Johns Hopkins Health Alerts: Talking About CyberKnife

2

Comments

  • bdhilton
    bdhilton Member Posts: 802 Member
    viperfred said:

    CyberKnife mis-information
    Prostate cancer outcome is luck of the draw for the uninformed consumer!

    dbhilton is not well informed about the CyberKnife or advanced radio therapy. "His" facts are copied from a 2008 post http://prostatecancerinfolink.net/2008/07/28/cyberknife-robotic-radiosurgery-for-localized-prostate-cancer/

    There is a lot of misinformation regarding the CyberKnife and other Modalities for treatment of localized prostate cancer. The economics opportunity from prostate cancer patients is a very large market. The leadership of ASTRO has also misrepresented the CyberKnife in print and digital media.

    CMS and private insures’ have started to use a phrase ” Evidence Based Health Care” as their guide lines for coverage. There is one big problem there is no “Evidence” gathered in randomized trials with controls to support a scientific conclusion. There was a MEDCAC meeting April 21, 2010 at CMS headquarters in Baltimore, MD for the treatment of prostate cancer with all forms of Radio Therapy. On a scale of 1 (low) to 5; the “Evidence” for each modality was rated as a 1. No modality has “Evidence” of superiority. My impression from this meeting is that Medicine is as much art as science and there is a lot of room for improving studies.

    “Evidence” for ever modality including robotic surgery takes years to develop.

    Surgery has dominated this market for many years and still is a major modality. The surgeons get the first bite at the apple. They give us our biopsy results and say the good news is that they can remove our prostate cancer. Most of us are in shock with the diagnosis of PCa and jump at the opportunity to have it removed. What we are not told are the surgical risk which are extensive, the short term risk and long term risk of recurrence.

    In the last 20 years radiation therapy and imaging have made dramatic advances. The result is lower risk of recurrence, no surgical, short term risk very low, long term risk will be available in the long term. However based on the 101 years, of knowledge, for radiation treatment of PCa, the long term risk of side effects are low.

    The latest study by Dr. Alan Katz http://www.ncbi.nlm.nih.gov/pubmed/20122161 supports the finding from the Naples study, Don Fuller CyberKnife Centers of San Diego,
    Dr. Alexander Gottschalk at UCSF, Dr. Jerome Spunberg, CyberKnife Center of Palm Beach and Dr. Clinton Medbery, III, St. Anthony Hospital Cyberknife Center Ok City, OK. These are the pioneers of CyberKnife treatment in the US currently treating PCa patients. The first PCa patient was treated with the CyberKnife in Dec. 2003 at Stanford in a clinical trial started by Dr. CR King. Dr. King was the visionary for treatment of PCa with the CyberKnife.

    The first clinical trial at started at Stanford was closed when Dr. King moved to UCLA to head the radio therapy dept. of their new institute of urology. He published an update in 2008 and is working on a new update. Consider every technology has a learning curve, the CyberKnife results from that learning curve are no worse than any other option at the same post treatment time-line and better patient outcome during the learning curve for other modalities. I am one of the patients in Dr. King's clinical trial with zero side effects. PSA pre CK was 5.0 ng/mL, completed treatment 5-5-2008, 27 month PSA, Aug 5, 2010 is 0.034 ng/mL.

    There are 1,000's of published studies for radio therapy. Radiation has been known to kill prostate cancer for a 101 years. Major advances have been made in the last 20 years (total dose of 60 Gy was typical). Imaging technology, Radiation sources (linear accelerators) have made major advancements in power, beam control and software to control treatment planning. Localized External Beam Radiation advanced from 2D-RT, 3D-RT, IMRT, Proton Therapy, IGRT-IMRT, CyberKnife/SBRT. Few studies follow patients over 5 to 8 years. The published data suggest that increasing the total dose improves cure. This is tricky as the increasing dose also results in collateral damage. Fixed beam Gantry system limit the dose per session/fraction/day to 1.8/Gy when treating prostate cancer. The number of sessions for IMRT is now up to 45 (9 weeks, 5 days a week) with a total of 78-86.4 Gy. The long term data is a good reference but of limited vale for todays therapy. It takes 10 years to provide 10 year data at which time the therapy is obsolete.

    What is known:


    1. The CyberKnife has very few side effects, confirmed local failure rates at 30 months median follow up are less than 1%.
    1. Increased total dose improves cure rates for any radio therapy.
    2. Increased (hypo fraction) dose per session/fraction increases cure and reduces total dose. Hypo fractionation is delivered by HDR Brachytherapy, the CyberKnife and at least one new clinical trial using the Novalis Tx.
    3. Lowering the dose to critical structures reduces side effects. This continues to improve with improving imaging, planning and in the case of the CyberKnife prostate tracking during the treatment. IMRT and Proton therapy use CT scans before the session without automatic beam correction for prostate movement.
    4. The three year cure rate has improved from 60-70% 20 years ago, to over 90% with the early detection and higher dose, and today's advanced therapies likely to have cure rates of 98-100%.

    Look at studies for all therapies to be an informed consumer. Surgery is no longer the Golden Standard. A treatment center t a good option if they do not have a CyberKnife. Most treatment centers with a CyberKnife also have IMRT and many also offer Brachytherapy. Doctors make more money from IMRT as they get paid per session. 45 sessions is a nice paycheck. The CyberKnife treatment is 4 or 5 days. The total cost of treatment is lower with the CyberKnife than IMRT . Always follow the money when consulting with doctors to filter out their bias and self serving interest. It is reasonable for a doctor of a specific modality to emphasize the features of his speciality. It is not professional for a doctor to be critical of a modality that they do not have expertise and or have current data to validate their claims.

    Be an informed consumer!

