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Cyberknife Procedure Update

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

At age 59 I was diagnosed with PCa in mid-March after my PSA had risen from 3.8 to 4.3 in 18 months. 1 of 12 biopsy cores showed adenocarcinoma with 15% involvement. Gleason rating was 3+3=6. DRE was normal. Staged at T1c. I had a prostate volulme of 47 ml, a PSA velocity of 0.23 ng/ml/yr and a PSA doubling time of 9.3 years. There was no evidence of perineural invasion. A second opinion on the pathology slides confirmed the original reading of 3+3=6 Gleason score. Interestingly, after eliminating dairy and red meat from my diet my PSA score in mid-May had dropped to 2.8 which my doctor characterized as "great, but you still have cancer."

After several consulatations, a lot of study, and a careful investigation of surgery, various forms of radiation (both photon and proton), and active surveillance, I have elected to pursue treatment with the Cyberknife procedure.

Cyberknife uses a robot to deliver a high dose of radiation with sub-millimeter accuracy to the prostate. Four gold markers (called fiducials) -- about the size of a grain of rice -- are inserted into the prostate and detailed MRI and CT scans are used to track the movement of the prostate in real time so that the dosage is accurately delivered without damaging surrounding organs and tissue.

I had the fiducials implanted yesterday. It was a pretty simple procedue that inserted the fiducials into the prostaste via the perineum using a live sonagram video taken with a rectal monitor. Unlike the biopsy procedure where the needles are inserted transrectally, this procedure did not require enemas or antibiotics and there was no resultant blood in the urine or stool. Best of all, there was essentially no pain. I was sedated during the procedure and it was conducted without incident or after effect. Afterwards, an x-ray of the prostate was taken to ensure the fiducials were properly placed. There is a very slight soreness in the area of my perineum today but not enough to warrant any pain killers.

The next step is to build a detailed 3-D picture of the prostate using a detailed MRI scan so that the dosage parameters can be calculated. This will take place in about a week as they have to wait to be sure that the fiducials are not moving. They will also build me a customized pod to lay in while undergoing radiation treatment to minimize body motion.

After the radiation plan is developed, the radiation is delivered in five sessions that each last about 45 minutes while the robot rotates about the body in six-degrees of axis while it adjusts itself to prostate movement. The prostate can move up to several millimeters in a short period of time through normal respiratory function, bladder filling, and gases in the colon so adjusting the robotic x-ray placement is critical in avoiding radiation to surrounding tissue.

In most cases, the radiation is delivered in five consecutive sessions. I had read a recent Stanford study that suggested a protocol that skipped a day between sessions to allow better recovery of tissue near the urethra and my physician team was ameniable to this delivery schedule.

I expect to start the radiation within a few weeks.

Cyberknife has a very low incidence of follow-on urinary difficulties which are mostly a sense of urgency and more frequent urination that resolves itself within a few days. Skipping days between radiation treatments is supposed to alleviate this potential side effect. Post treatment erectile function with Cyberknife indicates that men who have no ED before treatment are 85% potent following treatment. Men who experience a decrease in erectile function following treatment are treated successfully with Viagra-like drugs.

Success with Cyberknife, like all radiation treatments, is measured by reaching a stable PSA nadir at some point following treatment. Studies have shown that the higher dosages that can be delivered with Cyberknife are instrumental in a rapid PSA drop following treatment and a nadir that is typically below 1.0 ng/ml with a statistically insignificant percent of biological failures for men with early stage PCa (PSA <10, Gleason < 7, and Stage T1.)

My Tricare insurance covered Cyberknife without blinking. I understand Medicare also covers it. I've read that some insurance plans and HMOs may not cover Cyberknife although the procedure was approved for cancer treatment by the FDA in 2000.

Will keep you all posted as to the specifics of the treatment process and how it works for me.

bdhilton
Posts: 759
Joined: Jan 2010

I wish you well in your journey with the best results.

mrspjd
Posts: 693
Joined: Apr 2010

Thanks for the update and for keeping us posted on your progress and journey. My brother (yes, both my brother and husband have PCa, increasing the chances of PCa for our three sons) had this procedure at UCLA with Dr. King and he seems pleased with the result.
Wishing you all the best.
Sincerely,
mrs pjd

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Sounds great for the best outcome for you! I will be very interested in the progression following the procedure and so will many others. Question...have they tried to map out exactly where the cancer is within the prostate or will they be basically decimating the entire organ to be sure to kill all bad cells?

thanks again for you candor and recap of your experience as there is nothing like real life case studies to help others in the tough decisions that have to be made with this beast.

Randy in Indy

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Randy,

Like most radiation treatments, the entire prostate is radiated. The impact of this is that there is reduced ejaculate but no dry orgasms. Nerves and the penile bulb are generally not affected in Cyberknife treatments because of the ability of the robot to deliver extremely accurate dosage placement. If you were potent before radiation you will most likely be OK afterward. For those who have difficulty achieving a usable erection after radiation, Viagra or Cialis have been shown to be almost universally effective. Although the entire prostate is zapped, the ability of Cyberknife to spare surrounding organs and tissue is well documented. Occasionally there is some rectal bleeding in about 5-10 percent of the cases but this can be addressed through out-patient surgery where the damaged blood vessels in the colon are essentially cauterized.

I am happy to hear of your progress in recovery and the good news of your post-RP PSA readings.

142
Posts: 169
Joined: Dec 2009

It sounds from all your posts that you have made a well-considered decision. I wish you the best results.

hopeful and opt...
Posts: 1353
Joined: Apr 2009

By the way, last night I watched a dvd of a lecture that don Fuller, a radiation onclolgist at the cyberknife center of san diego gave in april , 2009.

Are you going to the this center?

Ira

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Hi, Ira. I am actually going to the Cyberknife center in north county at Vista. I have corresponded briefly with Dr. Fuller and he is well respected in San Diego.

viperfred
Posts: 20
Joined: Jun 2010

Hi Kongo,

Fantastic evaluation of the treatment options. Dr. D. Fuller is a wonderful doctor with excellent results treating PCa with the CyberKnife.

I was treated May 2008 for PCa with the CyberKnife at Stanford by Dr. Chris King (now at UCLA). Evaluated all options as you did and came to the same conclusion as you.

Side effects were very short term, urgency and frequency for bowel and urination, returning to normal within two months and today have ZERO negative side effects. Urination frequency before treatment was 2-3 times/night and is now 0-once a night. PSA is now 0.55 ng/ml, initial PSA was 5.0 ng/ml.

Glad your insurance company is covering the CK, many do not. In my case had to go to the CA Dept. of Managed Health Care and appeal the denial, the denial was overturned and two months later BS of CA added CK coverage for PCa.

