PC Treatment Options

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New Member

Date Joined Feb 2010
Total Posts : 2
   Posted 2/20/2010 1:24 AM (GMT -6)   
  New to this web site.Nearing decision on options
  Age-almost 55
  No family history of PC
  Diagnosed in 11/09
  PSA 4.4     3.3  10/08    2.7  9/07
  Gleason  3+4
  Samples  9of14 positive
  CAT Scan/Bone Scan -clear 12/09
  Type 2 Diabetes diagnosed 2 years ago controlled by weight loss of 30+ pounds
  Cholesterol controlled through meds and diet
  Urologist  suggested robotic surgery at Hartford Hosp.Met w/Dr Wagner. May not be able to spare left nerve
   Met w/Dr Cardinale in New Haven. Also candidate for Cyberknife if insurance pays. Would prefer this because of other health conditions, less time off from work,qualty of life issues. Also father had severe complications from cancer surgery 5 years ago and passed.
Both Dr Wagner and Dr Cardinale topsin their respective fields. Other than long-term studies both robotic and Cyberknife seem to be viable options.
 Also wife and son's health issuesa consideration in decision
  Interested in hearing from CyberKnife patients experiences. Must decide by 2/24

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4848
   Posted 2/20/2010 6:30 AM (GMT -6)   
Welcome to the site and sorry you have to be here....
Could you explain/expand on your last two statements:
 Also wife and son's health issues a consideration in decision
  Interested in hearing from CyberKnife patients experiences. Must decide by 2/24
I'm curious as to why your families health condition is part of your equation.....and also why the rush to make a decission by next week?

Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

Veteran Member

Date Joined Jul 2008
Total Posts : 981
   Posted 2/20/2010 10:03 AM (GMT -6)   
I don't think we ever had a cyber knife patient post here. Cyber knife advertises here frequently.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
7/30/08 - Psa: .32
11/10/08 - Psa.62 - Not unexpected bounce after the 80% drop the quarter earlier. Along with urine flow readings, an acceptable amount left in bladder measured by sonic. Results warrant skipping third quarter tests, and to return April, 2009 for final biopsy scheduled to
complete clinical research study  
April 2009 12 of 12 Negative Biopsy
2/16/10 12 of 12 Negative Biopsy 

Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 2/20/2010 10:30 AM (GMT -6)   
Where are you? CT? If not too far, NYC is a great resource.
www.franktalk.org ED website for PCa guys

46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
Two year PSA - undetectable!

Regular Member

Date Joined Dec 2009
Total Posts : 214
   Posted 2/20/2010 11:13 AM (GMT -6)   

Welcome - lots of good advice here!


Age:  63 
Biopsy: May 09 showed 2 of 12 cores positive for prostate cancer -- 1 at 5% and 1 at 25%.  Cancer indicated as non aggressive.  Gleason Score: 3+3.
RRP on Oct 23/09 in London, Ontario.  Excellent surgeon. 
7 Weeks Post Op -  The fears I had about bad things about the operation and recovery did not materialise except of course ED!!.  Otherwise, everything went very smoothly.  Incontinence not a problem.  Wear a pad when out just in case. Pain was never a problem.
Pathology:  Unremarkable 
First followup PSA and Visit: Feb 11/10 - 0.0.
Next PSA May
Next doctor's visit in 6 months      

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 2/20/2010 12:44 PM (GMT -6)   
Do a lot of research on cyberknife before you make a decision. It is used for small tumors in hard to get to areas such as the brain and liver, but has only recently be used for PC, so there is no long term data on its effectiveness. There are some doctors that doubt its effectivenss on large organs such as the prostate in which there is usually disease throughout the gland. The number of positive cores your husband indicates that this is the case in his PC.
Cyberknife is highly refractionated radiation. Surgery and regular IMRT would be good options as well as a combination of seeds and IMRT. The combination of seeds and IMRT will give a much higher dose and treat the entire gland as well as sufficient margins around the prostate with much less side affects than surgery.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


Veteran Member

Date Joined Jan 2010
Total Posts : 1011
   Posted 2/20/2010 3:01 PM (GMT -6)   
Don't know anything about cyberknife. Was not even brought up as a option when I was making my decision on treatment a year ago. I did end up have robotic surgery at Hartford Hospital. Dr Wagner was my surgeon. Surgery went very well. Both nerves were spared, but no guaratee going in. I had my surgery in the morning and was out of the hospital in the afternoon of the next day. I was able to return to work within 3 weeks. I was pretty happy with my care at Hartford Hospital. Would be happy to discuss further with you if you like.
Dx with PC Dec 2008, PSA 3.4, Biopsy: T1c, Geason 7