    Viberfred,
    Personal attacks

    Viberfred,
    Personal attacks on me are not going to make Cyberknife any better or worse. I am very informed about the CyberKnife and unlike some folks here I keep an open mind. I asked the gentlemen pushing Cyberknife some basic questions and instead of just providing answers I get attacked? Humm….
    Yes I copy and paste many things to inform pre and post PCa guys. Why is this issue because I do not post what you want to hear? Sorry I do not understand your point…
    I keep saying that “CyberKnife therapy may be an absolutely wonderful form of treatment for localized prostate cancer…” and I say that about every treatment you believe will work for you as I am not hear to push an agenda that a few people are so clearly attempting to do if it is as innocent as they just want to believe that their treatment is the best for everyone or as sinister as pushing this treatment for monetary gains.
    Ok since 2004, 4000 men have been treated by cyberknife…Ok, 250,000 men a year are diagnosed with PCa and are treated so since 2004, 1,500,000 men have been diagnosed and treated for PCa and 4000 of them have selected Cyberknife…I could be wrong but from my math that is .26% of the PCA population since 2004 have used this therapy plus the medical community has stated that there will not be any reliable long term data until 2014…
    Your “What is known” list is not scientific or factual in the less. Sorry but I am not going to “stick my head” in the sand and pretend that Cyberknife is magically and wonderful as you are stating without facts …I believe that it is a treatment option for PCa and I would personally look closely at it if I was having radiation as a first line treatment…
    We are here to help each other and I as others do not like the fact that some folks come in here with agendas…
    Best to all and have a great weekend-Peace
  • bdhilton
    bdhilton Member Posts: 802 Member
    viperfred said:

    CyberKnife mis-information
    Prostate cancer outcome is luck of the draw for the uninformed consumer!

    dbhilton is not well informed about the CyberKnife or advanced radio therapy. "His" facts are copied from a 2008 post http://prostatecancerinfolink.net/2008/07/28/cyberknife-robotic-radiosurgery-for-localized-prostate-cancer/

    There is a lot of misinformation regarding the CyberKnife and other Modalities for treatment of localized prostate cancer. The economics opportunity from prostate cancer patients is a very large market. The leadership of ASTRO has also misrepresented the CyberKnife in print and digital media.

    CMS and private insures’ have started to use a phrase ” Evidence Based Health Care” as their guide lines for coverage. There is one big problem there is no “Evidence” gathered in randomized trials with controls to support a scientific conclusion. There was a MEDCAC meeting April 21, 2010 at CMS headquarters in Baltimore, MD for the treatment of prostate cancer with all forms of Radio Therapy. On a scale of 1 (low) to 5; the “Evidence” for each modality was rated as a 1. No modality has “Evidence” of superiority. My impression from this meeting is that Medicine is as much art as science and there is a lot of room for improving studies.

    “Evidence” for ever modality including robotic surgery takes years to develop.

    Surgery has dominated this market for many years and still is a major modality. The surgeons get the first bite at the apple. They give us our biopsy results and say the good news is that they can remove our prostate cancer. Most of us are in shock with the diagnosis of PCa and jump at the opportunity to have it removed. What we are not told are the surgical risk which are extensive, the short term risk and long term risk of recurrence.

    In the last 20 years radiation therapy and imaging have made dramatic advances. The result is lower risk of recurrence, no surgical, short term risk very low, long term risk will be available in the long term. However based on the 101 years, of knowledge, for radiation treatment of PCa, the long term risk of side effects are low.

    The latest study by Dr. Alan Katz http://www.ncbi.nlm.nih.gov/pubmed/20122161 supports the finding from the Naples study, Don Fuller CyberKnife Centers of San Diego,
    Dr. Alexander Gottschalk at UCSF, Dr. Jerome Spunberg, CyberKnife Center of Palm Beach and Dr. Clinton Medbery, III, St. Anthony Hospital Cyberknife Center Ok City, OK. These are the pioneers of CyberKnife treatment in the US currently treating PCa patients. The first PCa patient was treated with the CyberKnife in Dec. 2003 at Stanford in a clinical trial started by Dr. CR King. Dr. King was the visionary for treatment of PCa with the CyberKnife.

    The first clinical trial at started at Stanford was closed when Dr. King moved to UCLA to head the radio therapy dept. of their new institute of urology. He published an update in 2008 and is working on a new update. Consider every technology has a learning curve, the CyberKnife results from that learning curve are no worse than any other option at the same post treatment time-line and better patient outcome during the learning curve for other modalities. I am one of the patients in Dr. King's clinical trial with zero side effects. PSA pre CK was 5.0 ng/mL, completed treatment 5-5-2008, 27 month PSA, Aug 5, 2010 is 0.034 ng/mL.

    There are 1,000's of published studies for radio therapy. Radiation has been known to kill prostate cancer for a 101 years. Major advances have been made in the last 20 years (total dose of 60 Gy was typical). Imaging technology, Radiation sources (linear accelerators) have made major advancements in power, beam control and software to control treatment planning. Localized External Beam Radiation advanced from 2D-RT, 3D-RT, IMRT, Proton Therapy, IGRT-IMRT, CyberKnife/SBRT. Few studies follow patients over 5 to 8 years. The published data suggest that increasing the total dose improves cure. This is tricky as the increasing dose also results in collateral damage. Fixed beam Gantry system limit the dose per session/fraction/day to 1.8/Gy when treating prostate cancer. The number of sessions for IMRT is now up to 45 (9 weeks, 5 days a week) with a total of 78-86.4 Gy. The long term data is a good reference but of limited vale for todays therapy. It takes 10 years to provide 10 year data at which time the therapy is obsolete.

