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

Day 1 includes: "Active Surveillance" | Matthew Cooperberg, MD, MPH, "Incontinence & ED Medical/Surgical Treatments" | Jeffrey Brady, MD, and "Prostate Treatments & Imaging" | Eugene Kwon, MD.

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

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 [phone] with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.

The information on the Prostate Cancer Research Institute's YouTube channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.

#ProstateCancer #Prostate #AmarKishanMD

[Bill]

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

[acos]

Hey, that is my oncologist! He is amazing!

[juanmacias]

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

[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.

[ElCidPhysics]

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.

[paulelkins]

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.

[SinnerSince]

Great talk. Thanks to everyone responsible for the production!

[JuanSanchez-ikwx]

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.

[daisuke]

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

[doctornebula]

Excellent presentation. Great teaching skills!

[peacefulruler]

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

[johnpaval]

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.

[robertbass]

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

[prosfromdover]

Dr. 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.

[jacobdonkersloot]

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

[roberthuff]

🎯 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.*

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[paulschmidt]

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

[Allessio]

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

[CessnaF]

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

[oldhounddog]

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?