Choosing Cyberkife, awaiting insurance OK

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Jackie

As one who had CyberKnife at 59 I certainly don't feel this treatment is too aggressive. You don't mention what your Gleason scores are and it would be useful if you let us know what they are. CyberKnife is generally optimized for patients with low risk prostate cancer although many men have had it with Gleason scores in the 7s or even higher.

CyberKnife is not an aggressive treatment. It consists of four or five sessions depending upon the protocol your radiologist chooses to use. I recommend having treatment every other day instead of on consecutive days as early trials indicate that there is less urinary issues.

At 59 I was diagnosed with a PSA of 4.2 and 1 of 12 cores positive with 15% involvement. No abnormal DRE and no history of prostate cancer. Stage T1c. I researched surgery, proton therapy, IMRT, cyrotherapy, and active surveillance and ended up with CK as my first choice.

I had my treatment in June 2010 and had no side effects whatsoever. I did feel a bit of urinary urgency after the final treatment but I took some Advil to reduce swelling and had no more problems. Erectile function was never an issue.

The minor side effects you refer to involve urinary and bowel toxicity. If experienced, these usually pass within a few weeks. The doctor can prescribe Flomax which you can use if you begin to experience an urge to urinate more frequently.

Each of my sessions, taken every other day, lasted about 45 minutes. You just lay on a bed, listen to your iPod music, and keep your lower body still. (They will build a foam cast for you to lie in to stabilize the lower body)

After each session I returned to work and never experienced any fatigue or any other ill effects.

There are several CyberKnife threads if you scan back through the pages in this forum that I recommend you read.

Good luck to you.

K

p.s. I also recommend that you have the fiducials implanted via the perineum instead of using the trans rectal method. Less chance of an infection and less painful.

hopeful and optimistic said:

With all respect, a question
I thought that cyberknife was precise, and only for gleason 6. I know that you know a lot more about this than I do, can you please provide documentation or a source that I can access to show where cyberknife is used for a gleason 7.

Thanks

CyberKnife
Ira,

CyberKnife for prostate cancer is now being used in a variety of situations. For example, one ongoing clinical trial I know about (http://clinicaltrials.gov/ct2/show/NCT00643617) indicates the following for inclusion criteria:

Inclusion Criteria:

Patient must be at least 18 years of age
Histologically proven prostate adenocarcinoma
Biopsy within 1 year of date of registration
Clinical Stage T1b-T2b, N0, M0
Patients belonging to one of the following risk categories:
Low Risk: CS T1b-T2a, Gleason Score 2-6, PSA < or = 10 ng/ml
Intermediate Risk: CS T2b, Gleason Score 2-6, PSA < or = 10 ng/ml or CS T1b-T2b, Gleason Score 2-6, PSA < or = 20 ng/ml or CS T1b-T2b, Gleason Score 7 and PSA < or = 10 ng/ml
ECOG performance status 0-1

Exclusion Criteria:

Clinical Stage T2c or greater
Prior prostatectomy or cryotherapy of the prostate
Prior radiotherapy fo the prostate or lower pelvis
Implanted hardware or other material that would prohibit appropriate treatment planning or delivery
History of an invasive malignancy other than basal or squamous skin cancers in the last 5 years
Hormone ablation for two months prior to enrollment or during treatment

Another ongoing study also includes Gleason 7 patients: http://clinicaltrials.gov/ct2/show/NCT00643994?spons="Accuray+Incorporated"&amp;spons_ex=Y&amp;rank=4

Georgetown University is one of several medical centers now using CyberKnife for advanced prostate cancer treatment. See http://www.georgetownuniversityhospital.org/body.cfm?id=555884

My radiologist has recently told me that CyberKnife is becoming fairly routine for men with both low rip and intermediate prostate cancers. Many of the trials have limits on Gleason score (usually less than or equal to 7) and PSA limits of 10 but I was told that most men who are treated are not part of a clinical trial.