Robotic Surgery March 2009 Hartford Hospital
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 2/20/2010 3:58 PM (GMT -6)   
First, welcome and sorry you're here, glad you came. I didn't know Cyberknife was a viable options for PCa surgery. If you go that route, after plenty of due diligence, etc. I hope you will stick around and keep us updated on this new (to us, at least) technique.
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 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN

New Member

Date Joined Feb 2010
Total Posts : 2
   Posted 2/20/2010 8:01 PM (GMT -6)   
Hi Steve,
Wife has health issues, one son is in 8 year battle w/ addiction and mother-in-law suffers some dimensia(?). Being laid up 3-4 weeks would cause alot of hardship on wife. We also assist in caring for 6 year old grandson. Also have barely enough sick days to cover surgery/recovery. Cyberknife would limit days out of work and make it easier on household.You'd have to live in our house to understand how it factors in to equation.

Need to let surgeon know by 2/24 as they have been holding a slot for 3/25. Insurance just reversed decision and will cover Cyberknife, which I would prefer. I would rather not go through surgery as I also have Type2 Diabetes,HBP and a bad back.Wonder how they would factor in.

Been going back and forth looking at both scenarios as I am a candidate for both kinds of treatment.Dr Cardinale (Cyberknife)and Dr Wagner(robotic surgery are both highly regarded).Seed implants were not an option.

This whole thing sucks-as you all well know. Stayin alive and quality of life issues.

Regular Member

Date Joined Jun 2009
Total Posts : 292
   Posted 2/22/2010 1:39 PM (GMT -6)   
I had gamma knife (a cyber knife cousin) surgery fifteen or so years ago for a small (1 cm) and it was mighty slick. I missed two days work instead of one month and never had a bit of trouble since. That being said, I had 20 years of history with the procedure to back up my decision and a surgeon who didn't care because he got paid either way so his advice was as unbiased as I could find. Targeting is the key with these precision tools and that is where my questions would start once I was convinced about the efficacy of the procedure. I had a steel halo screwed into my head to assure aiming. (I can't think of anywhere in my nether regions I'd want a screw inserted. :-)
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 PSA 9/10/09 <0.1

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 2/22/2010 3:41 PM (GMT -6)   
You do not have to make a decision by the end of this month. I say B.S. to any doc whom says so and would love to say face to face, you can be put on hormone therapy drugs, like casodex, lupron, zoladex, maybe avodart and others while you take the time to analyze your choices. This is the exact type of protocol used in the Bolla Study concept (by patients including myself whom had terrible stats and high risk level patient-I waited 5 months and psa went super low while waiting) and used often in conjuction with various types of radiations/combos and usually they advise waiting 5-6 months (4 minimum) before do radiations. These can be brachy seeds, brachy seed/combo's, various external radiations (IMRT-photon); Proton (Loma Linda et al); Neutron and neutron/photon is even available (only 2-3 places doing it).

Some folks have gone on casodex or its equals while deciding and waiting to do surgery or other protocols. NEVER should anyone be rushed into any treatment and you can get that info from the mostly knowledgable PCa docs like: Strum, Scholz, Barken, Meyers, and alot of others that know this beast from all angles... Alot of cashin on patients in the name of supposed medicine, some of these pushy docs don't run nomograms or other tests and other considerations that should be done...but would rather rush you into their 'curative' surgery-radiations-cyro-hifu-etc.....which comes with no guarantees anyway.

I know a guy whom did only ADT3(hormone) drugs for his PCa, low level case, 14 yrs. now and normal as a man, went 13 mos. on ADT3 quit and used only proscar as maintenance. This is not widely advertised (gee), has decent results...and Rick K. can still have surgery, radiation, HIFU, Cryo and other gigs. This same protocol has been used on higher level risk patients with favorable results, not considered a cure...buys time and choices and quality of life considerations and stops some docs from getting the latest Mercedes-Benz(lol).

Dx-2002 bpsa 46.6 12/12-biopsies all 75-95% PCa, Gleasons found 7,8,9's (2 sets about the same), ct and bone scan found clear, started with emergency room for total urinary blockage, then to uro doc....and 8 opinions that followed and a path that is little different...cancer was a little different too, than the average presentation...lucky to be in the condition I am right now. (ADT3 prior like Bolla Study, then neutron & photon radiations* then ADT2*off drugs cycle* then started DES*off cycle and intermittent the last 4-5 yrs.)
Agree with John T. on cyberknife, if you go external radiation you need pelvic areas considered to help get to possible areas outside the capsule for best results and that is better done in other methods. The docs cannot know precisely where all PCa cells are-PERIOD. (risk-rewards scenario)

Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 2/22/2010 1:54:54 PM (GMT-7)

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