    What is known:


    1. The CyberKnife has very few side effects, confirmed local failure rates at 30 months median follow up are less than 1%.
    1. Increased total dose improves cure rates for any radio therapy.
    2. Increased (hypo fraction) dose per session/fraction increases cure and reduces total dose. Hypo fractionation is delivered by HDR Brachytherapy, the CyberKnife and at least one new clinical trial using the Novalis Tx.
    3. Lowering the dose to critical structures reduces side effects. This continues to improve with improving imaging, planning and in the case of the CyberKnife prostate tracking during the treatment. IMRT and Proton therapy use CT scans before the session without automatic beam correction for prostate movement.
    4. The three year cure rate has improved from 60-70% 20 years ago, to over 90% with the early detection and higher dose, and today's advanced therapies likely to have cure rates of 98-100%.

    Look at studies for all therapies to be an informed consumer. Surgery is no longer the Golden Standard. A treatment center t a good option if they do not have a CyberKnife. Most treatment centers with a CyberKnife also have IMRT and many also offer Brachytherapy. Doctors make more money from IMRT as they get paid per session. 45 sessions is a nice paycheck. The CyberKnife treatment is 4 or 5 days. The total cost of treatment is lower with the CyberKnife than IMRT . Always follow the money when consulting with doctors to filter out their bias and self serving interest. It is reasonable for a doctor of a specific modality to emphasize the features of his speciality. It is not professional for a doctor to be critical of a modality that they do not have expertise and or have current data to validate their claims.

    Be an informed consumer!

    Please list the medical reports that support your claims
    thanks
  • mrspjd
    mrspjd Member Posts: 694 Member
    viperfred said:

    CyberKnife mis-information
    Prostate cancer outcome is luck of the draw for the uninformed consumer!

    dbhilton is not well informed about the CyberKnife or advanced radio therapy. "His" facts are copied from a 2008 post http://prostatecancerinfolink.net/2008/07/28/cyberknife-robotic-radiosurgery-for-localized-prostate-cancer/

    There is a lot of misinformation regarding the CyberKnife and other Modalities for treatment of localized prostate cancer. The economics opportunity from prostate cancer patients is a very large market. The leadership of ASTRO has also misrepresented the CyberKnife in print and digital media.

    CMS and private insures’ have started to use a phrase ” Evidence Based Health Care” as their guide lines for coverage. There is one big problem there is no “Evidence” gathered in randomized trials with controls to support a scientific conclusion. There was a MEDCAC meeting April 21, 2010 at CMS headquarters in Baltimore, MD for the treatment of prostate cancer with all forms of Radio Therapy. On a scale of 1 (low) to 5; the “Evidence” for each modality was rated as a 1. No modality has “Evidence” of superiority. My impression from this meeting is that Medicine is as much art as science and there is a lot of room for improving studies.

    “Evidence” for ever modality including robotic surgery takes years to develop.

    Surgery has dominated this market for many years and still is a major modality. The surgeons get the first bite at the apple. They give us our biopsy results and say the good news is that they can remove our prostate cancer. Most of us are in shock with the diagnosis of PCa and jump at the opportunity to have it removed. What we are not told are the surgical risk which are extensive, the short term risk and long term risk of recurrence.

    In the last 20 years radiation therapy and imaging have made dramatic advances. The result is lower risk of recurrence, no surgical, short term risk very low, long term risk will be available in the long term. However based on the 101 years, of knowledge, for radiation treatment of PCa, the long term risk of side effects are low.

    The latest study by Dr. Alan Katz http://www.ncbi.nlm.nih.gov/pubmed/20122161 supports the finding from the Naples study, Don Fuller CyberKnife Centers of San Diego,
    Dr. Alexander Gottschalk at UCSF, Dr. Jerome Spunberg, CyberKnife Center of Palm Beach and Dr. Clinton Medbery, III, St. Anthony Hospital Cyberknife Center Ok City, OK. These are the pioneers of CyberKnife treatment in the US currently treating PCa patients. The first PCa patient was treated with the CyberKnife in Dec. 2003 at Stanford in a clinical trial started by Dr. CR King. Dr. King was the visionary for treatment of PCa with the CyberKnife.

    The first clinical trial at started at Stanford was closed when Dr. King moved to UCLA to head the radio therapy dept. of their new institute of urology. He published an update in 2008 and is working on a new update. Consider every technology has a learning curve, the CyberKnife results from that learning curve are no worse than any other option at the same post treatment time-line and better patient outcome during the learning curve for other modalities. I am one of the patients in Dr. King's clinical trial with zero side effects. PSA pre CK was 5.0 ng/mL, completed treatment 5-5-2008, 27 month PSA, Aug 5, 2010 is 0.034 ng/mL.

    There are 1,000's of published studies for radio therapy. Radiation has been known to kill prostate cancer for a 101 years. Major advances have been made in the last 20 years (total dose of 60 Gy was typical). Imaging technology, Radiation sources (linear accelerators) have made major advancements in power, beam control and software to control treatment planning. Localized External Beam Radiation advanced from 2D-RT, 3D-RT, IMRT, Proton Therapy, IGRT-IMRT, CyberKnife/SBRT. Few studies follow patients over 5 to 8 years. The published data suggest that increasing the total dose improves cure. This is tricky as the increasing dose also results in collateral damage. Fixed beam Gantry system limit the dose per session/fraction/day to 1.8/Gy when treating prostate cancer. The number of sessions for IMRT is now up to 45 (9 weeks, 5 days a week) with a total of 78-86.4 Gy. The long term data is a good reference but of limited vale for todays therapy. It takes 10 years to provide 10 year data at which time the therapy is obsolete.

