfully reversed with a daily dose of Flomax. No other short term symptoms....including sexual function which is behaving just fine....I am 69 years old. I took interest in your note about using ED meds as prophylactic after treatment for 3 months,,,I will bring this up with my Urologist at 3 month followup. Thank you Dr. for a very informative presentation.... I feel a lot better now where I stand.
Pros From Dover - Are you an intermediate-risk or high-risk patient?
@@chedesgrieux2365 intermediate....3+4=7 for 2 slides....3+3=6 for 3 slides of biopsy. Borderline active surveillance or treatment. Had PSA of 5.9. My urologist recommended treatment...I chose cyber knife.,no regrets.
Did you have a normal or enlarged prostate?
Can SBRT be followed with HDR brachytherapy? IMRT success rates have been shown to be improved when used with HDR, has the same been shown with SBRT? Can results from SBRT be as good as IMRT plus HDR?
SBRT can be combined with HDR brachy; usually for high-risk cases. Obviously, the SBRT dose will be less. For instance, three sessions of SBRT vs the normal five.
Is this appropriate for high volume ( entire right side ) 4+3 Gleason with one core of 4+4?
First, if you have any questions, please feel free to contact us and we can have one of the patient advocates on our helpline give you a call. They are trained to provide information on these kinds of questions. Our contact information can be found here: pcri.org/helpline.
If those biopsy results are accurate, then the core of 4+4 would place this cancer within the high-risk category which means that there is a high risk (relative to intermediate-risk and low-risk prostate cancer) of the cancer spreading or having already spread. The cure rate for high-risk disease is still somewhat high, though-- around 70%. At the PCRI, we call high-risk prostate cancer the "Azure" stage of prostate cancer, and we have a playlist of all of our staging guide videos discussing it here: ua-cam.com/play/PLHj3V3RB2V-ietm3-kNkx48kbUnbtunL8.html. We also have newer videos discussing it in the context of newly approved technologies like the PSMA PET scan. You can find those by searching things like, "PCRI high risk prostate cancer" or "PCRI Azure."
I am not sure what has been done so far, but if the biopsy is accurate, then there is diagnosis of prostate cancer and the patient and his physicians would be in the "staging" process to assess the extent and potential extent of the cancer to determine the most appropriate intensity and duration of treatment. If you are in the United States, this should include an MRI and a PSMA PET scan. An MRI (if it was not already performed prior to a biopsy) to determine the size of the tumor, whether there is extension of the tumor outside the gland, or even if there are other tumors within the prostate that were not biopsied that could be a higher Gleason score and may benefit from more intense treatment. The PSMA PET scan is the best imaging tool for seeing if cancer has spread to other parts of the body. It is still imperfect and can miss microscopic disease, but it is the most sensitive tool we have.
If the staging is confirmed as a Gleason 4+4 prostate cancer that is confined within the gland, then the treatment protocol with the highest cure rate has been a combination of brachytherapy radiation, some form of beam radiation (including SBRT), and some duration of hormone therapy (6-18 months usually, but I have even heard of people doing 24 months or more; I am not 100% sure, but I do not think anything longer than 18 months has been supported by clinical trials for localized disease), but there could be variations based a person's age, general health, personal desires, etc.
With reference to the 2021 update to the HYPO-RT trial published in The Lancet, how do you explain "bowel bother" of 33% (CF) and 28% (SBRT) at 6 years?
I was recently diagnosed with prostate cancer. Biopsy was a Gleason 3+4=7. A group 2 cancer. I could have stayed in active surveillance but since my Dad had prostate cancer I decided to go with SBRT. I'm wondering if I should have had a combination treatment than just SBRT?
How old are you? Thanks.x
I was 65 when the mpMRI found the lesion (Pirads 4) last Sept and biopsy confirmed last November and treatment this Jan/Feb.
If you already have urinary symptoms due to BPH, does radiation makes those significantly worse?
I have the same question.
@@markj5769my radonc advised against radiation due to my BPH and reliance on Flomax. She said it would get worse and recommended surgery.
