It's Decision time

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

stereoA
New Member


Date Joined May 2011
Total Posts : 14
   Posted 5/30/2011 7:44 PM (GMT -6)   
Gentlemen (Ladies)
My diagnosis came in a a few weeks ago, ( got the news on May 12, one day BEFORE Friday the 13 but it didn't help) but with all the research I am doing it feels like it has been years. Anyway, here are the numbers. I am 54, had a 12 core biopsy, one core positive, lateral right, 2 mm. Gleason is 3+3. My Uro claims its T1c, but who knows. What is odd about this seemingly low grade cancer is that i have a high PSA - it upticked to 30 before biopsy. It is now at 22 because i took bactrim for 2 weeks for a small bladder infection. My PSA has been fluctuating like this for years, and ALWAYS goes down after a course of antibiotics - which is how we have been trying to beat it down. It finally settled on about 10 a year ago until it shot up to 30 before Christmas and it was time for a biopsy, with known results.
After a lot of consultations and owing to my life/insurance/professional situation i am down to 2 choices only: surgery (preferably DaVinci) or Cyberknife (Stereotactic Radiation) which unless i missed something no one or almost no one here was treated with, and i wonder why? (For those unfamiliar with the procedure cyberknife is a 5 day high dose of radiation but delivered with submilimeter accuracy)
What alarmed me on this forum is that there seems to be a large number of patients who had to go to radiation (IMRT usually) AFTER their prostatectomy, because of relapse. That seems like a very high rate of relapse. Surgical RP is supposed to be the one surefire method of getting all the cancer out: you go in there with a robot, look at things with a 20X magnification, and cut away - can someone shed some light on this?
Also, i am reading some study abstracts and the incidences of partial or total, albeit potentially not permanent ED seem A LOT more widespread than the websites of surgeons and hospitals would have us believe, and this in folks whose nerve bundles were spared. This issue is very important to me, as i believe to most of us. How are you guys out there doing in that regard?
Cyberknife would seem like a great option: almost no side effects, no incontinence and no ED, 5 days instead of 9 weeks, ultra accurate, but - CORRECT ME IF I AM WRONG - the Uros and Radiologists are basically guessing, right? They look at our numbers, the pathology report, and give us their best guess, and then give you the radiation and all we can do after that is watch the PSA again, and hope they did not miss and it does not start rising. And if it does, after radiation, in any form, there is apparently precious little one can do: the only therapies available - again, correct me iiaw - are life prolonging therapies, such as a hormone therapy, but there is no way to get rid of cancer anymore. Another subject that interests me and would like your input on is long term radiation effects, say on urinary tract: 10 or more years.
So, a big decision. Feel free to put in your 2 cents - i appreciate it!
stereoA

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7080
   Posted 5/30/2011 8:48 PM (GMT -6)   
StereoA,
Welcome to HW, but as always, we hate to see new members here.
 
I would not call my DaVinci followed by IGRT "relapse". I think for a lot of us it is better described as an attempt by the surgeon to remove the cancer, only to find that it had already broken the capsule and "gotten out".
 
Also, keep in mind that those of us here are rarely those who had good results. Those folks come by, visit a few months, and go on with their lives. A lot of us are here because we had/have issues of one sort or another, or just want to be around to help where we can.
 
From the comments about your biopsy, you would appear to be a fairly low-risk case, but that certainly does not mean you can ignore it and go on as before. It appears you have come to a first step decision. There are members here who have have cyberknife, and seem quite pleased with the results. I am a DaVinci alumni, and chose surgery (I chose a surgeon, who does DaVinci, rather than choosing DaVinci). I was (and still am) a believer in having a pathology report to tell me what was there. Cyberknife does not provide that option (not to be read as saying something against it, just a factor in my mind).
 
If you do radiation as a first treatment, followup surgery is possible, but it takes a very experiened surgeon, and many (most?) surgeons will say it is not possible. I considered RT as a primary, but the success % quoted was not impressive, so after two similar opinions, I dismissed it.
 
Zufus will chime in and remind you that we are in the Twilight Zone - Prostate Cancer is one of the least understood and predictable.
 