The CyberKnife uses a hypo fractionation dose which is high dose per session 7.25 Gy/session with the five day protocol and 9.5 Gy/session with the four day protocol, but much lower total dose than IMRT or Proton Therapy. Hypo fractionation (HDR Brachytherapy) has a very good cure history (around 15 years). Side effects for both protocols seem to be the same.

Over four thousand patients have been treated for PCa with the CyberKnife and the results are very good. There are many who do not understand the CyberKnife and there are those who intentionally misrepresent the CyberKnife. The number of patients treated for PCa by year(2003-2009) are on my web site http://www.iprostatecancer.com/

Good Luck,

bdhilton
Posts: 759
Joined: Jan 2010

Your web site is a commercial for Cyberknife...

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Not only that...the ratings for the other treatments are total and complete BULL Sh&t!! Saying incontience for surgery is 20-70% typical....BS.

viperfred
Posts: 20
Joined: Jun 2010

Randy look at the studies for surgery open or robotics. If you can provide studies with lower numbers send them to me and I will be glad to include them in my site and change the numbers.

It is easy to make comments without data. Take time to look at the studies, I have!

From my research and personal experience the CyberKnife is the best choice for localized PCa.

Men need to look at all treatment options and make an informed choice they feel is best for them. Trust no one including me, let clinical data, science and your instincts be you guide in consultation with your doctors.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

There are 3 surgeons in Indianapolis that have from 2-5% incontinence in there patients over the last 3 years in Dr. Scott, Dr. Hollensbe and Dr. Koch. These are there success rates - I am one that is fully continent from Dr. Hollensbe. Your figures from studies are outdated when compared to the surgeons at the forefront of the Robotic surgery. Mani Manning in Michigan, Atwari in NY, Burnett at John Hopkins...The group here in Indiana.....none of these guys even come close to 20% incontinenc with their patients....your website is a blatant AD for Cyberknife (Which is probably a very good procedure and outcome) However the figures you throw around for other treatments seriously downplay the success that has been achieved in other treatments....Please show me the exact studies that qualify you to say:

o Incontinence, 20 to 70% risk typical

Who were the surgeons, When were the surgeries?

Your information is misleading to a person who has not researched the large body of evidence.

Sorry, you cannot make me think anything other than that...I call it like I see it and I am usually correct.

Randy in Indy

bdhilton
Posts: 759
Joined: Jan 2010

Randy… This guy is a “Troll” plain and simple. He makes Cyberknife sound like a magically cure and this is really unforgivable with guys coming in here looking for real guidance…So in my eyes this guy has no credibility. It could be the next best thing since sliced bread but I have yet to find any real studies on cyberknife except by the manufacture for PCa….Sorry that is how I see it…and I love you retort "I call it like I see it and I am usually correct..." amen

Best to you

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Notice he has not commented on the largest study ever done on robotics that blows his retarded statistics away that he pushes on his web site.

"• Side effects
o ED, 20 % to 80% risk typical
o Incontinence, 20 to 70% risk typical"

TOTAL and COMPLETELY MISLEADING the NEWBIE's

Sorry VIPER you have been exposed.

Randy in Indy

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Here is a link to one of the largest studies done on Robotic. Check out these numbers...better update your web page:

http://nyp.org/news/hospital/robotic-prostate-surgery-study.html

Here's a small recap of the findings:

Specific study findings include the following:
•Ninety-three percent (93%) of patients achieved normal urinary function, with a median time of complete control of three weeks.
•Only slightly more than seven percent (7.2%) of patients had recurrence of prostate cancer symptoms (presence of prostate specific antigen, or PSA). Less than one percent (0.5%) of patients died during 71 months of follow-up.
•Nearly 80 percent (79.2%) of patients reported normal sexual function.

Randy in Indy

viperfred
Posts: 20
Joined: Jun 2010

There are many treatment options for localized PCa, and many treatments continue to improve with advancements in technology. There are no studies that show any treatment is better than any other.

The following link includes an article about the CyberKnife and comments from many stakeholders excluding the insurance companies. http://blogs.wsj.com/health/2008/11/28/is-cyberknife-ready-for-prime-time-in-prostate-cancer/

May Your PSA Never Increase!

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

I've been following this thread and have not commented yet. There are two comments in your most recent link which were interesting to me.
If you want to have an honest approach to help others when you direct them to your initial website link you should make sure and include these two comments along with links to the study that Randy posted.

1. “This is really pushing the envelope....... But it could turn out to be a disaster. No one knows.”
2. At least one study that followed patients for several years suggests the device is safe and effective, the WaPo says.
But that single study isn’t enough to provide clear evidence.

These two comments reinforce to me that I did make the right choice for my Gleason 7. I have actually looked into CyberKnife to learn more about it and I'm glad that CyberKnife appears to have worked for you and wish you many years of health. I as others on here researched extensively the different options before selecting treatment. It breaks my heart to read of those that just jump into whatever option their Doctor suggests. I'm glad my Doc encouraged me to research and he would back me with my choice.

The one thing that we each have to remember is that EACH CASE IS UNIQUE. My dad had proton with great success, I have a friend at Church that had Seed implants with great success.
I along with others on the forum have had great success with Davinci. I know of others that have had traditional Surgery with Great Success.

There are so many factors that affect each of us and our treatment outcomes such as PSA, Gleason Score, Free PSA, etc. etc. plus our own lifestyles, individual weight, exercise patterns, eating habits.

It is also interesting that you point out that your PSA is "now 0.55 ng/ml, initial PSA was 5.0 ng/ml." My PSA Pre-surgery was 5.3 and now is 0.
For surgery having a follow up PSA of .55 would indicate that I would need further treatment.
I realize that with Surgery the prostate is gone...and with the Cyberknife the prostate is zapped but still in you and which I believe would give you the .55 reading.

I'm glad Randy calls it as he sees it and hope that each of us can help other men that come down this path behind us and learn from our shared experiences.

Larry

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Larry, as you noted, Cyberknife leaves the prostate intact after radiation so there is always going to be some PSA. What they look for is a PSA nadir that is below 1.0. A biological failure would be a rising PSA after nadir. It sometimes takes 3 years to reach a nadir. I am unaware of any biological failures using Cyberknife.

bdhilton
Posts: 759
Joined: Jan 2010

Kongo,

I wish you the best results but do you really believe that there are “no biological failures using Cyberknife.” If that was the case this would be the only treatment used.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

BD, you're right. I misstated what I was trying to say. I should have said that in the low risk PCa groups that have been documented in various studies, I am not aware of any failures. That's based on the studies I have read using the low risk cohort and admitedly, the follow-up time is less than 5 years. Overall, I understand that there is a failure rate of 3-4% but this includes the higher risk patients. Failure is usually defined as an increasing PSA after nadir.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Viper,

Thanks for the encouraging report on your personal experience with Cyberknife. I’m hoping for similar results. I have read your many posts on the Cyberknife Discussion Forum and know that you are a knowledgeable and enthusiastic advocate of the procedure.