Very interesting.....I'm a very active/fit 66 year old w/ a Gleason 3+4=7 w/ 2 small lesions. (.5 & 1.0). After biopsy, 3 out of 12 show "3's" w/ a 4 found in the 1.0 lesion. This MRI SBRT looks like a vg solution...... How can we find out where this New technology is offered around the country? We live in Florida now. (Although our daughter still lives near UCLA).
Where in Florida do you live...
Start Proton-Beam next week in Jacksonville, FL,thanks.@@mattpellicano7184
I was at Moffitt Cancer Center in Tampa last week and they have SBRT in three locations. One near me at Morton Plant Lykes Cancer Pavilion in Clearwater.
Have there been any studies in which fasting has been used in conjunction with radiation treatment for prostrate cancer?
I sill can't believe that I shruked my prostate cancer with herbal supplements from DR. Osaka on youtube channel, who I came across actually couldn't believe it at first because it sounded impossible to me knowing how far I have gone just to get rid of it. All thanks to you sir Dr. Osaka
I would like to know as well
How long should you stay away from pregnant moms and small children after treatment? Before it got out of your system
At 7:25, why is grade-1 side effects higher than grade 2 and grade 3?
Grade 1 represents less serious side effects; they are more common
What is difference between cyber knife and sbrt?
Cyberknife is a brand name for SBRT.
I thought the gamma knife was more focused than conventional xray beams? Allowing for less collateral damage.
I had my prostate removed in October 2020. PSA, taken about every 3 months. PSA went from .02 to .5 in March 2022. Then had PSMA scan done early April 2022. A lymph node in the abdomen showed a slight uptake of PLY. Just had SBRT to that area. May 20th having PSA. hoping my RO hit the mark. Waiting now on pins and needles. I believe my RO knows you. He is Dr Saigal at Sarasota Memorial.
I sill can't believe that I shruked my prostate cancer with herbal supplements from DR. Osaka on youtube channel, who I came across actually couldn't believe it at first because it sounded impossible to me knowing how far I have gone just to get rid of it. All thanks to you sir Dr. Osaka
How bad were the radiation side effects?
@@TheIndalian tired for about 6 days
Have a psa of 7 and a Gleason of 7 5 cores positive one 4+3=7 and two are 3+4=7 and two 3+3=6 what kind of treatment should I consider.
@@luiscortez5179 I would say radiation or removal of prostate
Problem is SBRT does not cure cancer in the long term and once you have it, your options for treatment of the cancer are far less than ideal and many times nonexistent. This does not work and it is time that this information is made available to men. Sure there will be some short term isolated reductions in PSA, but beyond a year the results are more telling that this is not a good treatment for prostate cancer.
Can you (or anyone else) provide some evidence or links or is this your opinion? I am researching my situation as a PSA 11.3, 6 Gleason, T2b patient. Thanks.
Please provide some kind of evidence for your claims.
Have you any medical credentials at all?
There is no treatment with a 100% cure rate; this presentation contains many graphs showing that.
@@Maroonbearister someone posted with zero evidence, zero medical credentials, no links to sources, in contradiction to documented clinical trials and outcomes, and there's nothing to even show who they are. I wouldn't lose any sleep over it.
One guess is that they're a patient who didn't get the outcome they wanted (note that the studies and this presentation are very open and up front about this -- no 100% guaranteed cure rate; if a provider gives you such a guarantee then you are being conned, RUN!) -- and applied all-or-nothing thinking to that.
According to the results of the HYPO-RT trial (conventional fractionation vs. SBRT), biological failure-free survival at 5 years was 84% in both treatment groups.
@@oldhounddog57 Once again, these results are not an accurate assessment based on substantial testing. The medical business in the area of prostate cancer is putting forth misleading and inaccurate stats and thereby depriving men of all the legitimate information to make informed decisions. Ever heard the phrase each cancer is different? There are too many variables in these test results to make them even come close to some realistic accuracy. Once a patient bounces around the current system he finds that all the talk of treatment and cure is so much b.s.