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CyberKnife?

Dan70
Posts: 5
Joined: Sep 2017
Recently I got the word that I have PCa.
 

Age:70, otherwise good health and quite active

Gleason: 3+3= 6  , low risk

1 core: 1.5mm , 10% involvement

 Last PSA: 7.3
 

I was told the PCa is small and slow growing and has been caught early.

 

Obviously one option is AS.  My URO said men with PC like mine have a 60-70% chance of significant cancer after 15 years.  Anyone else been told similar outlook?  My normal approach to life would make it very hard for me to just "keep an eye" on the PCa knowing eventually some action must be taken

 

My URO also said CyberKnife would be a reasonable option although there is no rush  to make a decision.  I've been reading about the complications/side effects and they seem pretty minor although the entire gland would be radiated.

 

So my question-- What are your thoughts on wisdom of having CyberKnife done in the next year or so?

 

I've been following this forum for a while and think it is very helpful.  Greatly appreciate any feedback. Thanks guys!

Dan70 --- in Colorado

 
CC52
Posts: 103
Joined: Nov 2013

Dan,

To answer your second question first, based on the info you've provided, I'd be full speed ahead with active surveillance. I say that as someone that has undergone SBRT treatment (CyberKnife). Remain self aware, and continue your understanding of the options available to you. 

My answer to your first question is no. A 60-70% chance of significant cancer with your current numbers and given the variables of a Pca diagnosis, I would wonder about the accuracy of that statement. Seems like a scare tactic.

Of course, since you've been here for a while you have come to realize we all have to make decisions that work for us - that "fit" our specific needs. I encourage you to take a deep breath (actually many, with some wine in between Smile) and take your time. Be in no rush.

 

 

hopeful and opt...
Posts: 2226
Joined: Apr 2009

The statistics that you posted about progression for those on active surveillance is wrong. It is not correct.

For those who select active surveillance approximately 30 of cases show progression mainly because these men are not only Gleason 6, but have more significant gleasons that were not discovered at original biopsy. Basically, a gleason 6 will not metatisize outside the prostate. Many do not consider a gleason 6 to be cancer.

Men in a well managed active surveillance program can seek the initial active treatment that they might have considered at diagnosis without any adverse effects by waiting. In fact, the man will be able to live that time with a better quality of life, and not experience any side of effects from active treatment. Every active treatment has side effects.

Not saying that you qualify or do not qualify for an active survellance program. It is best for you to visit with a doctor who specializes in active surveillance. 

Some things that your doctor will need to investigate are the PSA/prostate size ratio..you want it to be less than 0.15.There is something called a multiparmetric 3T MRI which can show suspicious lesions within your prostate and possible extracapsular extension...you need to have this test.

Also there is a new fangled biospy machine that centers of excelence have that are three dimensional, that is this machine can target more aggressive lesions found by the 3T MRI, and provide a better biopsy that you can place more confidence in.

I have been in an Active Surveillance program since march 09. I have not experienced any side effects at all from active treatment. Technology has advanced since my diagnosis, and I can select a treatment that will be more effective now, then when I was diagnosed with less potential side effects. I am 74. I am hopeful that I can live the rest of my livfe without any treatment. In fact for men over 70 as you are, the requirements for active surveillance are relaxed

If you click my name to the left, you can see my medical history, some thoughts, and discussions by experts of active surveillance that you can click to hear what they have to say.

Please feel free to ask questions

 

 

Dan70
Posts: 5
Joined: Sep 2017

Thanks "CCV52 and Hopeful" 

Good info

Swingshiftworker
Posts: 1013
Joined: Mar 2010

So my question-- What are your thoughts on wisdom of having CyberKnife done in the next year or so?

If you believe in AS as a "treatment" approach, you'd put off treatment as long as there is no significant change (acceleration) of the cancer.  So, I'm not sure why you even want to consider treatment a year from now b4 even starting AS.  However, assuming there is no significant change in your prognosis at that time, I think you would be a very good candidate for CK in a year.  

FYI, I was one of the 1st members here to receive CK as a form of treatment.  I was diagnosed as Stage T1c, Gleason 6 w/a PSA <10.  I was treated in Sep 2010 at UCSF in San Francisco.  I had some PSA irregularities but a followup spectrographic MRI detected no cancer 4 years after treatment.  I was pronounced cancer free and my PSA has continued to drop ever since.  I experienced NO side effects whatsoever -- no ED, no incontinence, no problems whatsoever.