My personal studies and analysis covered the same scope and reached similar conclusions as what you outlined on your website, although I’m always reluctant to take too much stock in success statistics regarding side effects because of the great disparity of how they’re set up and the definitions they use. Many studies on ED define potency as the ability to achieve an erection sufficient for penetration at least once a month. To me, that’s not very potent. Similarly, incontinence covers the gamut of zero bladder control and permanent catheter use to an occasional sense of urgency or increase in frequency of urination.

In the study that Randy cited in his post, it’s pretty clear that the excellent results described in this 2007 report out of New York Presbyterian Hospital, were a function of a highly skilled and experienced surgeon (they emphasized that point more than once in the paper). I believe that the studies that show a much lower success rate with respect to incontinence and ED following surgery are a result of less experienced surgeons. Randy had excellent results with his DaVinci procedure, but it wasn’t just luck. Randy did a disciplined, deliberate, and wide-ranging study like you and I did then made a decision which was best for him. He then sought out one of the finest DaVinci surgeons in the country to do his procedure and he’s now a poster boy for DaVinci.

Unfortunately, not all men have the same experience as Randy for a variety of reasons. I personally believe that a man’s pre-treatment physical condition and lifestyle play almost as much as role in post-treatment outcome as the treatment team. None of the studies I’ve read normalize age, physical condition, stage, lifestyle, and so forth in establishing the study group.

Another thing about studies…the results are easily skewed based on the selection of the cohort. In Cyberknife, for example, the men included in the studies must meet a strict protocol that includes stage T1/T2, PSA < 10, Gleason less than 7, minimal involvement from biopsy cores, and prostate contained. (I know this because I'm in a study myself and had to qualify using this criteria) I’m happy to be in that category but frankly, for someone with my pathology, just about any treatment protocol has an extremely high likelihood of success. I don’t have any idea of the restrictions on the cohort group in the study that Randy cited, but I’m sure there was some.

Viper, I see that you are new to this forum. The regulars here are very sensitive to any perception of hype associated with pushing one treatment over another. The general protocol here is to cite one’s personal experience and provide unbiased information as a means of helping others who must face similar treatment decisions. In the recent past there have been posters on this forum who had a hidden agenda and were using this discussion board as marketing tool for one treatment over another. As I know a bit of your background from the other forum, I don’t believe you’re pushing Cyberknife over anything else, but be cognizant of the general sensitivity. Most of the regular posters are highly conversant with the nuances of PCa, the relevant studies associated with the treatment options, and have a great deal of experience with the side effects of treatment.

Randy and BD: I think you should give our PCa brother, Viper, some slack here. Based on what I know of Viper from another forum I am pretty confident he’s not a “troll” like some of the recent other intruders we’ve seen here.

bdhilton
Posts: 759
Joined: Jan 2010

Kongo,

As I have stated several times with you in the past and now, I am happy that you have chosen a process that you believe in and are moving forward in your journey. I also totally believe that lifestyle changes prior to and after surgery are critical for survival and keeping your health as good as you can…If fact I would call myself an “enthusiastic advocate” of diet and exercise.

Never once in my posts have I have stated that my procedure was the best, had the best results, etc… How and what we decide on as to treatment is a personal choice and the facts that are delivered here of all places should reflect the facts not manipulation of the facts or pure fantasy. Many of us have already had to sort through many “snake oil” salesmen to arrive to our treatment decisions. This whole PCa thing is enough to deal with without misrepresentation of outcomes or the realities of the specific treatments.

Based on my studies and consultations prior to my treatment selection, I found that there was some evidence to support as it relates to "CyberKnife" …”the idea of hypofractionation, but overall it cannot be denied that the procedure is experimental. Hypofractionation may well have merit, but long term (>10 year) results are not available for HDR Brachytherapy, which has been practiced since about 1997, and neither long nor short term (>5 year) peer reviewed results are yet available for CyberKnife.

Maybe in the long run, CyberKnife will prove to have similar (but possibly not better) outcomes vis-a-vis non-hypofractionated EBRT (External Beam Radiation Treatment), in which case, its selling point will be convenience.en it over methods with established records.”

Any man considering Cyberknife should make sure that his is a truly informed consent, and that he has chosen it over methods with established records….”

Sorry but counter to what you believe this individual has not stated the facts and this is a bit disturbing to me!

Best to you

BRONX52
Posts: 156
Joined: Apr 2010

I TOO HAVING BEEN FOLLOWING THIS CONVERSATION BUT FEEL I MUST CHIME IN. THERE ARE SO MANY TREATMENT OPTIONS AVAILABLE TO US SOMETIMES IT CAN BE OVERWHELMING. TO SAY ONE TREATMENT IS BETTER THAN ANOTHER IS UNREALISTIC. MY THOUGHTS ON THIS SUBJECT ARE SIMPLE. IF THE OPTION YOU CHOOSE IS SUCESSFUL, THEN THAT OPTION IS THE "BEST"(FOR YOU). LETS JUST HOPE AND PRAY THAT ALL OF US CHOOSE THE BEST TREATMENT FOR OURSELVES, AND IF WE SHOULD BE FORTUNATE ENOUGH TO BE TALKING ABOUT THIS MANY YEARS FROM NOW, WE CAN ALL SAY WE CHOSE THE BEST TREATMENT.-------ALOHA--DAN

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

You and I agree on most issues here but I take strong exception with your statement that Cyberknife is "experimental" as you characterize it. Cyberknife was approved by the FDA for cancer treatment in 2000 --- the same year DaVinci was approved by the FDA --- and has been used to treat prostate cancer since 2003 where it started at Stanford. DaVinci was approved for use in radical prostectomies by the FDA in 2005. How do you define "experimental?" I also don't understand your comment about HDR Brachy not have long term results as I have read many. And finally, I take exception to your assertion that in the long run Cyberknife may prove to have similar (but not better) outcomes over EBRT. I really have no idea what you are basing this authoritive assumption on as the cyberknife procedure delivers radiation much more accurately with much less dosage to surrounding tissue, not to mention several other factors relating to dosage efficacy, particularly with respect to early cancers. I fear you've misrepresented the facts in downplaying this treatment option.

