The Complete Guide to SBRT for Prostate Cancer | Amar Kishan, MD, UCLA

[@Bill3558]

I paid $500 out of pocket for the genetic Prostox test. Came in low risk. Will do SBRT.

[@juanmacias4854]

Now I understand why my doctor is doing a genetic profile, thanks for the excellent presentation.

[@acos48]

Hey, that is my oncologist! He is amazing!

[@ElCidPhysics90]

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.

[@doctornebula]

Excellent presentation. Great teaching skills!

[@paulelkins3570]

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.

[@tomswoverland]

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.

[@dprince5271]

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

[@stevenjohnson7745]

My heart goes out to you Tom. I’m hoping the remission holds.

[@dbrown4bbl]

Hi Tom - I’ve had 35 sessions over seven weeks, plus Lupron and abiraterone. Good luck.

[@SinnerSince1962]

Great talk. Thanks to everyone responsible for the production!

[@daisuke6072]

Excellent, succinct but thorough presentation, giving much food for thought.

[@peacefulruler1]

Great, clear, not boring!

[@jacobdonkersloot635]

Very nice presentation. The combination of real-time MRI with an SBRT instrument looks very promising.

[@SinnerSince1962]

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.

[@paulschmidt2251]

Great video. Facts help patients make good choices. Thank you

[@prosfromdover8860]

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.

[@chedesgrieux2365]

Pros From Dover - Are you an intermediate-risk or high-risk patient?

[@audtom52]

@@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.

[@WendellLive]

Did you have a normal or enlarged prostate?

[@robertbass6039]

There is a lot of good information here ,but even using a 15 inch computer screen and magnifying the screen to 175% ,i can not see many of the charts that are being displayed

[@Cessna8057F]

Many thanks! Articulate and so instructive for me as I am embarking on treatment options.

[@johnpaval9646]

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.

[@peacefulruler1]

27:30 Radiogenomics is the most interesting topic in this talk

[@MM-sf3rl]

WOW, is he brilliant❗️❤

[@emcinc9654]

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.

[@dprince5271]

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

[@TheIndalian]

How bad were the radiation side effects?

[@emcinc9654]

@@TheIndalian tired for about 6 days

[@luiscortez5179]

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.

[@emcinc9654]

@@luiscortez5179 I would say radiation or removal of prostate

[@roberthuff3122]

🎯 Key points for quick navigation: 00:00:34 *🎯 Radiation is designed to severely damage cancer cell DNA, causing the cells to die when they attempt to divide.* 00:01:15 *🏠 Focus of discussion: External Beam Radiotherapy (EBRT), specifically SBRT, and its effectiveness in treating prostate cancer.* 00:02:09 *⚡ Higher doses of radiation per day are more effective against prostate cancer, leading to shorter treatment courses.* 00:03:31 *🚀 SBRT delivers high doses of radiation over shorter periods using advanced imaging and delivery techniques.* 00:04:12 *📚 High-level studies support SBRT as a standard care option for prostate cancer in the U.S.* 00:05:34 *🔬 Studies show no difference in survival between high-dose daily radiation and conventional treatments.* 00:06:28 *🔍 Pace B trial: Early results suggest modern SBRT has short-term side effects equivalent to other radiotherapy forms.* 00:07:52 *📊 Data from the ucla study suggests long-term safety and effectiveness of modern SBRT for prostate cancer.* 00:09:18 *🚫 SBRT showed comparable or potentially lower severe side effects in comparison to traditional radiation therapies.* 00:10:44 *💪 SBRT is effective for high-risk prostate cancer, showing strong survival rates influenced by additional therapies.* 00:11:42 *🌐 MRI-guided radiation allows precise treatment by compensating for the prostate's movement during therapy.* 00:13:21 *📡 Real-time MRI tracking reduces potentially harmful side-effects by precisely targeting the prostate.* 00:15:52 *🏆 Early results from a trial indicate MRI-guided treatments significantly reduce moderate side effects.* 00:17:07 *🌀 SpaceOAR gel can reduce rectal radiation exposure, thus lowering potential side effects during prostate cancer treatment.* 00:18:12 *⚕️ Acute radiation side effects are primarily urinary, bowel, and sexual, manageable with medications.* 00:19:08 *💧 Acute urinary side effects are treated with NSAIDs and urinary medications; incontinence is rare.* 00:20:06 *🧻 Acute bowel side effects include urgency and frequency; less common than urinary symptoms and treated with over-the-counter meds.* 22:28 *📉 Short-term side effects from prostate cancer radiation peaked at one month and resolved by three months.* 22:56 *🏥 Significant late urinary side effects occur in 2-3% of patients, requiring interventions like hyperbaric oxygen therapy.* 23:37 *💊 Significant bowel effects such as proctitis affect about 1% of patients, potentially needing gastroenterologist intervention.* 24:19 *🔬 The risk of radiation-induced cancer is very low but must be considered in treatment decisions.* 25:01 *⚕️ Long-term erectile dysfunction affects approximately 23% of patients and is mostly related to blood flow issues.* 26:11 *💊 Medications like Viagra can help manage erectile dysfunction by improving blood flow, with daily doses acting as a preventive measure.* 26:52 *🌐 Innovations in radiation techniques, like real-time adaptive radiotherapy, aim to reduce side effects.* 27:36 *🧬 Radiogenomics studies individual genetic responses to radiation, offering insights for personalized treatment.* 28:31 *🧪 A DNA-based signature predicts the risk of urinary toxicity after SBRT, guiding treatment decisions.* 29:42 *📊 The ongoing Garuda trial aims to validate DNA tests predicting treatment side effect risks, enhancing care personalization.* Made with HARPA AI