    What is known:


    1. The CyberKnife has very few side effects, confirmed local failure rates at 30 months median follow up are less than 1%.
    1. Increased total dose improves cure rates for any radio therapy.
    2. Increased (hypo fraction) dose per session/fraction increases cure and reduces total dose. Hypo fractionation is delivered by HDR Brachytherapy, the CyberKnife and at least one new clinical trial using the Novalis Tx.
    3. Lowering the dose to critical structures reduces side effects. This continues to improve with improving imaging, planning and in the case of the CyberKnife prostate tracking during the treatment. IMRT and Proton therapy use CT scans before the session without automatic beam correction for prostate movement.
    4. The three year cure rate has improved from 60-70% 20 years ago, to over 90% with the early detection and higher dose, and today's advanced therapies likely to have cure rates of 98-100%.

    Look at studies for all therapies to be an informed consumer. Surgery is no longer the Golden Standard. A treatment center t a good option if they do not have a CyberKnife. Most treatment centers with a CyberKnife also have IMRT and many also offer Brachytherapy. Doctors make more money from IMRT as they get paid per session. 45 sessions is a nice paycheck. The CyberKnife treatment is 4 or 5 days. The total cost of treatment is lower with the CyberKnife than IMRT . Always follow the money when consulting with doctors to filter out their bias and self serving interest. It is reasonable for a doctor of a specific modality to emphasize the features of his speciality. It is not professional for a doctor to be critical of a modality that they do not have expertise and or have current data to validate their claims.

    Be an informed consumer!

    Kudos and many thanks to Viperfred and Kongo
    Kudos and many thanks to Viperfred and Kongo for setting the record straight and citing verifiable research facts and studies to refute the manipulated so-called "facts" & unsubstantiated info in the J-H article and subsequent comments posted by the CSN member who initiated this thread topic when posting the misleading article in the first place.

    I'm all for a good debate and discussion based on verifiable facts, references, etc. I also believe in being a responsible poster when initiating a thread on this PCa forum and therefore, posting articles that cite verifiable names and medical/scientific studies with facts and stats & research that support the claims or findings being put forth. Just because an article or statement comes from a respected institution or organization, say, Johns-Hopkins or the American Cancer Society (as in "most men only need PSA testing after age 50"--hogwash!), it does not make it factually accurate. Not only were the so called "facts" of the J-H article unsubstantiated, incorrect and manipulated, the article did not even list the author's name, a further clue that no one from J-H wanted to claim responsibility for the original misguided incorrect info, and that the article's agenda was far more a marketing tool for J-H PCa treatments & newsletters, etc. than a responsible educational discussion of valid alternative treatments for early stage PCa.

    Johns-Hopkins didn't post the article on CSN, a CSN member made the post. IMHO, if a CSN member is going to post a thread containing an article he/she believes has valuable credible important PCa info, please be responsible for that thread and be prepared to back it up with facts and references that can be verified. Don't confuse opinions and personal experiences with scientific fact. If you want to post info for discussion, that's great, but state that from the beginning by making your objective clear. When others cite credible & opposing info with real verifiable research and info, don't be defensive and hide behind the "don't attack the messenger, I'm just posting the article" argument (which by the way, is the exact argument the same thread poster used when I challenged another article they posted several months ago: http://csn.cancer.org/node/191271

    If you can't stand the heat, either get out of the kitchen (as in "I have nothing more to say on this subject and will not comment on this again" or better yet, just admit you haven't done your homework!) or be responsible, ready to cite verifiable names & studies when you post an "article" thinly veiled as a fact.

    Thanks again to Kongo and Viperfred for doing the in-depth research and articulating the info so well, and thereby, making this a valuable PCa discussion after all!
    mrs pjd
  • mrspjd
    mrspjd Member Posts: 694 Member
    bdhilton said:

    Please list the medical reports that support your claims
    thanks

    I know I'm going to regret this post...
    but--get over it! IMHO, as a woman...stop beating your chest and get off your soap box! OK, now I feel better.
  • steckley
    steckley Member Posts: 100
    mrspjd said:

    Kudos and many thanks to Viperfred and Kongo
    Kudos and many thanks to Viperfred and Kongo for setting the record straight and citing verifiable research facts and studies to refute the manipulated so-called "facts" & unsubstantiated info in the J-H article and subsequent comments posted by the CSN member who initiated this thread topic when posting the misleading article in the first place.

    I'm all for a good debate and discussion based on verifiable facts, references, etc. I also believe in being a responsible poster when initiating a thread on this PCa forum and therefore, posting articles that cite verifiable names and medical/scientific studies with facts and stats & research that support the claims or findings being put forth. Just because an article or statement comes from a respected institution or organization, say, Johns-Hopkins or the American Cancer Society (as in "most men only need PSA testing after age 50"--hogwash!), it does not make it factually accurate. Not only were the so called "facts" of the J-H article unsubstantiated, incorrect and manipulated, the article did not even list the author's name, a further clue that no one from J-H wanted to claim responsibility for the original misguided incorrect info, and that the article's agenda was far more a marketing tool for J-H PCa treatments & newsletters, etc. than a responsible educational discussion of valid alternative treatments for early stage PCa.

    Johns-Hopkins didn't post the article on CSN, a CSN member made the post. IMHO, if a CSN member is going to post a thread containing an article he/she believes has valuable credible important PCa info, please be responsible for that thread and be prepared to back it up with facts and references that can be verified. Don't confuse opinions and personal experiences with scientific fact. If you want to post info for discussion, that's great, but state that from the beginning by making your objective clear. When others cite credible & opposing info with real verifiable research and info, don't be defensive and hide behind the "don't attack the messenger, I'm just posting the article" argument (which by the way, is the exact argument the same thread poster used when I challenged another article they posted several months ago: http://csn.cancer.org/node/191271

    If you can't stand the heat, either get out of the kitchen (as in "I have nothing more to say on this subject and will not comment on this again" or better yet, just admit you haven't done your homework!) or be responsible, ready to cite verifiable names & studies when you post an "article" thinly veiled as a fact.