I agree with you completely that diet and lifestyle are critical factors in long term success regardless of treatment options and I share your loathing for the snake oil salesmen who prey on patients looking for hope.

And I agree that its far to presumptuous to second guess another's treatment choice if they've gone through the rigor of investigating and evaluating all the options available that are relevant to their individual cancer situation. After re-reading all the posts in this thread, I don't see where anyone has said their treatment choice is better than anothers, except perhaps you're disparaging remarks about "experimental" Cyberknife and other misrepresentations.

Best to you as well.

bdhilton
Posts: 759
Joined: Jan 2010

I have no vested interest in what treatment you select or have taken and I sincerely wish you the best of luck in your journey.

The items you “object” to are in “quotation marks” and are from very reliable medical scientist in my opinion…I am sorry that they do not agree with your “thought” or “belief”. No one likes to hear that the path they choose was wrong and they could have selected some magic bullet with no side effects…and that is what started the objection today first with Viper….

Your statement that “I am unaware of any biological failures using Cyberknife” and even your explanation after your statement that low risk PCa groups that have been documented in various studies, I am not aware of any failures”… Sorry 100% long term success rates do not exist with any treatment low or high risk cases.

Your treatment has the same side effects that any other radiation treatment has including long term ED issue 2-3 years after treatment… I hope you have the best outcome.

The jury is still out on the long term effectiveness of CyberKnife and the effect of larger cy dosages given (yes less days but larger dosages)...Does not mean it is not effective but the jury is out…I wish you the best

I have no interest to continue this dialog. From my perspective, this site is to help guys not slant the facts or press one treatment or agenda…

Best to all

viperfred
Posts: 20
Joined: Jun 2010

HDR Brachy therapy has been used for over 19 years not "5"

http://www.cetmc.com/ Started HDR Brachy therapy in 1991

http://linkinghub.elsevier.com/retrieve/pii/S0302283804006219 1992-2001 First patient in this study was treated in 1992

http://www.springerlink.com/content/tarm2hj0h1ff583v/ 2002-2003 HDR BT treatment

Science of Hypo fractionation:

Int. J. Radiation Oncology Biol. Phys., Vol. 52, No. 1, pp. 6–13, 2002
Copyright © 2002 Elsevier Science Inc.
DIRECT EVIDENCE THAT PROSTATE TUMORS SHOW HIGH SENSITIVITY
TO FRACTIONATION (LOW / RATIO), SIMILAR TO LATE-RESPONDING
NORMAL TISSUE
DAVID J. BRENNER, PH.D., D.SC.,* ALVARO A. MARTINEZ, M.D., F.A.C.R.,†
GREGORY K. EDMUNDSON, M.SC.,† CHRISTINA MITCHELL, R.N., B.S.N.,† HOWARD D. THAMES, PH.D.,‡
AND ELWOOD P. ARMOUR, PH.D.†
*Center for Radiological Research, Department of Radiation Oncology, Columbia University, New York, NY; †Department of
Radiation Oncology, William Beaumont Hospital, Royal Oak, MI; ‡Department of Biomathematics, M. D. Anderson Cancer Center,
Houston, TX

Int. J. Radiation Oncology Biol. Phys., Vol. 48, No. 2, pp. 315–316, 2000
Copyright © 2000 Elsevier Science Inc
TOWARD OPTIMAL EXTERNAL-BEAM FRACTIONATION FOR
PROSTATE CANCER
DAVID J. BRENNER, D.SC.
Center for Radiological Research, Columbia University, New York, NY

Int. J. Radiation Oncology Biol. Phys., Vol. 57, No. 4, pp. 912–914, 2003
Copyright © 2003 Elsevier Inc
HYPOFRACTIONATION FOR PROSTATE CANCER RADIOTHERAPY—WHAT
ARE THE ISSUES?
DAVID J. BRENNER, PH.D., D.SC.
Department of Radiation Oncology, Center for Radiological Research, Columbia University, New York, NY

Int. J. Radiation Oncology Biol. Phys., Vol. 52, No. 1, pp. 3–5, 2002
Copyright © 2002 Elsevier Science Inc.
THE PROSPECTS FOR NEW TREATMENTS FOR PROSTATE CANCER
JACK F. FOWLER, D.SC., PH.D.,* RICK J. CHAPPELL, PH.D.,† AND MARK A. RITTER, M.D., PH.D.*
Departments of *Human Oncology and †Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI

Int. J. Radiation Oncology Biol. Phys., Vol. 60, No. 4, pp. 1241–1256, 2004
Copyright © 2004 Elsevier Inc.
A CHALLENGE TO TRADITIONAL RADIATION ONCOLOGY
JACK F. FOWLER, PH.D., D.SC., WOLFGANG A. TOMÉ, PH.D., JOHN D. FENWICK, PH.D.,
AND MINESH P. MEHTA, M.D.
Department of Human Oncology, Medical School of the University of Wisconsin, Madison, WI

Acta Oncologica, 2005; 44: 265/276
REVIEW ARTICLE
The radiobiology of prostate cancer including new aspects of
fractionated radiotherapy
JACK F. FOWLER
Emeritus of Medical School of Wisconsin University, Department of Human Oncology, University of Wisconsin-Madison,
USA

Published in final edited form as:
Semin Radiat Oncol. 2008 October ; 18(4): 249–256. doi:10.1016/j.semradonc.2008.04.007.
Rationale, conduct, and outcome using hypofractionated
radiotherapy in prostate cancer
Mark Ritter, M.D., Ph.D. [Professor]
Department of Human Oncology and Medical Physics, University of Wisconsin School of Medicine
and Public Health, 600 Highland Avenue – K4/B100, Madison, WI 53792, ritter@humonc.wisc.edu

Trust no one, do the research and you will maximize the chance for cure and minimize risk.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

When are you going to update your rediculous advertising web site to include the latest and probably the largest study results of Robotic surgery results. Your page is grossly wrong for the average person using a dart board to pick their urological surgeon.

http://nyp.org/news/hospital/robotic-prostate-surgery-study.html

Robotic Prostate Surgery Study Finds 5-Year Outcomes Favorable
One of Largest Studies of Its Kind Led by Dr. Ketan K. Badani, Newly Appointed Director of Robotic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center
NEW YORK (Dec 18, 2007)

Prostate cancer patients receiving robotic prostatectomy—an advanced procedure to remove the prostate using a surgical robot—have excellent outcomes five years after surgery.

