Cyberknife Treatment--Side Effects

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  • mstoriop
    mstoriop Member Posts: 43 Member
    dao1 said:

    long term cyberknife effects

    i am trying to decide whether to get cyberknife.diagnosed 10 years ago,65 years old,psa-6.4,gleason 6.i am worried about urinary problems 3-5 years after cyberknife,as well as rectal issues,rectal cancer etc ;,a delayed reaction to the radiation as well as sexual issues.i dont know whether at my age it would be better to continue to not have tx or to have the tx .appreciate your response,thankyou

    Effects

    Hello dao1.  As you have no doubt seen in all posts the decisions regarding treatments are yours to make and are going to be the best for you.  These decisions need to be made with as much research and fact finding as you can handle.  I kind of believe that at least some of the end results of any treatment may be effected by the conditions going in.  To that extent knowledge of your prostate size, DRE, PSA velocity, PSA doubling time, PSA total and PSA% free would all be good things to factor in.  Also as you will find numerous references to in this network of very wise people is 3T MRI which also helps go a long way to help understand where you may be in the scheme of things.  In my case, and almost solely because of what I learned from so many gracious people on this forum I did all of the above and more as part of due diligence before deciding on Cyberknife (SBRT).  Hopeful attached above the 6 year study from Dr Katz but there is also a nine year study that was published a year or so ago.  This may help you with at least some statistics to look over.  I am a relative newbie here but there are several veterans who have longer experience which helped me.  I have two posts which showed what I more or less did to get to my decison point and what has happened recently as I just finished Cyberknife.  I'm more than happy to discuss my learnings and thought processes if that would help you out.        

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member

    swingshift

    My research indicates that SBRT is given in 4 or 5 sessions; not 3 or 4 sessions. I never heard of SBRT given in 3 sessions, so, I would appreciate if you can increase my knowledge and document the 3 session protocol...............thanks

    PS Here is an example of SBRT given in five fractions.

    cancer: disease control and quality of life at 6 years

    Alan J Katz, Michael Santoro, Fred Diblasio and Richard Ashley

    For all author emails, please log on.

    Radiation Oncology 2013, 8:118 doi:10.1186/1748-717X-8-118

    Published: 13 May 2013

    Abstract (provisional)

    Background

    Stereotactic body radiotherapy (SBRT) may yield disease control for prostate cancer in a brief, hypofractionated treatment regimen without increasing treatment toxicity. Our report presents a 6-year update from 304 low- (n = 211), intermediate- (n = 81), and high-risk (n = 12) prostate cancer patients who received CyberKnife SBRT.

    Methods

    The median PSA at presentation was 5.8 ng/ml. Fifty-seven patients received neoadjuvant hormonal therapy for up to one year. The first 50 patients received a total dose of 35 Gy in 5 fractions of 7 Gy. The subsequent 254 patients received a total dose of 36.25 Gy in 5 fractions of 7.25 Gy. Toxicity was assessed with the Expanded Prostate Cancer Index Composite questionnaire and the Radiation Therapy Oncology Group urinary and rectal toxicity scale. Biochemical failure was assessed using the nadir + 2 definition.

    Results

    No patients experienced Grade III or IV acute complications. Fewer than 5% of patients experienced any acute Grade II urinary or rectal toxicities. Late urinary Grade II complications were observed in 4% of patients treated to 35 Gy and 9% of patients treated to 36.25 Gy. Five (2%) late Grade III urinary toxicities occurred in patients who were treated with 36.25 Gy. Late Grade II rectal complications were observed in 2% of patients treated to 35 Gy and 5% of patients treated to 36.25 Gy. Bowel and urinary quality of life (QOL) scores initially decreased, but later returned to baseline values. An overall decrease of 20% in the sexual QOL score was observed. QOL in each domain was not differentially affected by dose. For patients that were potent prior to treatment, 75% stated that they remained sexually potent. Actuarial 5-year biochemical recurrence-free survival was 97% for low-risk, 90.7% for intermediate-risk, and 74.1% for high-risk patients. PSA fell to a median of 0.12 ng/ml at 5 years; dose did not influence median PSA levels.