    Thanks again to Kongo and Viperfred for doing the in-depth research and articulating the info so well, and thereby, making this a valuable PCa discussion after all!
    mrs pjd

    "don't attack the messenger, I'm just posting the article"
    I know I've posted links that I can not defend (such as the one to Dr. Muhall's ED lectures ... I couldn't defend what he was saying if my life depended on it). Do you really feel that a poster should be prepared to defend anything they post on this site with "real verifiable research and info"?

    Most of us are posting to get information or to provide others with insights we have stumbled across. I feel that is what bdhilton was doing. I also feel Kongo was right in giving a rebutal to the "study" ... he was probably wrong for shooting the "messenger".
  • Kongo
    Kongo Member Posts: 1,166 Member
    bdhilton said:

    Kongo
    You respect John Hopkins but they do not know what they are talking about here? Are we getting things out of proportion? CyberKnife therapy may be an absolutely wonderful form of treatment for localized prostate cancer.

    The CyberKnife® system was initially developed as a method to treat tumors in places like the brain that were inaccessible to physical surgery, and was originally approved by the FDA in 1992. Now it is being touted as “the next thing” in “radiosurgery” for prostate cancer.

    In 2003 an article was published by King et al. that reviewed the theoretical potential of the CyberKnife in treatment of prostate cancer. And a Phase II clinical trial has been initiated to explore whether CyberKnife surgery really does have potential in the treatment of prostate cancer. The trial hopes to enroll nearly 300 patients and won’t report outcomes until some time in 2014. This is the sort of thing that can happen when large number of people start to present with a treatable condition: the numbers and types of treatment start to expand, sometimes exponentially.

    Of course, because the CyberKnife is already approved, there is nothing to stop CyberKnife users from carrying out such “radiosurgery” today. And some centers clearly are. If you want to get an idea of the marketing that is already in place, have a look at this link (just as an example)http://sdckc.com/Prostate-Brochure.pdf . This morning in my mail I received an invitation to an “eSymposium” on CyberKnife use in the treatment of prostate cancer, in which one of the speakers is an employee of the manufacturer of the CyberKnife technology...hummmm

    Here are some questions that need better answers than those offered below:

    •Is CyberKnife as effective and as safe as other forms of therapy for the treatment of localized prostate cancer? Answer: We don’t know.
    •What is the cost of CyberKnife treatment for localized prostate cancer? Answer: We don’t know, but the equipment alone costs around $4 million.
    •Is the average health insurance carrier reimbursing for CyberKnife treatment of prostate cancer? And what about Medicare? Answer: We don’t know, but it would surprise us if they are.

    Again, CyberKnife therapy may be an absolutely wonderful form of treatment for localized prostate cancer. But what we know at the moment is that:

    •Many men who get actively treated for localized disease may not need treatment at all (especially some of the older ones).
    •Most men who have treatment for early stage disease do well with available therapies.
    •The available data on the short-term (let alone the long-term) outcomes of CyberKnife therapy for prostate cancer are minimal at best.
    •There are only three papers on CyberKnife therapy for prostate cancer in the PubMed database (and not one of the three offers peer-reviewed clinical data)-This is prety critical....
    •Several centers are actively promoting this form of therapy, despite the limited outcomes data available..

    I am justing stating the facts

    Facts are wrong again
    Perhaps it was a date problem of the PubMed database "fact" that is causing the problem here but there are 323 papers in the PubMed database today using "Cyberknife" as a search term. Narrowing the search to "cyberknife prostate" yields 23 papers, not the 3 you say are "just the facts."

    "Davinci", on the other hand, gets 148 hits.

    And BTW BD, I didn't get my CyberKnife treatment in San Diego. If you're going to suggest I'm involved in something like being a paid shill for a treatment center, at least get the facts right about who is supposedly paying me off.
  • bdhilton
    bdhilton Member Posts: 802 Member
    Kongo said:

    Facts are wrong again
    Perhaps it was a date problem of the PubMed database "fact" that is causing the problem here but there are 323 papers in the PubMed database today using "Cyberknife" as a search term. Narrowing the search to "cyberknife prostate" yields 23 papers, not the 3 you say are "just the facts."

    "Davinci", on the other hand, gets 148 hits.

    And BTW BD, I didn't get my CyberKnife treatment in San Diego. If you're going to suggest I'm involved in something like being a paid shill for a treatment center, at least get the facts right about who is supposedly paying me off.

    Please stop attacking me.
    Please stop attacking me. You have yet to answer any question with facts, You continue to “spin”. 100% of what you “paste “and claim to be fact is directly from the CyberKnife website. What 23 medical institutions have done studies on Cyberknife?

