Surgey vs Cyberknife

richmaniaci · August 2022

Hi Everyone,

Recently diagnosed with prostate cancer, Gleason score of 7. So far seems like its localized in the prostate. Consulted with a surgeon and radiation oncologist (cyberknife) at Memorial Sloan Kettering in NYC. Having a real hard time deciding which treatment to use. My wife and I are raising my grandson and my main goal is to be around and relatively healthy for a few more years. I will soon be 73 and am otherwise in good health. I have spoken to a few people who have had radical proctectomy but don't know anyone who has done cyberknife. Aside from different side effects, which has better results as far as preventing a recurrence? Any information and advice would be appreciated.

Rob.Ski · August 2022

I had surgery but, did talk to Cyberknife specialist at Georgetown before I decided. I think the results can be similar in terms of success/failure but, the Cyberknife doc recommended me for surgery. Mainly because I am relatively young at 51 and options, if a recurrence occurs, are better down the road with surgery as first treatment. My guess is I wouldn't have gotten that recommendation from him if I were 73. Chances are I would have gone a different route if I were older. Not because surgery wasn't successful but, I think risk / benefit changes with age. Just my opinion...

Clevelandguy · August 2022

Hi,

Its really up to you and your doctors based on your specific set of circumstances like location of tumor(deep within or close to escaping). Additional scans like a PET scan might give you a better picture of your tumor location. Were you a 3+4 or a 4+3, the higher number being more aggressive and the first number indicating the majority of the cancer cells, the second is the minority number of cells in your biopsy sample. Both are great treatments with the surgery removing all of the Prostate and the radiation only hitting the cancer cells. With radiation you will have a psa reading for a long time since you will still have some of your live Prostate still intact. Both treatments will have side effects but the amount or severity is dependent on doctor skills and equipment so pick the best doctors and facilities that you can.

Proton radiation is another radiation form that does not go completely through you body hitting other tissues or organs. It has a fixed measurable beam length where as Cyberknife will pass through your body so they will probably use a gel to protect your Rectum. I had surgery with minimal side effects, others on this site have had less or more side effects than me, there is no guarantee with surgery or radiation in its various forms so choose wisely. Here is a link to get you some basic info……….

https://www.cancer.org/cancer/prostate-cancer/treating.html

Dave 3+4

richmaniaci · August 2022

https://csn.cancer.org/discussion/comment/1699386#Comment_1699386

Thank you, that was helpful😊

richmaniaci · August 2022

https://csn.cancer.org/discussion/comment/1699379#Comment_1699379

Thank you, that was helpful info. My surgeon at MSK says that I am a candidate for surgery even though I am 72 so as you said I'm considering the risk/benefit of each

VascodaGama · August 2022

Hi Richman,

I agree with the comments of above survivors. Treatments for PCa deteriorate the quality of life of the patient to certain extent so that one must choose wisely. Surgery is more prone to incontinence and ED, and Radiation to colon issues. Both are proper to eliminate the bandit if the case is contained. However in low risk cases active surveillance (AS) may be a better choice for a 73 years old.

Memorial Sloan Kettering is one of the best places to be treated. I would think that the doctors you consulted have followed the due procedures in the diagnosis.

Here is a link to one survivor story who has chosen the Cyberknife route;

https://csn.cancer.org/profile/discussions/Swingshiftworker

Best wishes and luck in this journey.

VGama

richmaniaci · August 2022

https://csn.cancer.org/discussion/comment/1699407#Comment_1699407

Thank you very much for reaching out, I really appreciate it

centralPA · August 2022

Rich, if I were to choose radiation therapy, I would choose one of the new gizmos that continuously does an MRI while adjusting the beam to track. The trick with radiation is to zap the bad stuff while minimizing incidental radiation to the rest of the stuff. Almost all improvements in radiation are improvements in targeting.

Google on the MRIdian system. It does this.

lighterwood67 · August 2022

You probably already know this. But here you go. Good luck on your journey. I had RP in 2018; 67 years old at the time; PSA undetectable; fully continent; intimate with wife, if I can catch her (she is awfully fast).

What is CyberKnife?

CyberKnife is a brand name for a device that delivers stereotactic body radiation therapy (SBRT). It’s a form of external beam radiation. It can be used to treat prostate cancer and other types of cancer. Although it contains the word “knife” and is sometimes referred to as “radiosurgery,” there’s no knife or incision.

SBRT is an image-guided technique of delivering high doses of radiation with extreme accuracy. The purpose is to kill cancer cells while limiting damage to healthy tissues and organs.