    Conclusions

    In this large series with long-term follow-up, we found excellent biochemical control rates and low and acceptable toxicity, outcomes consistent with those reported for from high dose rate brachytherapy (HDR BT). Provided that measures are taken to account for prostate motion, SBRT's distinct advantages over HDR BT include its noninvasiveness and delivery to patients without anesthesia or hospitalization.

    Poor Recollection

    Hopeful:  My menory of how many treatment I got is actually quite hazy.  It could have been 5 over every other day over 2 weeks.  Frankly, I don't remember.  I'd go w/the info that you have, not my poor recollection of it. 

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    Start A New Thread

    Dao;  I'd suggest starting a new thread to discuss your concerns reather than tacking it onto the end of this very old thread.

    If you do that, please clarify how it came to be that you were diagnosed w/PCa 10 years ago, what you have been doing in the interim and are only now thinking about being treated w/CK. 

     

  • Buzzworth
    Buzzworth Member Posts: 2
    3 years on

    It has been three years since I went through cyberknife for prostate cancer.  All is well and my PSA has dropped to acceptable levels almost immediately after the procedures.  Since then I have always encountered a burning sensation while urinating.  The doctors have never shown much concern and it is certainly not debilitating.  I took Flomax for a short time and was switched to Rapaflo soon after when the Flomax made me dizzy upon standing.  I am still taking Rapaflo and see no end in sight as it makes it easier to relieve myself.

    I am usually up 2-3 times a night to go.

    Has anyone else had the problem of the burning pain?  I am due to see my doctor soon as it has been almost a year and that is the cycle I am now on.  It would be nice to find some relief and possibly even be able to quit needing the Rapaflo.

     

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    Buzzworth said:

    3 years on

    It has been three years since I went through cyberknife for prostate cancer.  All is well and my PSA has dropped to acceptable levels almost immediately after the procedures.  Since then I have always encountered a burning sensation while urinating.  The doctors have never shown much concern and it is certainly not debilitating.  I took Flomax for a short time and was switched to Rapaflo soon after when the Flomax made me dizzy upon standing.  I am still taking Rapaflo and see no end in sight as it makes it easier to relieve myself.

    I am usually up 2-3 times a night to go.

    Has anyone else had the problem of the burning pain?  I am due to see my doctor soon as it has been almost a year and that is the cycle I am now on.  It would be nice to find some relief and possibly even be able to quit needing the Rapaflo.

     

    Start A New Thread

    Buzworth, please start a new thread. You can use the same title and post; just cut and past it.

    FWIW, I was treated w/CK 7 years ago and never had any urinary burning but have continued to experience urinary urgency/frequency as I did before I was treated. Others may have had a different experience but it would be better if they addressed it in a separate thread in devoted to your concerns.

  • Billdonaldson
    Billdonaldson Member Posts: 9 Member
    Cyberknife after week 6

    finished 6 weeks ago and feeling great. First two weeks after treatment a bit of urgency but not now. Feeling good about my decision for Cyberknife treatment! Still not taking antioxidants and probably won’t start them for a few more months. Don’t want to hinder the radiation cancer killing. 

  • Billdonaldson
    Billdonaldson Member Posts: 9 Member
    Finesteride

    are any of you guys still taking finesteride after cyberknife treatment ? 

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member

    Cyberknife after week 6

    finished 6 weeks ago and feeling great. First two weeks after treatment a bit of urgency but not now. Feeling good about my decision for Cyberknife treatment! Still not taking antioxidants and probably won’t start them for a few more months. Don’t want to hinder the radiation cancer killing. 

    Glad to hear it but . . .

    Glad to hear that your CK treatment seems to have gone well.  If you want to discuss your treatment and any other issues, it would be better if you started a new thread rather than tack onto the end of this very old tread to do so.

    BTW, I never took finesteride after treatment w/CK and don't know any one else who did.  If you start a thread mentioning CK and finesteride in it, you may get a response from someone who did or still does.

  • Billdonaldson
    Billdonaldson Member Posts: 9 Member
    edited December 2017 #90
    Finesteride after Cyberknife treatment

    hi all you fellow Cyberknife warriors. Are any of you taking finesteride after treatment? If so for how long after your Cyberknife treatment.