    According to your numbers, Cyberknife has done .26% of the treatments since 2004 (the 4000 number comes from you). .Your past posting claim you are from San Diego and in your past post stated you had your treatments in San Diego and now you are denying this? Who are you? ..
  • Kongo
    Kongo Member Posts: 1,166 Member
    bdhilton said:

    Viberfred,
    Personal attacks

    Viberfred,
    Personal attacks on me are not going to make Cyberknife any better or worse. I am very informed about the CyberKnife and unlike some folks here I keep an open mind. I asked the gentlemen pushing Cyberknife some basic questions and instead of just providing answers I get attacked? Humm….
    Yes I copy and paste many things to inform pre and post PCa guys. Why is this issue because I do not post what you want to hear? Sorry I do not understand your point…
    I keep saying that “CyberKnife therapy may be an absolutely wonderful form of treatment for localized prostate cancer…” and I say that about every treatment you believe will work for you as I am not hear to push an agenda that a few people are so clearly attempting to do if it is as innocent as they just want to believe that their treatment is the best for everyone or as sinister as pushing this treatment for monetary gains.
    Ok since 2004, 4000 men have been treated by cyberknife…Ok, 250,000 men a year are diagnosed with PCa and are treated so since 2004, 1,500,000 men have been diagnosed and treated for PCa and 4000 of them have selected Cyberknife…I could be wrong but from my math that is .26% of the PCA population since 2004 have used this therapy plus the medical community has stated that there will not be any reliable long term data until 2014…
    Your “What is known” list is not scientific or factual in the less. Sorry but I am not going to “stick my head” in the sand and pretend that Cyberknife is magically and wonderful as you are stating without facts …I believe that it is a treatment option for PCa and I would personally look closely at it if I was having radiation as a first line treatment…
    We are here to help each other and I as others do not like the fact that some folks come in here with agendas…
    Best to all and have a great weekend-Peace

    Fred
    Fred,

    Great job in uncovering the link which had been copied verbatim and pasted in this thread without citation, making it appear to be original thoughts on the matter when in fact it was someone named “Sitemaster” posted on a web site for a “not for profit” company out of Virginia that blatantly advertises its medical director’s very much for profit Krongrad Institute in Florida. In other words, the post came from a site which has as one of its main purposes the promotion robotic surgery at a profit.

    Pretty clear to me what the agenda there is all about. Whether the poster realized that or not is a whole other matter but I prefer to think he was just taken in like so many of us are when we search the internet for answers to questions about prostate cancer.

    Another reason, in my opinion, that we should cite our sources where it makes sense so that others can look at the purported "facts" in the original context and clearly indicate opinions as opinions and not try to pass them off under some sort of medical "gold standard" mumbo jumbo.
  • bdhilton
    bdhilton Member Posts: 802 Member
    Kongo
    I have read your postings for months with "reserve"... I am dropping this discussion with you as you have yet to provide any facts outside that you post 100% from the Cyberknife web sites and you just attack me with nonsense...I believe we are all smarter than that here…

    Again, the purpose of this site is to inform and support folk’s pre and post treatment and you seem incapable of this without your “cyberknife” spin. You let everyone know how “important” you are (that raises red flags) so my latest question is where do you find so much time to post...I find this most interesting...I am going to go enjoy my weekend… I hope you do the same...
  • BRONX52
    BRONX52 Member Posts: 156
    mrspjd said:

    I know I'm going to regret this post...
    but--get over it! IMHO, as a woman...stop beating your chest and get off your soap box! OK, now I feel better.

    NEED A BREAK
    This website provides valuable information for those seeking help to deal with their prostate cancer issues. This particular thread has created quite a stir among many members and has come down to a turf war. To continue to argue about one treatment or another, citing studies, demanding verification of facts and the personal attacks is really demoralizing. I realize that both sides in this issue feel they have a right to state the facts. Some can be verified while others cannot. The tone of this discussion, in my opinion, has taken a turn for the worst. Others viewing this thread won't be able to see the valuable information provided because of the constant bickering and name calling. It certainly has turned me off. I think I need a break from this website!!!
  • mrspjd
    mrspjd Member Posts: 694 Member
    steckley said:

    "don't attack the messenger, I'm just posting the article"
    I know I've posted links that I can not defend (such as the one to Dr. Muhall's ED lectures ... I couldn't defend what he was saying if my life depended on it). Do you really feel that a poster should be prepared to defend anything they post on this site with "real verifiable research and info"?

    Most of us are posting to get information or to provide others with insights we have stumbled across. I feel that is what bdhilton was doing. I also feel Kongo was right in giving a rebutal to the "study" ... he was probably wrong for shooting the "messenger".

    yes and no
    When CSN members (messengers) make irresponsible posts to support their obvious agenda, with info in the guise of a thinly veiled "factual" article that supports the posters biased point of view, then yes, I do expect some add'l info to verify the claims put forth. If the article is posted in the form of, say, "What do you think, let's discuss whether this info/article has merits," then, no, the verifiable facts will emerge in the discussion. In the case of Dr. Muhall, his name and research are easily googled, verified, etc. The J-H article had no author and even I recognized that many statements in the article were down-right incorrect and misleading. This poster has consistently used the "don't attack the messenger..." and claimed "personal attack" as an argument when confronted with verifiable studies and info that refute general PCa articles with a biased agenda. With all due respect, and as well-intentioned as this poster may be, this is a disservice to the readers seeking unbiased PCa info on this forum.
  • Kongo
    Kongo Member Posts: 1,166 Member
    bdhilton said:

    Please stop attacking me.
    Please stop attacking me. You have yet to answer any question with facts, You continue to “spin”. 100% of what you “paste “and claim to be fact is directly from the CyberKnife website. What 23 medical institutions have done studies on Cyberknife?

    According to your numbers, Cyberknife has done .26% of the treatments since 2004 (the 4000 number comes from you). .Your past posting claim you are from San Diego and in your past post stated you had your treatments in San Diego and now you are denying this? Who are you? ..

    Oh Good Grief
    BD, I never said anything about 23 institutions. I said, in reference to your earlier post that only 3 papers about Cyberknife and prostate cancer where in the PubMed database, that today the search yields 23 papers. Fell free to go to pubmed.gov and enter the search terms yourself.