K

p.s. One interesting thing about clinical trials. Most state laws stipulate that if you are accepted for a clinical trial in the treatment of cancer, insurance companies must provide coverage.

http://www.cancer.gov/clinicaltrials/payingfor/laws#Anchor-Overvie-48605

You Made The Best Choice!
IMHO, you made the best choice for the treatment of low risk PCa. It is, as you have said, really a "no brainer." CK is the most precise method of treating CK currently available and is definitely not TOO aggressive, given its effectiveness and the lower risk of significant side effects associated w/its use.

I had CK in Sept 2010 at UCSF (but made the decision to go w/CK in April 2010 only 3 months after I was diagnosed w/PCa). Had to wait until July 2010 in order to switch from Kaiser to Blue Shield on order to get CK and then had to wait 3 months to get a place in the machine.

No urinary or bladder irritation and no ED. The reason my PCa was discovered in the first place because of my complaints about of urinary frequency which I thought were just due to BPH (an enlarged prostate). The frequency was not increased or decreased by the treatment and I still have to pee with some frequency. So, there's really been no change in that regard.

The only noticeable effect of the treatment has been reduced ejaculate volume, which is to be expected with all forms of radiation treatment. Still have some but very little ejaculate. Don't know if there's still any fertile sperm in it, but the limited ejaculate makes impregnating anyone extremely unlikely. So, if you want to have an more kids of your own, you should bank your sperm before treatment.

I was rated at Stage T1c and Gleason 6 (3+3). Only 1 core (less of 0.6 mm involved). My PSA was only at 4.5 before the biopsy in Jan 2010, spiked to 29.7 after the biopsy and fell to 5.9 in June 2010 before the treatment. Didn't take (but should have taken) another PSA test just before the treatment to get a more accurate baseline. My PSA has continued to vacillate following treatment from a high of 12.30 in Dec 2010 to a low of 3.03 in Mar 2011 then back to 5.07 in June 2011 then back down to 3.56 in Sept 2011. Needless to say the variability and relatively high continuing level of my PSA scores is disconcerting.

There are studies that indicate that a reassessment to determine if the treatment has failed is mandated if the PSA level does not drop to between 1-1.5 two years following treatment. That'll be in Sept 2012 for me and, if my PSA level does not drop to that level by then, I'll be asking for an endorectal MRI and a MRSI (magnetic resonance spectroscopic imaging screening to determine the then current status (and location, if any) of the PCa.

Others, like Kongo, have had much better success w/their PSA testing and have achieved PSA scores below 1 within 3-6 months following treatment. Hopefully, you'll have the same experience as they have but don't be surprised if you don't.

Good luck!

jackiegleasonscores said:

Thanks K and SS
Thanks everyone. Left out my gleason scores which were no higher than 6.
SwingShift, I too notice ejaculate down by I'd say two thirds since biopsy. Could biopsy 5 weeks ago had that much effect? Still light blood in ejaculate but was told to expect that. Also seem to be experiencing what I can only describe as strains around the penis base area. Am I imagining this? All this after only a biopsy?

Active Surveilance for delayed treatment
Based on your biopsy results, I would consider active surveillance as a treatment option. It may be that you have an indolent cancer, that is not likely to spread, so an ative treatment may not be necessary. I suggest that you see a doctor that specializes in this treatment option, preferably at a major center of excellence. I have been doing this for since, 3/09. You may click my name to see what I have done.
As far as PSA which is an indicator only, I wonder if you have any other data points that you can provide?

Also I wonder what the size of your prostate is? There is ratio psa/prostate size the lower the better.....0.15 or better.

I also suggest that you have an endorectal MRI (combined with a spectroscopy) to see if there is extra capular extension, stage your cancer, see if there is an indication of cancer in one lobe or two and how much cancer.

