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Father aged 75 is diagnosed with Gleason 9. Is CyberKnife Treatment an option as it is still localized? Any recommendations?

avidity
Posts: 5
Joined: May 2011

Hello,

My dad has been diagnosed to have Prostate Cancer with Gleason score of 9 with PSA level of 8.81. The cancer is localized and has not spread to other parts of the body or Bone. This is confirmed with MRI, CT scan and PET Scan.
The doctors recommended Radiation Therapy and Harmonal Therapy.

For Radiation therapy is Cyberknife an option?
The doctor recommended that since Brachytherapy is ruled out as dad is a heart patient as well has the L5/L6 Ciatica issue and since this procedure involves lot of invasive procedure hence it does not seem to be an Option.

Does somebody has any pointer? Please let me know.
Thanks in advance.

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

Sorry to hear about your father. A gleason 9 as you know is one of the more difficult prostate cancer diagnosis. I was a Gleason 7 and looked into Cyperknife at Knoxville Tn in 2009. At that point they told me they would not treat over a Gleason 6. I do not not if that is true for all centers and if that is still the guideline in 2011.

Best wishes as you assist your father in his treatments.

Larry (lewvino) Age 56

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

Having gone through the CyberKnife treatment I do know that the standard acceptance criteria is that Gleason 7 scores are the limit for treatment. I do know that some CK centers are doing research with higher risk patients such as your father. I would encourage you to discuss these issues directly with a CK center and be sure you understand the risks associated with experimental studies.

Best of luck to your family.

avidity
Posts: 5
Joined: May 2011

Thank you all for your reply. Appreciate it.
So is IMRT the only way?

VascodaGama's picture
VascodaGama
Posts: 1752
Joined: Nov 2010

Avidity

In cases diagnosed as “localized” cancer, surgery is also an option. Gleason 9 means that the cells are of the highest aggressivity type, and the PSA is high but it is not enough to rule on the type of treatment. Your dad’s heart complications may have influenced the doctor to prefer RT with HT, but you could get a second opinion from other urologist and then rule out the surgery approach.
PET scan is very reliable when used in combination with other image studies such as CT and ultrasound, which may suggest a “decent” diagnosis, and in such setting surgery would have a good outcome in your dad’s case.

The pathologist report on the biopsy holds crucial information for the treatment choice. Age and other private issues are also important to consider.

IMRT/IGRT is also a reliable treatment with many years and successful results of application. Nevertheless, a second opinion is always recommendable before any final decision.
You should consider the side effects of those treatments too. Just google the title and get a list of them for your daddy to choose because there may be some that are more acceptable than others.

I recommend you to get this book; “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh; which may help you understanding options between surgery and radiation.

Wishing the best to your daddy.

Vgama

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

You have not mentioned your fathers overall health or age but yes surgery is an option depending on those factos. I know of another man that lives in the area that I did that was a Gleason 9. I beleive around age 62 or so. He had surgery and then followed with hormone therapy. Last time I saw him he was doing very well.

Larry (lewvino)

alihamilton's picture
alihamilton
Posts: 348
Joined: Jan 2004

It is always difficult making decisions as to what the best options are. My husband was also dx with Gleason 9 early last year and had HDR treatment instead of Brachytherapy. He could not have surgery because he had rectal cancer surgery in 2003 and to have prostate surgery would have been very risky. He could not have radiation as he had radiation for the rectal cancer. He could not have Brachytherapy because he had had a TURP operation to reduce the size of the prostate and there was not enough tissue to insert the seeds. So you see, he had very little choice! He is also getting hormonal therapy every three months and so far that has kept the PSA at 0.1. He is feeling well and we take it one day at a time. I also have an incurable form of Lymphoma but am in remission and feeling pretty well.

The most helpful thing your Dad can do is research as much as possible and make a decision as to the best course of action. I hope he does well.

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