The results of what may be the largest and longest study of its kind are published in a recent issue of the journal Cancer, and led by Dr. Ketan K. Badani, the newly appointed director of robotic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of urology at Columbia University College of Physicians and Surgeons. Previously, Dr. Badani was a clinical fellow in robotic and laparoscopic urologic oncology at Henry Ford Hospital in Detroit, where the 2,766 procedures followed in the investigation were conducted over a six-year period.

Dr. Badani says, "We found that in highly experienced hands, the results after robotic surgery are outstanding for cancer control, with minimal complications and few side effects of urinary incontinence and sexual dysfunction."

"In addition, blood loss is far less than with traditional surgery. This, along with minimizing trauma to the body tissues, translates into short hospital stays, and more importantly, quick recovery—allowing patients to resume their regular activities, whether that means going for a run or playing 18 holes of golf," adds Dr. Badani, who has personally performed more than 700 of the robotic procedures.

Specific study findings include the following:
•Ninety-three percent (93%) of patients achieved normal urinary function, with a median time of complete control of three weeks.
•Only slightly more than seven percent (7.2%) of patients had recurrence of prostate cancer symptoms (presence of prostate specific antigen, or PSA). Less than one percent (0.5%) of patients died during 71 months of follow-up.
•Nearly 80 percent (79.2%) of patients reported normal sexual function.
The study also compared clinical outcomes of the first 200 patients with that of the final 200 patients to see if there were improvements. They found a reduced amount of blood loss and fewer cases of positive surgical margins (4 percent, down from 7 percent)—when the initial cut does not cut away all of the cancerous tissue. The surgery also was performed faster (131 minutes vs. 160 minutes).

"With five years of follow-up, we can now see that, not only is robotic prostate surgery safe and effective, but it continues to improve," says Dr. Badani. "As with any highly technical operation, the study points to the importance of experience. With the knowledge and practice of many procedures, outcomes for patients improve. NewYork-Presbyterian/Columbia is one of only a few premier centers that can offer this level of specialized surgery to patients."

Dr. Badani has helped pioneer novel techniques to preserve sexual potency in men undergoing robotic prostatectomy while optimizing cancer control. He has performed live robotic demonstrations at both national and international meetings and has lectured and published extensively on outcomes of patients undergoing robotic surgery. He received his medical degree from Case Western Reserve University School of Medicine in Cleveland, Ohio, and completed both his urologic residency and fellowship in robotic and laparoscopic urologic oncology at the Vattikuti Urology Institute at Henry Ford Hospital in Detroit.

The Cancer study is co-authored by Drs. Sanjeev Kaul and Mani Menon—both of the Henry Ford Hospital in Detroit.

NewYork-Presbyterian/Columbia offers a comprehensive urologic surgery program with robotic surgery available for robotic prostatectomy, robotic nephrectomy (kidney), robotic cystectomy (bladder) and robotic adrenal gland surgery. In addition to Dr. Badani, members of the robotic urologic surgery team include Drs. Mitchell C. Benson, James M. McKiernan, Erik Goluboff and Carl A. Olsson.

Robotic Prostatectomy
During robotic prostatectomy, the physician makes five to six small incisions in the abdomen, through which surgical instruments and a tiny stereoscopic camera are inserted. The camera improves visibility, and robotic arms make for easier suturing.

Robotic prostatectomies make use of Intuitive Surgical's da Vinci™ Surgical System, which has been approved by the FDA for a number of innovative clinical procedures employed at NewYork-Presbyterian Hospital.

Prostate cancer is the second most common cancer death after lung cancer. Each year, over 200,000 Americans are diagnosed with prostate cancer, and as many as 32,000 will die from the disease.

hopeful and opt...
Posts: 1353
Joined: Apr 2009

Columbia Presbyterian..........could be that ashutosh k. Tewari, M.D. is out.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I was smiling so when reading your post....thinking "man he is way more a diplomat than I will ever be" I'll give the guy a break if he posts a disclaimer on the top of his web site in big unavoidable font something to the fact of:

THIS IS A PERSONAL WEB SITE WITH MY OWN PERSONAL OPINIONS REGARDING OUT COMES AND RATINGS OF TREATMENTS USING THE RESEARCH I FOUND THAT MAY BE OUTDATED, BIASED AND OBSOLETE

Yes, that would do...

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

You're a tough, hombre, Randy but I get your point.

viperfred
Posts: 20
Joined: Jun 2010

Hope all of remain free of PCa.

The CyberKnife is an economic treat to all other options. There are several published peer review studies that include the first patient treated(2003) at Stanford by Dr. Chris King. Last updated in 2009 and is in the process of being updated.

Stereotactic body radiotherapy for organ-confined prostate cancer
BMC Urology 2010, 10:1 doi:10.1186/1471-2490-10-1
Alan J Katz

Stereotactic Body Radiotherapy: An Emerging Treatment Approach for Localized Prostate Cancer
Technology in Cancer Research and Treatment
ISSN 1533-0346
Volume 8, Number 5, October 2009
©Adenine Press (2009)
by Jay L. Friedland, M.D.1
Debra E. Freeman, M.D.1*

Dr. Don Fuller has published studies and last time we spoke 4-21-2010 he had treated over 200 patients with no failures.

Zero recurrence for any therapy is unrealistic. Surgery can not remove cells they can not see, one PCa Stem Cell that survives any form of RT Chemo, Cyro or HIFU may result in a recurrence.

The number of patients with recurrence for the CyberKnife is low. From the three major studies combined I think the total number is less than 10. The expected 10 year cure rate is 98% or higher based HDR Brachy Therapy results. I like those odds.

I know two brothers that were diagnosed with PCa at about the same time. One was treated with the CyberKnife the other opted for surgery. Both felt they made the best choice for them.

The CyberKnife is no more experimental than surgery with robotics. The ASTRO leadership has misrepresented the CyberKnife in print and electronic media.

Based on my research and treatment outcome I am biased and believe the CyberKnife is the best option for localized PCa.

What is most important is for men to have the opportunity to make an informed choice after considering the risk and reward for each modality in conjunction with their doctors.

PCa patients must do their your own research and trust no one including me.

The patient has to live or die with the choice they make. Make is wisely!

viperfred
Posts: 20
Joined: Jun 2010

Prostate Cancer Patients must be informed!

Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy
http://jama.ama-assn.org/cgi/content/abstract/302/14/1557

Role of experience and surgery
http://www.sciencedaily.com/releases/2007/07/070724161655.htm

Everyone has an opinion!