Did you have a second opinion from an independent expert pathologist on your biopsy slides...........this is of the upmost importance....it is CRITICAL.

hopeful and optimistic said:

Thanks for the detailed response
I can understand treatment for low volume gleason 7 cancer, and have come across a clinical study ; however, I didn't notice information showing results for greated volume gleason 7 cancers. It's very possible that I am missing something?

good questions
Ira,

You pose some very good questions about CK (aka SBRT) and similar questions have come up before in another thread. If you haven’t already seen it, the following info in previous posts may be helpful in regard to SBRT/CK tx for low to intermediate risk PCa, especially disease that is "believed or suspected" to be prostate/organ confined with no ECE (extra capsular extension):
http://csn.cancer.org/node/224205#comment-1117606
http://csn.cancer.org/node/224205#comment-1118071

Best,

mrs pjd

Swingshiftworker said:

You Made The Best Choice!
IMHO, you made the best choice for the treatment of low risk PCa. It is, as you have said, really a "no brainer." CK is the most precise method of treating CK currently available and is definitely not TOO aggressive, given its effectiveness and the lower risk of significant side effects associated w/its use.

I had CK in Sept 2010 at UCSF (but made the decision to go w/CK in April 2010 only 3 months after I was diagnosed w/PCa). Had to wait until July 2010 in order to switch from Kaiser to Blue Shield on order to get CK and then had to wait 3 months to get a place in the machine.

No urinary or bladder irritation and no ED. The reason my PCa was discovered in the first place because of my complaints about of urinary frequency which I thought were just due to BPH (an enlarged prostate). The frequency was not increased or decreased by the treatment and I still have to pee with some frequency. So, there's really been no change in that regard.

The only noticeable effect of the treatment has been reduced ejaculate volume, which is to be expected with all forms of radiation treatment. Still have some but very little ejaculate. Don't know if there's still any fertile sperm in it, but the limited ejaculate makes impregnating anyone extremely unlikely. So, if you want to have an more kids of your own, you should bank your sperm before treatment.

I was rated at Stage T1c and Gleason 6 (3+3). Only 1 core (less of 0.6 mm involved). My PSA was only at 4.5 before the biopsy in Jan 2010, spiked to 29.7 after the biopsy and fell to 5.9 in June 2010 before the treatment. Didn't take (but should have taken) another PSA test just before the treatment to get a more accurate baseline. My PSA has continued to vacillate following treatment from a high of 12.30 in Dec 2010 to a low of 3.03 in Mar 2011 then back to 5.07 in June 2011 then back down to 3.56 in Sept 2011. Needless to say the variability and relatively high continuing level of my PSA scores is disconcerting.

There are studies that indicate that a reassessment to determine if the treatment has failed is mandated if the PSA level does not drop to between 1-1.5 two years following treatment. That'll be in Sept 2012 for me and, if my PSA level does not drop to that level by then, I'll be asking for an endorectal MRI and a MRSI (magnetic resonance spectroscopic imaging screening to determine the then current status (and location, if any) of the PCa.

Others, like Kongo, have had much better success w/their PSA testing and have achieved PSA scores below 1 within 3-6 months following treatment. Hopefully, you'll have the same experience as they have but don't be surprised if you don't.

Good luck!

The World of Choices
Hello jackie:

Given your low risk staging, you have the world of choices at your disposal. I assume you checked out PBT, IMRT and Brachytherapy also. CK is documented as a solid choice for true low risk patients. Impressive cure rate stats with relatively low side effects.

Good luck!

hopeful and optimistic said:

focal therapy for very low level prostate cancer
I wonder what others think of this procedure, and how it compares to active surveillance and other treatments including cyberknife for very low level disease.

Here is one study that was done, this are various clinical studies and some do this procedure.

http://www.ncbi.nlm.nih.gov/pubmed/21675840

I tend to think that as image for prostate improves and biopsies become more sophisticated, this technique will more often be used as a treatment.

