New Prostate Cancer Dx

Old Salt

Five Cyberknife treatments?

To add to the dilemma of which treatment to choose, one can just do five Cyberknife treatments.

Katz et al. published 7-year results (five sessions of 35 Gy each), and for intermediate-risk patients the 'success' rate was 90% (success = freedom from biochemical relapse) after 7 years.

http://www.ncbi.nlm.nih.gov/pubmed/25229051

As an aside, HD brachy is more invasive than SBRT.

RonJT

Old Salt said:

Five Cyberknife treatments?

To add to the dilemma of which treatment to choose, one can just do five Cyberknife treatments.

Katz et al. published 7-year results (five sessions of 35 Gy each), and for intermediate-risk patients the 'success' rate was 90% (success = freedom from biochemical relapse) after 7 years.

http://www.ncbi.nlm.nih.gov/pubmed/25229051

As an aside, HD brachy is more invasive than SBRT.

5 cyberknife rx

Thanks old salt.  Interesting articale.  I seem to be in the high intermediate risk group so for me bDFS is closer to 79% if I read things right.  Still not bad.  I would like to find a similar study for the 25 IMRT sessions plus Cyberknife boost. 

Old Salt

RonJT said:

5 cyberknife rx

Thanks old salt.  Interesting articale.  I seem to be in the high intermediate risk group so for me bDFS is closer to 79% if I read things right.  Still not bad.  I would like to find a similar study for the 25 IMRT sessions plus Cyberknife boost. 

IMRT plus SBRT boost

Unfortunately, there are very few refereed publications in the medical literature. I found just a (small) phase II study

http://www.ncbi.nlm.nih.gov/pubmed/20815416

24 patients that were followed for 6 months; the paper focusses on side effects. No long-term data; hence the paper doesn't address the topic of this thread. There likely will be a follow-up.

 

RonJT

Old Salt said:

Need some more detail

25 sessions of IMRT? At what dose? Followed by how many sessions of SBRT (at what dose)?

As an aside, I got an SBRT/Cyberknife boost (3 x 6.5 Gy) prior to 25 sessions of IMRT (1.4 Gy each). My prostate was significantly worse (Gleason 9), compared to yours.

Based on papers that I read, I believe that HD Brachy and SBRT (as boosts) are comparable in outcomes. You might consider the experience of the radiation oncologist when deciding which way to go.

RT dose

Thanks for your input Old Salt

The dose for 25 sessions of IMRT will be 45Gy.  The cyberknife dose would be 2 sessions at 9.5Gy each.  So total dose would be 64Gy.  I am at risk for pelvic node involvement so they will be included in the RT.  Total ADT is scheduled to be 4 months Lupron + Casodex.  I am leaning toward cyberknife over HDR brachytherapy option for the boost.  Dr Gottschalk at UCSF is very experienced.  I am including this research article for anyone facing the same decision.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721063/