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Viper

When are you going to update your rediculous advertising web site to include the latest and probably the largest study results of Robotic surgery results. Your page is grossly wrong for the average person using a dart board to pick their urological surgeon.

http://nyp.org/news/hospital/robotic-prostate-surgery-study.html

Robotic Prostate Surgery Study Finds 5-Year Outcomes Favorable
One of Largest Studies of Its Kind Led by Dr. Ketan K. Badani, Newly Appointed Director of Robotic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center
NEW YORK (Dec 18, 2007)

Prostate cancer patients receiving robotic prostatectomy—an advanced procedure to remove the prostate using a surgical robot—have excellent outcomes five years after surgery.

The results of what may be the largest and longest study of its kind are published in a recent issue of the journal Cancer, and led by Dr. Ketan K. Badani, the newly appointed director of robotic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of urology at Columbia University College of Physicians and Surgeons. Previously, Dr. Badani was a clinical fellow in robotic and laparoscopic urologic oncology at Henry Ford Hospital in Detroit, where the 2,766 procedures followed in the investigation were conducted over a six-year period.

Dr. Badani says, "We found that in highly experienced hands, the results after robotic surgery are outstanding for cancer control, with minimal complications and few side effects of urinary incontinence and sexual dysfunction."

"In addition, blood loss is far less than with traditional surgery. This, along with minimizing trauma to the body tissues, translates into short hospital stays, and more importantly, quick recovery—allowing patients to resume their regular activities, whether that means going for a run or playing 18 holes of golf," adds Dr. Badani, who has personally performed more than 700 of the robotic procedures.

Specific study findings include the following:
•Ninety-three percent (93%) of patients achieved normal urinary function, with a median time of complete control of three weeks.
•Only slightly more than seven percent (7.2%) of patients had recurrence of prostate cancer symptoms (presence of prostate specific antigen, or PSA). Less than one percent (0.5%) of patients died during 71 months of follow-up.
•Nearly 80 percent (79.2%) of patients reported normal sexual function.
The study also compared clinical outcomes of the first 200 patients with that of the final 200 patients to see if there were improvements. They found a reduced amount of blood loss and fewer cases of positive surgical margins (4 percent, down from 7 percent)—when the initial cut does not cut away all of the cancerous tissue. The surgery also was performed faster (131 minutes vs. 160 minutes).

"With five years of follow-up, we can now see that, not only is robotic prostate surgery safe and effective, but it continues to improve," says Dr. Badani. "As with any highly technical operation, the study points to the importance of experience. With the knowledge and practice of many procedures, outcomes for patients improve. NewYork-Presbyterian/Columbia is one of only a few premier centers that can offer this level of specialized surgery to patients."

Dr. Badani has helped pioneer novel techniques to preserve sexual potency in men undergoing robotic prostatectomy while optimizing cancer control. He has performed live robotic demonstrations at both national and international meetings and has lectured and published extensively on outcomes of patients undergoing robotic surgery. He received his medical degree from Case Western Reserve University School of Medicine in Cleveland, Ohio, and completed both his urologic residency and fellowship in robotic and laparoscopic urologic oncology at the Vattikuti Urology Institute at Henry Ford Hospital in Detroit.

The Cancer study is co-authored by Drs. Sanjeev Kaul and Mani Menon—both of the Henry Ford Hospital in Detroit.

NewYork-Presbyterian/Columbia offers a comprehensive urologic surgery program with robotic surgery available for robotic prostatectomy, robotic nephrectomy (kidney), robotic cystectomy (bladder) and robotic adrenal gland surgery. In addition to Dr. Badani, members of the robotic urologic surgery team include Drs. Mitchell C. Benson, James M. McKiernan, Erik Goluboff and Carl A. Olsson.

Robotic Prostatectomy
During robotic prostatectomy, the physician makes five to six small incisions in the abdomen, through which surgical instruments and a tiny stereoscopic camera are inserted. The camera improves visibility, and robotic arms make for easier suturing.

Robotic prostatectomies make use of Intuitive Surgical's da Vinci™ Surgical System, which has been approved by the FDA for a number of innovative clinical procedures employed at NewYork-Presbyterian Hospital.

Prostate cancer is the second most common cancer death after lung cancer. Each year, over 200,000 Americans are diagnosed with prostate cancer, and as many as 32,000 will die from the disease.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Mat when I feel I am right about something.

This prostate thing is pretty tricky sometimes...but then again it seems simple if you have very little involvment and catch it early....I am guessing that those who catch it early and very little involvement will have pretty much a 95-99% cure rate no matter what treatment choice is selected....There really needs to be studies done by many different variables like:

Age
fitness
volume of cancer
gleason
lifestyle
diet
family history
mental health status
surgeon skill level
Oncologist skill level

for starters...I am sure many other factors could and should be considered besides these few off the top of my head...but think if they could categorize much of this and then take them against the treatment choice a more definitive path could be created for cure.

A guru on Prostate Cancer should be organizing a database to collect all this data and crunch it for better prostate cancer care.

my two cents

Randy in Indy

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

A Dr. Critz near Atlanta keeps an extensive database on his patients that he treats with a technique called prostrcision. I'm not sure what all variables he keeps but I did visit him before selecting on Davinci. When he ran all my numbers through his computer database He only gave me a 54% chance of being cancer free in 10 years following his treatment. To me that was a crap shoot and I wanted a better chance of being cancer free from first line of treatment.

larry

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

People with little involvement of cancer have a much better chance of using just about any theraphy and having a better result....that's why the doc's all clammer for them after viewing their biopsy results to build a success story to sell to others....it's somewhat of a money game with many of the surgeons...after they learned about my background they all wanted to treat me. I found a cocky athletic type guy that basically said he was a rock star surgeon and I believed him because he was pretty much like myself...so far he was right. I will give him the award after 10 years of Non-detectable readings. - if this site is still here I will post to it in 10 years....mark my words.

Randy In Indy

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

Randy, I'll be looking forward to reading your post in 10 years. My dad is at about year 14 following Proton treatment. As you say his was caught early and had great success.

It was interesting when I talked to the guy in Atlanta that at least he was honest with me. When he asked if I was ready to select my treatment I said no. I have one more Doc i'm seeing up in Nashville. He then said are you Seeing Dr. Smith at Vanderbilt? I said yes, he then told me "he is one of the best you will find, give him my regards when you see him."

So glad you found a great surgeon also.

Did you listen to that lecture by Dr. Mulhall? SOmeone posted a link on another thread.
Very good lecture. Again I'm so glad I chose Davinci over radiation for first line of treatment. It seems that with radiation you won't start getting some of the side effects till 5 years down the road. That is exactly what happened with my dad. I thought at 54 I'm young and can fight any side effects now and win the battle. So far it has worked for me.

Larry

viperfred
Posts: 20
Joined: Jun 2010

Management of Prostate Cancer is very complex, add to that misinformation by doctors and misunderstood by many.

