New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

New Member

Date Joined Mar 2009
Total Posts : 8
   Posted 6/27/2009 2:10 PM (GMT -6)   
Thanks to all of you that responded to my post on June 13th about treatment options.
Since that time my brother informed me about a new treatment called Cyberknife.  I looked up the information on the internet, and it sounds very non-invasive yet effective.  Has anyone had this treatment, or does anyone know someone that has? 
One last query: I have heard that you cannot have prostate removal surgery, or any surgery, once you have had radiation.  I don't believe that, but I am curious to know if that is true.
Thanks again for the great support from this forum.
Age 60

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 6/27/2009 2:57 PM (GMT -6)   
I asked my doc about Cyberknife and he told me it wasn't appropriate for PCa removal.  Although surgery is "possible" in some cases after radiation, then extremely high percentage of rectal wall damage, bladder damage and other severe damage to the area precludes doing surgery after radiation.  A very high percentage of surgeons will refuse to attempt it, the radiation makes the remaining tissue "tacky or sticky" resulting in very profound damage to the organs in the area.  We've had a couple of guys here that had surgery after radiation and their results and experiences were things made from horror stories. I imagine you would have to go thru 100 surgeons to find one who would attempt salvage surgery, and then would probably require waivers of responsibility.  Sorry to seem so pushy with this, but that's been the experiences of guys here, as far as I know.  

James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
21 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 6/27/2009 3:08 PM (GMT -6)   
The observations of James C agree with what I have read. Very few surgeons will attempt such an operation. I haven't read anything about the success rate of those that do.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3 + 4 = 7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Post surgical pathology report. Lymph nodes negative, Seminal vesicles negative
Surgical margins positive, Capsular penetration extensive Gleason 4 + 3 = 7
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
At 10 weeks: no pad at night -- slight unpredictable leakage day/1 pad.

Forum Moderator

Date Joined Sep 2008
Total Posts : 4278
   Posted 6/27/2009 4:05 PM (GMT -6)   
Dear propaul:
Here is a fairly balanced article on cyberknife from the Washington Post.  I looked into this treatment when I was considering options but felt that, despite its' promise, there just wasn't enough data on cure rates or SE's over the long term.
Re salage surgery after radiation there are only a very few specialists that will try it.  There is not much data that I can find on the success rate but, anecdotally, there are lots of disaster stories from those who have tried it.  Divo, who is one of our forum members, posts about this from time to time...her's husband's experience was NOT good.  You may want to check out her posts.
I think James C. did an excellent job of describing why the success rate might not be high.
From my personal standpoint, if my brachytherapy was to fail, under no circumstances would I choose salvage surgery.  There are other options...
Hope this helps,
Age 62
Gleason 4 +3 = 7
PSA 4.2
2 of 16 cores cancerous
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 6/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Regular Member

Date Joined May 2009
Total Posts : 476
   Posted 6/28/2009 9:09 PM (GMT -6)   
Cyberknife is radiation delivered in few treatments, as opposed to conventional radiation treatment where it is delivered over 40 or so treatments. The mechanism is the same, but toxicity is higher if the body has less time to adjust. It benefits the medical institutions (less time on expensive machines) much more than the patient.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA results:            1/8/2008-33.90, 1/11/2008-29.50, 1/31/2008-38.20,

2/21/2008-32.00, 3/13/2008-26.20, 4/3/2008-26.60, 4/24/2008-20.60

RRP at Duke (Dr. Moul) on 6/16/2008

Pathology:              Gleason downgraded 4+3=7,   Duke: T2c N0MX, one positive margin,

2nd opinion at Sloan Kettering: T3a N0MX, extraprostatic extension, two positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009

IMRT to start mid-Aug

New Member

Date Joined Mar 2009
Total Posts : 8
   Posted 6/28/2009 9:58 PM (GMT -6)   

Your responses have been a great help to me.  I have been told that I have many options, and I am trying to do what everyone must think they can do - get rid of the cancer without any side effects.  (From what I see it's pretty near impossible.)  It just seems that robotic surgery is so invasive, and the recovery period so long - about 2 years I am told for complete return to what is considered acceptable.  Luckily I have the time to wait until I accept that I have Prostate cancer, and that I must do something or risk a fate worse than the side effects of surgery.