 
DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

windycitytiger
Regular Member


Date Joined May 2011
Total Posts : 79
   Posted 5/30/2011 8:58 PM (GMT -6)   
Have you looked at the Partin Tables? With a PSA of more than 10 and a Gleason of 6, you have a 70% chance that your cancer is confined to the prostate. If that's the case, surgery may be your best choice.
Age 50
PSA 5.7
Biopsy 8 of 12, 6@3+3, 2@3+4
Probably having surgery in July

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 5/30/2011 10:25 PM (GMT -6)   
Hopefully John T will post here and explain how a biopsy can not be trusted to find all the cancer that may exist....Alarm bells ring when a small amount of G-6 cancer found during a biopsy produces a very high PSA level..Since you have a history of having an elevated PSA level, it makes it all the more difficult for your urologist to determine what exactly is going on...

Another thing to consider..The people on this board are for the most part actively fighting their cancer..The ones who had surgery and were "cured" (we use that word objectively) get on with their lives and drift away, hopefully never to return here..Generally speaking, if you make it out 5 years and have an undetectable or a very low and stable PSA there is little reason to post here.....

As a primary treatment, the Cyberknife has not been used very much, so not enough TIME has passed to perform any objective analysis of how effective it is compared to other treatments..

There is evidence developing now that da-Vinci surgery is no more effective than the open procedure, and in high-risk cases, the open method seems to get better results. I had da-Vinci surgery, performed by a top surgeon, excellent reputation, plenty of experience..It left me impotent, with a life-threatening staph infection and did not cure my cancer..But I was high-risk going in, Partin gave me a 50% percent chance of success so I took it...I'm just saying that robotic surgery offers no magic...

If you have not read Dr. Patrick Walsh's book, "Guide to Surviving Prostate Cancer" you should do so...There are several other good books dealing with this subject.. With the Cyberknife people advertising their services during radio broadcasts of baseball games and other sports events, putting up billboards, I would filter their claims carefully, especially the part about zero side-effects..
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

stereoA
New Member


Date Joined May 2011
Total Posts : 14
   Posted 5/30/2011 10:56 PM (GMT -6)   
142
Thank you for this response. You are right, in many cases it is not a relapse, but a follow up to treat what could not have been gotten out with surgery: i stand corrected. I would love to talk to a surgeon who thinks RP is still possible on a radiation treated prostate. The problem is, i believe, that if Ca was still present it would not be in the now dead prostate, it would be somewhere else, like surrounding tissue, or elsewhere and you are looking at radiation again, which is not an option because the cumulative dose will be too high. Or perhaps it is - i have no idea.
You make a very valid point regarding pathology. For me i think i would have gone to Cyberknife if it wasn't for the fact that my PSA is so high, so perhaps the horses have left the barn and i need to do surgery and have the option of radiation treatment later. That's the decision i now face. I believe my Ca is organ confined, but the PSA level leaves the lingering doubt.
Also, the more i read the more i see that at a 2 year intersect Rp and radiation have you at statistically identical condition regarding relapse and side effects (ED especially), with a proviso that after radiation your sexual function will now decline at a faster than normal rate.
Thanks for your insight.
windycitytiger
i have seen the tables, but why do you think that with the cancer confined to prostate surgery is better than cyberknife?

stereoA
New Member


Date Joined May 2011
Total Posts : 14
   Posted 5/30/2011 11:37 PM (GMT -6)   
Fairwind

I am looking at your signature: did you have G-6 or higher? Why did partin only give you a 50%? Why were you considered high risk? What was the post op pathology? It sure seems like many things did not go right: impotence, staph, cancer remaining.. i am very sorry to hear that, but i sincerely hope your treatment progresses and you will prevail in the end. Hang in there.
I understand about DaVinci being no magic, which is why I am looking at other options, even though EVERYONE i talked to in the first 2 weeks pushed me towards surgery (i am talking about medical professionals from various related fields).
AS for the cyberknife, i have never seen an ad for it (i don't live in Florida), i have never even heard about it until i found it on the internet and all my info comes from published abstracts (very few of those, the technique is too new), and from forums such as this one. Apparently it has been performed as primary on over 6000 patients so far. The guys on cyberknife forum who were treated swear by it; i have not read a single report that was in any way negative. And little wonder, the serious side effects of radiation do not manifest themselves until much later, when damaged organs start to go. Imagine: the prostatic urethra gets the same dose as prostate itself: how on God's green earth can it not be damaged? What good is a nice erection if you are practically urinating from the damage (that is what my dermatologist, a wise older whole body treating type doctor asked, and he had radiation training for skin cancers) - during an intimate encounter?
Fairwind, i do hope things get better for you, Sir. Thank you for the advice and kind words. Be well.

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 5/30/2011 11:43 PM (GMT -6)   
stereoA -

Welcome.