    Not sure why you have your shoe stuck on gum about the percentage of people getting CyberKnife treatment or what that statistic is supposed to mean. Didn't your mother ever tell you that just because everyone else is jumping off a cliff it doesn't mean you have to follow suit? More and more men are choosing this treatment for a lot of reasons but I would be very surprised if it became the most common method of treating PCa. As we all know each case of prostate cancer in unique and it will always be a challenge to sort out which treatment is best for any one individual.

    I had my treatment at CyberKnife of Southern California at Vista, not at a center in San Diego. Vista is a town about 40 miles north of San Diego. There is a center in San Diego and it is highly respected. I just didn't go there.

    BD, I didn't attack you in this thread. I stated that I felt the argument in your original post that fiducial placement was somehow critically tied to the experuience of the surgeon placing the fiducials which made critical was nonsense, that the doctor was unnamed and that there was no study or other evidence cited. In other words, I rebutted the information you posted, not you.

    If you go back and review the posting series on this thread I think you'll find you were the one that started attacking me and frankly, I was extremely offended by your aspersion that I am somehow working for some treatment center. I don't believe you actually beleived that and stating it in the forum was beyond mean spirited.
  • steckley
    steckley Member Posts: 100
    mrspjd said:

    yes and no
    When CSN members (messengers) make irresponsible posts to support their obvious agenda, with info in the guise of a thinly veiled "factual" article that supports the posters biased point of view, then yes, I do expect some add'l info to verify the claims put forth. If the article is posted in the form of, say, "What do you think, let's discuss whether this info/article has merits," then, no, the verifiable facts will emerge in the discussion. In the case of Dr. Muhall, his name and research are easily googled, verified, etc. The J-H article had no author and even I recognized that many statements in the article were down-right incorrect and misleading. This poster has consistently used the "don't attack the messenger..." and claimed "personal attack" as an argument when confronted with verifiable studies and info that refute general PCa articles with a biased agenda. With all due respect, and as well-intentioned as this poster may be, this is a disservice to the readers seeking unbiased PCa info on this forum.

    yes and no
    I agree with yes and I agree with no ... I do not agree that either bdhilton or Kongo have a "biased agenda". Why would they? Financial gain, bragging rights? I don't think so. I feel that both are presenting information they think is correct ... and I thank them both for there efforts, and passion, in presenting it.

    PS. I'd still like to get information on the resolution of scanning devices ... can they see microscopic tumors? I have not been able to find any information on this subject.
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    steckley said:

    Cyberknife
    I am sure I would have considered Cyberknife ... if I had known about and if my HMO had it!

    Based on my very limited knowledge of Cyberknife (gained through posts on this site) the only question I have is, "Is the resolution of the scanning devices used to determine where tumors are good enough to spot the small muti-focal tumors common with PCA?".

    Thank you
    to ALL posters who have contributed to this thread.......since I am evaluting various forms of therapy to included Cyberknife I am gratful for the information that was provided....I believe all the posts were made with excellent intentions and were informative.....thank you.

    I hope that future posts in this thread, and elsewhere will be directed at developing knowledge about the treatment, and not "deflecting" to win a point or a position by directing comments toward fellow posters....of course, we want to let others know how to improve their posts so we can all gain informaton. which need to be done in an assertive way.

    I hope that this thread will continue.

    My two cents

    Ira
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    steckley said:

    yes and no
    I agree with yes and I agree with no ... I do not agree that either bdhilton or Kongo have a "biased agenda". Why would they? Financial gain, bragging rights? I don't think so. I feel that both are presenting information they think is correct ... and I thank them both for there efforts, and passion, in presenting it.

    PS. I'd still like to get information on the resolution of scanning devices ... can they see microscopic tumors? I have not been able to find any information on this subject.

    steckley---scanning devices
    I'm not sure if this is what you are looking for, but here are two different tests that may be applicable to your question.


    There is a molecular test performed by a company Aureon, where they , I guess take samples from the sldes from your biopsy and look for aggressive tumors...they then mathematically compare it with other factors such as PSA, gleason, etc to approximately 1000 men who have had radical protectemy, and come up with the likelyhood of the the cancer progressing 8 years in the future.

    But be cautioned on the following; there is a sensitivity of 74percent and a a specificity of 64prcent. What that means is tat among 100 bad tuors, for example, they only can identify 75 of them. And among 100 good tumors, they identify as bad in 36. to be honest this is notmuch different than achieved withjust your psa and gleason and percent tumor.

    I believe that you can contact Aeuron www.aureon.com or 1-888-797-7284

    -----------------
    MRI

    There is an MRI scan for prostate cancer that is done with a special coil in the rectum. This are certain major hospitals that have a Tesla magnet. There is a 1.5 Tesla magnet, the effective resolution is limited to tumors 0.5cc or larger. There is also a 3 Tesla machine which may have a bit finer resolution.

    The most effective MRI for the prostate is called a MRSI (MRI/MRS) and includes the ability to identify cancer metabolites using spectographic analysis.....Basically using the spectoscopy with the MRI provides more accurate results, both the MRI and the spectroscopy are done at the same time.

    The MRI is generally covered by insurance, however the spectroscopy is considered investigational and is not covered by medicare which I use.

    The test indicates if there is any nodule involvement, if there is involvement in one or two lopes , wll show size of prostate, any evidence of extracapular extension, will stage your disease.
  • Swingshiftworker
    Swingshiftworker Member Posts: 1,013 Member
    bdhilton said:

    Kongo
    I have read your postings for months with "reserve"... I am dropping this discussion with you as you have yet to provide any facts outside that you post 100% from the Cyberknife web sites and you just attack me with nonsense...I believe we are all smarter than that here…

    Again, the purpose of this site is to inform and support folk’s pre and post treatment and you seem incapable of this without your “cyberknife” spin. You let everyone know how “important” you are (that raises red flags) so my latest question is where do you find so much time to post...I find this most interesting...I am going to go enjoy my weekend… I hope you do the same...