     Thanks 

  • Billdonaldson
    Billdonaldson Member Posts: 9 Member
    Lowest psa after cyberknife

    question, what is your lowest psa after a few years from Cyberknife treatment? Thanks 

  • Old Salt
    Old Salt Member Posts: 1,277 Member
    edited January 2018 #92

    Lowest psa after cyberknife

    question, what is your lowest psa after a few years from Cyberknife treatment? Thanks 

    Bill

    You asked a lot of questions, but as stated before it would have been better to start a new thread. There's a button for that on the left side of the 'start' screen (Add a new Forum topic)

    https://csn.cancer.org/forum/126

    It would be helpful if you could provide background. Presumably you are taking finasteride because of BPH (benign prostate hyperplasia). Please expand on that issue as well as your prostate cancer diagnosis.

    With respect to PSA levels after SBRT, one typically reaches a nadir of less than 1, but the level may bounce around quite a bit after that.  If the PSA goes over nadir + 2, some action is usually recommended.

  • Steve1961
    Steve1961 Member Posts: 462 Member

    Poor Recollection

    Hopeful:  My menory of how many treatment I got is actually quite hazy.  It could have been 5 over every other day over 2 weeks.  Frankly, I don't remember.  I'd go w/the info that you have, not my poor recollection of it. 

    ck treatment

    just saw dr gotschaulk today its 4 treatments  2 aweek for 2 weeks  at least thats what it is in 2018

     

  • Steve1961
    Steve1961 Member Posts: 462 Member
    question

    saw dr gottschaulk  leaning towards cyberknife...guess i wont know if i am a true candidate until i make the decision   and they do mthe t3MRI  and the ct scan..i guess the mri will show if its contained....wonder why the stanford surgeon said the mri was not needed..he said if anything did escape it would so mi nute it would never show up on an mri...SOOOO my question is how can one really tell if it is contained or not...thanks

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    Dr. Gottschalk

    Dr. Gottshalk was my supervising radiation oncologist when I was treated w/CK in Sept 2010.  I doubt that he would authorize the treatment if there was any doubt that the cancer was contained w/in the prostate.

    The only way you'll know w/reasonable certainty if the cancer is contained or not is to get an MRI/MRSI which is a spectrographic scan of the prostate done w/a 3T coil and dye.  I had this done when my PSA bounced in 2013 and rose 3 times in a row (an indicator of recurrence).  The scan came up completely negative (a relief) and my PSA has dropped consistently ever since. 

    The procedure is very expensive and I doubt it would be approved by your insurer pre-treatment but you won't know unless you ask.  Good luck!

  • krikri
    krikri Member Posts: 3
    HI JMadison,

    HI JMadison,

    I hope you are doing well now. Please did you go with CK or a different method and how did you make out.

    please your response will be highly appreciated as I am oresently thinking of CK as my PC treatment option

  • krikri
    krikri Member Posts: 3
    Kongo said:

    CK Side Effects
    Welcome to the forum. I had CyberKnife treatment in June and have had zero side effects. After CK, some men (about 4%) experience a mild degree of bowel toxicity (they have loose stools) and urinary urgency (they feel like they have to go to the toilet frequently). Both of these symptoms tend to pass within a few days or weeks of treatment. Urinary urgency can be treated with Flomax or in mild cases, Advil.

    "Nerve sparing" is not really a term used with CyberKnife. I assume you're wondering if you can still have sex afterward. The nerves really don't come into play with CK, although very long term effects of SBRT on the nerve bundles that encase the prostate is unknown, other forms of radiation frequently have the effect of damaging these nerve bundles several months to years after being irradiated. They typical radiation dose pattern for the prostate using CK avoids concentrating radiation dosages at or near the nerve bundles, but since it is an external source of radiation there is some exposure as the entire prostate is radiated. Over 85% of men with no ED issues before treatment have no ED issues after treatment. Of all forms of radiation used to treat prostate cancer, SBRT (which CK is one method of delivery) has the least amount of side effects. Age, of course, also affects the level of potency. The good news is that even if there is a decrease in potency as a long term side effect of radiation, it is a condition easily corrected by Viagra like drugs.

    If you scroll through two or three pages of posts you will see several threads (some have sparked heated debates) pertaining to CyberKnife that pretty much plumb the depths of the pros, cons, and technical aspects of this treatment protocol. I would suggest you read the previous posts and I'm sure any of the men who have undergone this treatment would be happy to address any further technical questions you might have.