The CyberKnife system has continual image guidance software that works in real time to adjust to your breathing cycle and tumor movement. SBRT allows for large doses in a specified area, so you can complete your treatment in a few days. By comparison, conventional radiation therapy takes as long as eight or nine weeks to complete.

Continue reading to more about what to expect from treatment with CyberKnife.

Who is a candidate for CyberKnife?

CyberKnife can be used as a first-line treatment for early-stage prostate cancer. It can be combined with hormone therapy for cancer that has spread into nearby tissues. It can also be used to slow progression in advanced cancer or cancer that has recurred after previous treatment.

CyberKnife vs. traditional treatments

Prostate cancer treatment is not the same for everyone. Surgery, radiation therapy, chemotherapy, and hormone therapy are designed to do different things.

There are a few benefits of CyberKnife when compared to other treatments:

There’s no incision or pain, as you might have from surgery.
There’s no need for anesthesia or a hospital stay.
As soon as it’s over, you can get up and return to your normal activities.
It’s a lot less time-consuming than conventional radiation or chemotherapy.
There’s no extended recovery period.

Another type of radiation used for prostate surgery is brachytherapy. It involves implanting radioactive pellets in your prostate. The pellets release radiation over a period of days or weeks. It’s a good option for early-stage or low-grade prostate cancer. CyberKnife may be a better choice if you can’t have anesthesia or if your anatomy makes brachytherapy difficult.

If you have treatment with CyberKnife, you may need other therapies as well. Your doctor will make a recommendation based on variables such as the stage and grade of the cancer, as well as your age and any other health conditions you may have.

How do you prepare for CyberKnife?

You’ll need to go through a few steps before treatment can begin.

With ultrasound as a guide, a urologist will use long needles to place gold markers in your prostate. This will be similar to when you had your biopsy. CyberKnife will use the markers to track the tumor during treatment.

Then you’ll need some imaging tests to assess the location, size, and shape of the tumor. This data is sent to the CyberKnife software, so the proper dose, exact location, and number of treatments can be determined.

Your doctor will fill you in on details before you begin so you can plan accordingly.

You’ll likely need one to five treatments on consecutive days. This can all be accomplished on an outpatient basis.

There’s no need for anesthesia or other medications, so you can eat and take medications as usual. Avoid lotions and powders on the area to be treated, and wear comfortable clothing. No further preparation is needed.

What happens during the procedure?

You’ll be placed in the proper position on a table. Then, a computer-controlled robot will move slowly around the table, targeting radiation where it’s needed. The software will adjust radiation for your breathing pattern and any movement of the tumor.

This is a noninvasive, painless procedure. Each session will last anywhere from 30 to 90 minutes. Once it’s over, you should be able to get up and resume your normal activities right away.

What are the side effects?

Side effects of SBRT are similar to those of other types of radiation treatment for prostate cancer, such as:

urinary problems
rectal irritation
erectile dysfunction
fatigue

These side effects are usually temporary.

What happens after treatment?

Treatment with CyberKnife generally doesn’t interfere with normal activities.

Your doctor will advise you on a follow-up schedule of visits. A few months after treatment, you’ll probably need to schedule new imaging tests, such as CT, MRI, or PET. The images will help your doctor evaluate your response to radiation treatment.

If no cancer can be found, you may not need further treatment. You’ll need careful monitoring for some time, though. That usually involves routine physical exams, PSA testing, and imaging tests to check for signs of recurrence.

If there’s still evidence of cancer after SBRT, your doctor will make some recommendations on the next steps.

Takeaway

SBRT is generally considered safe and effective, though not without side effects. It’s less time-consuming than some other types of radiation therapy. CyberKnife may not be available at all treatment centers. Ask your doctor if SBRT with CyberKnife is a good choice for you.

richmaniaci · August 2022

Thank you lighterwood 67, it's good to know that my quality of life might not be as bad as I anticipate. Waiting on a PET scan and then will make a decision on treatment. The personal experience you shared, and info provided are very helpful

centralPA · August 2022

Rich, you didn't mention brachytherapy as an option. If I was a candidate (I'm not due to having had a HoLEP procedure) it would be my first choice. You should at a minimum consider it.

This picture from the book by Dr. Scholz summarizes why you should consider it. Cheaper and better in general. Doesn't make as much money for the hospitals.

richmaniaci · August 2022

Thank you Centralpa, appreciate the advice, I did discuss that option with the radiation oncologist at MSK, his suggestion was that CyberKnife would be a better option for me, seeding and cryotherapy would be options if there were to be a recurrence