There are definitely surgeons who do what is called "salvage prostatectomy" which is RP after radiation of some sort has failed. My surgeon (at UCSF) said he does this. It is a tricky surgery.

For example, here is one article:
www.ncbi.nlm.nih.gov/pubmed/21568696

That said, I don't believe your hypothesis is correct: "if Ca was still present it would not be in the now dead prostate, it would be somewhere else." It may simply be that the radiation did not kill everything, and the PC remains in the now largely dead (but not completely dead) prostate.

I went to see a leading radiologist and a leading surgeon, and even the radiologist said that in my case if he were me he'd get surgery. Each case is different. For example, you didn't say how old you are. The usual wisdom says that radiation morbidity grows over time, whereas surgical morbidity is high at the beginning and then (often) diminishes. Given small cancer in one core only and G6 you will likely get bilateral nerve sparing surgery if you go the RP route, with good chances for trifecta outcome. If you are 45 vs. 75 the tradeoff between surgery and radiation looks very different. A 45 year old is more likely to come through the surgery with urinary and erectile function intact, but conversely is more likely to live long enough to suffer from the long term radiation damage. A 75 year old is less likely to come through surgery intact, and does not need to worry about radiation-related morbidity that may surface 20 years later.

HOWEVER -- please keep in mind that your case is NOT garden-variety in that you have much higher PSA than your biopsy indicates should be the case. So, odds are that there is some more cancer that the biopsy hasn't found, maybe a transition zone tumor, but that does NOT mean that the cancer has spread outside the prostate and therefore surgery is of no use. I would consider the following: (1) color doppler ultrasound to look for more PC. (2) saturation biopsy to look for more PC. Finally, if you can't pay for or don't want to do either of those, it is in my opinion an argument for RP over radiation. If you don't know where the tumor is, how do you know where to aim the cyberknife? Precision is useless if you don't know where to point the beam. If you do RP, then you have the specimen to examine and see if what they find squares with the high PSA. You will find out if there are positive margins, and if the PSA falls to undetectable as it should. If necessary, you can move on to an adjuvant therapy right away.

good luck with your decision.
"If the tool in your hand is a hammer, then every problem looks like a nail."

DX age 54 12/2009
PSA 5.6, DRE-, high pre-op PSAV. Clinical stage T1c
Biopsy: Gleason 3+4 with PNI / 6 of 14 cores + / 10% of total length + / worst 45% +
DaVinci RP 2/2010
pT2cNx / Gleason 3+4 / PNI+ / SM- / SV- / EPE- / Tumor vol 3cc / vol 40cc / 63 gm
PSA in 2010: <0.01, 0.01, 0.01
PSA in 2011: 0.01

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 5/30/2011 11:44 PM (GMT -6)   
I have not been able to find out what makes the Cyberknife machine able to deliver it's total dose in 5 treatments or less when other high precision linacs now in use require 38 or 40 fractions (treatments) to deliver their total dose..

If your cancer is indeed G-6 and it's confined inside the capsule, then surgery can provide a 97% success rate, very hard to beat that...As an added benefit, the entire gland can be examined by the pathologist and a much more accurate determination of the extent of your cancer can be made as opposed to just the needle biopsy...

With radiation, any type of radiation, it's very hard to administer a 100% lethal (to the cancer) dose without causing unacceptable damage to the surrounding healthy tissue...At age 54, you may have 30 years or more to live...That gives the side-effects of radiation a lot of time to do it's thing, none of which are pleasant....

We have all gone through "Decision Time" and it's not easy....Find the best doctors you can, listen carefully to what they have to say and make up your mind..Time is on your side, so take your time..You might want to consult with a Medical Oncologist, someone who is not in the picture yet and hopefully never will be..Ask him or her what he thinks about your treatment choices..After all, they have seen it all and have insights not presented by surgeons, urologists and Radiation Oncologists...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 5/31/2011 1:10 AM (GMT -6)   
StereoA,

Sorry you have to join us but welcome. Members of this forum are very knowledgeable, supportive and can provide you with excellent emotional supports. They will answer many of your questions honestly and clearly. This forum gave me great insights and great emotional supports during my darkest moments last year and for that I am forever grateful. However, none of us are doctors and so ultimately you still have to rely on professional help. Ultimately what treatment you choose is your personal choice.