To know the long term 10 or 20 years of any therapy takes takes 10 or twenty years. Surgery and Photon therapy have been used for treating PCa for about 100 years. Both have improved with advancements in technology. Cyro and Proton and HIFU relatively new.

Surgery would be a great option if the cancer cells would limit their spread to the tissue being removed and stayed away from critical structures. Photon Therapy is in the same boat, if you could but the Brags Peak only on the cancer cells the cure would be very high. Photons (Rapid Arc, IGRT, IMRT and the CyberKnife, Brachytherapy : x-rays) are subject to the same problems of not knowing where the cancers cells are hiding. When critical structures are cut, bombarded with ionizing radiation, frozen or cooked we have side effects. Some side effects will be short term and resolve some will not.

ED is caused by two different incidents nerve damage by a slice during surgery and blood flow restriction caused by radiation. Blood flow can be improved by nature, drugs such as Viagra. Nerve damage may be repaired by nature or managed with injections or a pumps. Know all risk, look at the peer-review articles. The rest are full of opinions not subject to quality standards of peer-review.

Every therapy has risk. The treatment choice is difficult enough but add the fact that technology advancements continue to all therapies and their outcome good or bad will not be known for years.

I know of no long term studies (from the last 20 years) that show risk from radiation therapy for PCa that are higher than any other non RT modality. The time line may change and
I am happy to accept the side effect out in the future rather than at time zero of therapy.

When possible my site will be updated, most current information is from the rss feeds which will be expand when I have time.

I am a fan of my therapy as others are fans of theirs.

My goal is for men to be informed so they can make a choice that is best for them.

Stay Cancer Free and Healthy.

There are none so blind as do not wish to see.[1]

[1] Darwin, E. (1794). Zoonomia: or the Laws of organic life. Vol. II, p.244. Third edition (1801). J.Johnson, London

steckley
Posts: 100
Joined: Aug 2009

Hey guys I heard eating crow is a great cure for PCa ... or was it high blood pressure?

marge
Posts: 8
Joined: Feb 2010

Reading this thread is very hard, can people actually learn anything here?

bdhilton writes..."From my perspective, this site is to help guys, not slant the facts or press one treatment or agenda…" However he presses his agenda, calling viper a "troll" etc. Name calling does not a happy well informed forum make.

Let's face it, no one who has a treatment that worked out great is a "troll", they simply want to share their good news and hope it extends to others. News on cyberknife, proton and HIFU is rare, let's not run these men - who have had a good go of it - off! Or, is the agenda here to only accept men who have had a bad go of it (except surgery...)? Of course these men who had good outcomes are slanted, they are happy! viper is years out, to come here and share his info is great, a true kind heart. There will be others who show up who are not happy after cyberknife, if you quit attacking people, we may get to the bottom of the show. Sift all info through your mind, don't tell us what to think about the person.

No one comes here to sell anything, the happy ones come hoping they can help someone find their state of happiness. You, that run off posters, are the ones trying to slant the facts and press treatments, covering up and supressing the new treatments.

Out of 4,000 men who have had cyberknife, only one is here, we need him.

BTW, my doctor told me incontinence is 60% after surgery.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Ovbiously, you did not go to Viper's "info Ad" web site which grossly characterizes other forms of therapy in a rediculous light of sad statistics that are outdated and plain WRONG. Especially to a newbie that has not done his own research. Statistics he posts on his website for both Open and Robotic must be from the surgeons of podunk town USA...certainly not any statistics from the plethera of very good surgeons in the US. I can give out probably 12 surgeons from accross the country that would blow his numbers to pieces with both incontinence and ED percentages. Please research more. Interesting you say your doctor says 60% incontinence after surgery - I would say he's not to up on the reality of what is happening today....Wow then I guess the thousands who were under this doctors care were REALLY lucky

http://nyp.org/news/hospital/robotic-prostate-surgery-study.html

"...Previously, Dr. Badani was a clinical fellow in robotic and laparoscopic urologic oncology at Henry Ford Hospital in Detroit, where the 2,766 procedures followed in the investigation were conducted over a six-year period.

Dr. Badani says, "We found that in highly experienced hands, the results after robotic surgery are outstanding for cancer control, with minimal complications and few side effects of urinary incontinence and sexual dysfunction."

"In addition, blood loss is far less than with traditional surgery. This, along with minimizing trauma to the body tissues, translates into short hospital stays, and more importantly, quick recovery—allowing patients to resume their regular activities, whether that means going for a run or playing 18 holes of golf," adds Dr. Badani, who has personally performed more than 700 of the robotic procedures.

Specific study findings include the following:
•Ninety-three percent (93%) of patients achieved normal urinary function, with a median time of complete control of three weeks.
•Only slightly more than seven percent (7.2%) of patients had recurrence of prostate cancer symptoms (presence of prostate specific antigen, or PSA). Less than one percent (0.5%) of patients died during 71 months of follow-up.
•Nearly 80 percent (79.2%) of patients reported normal sexual function.

This studied 2,766 patients over 6 years....What kind of study is your doctor quoting his 60% incontinence from...hopefully it's not his surgeries...if so...better look for another surgeon. I don't mean to be mean..but give me a bloody break....the stats on Viper's site are just plain pointedly WRONG and a horrible dis-service and this is not to say Cyberkinfe is a bad procedure because I will never say that and hope it becomes the gold standard..but please do not put false and incorrect info regarding the statistics of other treatments to point a golden finger towards the one of your own personal preference = that is worse than no information at all in my honest opinon.

Randy In Indy

BRONX52
Posts: 156
Joined: Apr 2010

I CONCUR----NO PROCEDURE IS THE BEST !! IF THAT WERE THE CASE, THERE WOULD ONLY BE ONE PROCEDURE FOR ALL. I HAD DAVINCI SURGERY AND DON'T REGRET MY DECISION. HEY, LOOK AT IT THIS WAY----IF THE PROCEDURE WORKS FOR ME I CONSIDER THAT TO BE THE BEST(FOR ME). ON THE OTHER HAND, SOMEONE COULD HAVE SUCCESSFUL RADIATION,CYBERKNIFE, ETC; AND THAT WOULD BE THE BEST TREATMENT (FOR THEM). TO SAY ONE IS BETTER THAN THE OTHERS IS UNREALISTIC. EACH CASE AND CIRCUMSTANCE ARE UNIQUE TO THE INDIVIDUAL. THATS PROBABLY WHY THERE ARE SO MANY TREATMENTS AVAILABLE !!! JUST MY OPINION====DAN

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

You are exactly right but what is a crime is someone who posts information that is misleading or worse yet plain wrong....that is exactly what Viper has done with his "INFO AD" web site for Cyber Knife, again Cyber Kinfe may be the best treatment ever but, this site is not for ADVERTISING ones preferences in treatment especially with wrong information about other treatments that will mislead a newbie into thinking a treatment that has actually saved many lives and with very little side affects under the right circumstances is made out to be the wrong choice via listing statistics that are just not the case for the recent advances in a particular treatment. Fighting this beast is daunting enough without adding mis-information to the mix.

