Monday, December 4, 2017

Questions to ask an SBRT doctor

SBRT doctor questions
1.     How many have you performed?
2.    How has your practice of SBRT changed over the years?
3.    What is your 5-yr freedom from recurrence rate for patients at my risk level? What proportion of your recurrences were local-only?
4.    What kind of urinary and rectal reactions can I expect? How long can I expect them to last? What medications or interventions do you typically give for that? Should I expect those symptoms to recur later?
5.     What is your rate of serious (Grade 3) adverse events? Do you see urinary strictures? Urinary retention requiring catheterization? Fistulas? Rectal bleeding requiring argon plasma or other interventions?
6.    What is the margin you will treat around the prostate? Is it less on the rectal side?
7.     What is the prescribed dose to the planned target volume?
8.    Do you work off a fused MRI/CT scan?
9.    What machine do you use (e.g., VMAT, CyberKnife, step-and-shoot, Tomotherapy, etc.)?
·      If CyberKnife: Do you use the IRIS or a new multileaf collimator?
·      Do you set a limit on “hot spots”?
10.  Do you use fiducials or Calypso transponders? Do you do transperineal placement of them?
o   What system do you use for inter-fractional tracking?
o   What system do you use for intra-fractional tracking?
11.   In my treatment plan, what do you identify as “organs at risk” and what dose constraints do you put on them?
o   What dose will my penile bulb receive?
12.  How long does each treatment take?
13.  How will I be immobilized during each treatment?
14.  Are there any bowel prep or dietary requirements?
15.  Should I avoid taking antioxidant supplements during treatment?
16.  In your practice, among men who were fully potent, what percent remained fully potent 3-5 years later?
o   Have any men retained some ability to produce semen?
o   What is your opinion of taking Viagra preventatively?
17.  Do you monitor side effects with the EPIC questionnaire?
o   In your practice, what percent of men experience acute urinary side effects?
o   In your practice, what percent of men experience acute rectal side effects?
o   In your practice, what percent of men experience late term urinary side effects?
o   In your practice, what percent of men experience late term rectal side effects?
18.  What kind of PSA pattern should I expect following treatment?
19.  What is the median PSA nadir you are seeing in your practice, and how long does it take to reach that, on the average?
20. In your practice, what percent of men experience biochemical recurrence?
o   What % of those have been local?
o   If there should be a biochemical (PSA) recurrence, what would the next steps be?
o   Have you ever used SBRT, brachy, or cryo for salvage after a local SBRT failure, and was that focal or whole gland?
21.  Are you open to email communications between us?


  1. Wow Allen Great list.. Is it ok to print this ? Ed

  2. Consider adding ViewRay MRIdian to #9. In addition to live monitoring and gating to protect OAR and thus allows for smaller margins. The use of MRI avoids the need for fiducials and spaceOAR.

    1. Very few out there. Kishan at UCLA is running an RCT to see if it makes a perceptible difference.