Elite Member

Date Joined Oct 2008
Total Posts : 25394
   Posted 6/29/2009 7:52 AM (GMT -6)   
Can you have salvage surgery after failed radiation? The technical answer is yes, but it would be all but impossible to find a reputable surgeon that would do it. My own surgeon with 30 years experience said he only saw two done, when he was in medical school, and they so screwed up the lives of the patient, and it was the most brutal surgery he had ever seen even to this day. After radiation scrambles ,melts, disfigures the prostate bed, there isn't much in the way of any clear margins, edges, or boundaries for a surgeon to operate. Even if you get through the surgery, the failure rate for ridding any PC reaccurance is very high.

This is why it is so important to choose your primary treatment well. If you are low gleason, low PSA, low staging ,low % of cancer in any biopsy cores, there are non-surgerical methods that should be effective and safe. But if any of the above are on the high side, surgery would make more sense for most people.

You have to remember, you don't get a second chance on the primary treatment, and you need it to erradicate the PC completely if possible, and if not, at least give you a shot at a second attempt for a cure.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist

Veteran Member

Date Joined Sep 2008
Total Posts : 744
   Posted 6/29/2009 3:53 PM (GMT -6)   
I can understand why salvage surgery isn't so much of an option because radiation tends to make it's target into something like a paste, but why can't a second course of radiation treatment be done? Perhaps a treatment that is composed of half as many Gy's delivered? Maybe a second radiation treatment course would get any remaining local cancers the first one didn't get.

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 6/29/2009 4:05 PM (GMT -6)   

Greetings, Paul.  I would agree with my brothers here who have said there are very few doctors who would attempt salvage surgery after radiation.  The radiation just does so much to the prostate bed that it is almost impossible and yes, there are lots of horror stories out there regarding those who have tried the surgery.

There is somewhat of a bias here on this board towards surgery - me included.  Yes, there are side effects but don't assume they will be for 2 years.  My doc advised me to be prepared for incontinence and impotence for 2 years, but neither have effected me very much right from the start.  Sure, there are some issues but nothing that couldn't be dealt with. 

You do have time so make a good decision and then don't look back.  Do the research and once you have a treatment then do it and let the healing begin.  David

Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me

Regular Member

Date Joined Jun 2009
Total Posts : 292
   Posted 6/30/2009 11:31 AM (GMT -6)   
I had Gamma Knife treatments for a AN tumor in 1995. Think of GK as the cyberknife's older brother.
At the time I was told that the intense pinpoint radiation was only good on tumor up to a certain size and it was less effective beyond that. I recall my tumor was only 1.5 centimeters in size and even then there was repositioning etc to get full coverage. There is a cyberknife located only four hours up the road from me but I never even considered it as a option. Your results may vary.

My doc has done over 2000 RP. He said he has done one after radiation and that things were a mess, making it a very difficult surgery. I got the impression he'd just as soon never do it again.
Diagnosed at 54
PSA 8.7
Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7
Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09
Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence
Pad free week 5
PSA 6/6/09 <0.1

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 6/30/2009 11:58 AM (GMT -6)   
Cyberknife is used to treat many types of cancer, liver, brain ect where there are very small spots of cancer.
PC is usually multifocal, occurs in many areas of the prostate at the same time, and the tumors are normally larger, making cyberknife an inappropriate treatment for the vast majority of PC.
A PET scan can identify small cancers that can be effectively delt with by cyberknife, but PET scans don't work with PC as the isotope won't bind to the PC cells as it does in other cancers.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July


New Topic Post Reply Printable Version
Forum Information
Currently it is Wednesday, September 26, 2018 2:06 AM (GMT -6)
There are a total of 3,006,714 posts in 329,386 threads.
View Active Threads

Who's Online
This forum has 161846 registered members. Please welcome our newest member, fdgdfhdff8806.
102 Guest(s), 1 Registered Member(s) are currently online.  Details