Many of us who had successful surgery with minimal side effects tended not to hang around too much. I used to sign on regularly but now only visited this forum occasionally. Anyway, regards and good luck to you.
65 Dx June-2010 PSA: 10.7, biopsy: Adenocarcinoma, 1 core Gleason 6, 3 cores atypia; Clinical stage T2; CT, Bone Scan, MRI all negative

8-23-10 Robotic RP; Pathology: Organ confined, negative margins, Lymph nodes, Seminal Vesicle clear; PNI present; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason 4+. Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 no incontinence, no ED. 3/2011 PSA: <.1

Ausboy
Regular Member


Date Joined Mar 2011
Total Posts : 92
   Posted 5/31/2011 7:11 AM (GMT -6)   
Hi Stereo
I think everyone here has been where you are right now, it sucks, but you have to make a decision and be happy with it for what ever reason.
I agree with others, most are here because of not having optimal outcomes and still seeking info, assurance, advice, comfort what ever.
If you would like to read some more pc treatment expiriences that cover all treatment options, have a look at YANA, it has all different types of guys from all over the world and what treatment options they chose and how they are doing.
I found it helpful, see my signature started at G6, ended up with none of that and all different sorts up to G9, biopsy result is only part of the story, a guide at best. for me it was either open or Robotic I chose robotic and am comfortable with choice and doctor, that is the important thing, find a good one, what ever you choose. A friend of mine with similar stats to yours chose hi-dose brachy, he is very happy and a zero. I am 11 weeks post Op, feel good, pad free, dry and working on ed, and most importantly a big fat "0" tongue
And yes ED is understated in most studies, my belief is if they told the truth mortality rates would be back where they were in the nineties, and no one wants that.
good luck, hope all goes well
age 49, dx 21-01-2011 PSA 5.6
12 cores all positive >80% in some, Gleason 3+3=6, T2B
RALP 10-03-2011, post OP pathology, Gleason 4+3=7 and 1% 5+4=9
Prostate 50g, 48mmx40mmx40mm, largest tumor 48mmx34mmx24mm, extensive PIN also present, EPE left apex .2mm, perineural invasion, clear margins closest was .7mm, lymph nodes not checked.
path stage pT3A Nx Mx R0
post OP PSA ? 11/5/2011 - 0.03

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4271
   Posted 5/31/2011 9:24 AM (GMT -6)   
Hello, Stereo...welcome to HW.  Sorry you have to be here but I trust you will find this to be a helpful and caring place.  I would like to offer the following thoughts on your situation and addresss some of the comments on this thread:
 
1.  I briefly considered Cyberknife as it intuitively seems like a good alternative.  The problem I had with it was the lack of long term data on either its' efficacy or side effects.  Perhaps you will be able to find better info, but I'm very much data and logic driven and was unable to find convincing long term info on this alternative.
 
2.  It is true that surgery after radiation is difficult.  However, that is only part of the story.  In the first place, radiation tends to treat areas slightly beyond the prostate to begin with so there is liklihood that cancer in those areas will be killed along with the cancer in the prostate.  Secondly, even if the primary radiation fails, there are alternative salvage treatments that are just as effective as the salvage radiation that follows failed surgery.  For example, after a failed permanent brachytherapy, one may consider implanting seeds with another isotope, HDR brachytherapy, cyrotherapy, HIFU and (of course) HT.  The point is that there are salvage treatments for both failed surgery and failed radiation...they just happen to be different.  You will most likely get the info about radiation backup to surgery from a uro-surgeon but you likely need to speak with a radiation oncologist or prostate oncologist to get the info about salvage treatments for failed radiaition.
 
3.  We often hear from patients on this forum about how they value the information provided by a "final pathology" from their surgery.  But, I would encourage you to ask yourself and your uro the question, "what will you do with the information once you have it?"  The most frequent answer is "nothing"...since the most common thing that is done after surgery is to wait and see what happens via PSA readings.  So, you may get info that a recurrance is "more likely" but unless you are prepared to enter adjuvant treatment immediately after surgery, then that info is interesting but not something on which you will take action.
 
4.  There are a couple of references to long term radiation side effects.  It is certainly true that there are rare side effects that occur with all treatments.  There MAY be some peripheral radiation damange or a patient MAY die on the table during prostate surgery.  However, I would encourage you to focus on main area under the curve and not the tails.  Focus on the big three - cure, urinary effects and sexual effects.  Most other side effects are rare in all treatments.  And...if you have specific radiation concerns, you should speak to a radiation oncologist rather than relying on your urologist or on-line forums for your information.
 
