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cyberknife success rate

CSN BOB
Posts: 1
Joined: Dec 2017

Hi Everyone... Just diagnosed with prostrate cancer. I'm 67 in otherwise very good health,gleason score is7, PSA11.5,biopsiedtwice, Gleason score described as 7  [3+4] and tumor is 

local- still only in prostrate. I have to choose the method of treatment. I prefer cyberknife but have some questions. Would I be a good candidate for cyber with the scores I have? I really 

don't want surgery if I can possibly avoid it and has anybody been treated with cyber with a 7 score? I'm in the Philadelphia area and looking for the most experienced doctors. Any help would

be greatly appreciated. Thanx

ASAdvocate
Posts: 116
Joined: Apr 2017

You are well within the guidelines for SBRT (Cyberknife, SHARP). It is now frequently being used (with HT) to treat Gleason 9 cases that surgery is unlikely to cure. There are many articles for you to read over. Here is one: https://www.sciencedaily.com/releases/2016/04/160418145458.htm

 

Please google " Katz SBRT" and "Zelefsky SHARP" to find more recent results about this impressive treatment for prostate cancer.

 

 

hopeful and opt...
Posts: 2224
Joined: Apr 2009

......to hellp determine if the cancer is within the prostate

T3 MRI

This is an MRI scan for prostate cancer that is very effective in indicating if there is any nodule involvement, if there is involvement in one or two lobes, will show size of prostate, may show evidence of extracapular extension, will stage the disease. An MRI with the 3.0 Tesla magnet, is the gold standard. There are certain major hospitals that have MRI machines with a 3.0 Tesla magnet. 

In my layman’s opinion it is advisable to have such a test before any treatment. If the cancer is outside the prostate you may wish to reconsider a treatment decision.

Basically the MRI provides finer resolution than the bone and cat scans, and is more effective in determining if the cancer is outside the prostate.




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fullmoon50
Posts: 40
Joined: Dec 2017

Can you explain how to look for hospitals that have these specialized MRI equipment? Thanks”

hopeful and opt...
Posts: 2224
Joined: Apr 2009

One can go to a local support group. The members will have information available about local treatment opportunities.

One can ask the doctor that they are seeing, or make calls to various facilities.

In your case, you mentioned that you are interested in going to UCSD( UC san diego). They probably have excellent facilities...double check, give them a call.  There are various regional hospital that have T3 multiparametric  mri equipment and skilled personnel that can administer. Also there is UCI (uc irvine) and UCLA available to you.

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

I am not sure if your high PSA justifies a CK treatment if your intent is cure. In fact the value (PSA) makes your case suspicious in being contained. Can you provide details on the judgment that took you to ascertain the scores described above?

CK has high rates for cure when cancer is whole within the gland, independently of the type of Gleason rate. Any cancerous cells in the gland are supposed to die.

In the past, CK treatments were refused in high Gleason scores (7, 8 and 9) because these cases typically were/are associated with existing extracapsular extensions/metastases, therefore turning the case none contained and less probable for success. Gleason 7 (and some higher scores) are now being accepted in CK treatments because of the better ways in locating the cancer (state-of-art image exams) and for the benefits CK provide in both, shorter periods of administration and higher efficacy of hyperfractionate modality. The data used to justify the successful rates of CK today were most collected from cases scrutinized, with high points for being contained (since the introduction of CK in PCa treatments). It is unfair, therefore, to compare the results against other modalities of treatment if both data are not all from similar contained cases. In such a situation the only modality proven to pair CK results in terms of outcomes is the HRBT which is also used in contained cases, but the former is invasive where CK is non-invasive.

SBRT is not CK (in naming) but it involves the same principles of CK radiation. The difference is the way the machine delivers the ionizing rays. SBRT systems involve high-dose radiation beams entering the body through various angles and intersecting at the desired target. This would be friendlier (lesser Gy) for the tissues it crossed before and after the target. In fact it equals to IMRT fractionated doses but provides lesser total level of Gy at the end of the treatment.

In any case, radiation therapies are not a walk-in-the-park. It involves risks and side effects that should be introduced to the patient. You may need to research more before making a final decision.

Best wishes and luck in your journey.

VGama

Old Salt
Posts: 720
Joined: Aug 2014

Actually, the therapy CSN BOB is considering is called SBRT (Stereotactic Body Radiation Therapy). CyberKnife is the best known instrument/technology used to apply SBRT. But there are other instruments/technologies that can be used for SBRT. ASAdvocate already mentioned one other (SHARP). Chris King, one of the SBRT pioneers, now uses an instrument made by Varian. With this one, the 'time on the bed' is much shorter. The fact is though that there are many more reports in the medical literature that are based on CyberKnife. 

ASAdvocate mentioned Dr Katz. He has used CyberKnife for more than ten years and has published extensively on the outcomes. His nine-year results can be found here:

https://meetinglibrary.asco.org/record/119573/abstract

Study of the above and other papers shows that SBRT can be used to treat Gleason 7 cases with very good outcomes. 

H&O mentioned that it would be useful to do an MRI to precisely locate the cancer; a good recommendation. 

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

In my above post I was trying to inform the many that when talking about CK one should in fact use  the term SBRT because of the various machines using the same method in delivering radiation, all providing similar results. CK is just one of them delivering hyperfractionation doses, which has been found as the reason for the good results. SBRT manages to acumulate the energy of various beams into a single spot in one go (similar to High dose Brachytherapy). IMRT would require a number of fractions for the same accumulated dose.

When comparing treatments there is the tendency in laying down outcomes based on results in terms of the length of the remission period (cure), and in this regard high dose RT aplyed at once seems to have better effect (assurance in killing the cancerous cells). Surely, this occurs at the cells in the line of the rays. Neigboring tissues would not be affected so that cancer at the areas off the rays (out of the field of attack) would progress in living and spreading.

Best

VG

Swingshiftworker
Posts: 1013
Joined: Mar 2010

CSN Bob:  The only way to find out if your PCa is suitable for treatment w/CK (SBRT for Vasco) is to consult a radiation oncologist who specializes in the treatment.  CK was first used only w/Gleason 6 patients but it was later expanded to include Gleason 7 patients as well.  The key is whether the cancer is still confined to the prostate or not.

You can go to Accuray's site (the mfgr of CK) here to find a treatment center near you: http://www.accuray.com/treatment-centers

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