 

 

ASAdvocate
Posts: 116
Joined: Apr 2017

Another case of somebody with the lowest possible risk prostate cancer being wrongly scared by a greedy and ill-informed urologist into having unecessary surgery. 

It's infuriating to hear that this overtreatment is still being pushed.

But, you mentioned CK, which indicates that you have given critical thought to your options. That would be my choice if I ever need treatment.

The National Comprehensive Cancer Network, an authority of experts, prescribes AS as your default treatment. They know more than your doctor does.

I have been on AS for nine years. All good. But, you must adhere to a strict AS protocol of testing. That has no side effects, amd many studies have shown that being in an AS program does not cause any increased risk of mortality if things change and you later need to have treatment.

Good luck.

 

Clevelandguy
Posts: 460
Joined: Jun 2015

Hi,

Do you know where in your prostate the cancer is located?  To me that would determine when & possibly what type of treatment.  If your cancer is near the outside of the prostate you might want to deal with it sooner than later.  If it's in the middle of the gland you should have some time to make decisons since it's 3+3.  Several good procedures to deal with the cancer such as surgery &  various forms of radiation if you decide to go that route. Investigate the procedures and make an informed choice.  Be cautious of people & doctors steering you towards one treament or another.  Use your own brain and make the decison that you will be happy with.

Dave 3+4

Dan70
Posts: 5
Joined: Sep 2017

Thanks for your ideas SWINGSHIFT, AS and CLEVELAND.

Certainly no urgancy making my decision at this point. Leaning toward AS for a while

mstoriop
Posts: 37
Joined: Dec 2016

Hello Dan.  You've only had a few responses here but I can tell you in a small amount of posts you've gotten great direction.  Hopeful has referenced 3T MRI and Prostate size ratio.  Cleveland references lesion location which I believe MRI can identify.  Other facts you may already have but if not would be good to gather are PSA velocity, PSA doubling time, maybe PSA % free and DRE results.  I can also recommend, as it worked very well for me even at some extra cost and time, to talk to as many doctors of the different treatment options at as many different facilities as you can handle.  I found this very personally enlightening and did in fact help me decide my ultimate treatment path and the facility to use plus helped me decide to safely delay my treatment choice for several extra months for family reasons.  I was looking for any recommendation from anywhere from anyone for AS as I think my views and thoughts would have handled it well.  Unfortunately I was close but slightly out of the parameters to justify this.  I agree with CC52 and ASadvocate you certainly seem to be a candidate to consider AS.  In my case I did choose CK and finished my protocol August 18th.  I will not have a PSA test for a few months yet but as far as it goes at this early stage the treatments were a breeze and I have no problems of any sort period.  You have plenty of time and plenty of options open to you so good luck with your due diligence.  CC52 used wine to assist his thinking I suggest small batch bourbons with maybe a beer mixed in.  Best wishes.    

hopeful and opt...
Posts: 2226
Joined: Apr 2009

 

"Cleveland references lesion location which I believe MRI can identify. "

The MRI shows location of suspicious lesions i.e. one lobe or two; a radiologist can then examine the results of the MRI and  can rank lesions found by likelihood of clinical significance on a "pi-rads" score of one to five.

Most important, the MRI may indicate extracapsular extension, that is if the cancer may be outside the prostate

Dan70
Posts: 5
Joined: Sep 2017

Thanks MSTORIOP and HOPEFUL

Yes, I am very thankful for the helpful and EXCELLENT

advice I am seeing.  btw- my choice is scotch but bourbon would be #2

Old Salt
Posts: 720
Joined: Aug 2014

Even if your urologist were right, (he is NOT), would you mind getting some (additional?) prostate cancer at age 85? By then you hopefully would have had 15 years with a high QOL.

As an aside, CyberKnife is just an instrument to do SBRT (Stereotactic Body Radiation Therapy). There is at least one other machine (made by Varian) that can do the same type of radiation therapy (and faster, I have read).

 

Dan70
Posts: 5
Joined: Sep 2017

Good Point! Yes, I knew CkK was just one maker of that technology

 

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