5.  If side effects and quality of life are important to you, then I would encourage you to consider brachytherapy as an option.  The long term cure rate has been shown to be similar to surgery, the urinary side effects are generaly minor vis-a-vis surgery and the incidence of ED is more like 35% vs. 50% for surgery.  A couple of years back the New England Journal of Medicine published a QOL survey with comparisons between the various treatment options.  Despite the fact that the brachytherapy group in this study was older than the surgery group, the QOL score for both urinary and sexual functions was signifcantly higher for brachytherapy patients than for surgical patients.  If you want a first person version of brachytherapy, feel free to copy and paste my "journey" at the bottom of my signature.
 
6.  I think there are three particularly good books that you might consider reading to get a good perspective on your disease.  They provide different and valuable perspectives, IMHO.  The books are, "Surviving Prostate Cancer" by Walsh, "A Primer on Prostate Cancer" by Strum and "Invasion of the Prostate Snatchers" by Scholz/Blum.
 
Good luck and please keep us posted on your progress.
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

stereoA
New Member


Date Joined May 2011
Total Posts : 14
   Posted 5/31/2011 10:40 AM (GMT -6)   
Ausboy, Newporter, thank you. Your support means a lot.

Fairwind, proscapt, you are so right. Here it is in a nutshell; providing all goes well i can have issues for 6-24 months, and then be ok.With radiation ill be ok for awhile, and then things will start going to pot. As you said, at 54 my life expectancy is easily 25 years, so in 10 or 15 or so when fibrosis starts to set in the urethra, and it constricts or worse, plus whatever else might be happening, with the rectum for one, oh boy, it does not sound pleasant at all. One indicator of long term damage might be BT long term effects studies: i believe those will be similar to cyberknife. I have to read more on that. As for that and the accuracy, they go one step beyond most IMRT's: they implant some gold markers in the prostate and the machine tracks it with great precision. As a matter of fact it will stop and turn off when you move, and then reacquire and proceed. One of the main problems with garden variety IMRT is that the prostate will move inside your body while you are immobilized, so the dose is never really precise. That said, a RO in Northridge in LA said their IMRT machine uses the gold seeds too for tracking. I believe without that it is a hit and miss at best, and much radiation is delivered to the surrounding tissue. BTW, the cyberknife does not target the tumor itself, it irradiates the entire organ. Finally, i think one can think of cyberknife as a sort of High dose BT, but much much more precise.
I also understand about the biopsy: it states clearly the results are what was FOUND, not necessarily what WAS THERE. That can only be determined by post op pathology. And that is another good argument for surgery. With me there is one core positive, and a small 2mm tumor, but as is the case with most Pca, i believe mine is most likely multifocal, especially given the high PSA.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 5/31/2011 11:22 AM (GMT -6)   
StereoA,
There have been no posters on this forum who have had cyberknife. You can post your question on Healthboards as there are a couple of posters that have had cyberknife and rave about it. The main issue is the lack of long term data. 5 year data was just published and was comparable to other conventional treatments and the SEs were low.
Long term radiation issues were common 15 years ago, but as accurracy has improved the issues have become much less. Every treatment has its risks and benefits. My own philosphy after reading thousands of patient posts and research papers is for low risk PC to go for the treatment that has the least side effects as the probability of cure is similar and very high for all treatments. For high risk PC, where the risk of premature death is high, I would opt for a more agressive combination treatment, surgery or radiation along with a short course of Hormone Treatment.
If you decide on Cyberknife please continue posting your experiences as information on this new treatment is sorely lacking on this forum.
You may want to consider a color doppler ultrasound or MRIS to confirm that the cancer is still contained and you are not opting for a treatment that would not have a high probability of 1st time cure.
JohnT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 5/31/2011 11:39 AM (GMT -6)   
The following study was just posted today on the New Prostate Cancer InfoLink

The results reported by Kang et al are as follows:

•Average (median) age of patients was 69 years (range, 53 to 79 years).
•Average (median) duration of follow-up was 40 months (range, 12 to 78 months).
•The 5-year prostate cancer-specific survival rate was 100 percent.
•The 5-year progression-free survival rate was 100 percent.
•At least follow-up the biochemical progression-free survival rates were
◦100 percent for the low-risk patients
◦100 percent for the intermediate-risk patients
◦90.8 percent for the high-risk patients
•Adverse effects of SBRT were
◦6 acute and 3 late grade 2 urinary toxicities
◦4 acute and 5 late grade 2 rectal toxicities
•There were no grade 3 or higher treatment-related toxicities.
Kang et al. conclude that SBRT is a safe and well tolerated forms of treatment of localized prostate cancer — even for relatively high-risk patients.

