Oct 02, 2010 - 7:35 am
BACKGROUND: Diagnosed in March 2010 at age 59 after a PSA from a routine physical had increased to 4.3. DRE normal, no physical symptoms, prostate was not enlarged, no history of PCa in family. Biopsy revealed 1 of 12 cores graded at Gleason 3+3=6. Second biopsy confirmed initial pathology. Staged at T1c. Bone scan, chest x-ray, and blood panel were normal.
Primary physician, urologist, and oncologist recommended surgery. Additional consultations were taken at Loma Linda Medical Center for proton treatment, IMRT treatment using the Varian RapicArc machine, and SBRT using CyberKnife. I also researched and consulted about Active Surveillance (AS) as an option, and investigated Cyrosurgery, High Intensity Focused Ultrasound (HIFU), and brachytherapy (seeds).
I elected to be treated with SBRT using CyberKnife.
TREATMENT: After work ups which included another PSA test, yet another biopsy opinion, MRI and CT scans, I had four gold prostate fiducials placed via the perineum so that CyberKnife could track the movement of my prostate in real time during treatment. After another CT scan verified the fiducials were stable, I began treatment in June 2010, which consisted of 5 sessions, each 45 minutes in length, conducted every other day. I received 5 fractions of radiation at 7.25 Gy per session for a total heterogeneous dose of 36.25 Gy. The biological equivalent dose (BED) was 91 Gy.
EFFECTS AND FOLLOW UP: Following my morning sessions I went to work and resumed a full work and travel schedule without any limitations or effects. One month follow up had zero clinical symptoms with no effects of tiredness, urinary issues, nocturia, pain, burning, blood in urine or stool, and no erectile issues.
At three months (yesterday) my PSA had dropped to 1.35 which is on the expected glide slope for post CyberKnife PSA decline. PSA nadir is typically reached between 18 and 30 months. I still have had no side effects with either urinary or rectal toxicity and have had no decrease in sexual performance.