[@JuanSanchez-ik7wx]

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.

[@niashirin111]

@@JuanSanchez-ik7wx why are you keen on brachytherapy? As far as I can see in the slides, they have the most side effects

[@JuanSanchez-ik7wx]

@@niashirin111 From an engineering standpoint, pellets placed in precise locations means 100% efficiency and no collateral damage to other organs. I eventually did the 7 week plan of radiation. And there were side effects. Urinating is down to a trickle. I have back pain on the right side now. Could be unrelated but I am a big believer of Occam's razor. SBRT requires a dialy regiment of clean colons, gas evacuation and a full bladder. Getting all three of those to happen every day at the same time is xtremely difficult and in reality impossible. SBRT relies on the technicians ability to read the image correctly. Lots of room for error, with consequences as well as benefits. I could find no one who would do the procedure in the entire state of florida.

[@niashirin111]

@@JuanSanchez-ik7wxI like your reasoning. Thanks for the insight.

[@edg531]

@@JuanSanchez-ik7wx “Clean colon, gas evacuation, and a full bladder...” That was the nightmare I lived for 28 grueling sessions of VMAT radiation. So glad it’s done!

[@JuanSanchez-ik7wx]

@@edg531 35 for me. I'd like to know where they get these numbers from. I would think that every other day for 7 weeks would be more than sufficient.

[@oldhounddog57]

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?

[@wilander1]

Would appreciate hearing your thoughts on MRI LINAC. Do you think this will be the future gold standard in high dose radiation delivery?

[@johnmchale8308]

yes it is now.....

[@Allessio777]

If you already have urinary symptoms due to BPH, does radiation makes those significantly worse?

[@markj5769]

I have the same question.

[@dgre334]

​@@markj5769my radonc advised against radiation due to my BPH and reliance on Flomax. She said it would get worse and recommended surgery.

[@stevenjohnson7745]

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?

[@jacobdonkersloot635]

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.

[@dmcarden]

Just wondering why they can't avoid the neurovascular bundles and internal arteries or using less radiation on those.

[@oldhounddog57]

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?

[@theobauer4845]

How should the risk of developing a second tumor be assessed

[@duanemcclun]

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?

[@wormsnake1]

How old are you? Thanks.x

[@duanemcclun]

​ I was 65 when the mpMRI found the lesion (Pirads 4) last Sept and biopsy confirmed last November and treatment this Jan/Feb.

[@PeteMaclean-o9x]

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.

[@lyfandeth]

I thought the gamma knife was more focused than conventional xray beams? Allowing for less collateral damage.

[@annarivera4636]

How long should you stay away from pregnant moms and small children after treatment? Before it got out of your system

[@jdotoz]

No radioactive material is deposited with external-beam treatment. The patient is never radioactive, even during treatment.

[@peterb2346]

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).

[@mattpellicano7184]

Where in Florida do you live...

[@peterb2346]

Start Proton-Beam next week in Jacksonville, FL,thanks.@@mattpellicano7184

[@kvmalley]

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.

[@sandraredmond4812]

Is this appropriate for high volume ( entire right side ) 4+3 Gleason with one core of 4+4?

[@ThePCRI]

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: kzbin.info/aero/PLHj3V3RB2V-ietm3-kNkx48kbUnbtunL8. 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.

[@stevenjohnson7745]

Have there been any studies in which fasting has been used in conjunction with radiation treatment for prostrate cancer?

[@dprince5271]

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

[@sandraredmond4812]

I would like to know as well

[@TheIndalian]

At 7:25, why is grade-1 side effects higher than grade 2 and grade 3?

[@jacobdonkersloot635]

Grade 1 represents less serious side effects; they are more common

[@sandraredmond4812]

What is difference between cyber knife and sbrt?

[@ThePCRI]

Cyberknife is a brand name for SBRT.

[@rogerstaton2777]

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.

[@Maroonbearister]

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.

[@scottwillis5434]

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.

[@scottwillis5434]

@@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.

[@oldhounddog57]

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.

[@rogerstaton2777]

@@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.