The key difference between the current study and the two previously-reported sets of data on US-based patients is that in the US cohorts all of the patients were classified as either low or intermediate risk, whereas two-thirds of the Korean patients discussed above were classified as high risk.

Clearly we shall need more data to get a sound understanding of the potential of SBRT as a treatment for patients with high-risk, localized prostate cancer. In addition, we still need longer follow-up on larger numbers of patients before we can be comfortable about the potential of SBRT in the treatment of localized prostate cancer, but good data do appear to be accumulating, and the initial potential of this type of therapy seems to be confirmed at the 5-year data point.

JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7080
   Posted 5/31/2011 12:57 PM (GMT -6)   
Over on CSN's prostate board, a poster "Kongo" did cyberknife. He also posts here at times. He has been very positive about his experience.

stereoA
New Member


Date Joined May 2011
Total Posts : 14
   Posted 5/31/2011 1:40 PM (GMT -6)   
Tudpock

Thank you. Very informative and insightful. It is good to hear from someone who considered what i looked at, and chose a treatment option that resembles it. As i wrote above, BT long term effects are probably similar to cyberknife. I am sure you thought this through before deciding on the best option for yourself, and your excellent results confirm that it was the right choice. At this point i am leaning towards radiation myself. The reason i cannot do IMRT is i don't have 9 weeks - not until next spring anyway, and everyone says i probably should not wait that long. Finally, i was advised not to do BT simply because of my high PSA (this is from and IMRT RO who also does seeds in all forms, and thinks its a good and viable option) - why he would think that is beyond me. He also said he would NOT like to be involved if i went cyberknife with a EBRT boost - the boost being done in his facility. A big opponent of cyberknife it seems. You know, many people cite lack of long term studies for cyberknife: its a new procedure so you can only go a few years back. Consider this, for IMRT the total dose was in a 60Gy or thereabout area for years, and there are many studies on long term effects. The dose was upped to around 80Gy or so in the last few years, and so consequently there are no studies for long term effects of any kind for that because it is a recent change, and yet noone seems bothered by it. FYI, the total cyberknife dose is about 35Gy. Just that alone seems like a good thing, providing you get your result.

Ausboy

I looked at YANA website and you are right it is great. I looked at the big comparison chart with hundreds of names and chosen treatments and effects of those and you are right about ED and surgery: if everyone realized the potential people would shy away from it and mortality rates would shoot back up. Still, the prevalence of Ed post surgery is of some concern: more than half of guys who went under the knife seem to have ended up with some form of ED. A lot more than half, it seems. For me, if i was 70 or so, i probably would not care (thats me and my choice - i am not saying everyone after 70 should give up on sex - no way!). As i am 54 and in a new and very rewarding relationship that i sacrificed a lot for, side effects are not just important, they are life defining. So at this stage i am leaning towards radiation more, knowing that i may have problems in the future. But i will not make the decision until mid June, after i have talked with everyone i contacted.

To All

A big Thank You from the bottom of my heart., Your support, knowledge and encouragement are a beacon of hope for me. I the short time that i posted - a day or so - i got more information and tangible help that in the last few weeks of talking with doctors, family and friends. Seriously, Thank You guys!

stereoA
New Member


Date Joined May 2011
Total Posts : 14
   Posted 5/31/2011 1:57 PM (GMT -6)   
John T

Thank you. Those were published just today! Good news and EXCELLENT stats, obviously. FYI, the first cyberknife patient was treated in 2003, he was a neurosurgeon, still around and cancer free.
As for me i don't quite know - no one seems to know really - whether i am a low, intermediate or high risk - one core, G-6, but latest PSA 21.8. But even if high risk, a 90% toxicity free is not bad after 5 years.
New Topic Post Reply Printable Version
Forum Information
Currently it is Wednesday, September 19, 2018 5:27 PM (GMT -6)
There are a total of 3,004,854 posts in 329,176 threads.
View Active Threads


Who's Online
This forum has 161749 registered members. Please welcome our newest member, bullit398.
221 Guest(s), 11 Registered Member(s) are currently online.  Details
Lioness1, Rainy cloud, mattamx, cashlessclay, ceebs13, ASAdvocate, Alxander, oregonhay, RunJerRun, Korissa, MacroMan