Honestly, if CSN looked at Viper's site and with the knowledge that he posted his "INFO AD" in his very first post on here they might just boot him from the site. When I came here I received much help from many people to get me through this fight with the beast...for that I am eternally thankful!!!...and I want to make sure people are given an equally fair chance to recieve the same help I did...not some slanted INFO AD placing a personal choice of treatment on the top above all others. I have no problem with people linking to all the studies in the world about any treatment because everyone can read and make their own mind up...but advertising is WRONG...on this site. It's just that plain and simple for me.

Randy In Indy

marge
Posts: 8
Joined: Feb 2010

yes, Randy keeps on advertising for surgery, reading only the best reports, only stating his experience, not accepting all the others, who had surgery and it was the worst thing to happen to them, keep on putting others down who just want to share their experience and relate figures they find, the figures and statistics are all over the board, my surgeon said, no one really knows for sure because men won't admit to being in less great shape (then he said, but I think it's 60%) It's easier to just put up with the shape we end up in than complain and get more surgery (the switch).

He isn't selling, he isn't making money, he sees things differently than you, your rose colored glasses are great for you, but they don't always work out. People come here to help themselves or to help others. Plain and simple a "troll" is someone who is obsessed with helping others.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I have not once or ever will try to sell Surgery....Got it! I would bet there is not one other person on here that would agree with you....I have posted nearly 400 posts since Oct 09....you have posted 4 times...and Now you sound like HIFU gal with a new ID...LOL

I call it like I see it...and I am usually right.

Randy In Indy

marge
Posts: 8
Joined: Feb 2010

Calling names again?

yes, I've been watching you, and you are great at calling people names, and selling surgery, while others who are just like you who have had another experience aren't allowed to speak without you attacking them.

You sold surgery to others here, I've read them, bdhilton is one.

Don't you see ~ you are what you call others ~ a troll, selling what you know. Let the people here who come to help, actually help...viper has a story, hifu gal did too, HIFU is credible, so is cyberknife, but you dominate and rule, and bdhilton follows your lead.

You have good info and a kind heart that you want others to learn from you, but what you don't realize is that not everyone is going to follow you, nor should they follow viper, they just want info, not your opinion, and not your censoring.

Why is everyone who had a different treatment a threat to you?

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Please post anything I have posted in my 400 posts on this site as "selling surgery" Sorry, you cannot be I have not. It is absolutely proposterous that you claim I have sold surgery to BD Hilton..I am sure he will have something to say about that himself...besides he did not even have robotic....Name calling...hmmmm HiFu Gal...is that name calling...You are simply very, very humorous for everyone reading here to see....I call it like I see it. What I wish is that I could identify IP Addresses....now that would be funny to see who has posted under what ID's - there are not many multiple ID posters on this site but Marge...I really believe in my heart...you are.

Where is your picture by the way....please post one so I can see who I am jousting with...lol

Randy In Indy

bdhilton
Posts: 759
Joined: Jan 2010

Randy,

As I stated a few days ago on this specific discussion, I have no interest in participant anymore. Yes it does make me smile that “YOU” converted me to surgery and I am your dupe…

Anyway, I am not here for the likes of marge, viperfred, hifugal, etc… I am here to support the guys and their mates pre and post treatment…

Best to all…

viperfred
Posts: 20
Joined: Jun 2010

Tried to find the clinical study referenced as " the latest and probably the largest study results of Robotic surgery results" The link provided PR for
NewYork-Presbyterian Hospital on their web page.

The following link is to an abstract by :
Ketan K. Badani, MD Sanjeev Kaul, MD, Mani Menon, MD

The number of patients is 2766 so it seems likely this is the subject study.

http://www3.interscience.wiley.com/journal/116322982/abstract

Results in quotes:

"The mean age of the patients was 60.2 years and the mean prostate-specific antigen (PSA) level at time of diagnosis was 6.43 ng/mL; 42.4% and 64.2% of patients, respectively, had a biopsy and pathologic Gleason sum of 7. The mean surgical and console time was 154 minutes and 116 minutes, respectively. Estimated blood loss was 100 mL; 96.7% of patients were discharged within 24 hours of surgery. At a median follow-up of 22 months, 7.3% of men had a PSA recurrence. The 5-year actuarial biochemical free survival rate was 84%. "

What I find interesting is the recurrence rate at a median of 22 months is 7.3% and 5 year biochemical free survival is 84% . The NewYork-Presbyterian Hospital ad runs the sentence with 7.3% recurrence into the sentence "Less than one percent (0.5%) of patients died during 71 months of follow-up." When I read the "ad" I thought the 71 months follow-up had a recurrence of 7.3% which would not be unexpected from an experienced surgeon. However at 22 months 7.3% is less than exceptional and at 5 years 16% seems poor compared to other modalities.

I would like to have the complete paper to see the peer reviewed data for incontinence etc.

http://jama.ama-assn.org/cgi/content/short/302/14/1557?home This study in JAMA, Oct. 2009 shows a different result than the older NY Presbyterian 2007 "ad"

Here is an article in the NY Times http://www.nytimes.com/2010/02/14/health/14robot.html form Feb 2010.

Men need to take time to understand all treatments so they can make an informed choice.

Trust no one!

There are none so blind as do not wish to see.[1]

[1] Darwin, E. (1794). Zoonomia: or the Laws of organic life. Vol. II, p.244. Third edition (1801). J.Johnson, London

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

What I find very transparent is your need to be so scientific in presenting studies yet your ad states these statistics about surgery in a very unscientific way:

• Side effects
o ED, 20 % to 80% risk typical
o Incontinence, 20 to 70% risk typical

How can you state this when a study encompassing 2,677 patients DID NOT FIND INCONTNENCE OR ED EVEN CLOSE TO YOUR LOWEST ABOVE STATED "RISK" Figure of 20% Get real - your website is slanting opinion on treatment options so far from the truth it's nothing short of ludicrous!

CASE CLOSED!

Good luck trying to peddle your deceptive ad for cyberkinfe...you are actually doing what merits Cyberknife has a dis-service in how you go about promoting it. I have been in marketing and sales for over 30 years.

Randy in Indy

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