    Wow!
    Gone for just a day and things have really heated up here. I haven't read such an "interesting" tread for months! :)

    FWIW, I agree w/mrspjd and I still agree w/Kongo and ViperFred. I also don't see how anything Kongo or Viper have said can be interpreted as a "personal attack" on BD but I'm glad (if it's true) that BD is dropping the matter, because tit-for-tat rebuttals (such as we've seen in this thread) never seem to add anything of value to the discussion of the topic at hand -- be it CyberKnife or anything else.

    It's usually just guys having a pissing contest and the only thing that happens in that case is that your shoes or feet get wet and smelly. So, enough already. ;)
  • viperfred
    viperfred Member Posts: 20
    bdhilton said:

    Kongo
    I have read your postings for months with "reserve"... I am dropping this discussion with you as you have yet to provide any facts outside that you post 100% from the Cyberknife web sites and you just attack me with nonsense...I believe we are all smarter than that here…

    Again, the purpose of this site is to inform and support folk’s pre and post treatment and you seem incapable of this without your “cyberknife” spin. You let everyone know how “important” you are (that raises red flags) so my latest question is where do you find so much time to post...I find this most interesting...I am going to go enjoy my weekend… I hope you do the same...

    mis-information
    Hi dbhiltion,

    The link to Dr A. Katz study is provide in my post above. It has citations if you are interested. Do a search for Christopher R. King CyberKnife 2003. This publication cites the background supporting the CyberKnife for PCa.

    I am happy to provide evidence to support all my statements. Please be specific so the proper publications can be provided.

    Mis-representation of fact is done by those who are mis-informed or have a specfic agenda.

    My agenda is for men to make an informed choice.
  • steckley
    steckley Member Posts: 100

    steckley---scanning devices
    I'm not sure if this is what you are looking for, but here are two different tests that may be applicable to your question.


    There is a molecular test performed by a company Aureon, where they , I guess take samples from the sldes from your biopsy and look for aggressive tumors...they then mathematically compare it with other factors such as PSA, gleason, etc to approximately 1000 men who have had radical protectemy, and come up with the likelyhood of the the cancer progressing 8 years in the future.

    But be cautioned on the following; there is a sensitivity of 74percent and a a specificity of 64prcent. What that means is tat among 100 bad tuors, for example, they only can identify 75 of them. And among 100 good tumors, they identify as bad in 36. to be honest this is notmuch different than achieved withjust your psa and gleason and percent tumor.

    I believe that you can contact Aeuron www.aureon.com or 1-888-797-7284

    -----------------
    MRI

    There is an MRI scan for prostate cancer that is done with a special coil in the rectum. This are certain major hospitals that have a Tesla magnet. There is a 1.5 Tesla magnet, the effective resolution is limited to tumors 0.5cc or larger. There is also a 3 Tesla machine which may have a bit finer resolution.

    The most effective MRI for the prostate is called a MRSI (MRI/MRS) and includes the ability to identify cancer metabolites using spectographic analysis.....Basically using the spectoscopy with the MRI provides more accurate results, both the MRI and the spectroscopy are done at the same time.

    The MRI is generally covered by insurance, however the spectroscopy is considered investigational and is not covered by medicare which I use.

    The test indicates if there is any nodule involvement, if there is involvement in one or two lopes , wll show size of prostate, any evidence of extracapular extension, will stage your disease.

    Scanning devices
    Hopeful,

    Thank you for the information. Very helpful.

    It would appear to me that based on these resolutions, a procedure that uses these scanning devices (and statistical methods)to target PCa tumors will miss small tumors.
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    steckley said:

    Scanning devices
    Hopeful,

    Thank you for the information. Very helpful.

    It would appear to me that based on these resolutions, a procedure that uses these scanning devices (and statistical methods)to target PCa tumors will miss small tumors.

    Well
    the test that Aureon does is on a molecular level, and analyzes tumors, both good and bad, however in my opinion the test needs to be improved for accuracy......I believe that we will probably see other companies doing this type test, that will produce better results in the near future...... This test does add so one can better predict progression in the future.

    The MRI Tesla machine does find very small tumors, but not on a molecular level. The Tesla machines , as I understand are the state of the art. The spectroscopy improves the results of the MRI.

    For my active surveillance program, I first get an MRI, no spectroscopy, using a Tesla machine, then a targeted biopsy using a state of the art three dimensional machine that is able to target these lesions found in the MRI to see if they are cancerous......
  • steckley
    steckley Member Posts: 100

    Well
    the test that Aureon does is on a molecular level, and analyzes tumors, both good and bad, however in my opinion the test needs to be improved for accuracy......I believe that we will probably see other companies doing this type test, that will produce better results in the near future...... This test does add so one can better predict progression in the future.

    The MRI Tesla machine does find very small tumors, but not on a molecular level. The Tesla machines , as I understand are the state of the art. The spectroscopy improves the results of the MRI.

    For my active surveillance program, I first get an MRI, no spectroscopy, using a Tesla machine, then a targeted biopsy using a state of the art three dimensional machine that is able to target these lesions found in the MRI to see if they are cancerous......

    Scanning devices
    Hopeful,

    Thank you for the information on your AS testng protocol. I was not aware of what AS patients did for screening ... I assumed they just did repeat biopsies. Nice to know the biopsies can be targeted.

    I find the rapid inprovements in technolgy astounding. Twenty years ago, who would have dreamed that you could remotely resolve images as small as what can be seen today. Amazing.

    I'm guessing that in the not so distant future we'll be able to wave a flashing light (think Star Trek and Dr. McCoy) over someones abdomen and make a diagnosis.

    Thanks.