Need some feedback on after-effects of therapy, especially prostatectomy and CyberKnife

schin

I am 46 years old with a new diagnosis of prostate cancer.  PSA 6.4 (free 23%), negative DRE but bilateral disease by biopsy, 6 out of 15 cores positive, max core tissue involvement 10%, Gleason 6 (3+3), PCA3 43%.  My prostate volume is 35 by DRE, and 22 by ultrasound.  I have no urinary symptoms and have never had any issues with potency.

I have ruled out AS due to my relatively young age, and am mainly considering robotic laparoscopic prostatectomy or CyberKnife.  My take on the literature is that for low-risk disease like mine, outcomes for these two modalities are similar.  So my decision is probably going to be based on side-effects and complications.  

If you've gone down one of these roads, please tell me about the aftermath with respect to urinary, rectal, and potency effects, and whatever else you think I should hear.  Thanks in advance!

***EDIT:  I have not eliminated brachytherapy either, so if you have experience with that please tell me about it as well.

Swingshiftworker

CyberKnife -- No After effects!

I had CyberKnife done in Sept 2010 and there were absolutely NO after effects from the treatment.  Others here and elsewhere who received CK had the same results.

The same absolutely canNOT be said of surgery -- open or robotic.  The risk of side effects from surgery is immense.  You will likely experience ED and incontinence for 6 months to a year and in the worst cases both will be PERMANENT!!!  There are also the "other" risks of surgery, which include infection and NEGLIGENCE -- particuarly collateral tissue damage, including but not limited to perforated retucal/bladder tissue. 

So, if you are eligiible, the choice between CK and robotic surgery is really a NO BRAINER.  CK all the way!!!!

 

 

hopeful and optimistic

Additional diagnostic tests

T3 MRI....this MRI has a very fine resolution, and may show if there is extracapsular extension, suspecious lessions within the prostate and where they are. You need to know this so you can continue with localized treatment. Ultrasound does not have a fine resolution.

 

Additionally I strongly recommend that you have a second opinion on the pathology slides by a world class pathologist who specializes in prostate cancer. Johns Hopkins is one institution. Simply contact your doctors office and request that the slides be sent.

 

When you have treatment it is important to have an expert who does it. 

Surgery....side effects can be severe, generally younger men have better results with surgery than older men...the operation can be exactly of the same quality, but a younger man like you will have less side effedts. If you decide on robotic surgery, you want a surgeon who has done lots and lots of them since the learning curve is very high. Unless the doctor has done at least 500 to 1000 or more, he is practicing. 

Cyberknife.........is one platform of SBRT...there are comparable platforms such as  Novales. This procedure is very precise, has less side effects than surgery. There is about a 95 percent sucess rate. There is a discussion site that specializes in Cyberknife that I recommend  you visit,  Not only lay people post, but there are a couple of docs that will give you input     http://www.cyberknife.com/Forum.aspx

 

Since family members are more likely to develop this disease, please let them know, father, brothers, uncles, etc.

Attend support groups in your area, there is a group USTOO that is international and may have a local group for you to visit.

Read, research internet, books, etc and research some more.

Come back to us with any questions.

Beau2

Younger men

I feel Hopeful was correct on the surgery. I am quite a bit older and my surgery was over five years ago so my experience probably does not apply to you. I am not sure if there are any young surgery patients on this site anymore (randyinindy?) ... there are some on the www.healingwell.com prostate cancer site that would probably share their experience. In general, anecdotaly, it is like Hopeful says, the younger the guy is the better his SEs. FYI I am 67 years old .... No incontinence problems ... I do use pills for ED.

CC52

Choices

We all come at this in different ways Schin. Age, diagnosis (severity), quality of life all factor into a man's decision making.

After my initial Dx last October, I spent the months following reading and researching all I could about treatment options. Seems that you are doing that as well.

I heard about CyberKnife because my mother in-law had a malignant spot on a lung removed with it. Seemed a great option to surgery, and that was/is certainly high on my list. For me there were far too many potential side effects with DaVinci (robotic) surgery, conventional radiation was too lengthy w/side effects, and brachytherapy has issues too. There are still longterm unknowns with CyberKnife, but I am convinced this is the way of the future and I want my treatment to benefit others after me.

With that, I'll tell you I have just entered into treatment via CyberKnife, so I can't speak to your questions - only share how I got to this decision. The fiducials (gold markers inserted into the prostate to aid in locating it during the treatments) were placed last Wednesday, followed by MRI and CT scans this week, then treatment will begin a week or two afterward.

Good luck as you continue toward your decision.

CC

Old Salt

Swingshiftworker said:

CyberKnife -- No After effects!

I had CyberKnife done in Sept 2010 and there were absolutely NO after effects from the treatment.  Others here and elsewhere who received CK had the same results.

The same absolutely canNOT be said of surgery -- open or robotic.  The risk of side effects from surgery is immense.  You will likely experience ED and incontinence for 6 months to a year and in the worst cases both will be PERMANENT!!!  There are also the "other" risks of surgery, which include infection and NEGLIGENCE -- particuarly collateral tissue damage, including but not limited to perforated retucal/bladder tissue. 

So, if you are eligiible, the choice between CK and robotic surgery is really a NO BRAINER.  CK all the way!!!!

 

 

Side effects of CyberKnife (CK)

 

Swingshiftworker may not have had any side effects from the CK treatment (formally known as Stereotactic Body Radiation Therapy; SBRT), but side effects have been noted when larger groups of patients have been studied. Various published studies in the medical literature document this statement. I will mention just a few.

Katz reviewed (2010) various CK treatment protocols. One study reported that the side effects (toxicity profile) were no worse than seen with other (conventional) methods to control prostate cancer. Other studies also reported that that the toxicity of CK treatment was generally mild.

To give another example (from the Georgetown University Hospital CK program), Chen et al (2013) concluded that “Late GI and GU toxicity rates were comparable to conventionally fractionated radiation therapy and brachytherapy. Late urinary symptom flares were observed, but the majority resolved with conservative management. A high percentage of men who were potent prior to treatment remained potent two years following treatment”.

My point is not to discourage anybody from considering SBRT using CyberKnife. In fact, I had three such sessions at Georgetown University Hospital, followed by 25 IMRT sessions. You probably guessed that my case was more serious (Gleason = 9) than the one that is the topic of this thread.