    As you may know, CK is pretty much for low risk prostate cancer and is not appropriate for intermediate or advanced stages.

    Best to you.

    =====================

    Diagnosed in March 2010 at age 59 with an elevated PSA of 4.3. Biopsy revealed 1 of 12 cores positive with 15% involvement. Gleason 3+3=6. Confirmed with second pathology reading. DRE negative. No physical symptoms and no family history of prostate cancer.

    Treatment: 5 fractions of SBRT using CyberKnife. No side effects. 3 month PSA level was 1.3.

    Hi, I was diagnosed with PC

    Hi, I was diagnosed with PC and I am presently thinking of my options. I have heard alot about CK and I know that it is relatively new compered to other methods. Pleade I was woundering if you can just tell me if you are experiencing any other side effect since it has been over 7 yrs since you had your last intervention.

    I look forward to hearing from you

     

    Thank you

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,339 Member
    krikri said:

    HI JMadison,

    HI JMadison,

    I hope you are doing well now. Please did you go with CK or a different method and how did you make out.

    please your response will be highly appreciated as I am oresently thinking of CK as my PC treatment option

    jmadison has not posted since march 2011

    Best for you to start a new thread with your medical information pertaining to prostate cancer, PSA results, image tests, biopsy results, age, etc etc so you can receive individualized attention

  • Old Salt
    Old Salt Member Posts: 1,277 Member

    jmadison has not posted since march 2011

    Best for you to start a new thread with your medical information pertaining to prostate cancer, PSA results, image tests, biopsy results, age, etc etc so you can receive individualized attention

    Yes; a new thread would be good

    Several of us (frequent responders) have gone the SBRT route and may be able to give reasonable responses to focussed questions.

  • Steve1961
    Steve1961 Member Posts: 462 Member

    Dr. Gottschalk

    Dr. Gottshalk was my supervising radiation oncologist when I was treated w/CK in Sept 2010.  I doubt that he would authorize the treatment if there was any doubt that the cancer was contained w/in the prostate.

    The only way you'll know w/reasonable certainty if the cancer is contained or not is to get an MRI/MRSI which is a spectrographic scan of the prostate done w/a 3T coil and dye.  I had this done when my PSA bounced in 2013 and rose 3 times in a row (an indicator of recurrence).  The scan came up completely negative (a relief) and my PSA has dropped consistently ever since. 

    The procedure is very expensive and I doubt it would be approved by your insurer pre-treatment but you won't know unless you ask.  Good luck!

    Gottschaulk

    So this is interesting....I just went to Stanford for brachytherapy consultation...Stanford does Cyberknife but not for the prostrate ..the reason is because the method had not been perfected yet  stanford is saying with Cyberknife they still do not know what dose of radiation to use on each patient...they will never over radiate so until now they are still guessing and they say that UCSF is a research hospital and that all Cyberknife patients are technically guiniipigs ....hmmmm Stanford says they will not do it until it’s perfected ....great...

  • Steve1961
    Steve1961 Member Posts: 462 Member
    LIMBO STILL

    SO STANFORD BRACHYTHERAPY MAN SAYS THATS USING CYBERKNIFE IS A GAMBLE ONLY BECAUSE THEY USE THE RADIATION  USEDIN THE  40 TREATMENT COURSE IS THE SAME AS CYBERKNIFE BUT  CONDENSE IT INTO 4 TREATMENTS..THE PROBLEM IS THEY HAVENT PERFECTED THE DOSE TO USE..THEY SAY IT ISNT AS SIMPLE AS DIVIDING 40 BY 4..SO THEY ARE MOST LIKLEY UNDER RADIATING THAN  OVER RADIATION BECAUSE THEY WOULD NEVER TAKE THE RISK OF OVER READIATING.....SO I ASKED THE CYBERKNIFE MAN AT UCSF IF THIS IS TRUE  AND HOW DO THEY CALCULATE HOW MUCH RTADIAITION TO GIVE AND IS THE AMOUNT DIFFERENT FOR EACH PATIENT.....WILL LET YOU ...SO DAMN CONFUSING