Cyberknife?

Swingshiftworker said:

Yes, I'd Do It Again
I chose CyberKnife (CK) because it provided the greatest possibility of a cure with the least risk of all of the treatment options known and available to me, including surgery, brachytherapy BT) and proton beam therapy (PBT).

Surgery and BT were what was offered to me at Kaiser where I was a member. After I found out about all of the risks and possible side effects of surgery, I swore that NO ONE would ever cut my prostate out unless my life depended on it and no other treatment option was available. Apart from surgery, Kaiser has also made a major investment in low dose rate BT. I went to their NorCal treatment center in Roseville and was screened and cleared for it but, after I did research on BT, I decided that it wasn't for me for 3 main reasons: 1) radioactive seeds placed PERMANENTLY in my body, 2) the lack of precision involved in the placement and potential movement of the seeds and 3) the risk of collateral tissue damage (mainly to the urethra) associated w/Reason #2.

So, I looked for other options and found CK and PBT. PBT required over 40 daily treatments over a month which required living in SoCal and requires the placement of a water filled balloon in your rectum during each treatment and the creation of a body cast that you have to lie still in during treatment. CK required only 4 treatments over a week and no balloon or body cast because CK can monitor and adjust for body and organ movement. CK was also paid for by Blue Shield (which I switched to from Kaiser) while PBT was not.

This led me to choose CK. There was enough data out there -- 5 years worth -- for me to feel comfortable that CK works. IMHO, LONG term data is over-rated because if you wait long enough to collect LONG term data, the technology has already changed so much that the data is almost irrelevant.

Although my PSA scores have not dropped as much as I'd like, my prognosis is still positive and a cure is likely. However, even if the treatment fails, CK has done no harm -- I have no ED, no incontinence and no collateral tissue damage -- and I can still get follow-up treatment if needed. So, I have absolutely no regrets!

Swingshiftworker said:

Follow Up Treatment?
I've discussed my concerns regarding the possibility of CK failure and PCa reoccurence in detail by email w/my radiation oncologist (RO).

Based on the study that I mentioned in my tread: Post CK Update - Measures of Reoccurence, my RO grudingly agreed that a reassessment 2 years following treatment may be warranted if my PSA level does not drop to around 1.5 within in that time period.

My PSA is still over 3 a year following treatment and I'm just hoping it will drop to around 1.5 w/in the next 12 months. If it doesn't, my RO and I will probably have to argue about what method of diagnosis, if any, to use to determine if there has been a failure/reoccurence. I'd lean towards using a E-MRI and maybe (despite the risks and lack of reliability) another biopsy to do this.

BTW, my RO also gave me a study indicating that re-biopsies prior to 2 years following treatment are not recommended because of a lack of reliability in the results w/in that time period.

As for the methods of follow up treatment, my RO has already suggested LDR BT but I would be opposed to that. I suggested another CK treatment, as a possibility, and he did not immediately reject that idea but, if not that, I'd lean towards HDR BT because no seeds are permanently implanted in the prostate and because of an apparently lower risk of collateral tissue damage leading ED, incontinence and other problems.

HIFU is another possibility but the jury is still out on that method and I'd have to pay for it myself, so I doubt that I'd go that route.