What is Focal Therapy?
According to the abstract: "Focal therapy (FT) is another organ-preserving strategy applying energy (cryotherapy, laser ablation and/or high-intensity focused ultrasound) to destroy tumors while leaving the majority of the organ, surrounding tissue and structures unscathed and functional."

So, it's not one particular type of treatment but one of a number which apparently are used to focus only on the tumor thereby leaving the remainder of the prostate intact. Not sure how they can do this because I don't think they can pinpoint the location of the cancer that precisely.

I don't know what laser ablation is and don't don't know how effective it is, but I assume that it's a method of applying heat in the form of of a laser beam at a particular location in the prostate. I assume that the laser beam can be very precisely focused, but how well the tumor and any rivulets can be identified is the question.

I've heard a lot about Cryotherapy and all of it has been bad -- resulting in the greatest likelihood of collateral tissue damage leading to ED and incontinence. So, that would be a no-go for me regardless of the ability to locate and focus on the tumor.

On the other hand, a lot of people are turning to HiFu for PCa treatment with reported success. However, I believe that the HiFu specialists are applying it to the entire prostate (as is done w/CK) but again I don't know how you can properly identify the source of the cancer w/sufficient precision in order to negate any doubt about whether "all" of the cancer w/in the prostate has been treated. As it was explained to me, that's why ALL of my prostate was treated w/CK.

An endorectal MRI and MRSI can be used to identify the locus of PCa with some precision if the mass is of sufficient size, but it cannot find it all -- particularly the rivulets of cancer extending (if any) extending from the mass. So, I really question whether focal therapy is really a suitable adjunct to Active Surveillance in lieu of full (rather tha focal) treatment of the prostate w/CK, HiFu or other less damaging treatment methods.

Swingshiftworker said:

What is Focal Therapy?
According to the abstract: "Focal therapy (FT) is another organ-preserving strategy applying energy (cryotherapy, laser ablation and/or high-intensity focused ultrasound) to destroy tumors while leaving the majority of the organ, surrounding tissue and structures unscathed and functional."

So, it's not one particular type of treatment but one of a number which apparently are used to focus only on the tumor thereby leaving the remainder of the prostate intact. Not sure how they can do this because I don't think they can pinpoint the location of the cancer that precisely.

I don't know what laser ablation is and don't don't know how effective it is, but I assume that it's a method of applying heat in the form of of a laser beam at a particular location in the prostate. I assume that the laser beam can be very precisely focused, but how well the tumor and any rivulets can be identified is the question.

I've heard a lot about Cryotherapy and all of it has been bad -- resulting in the greatest likelihood of collateral tissue damage leading to ED and incontinence. So, that would be a no-go for me regardless of the ability to locate and focus on the tumor.

On the other hand, a lot of people are turning to HiFu for PCa treatment with reported success. However, I believe that the HiFu specialists are applying it to the entire prostate (as is done w/CK) but again I don't know how you can properly identify the source of the cancer w/sufficient precision in order to negate any doubt about whether "all" of the cancer w/in the prostate has been treated. As it was explained to me, that's why ALL of my prostate was treated w/CK.

An endorectal MRI and MRSI can be used to identify the locus of PCa with some precision if the mass is of sufficient size, but it cannot find it all -- particularly the rivulets of cancer extending (if any) extending from the mass. So, I really question whether focal therapy is really a suitable adjunct to Active Surveillance in lieu of full (rather tha focal) treatment of the prostate w/CK, HiFu or other less damaging treatment methods.

focal therapy laser
I agree that there can be cancerous cells in other parts of the prostate that are not identified, that can grow.

Also there are men who have focal, and that is all that is required.

I don't know what the likelyhood is of each of the above two events.

I don't know if laser can be redone, or which other treatment can be done if the cancer progresses from the other parts of the prostate.

It seems appropriate for a man to be closely monitored if he has has had focal therapy.

In my opinion as technolgy improves, this will be a preferred treatment since it is less invasive

Swingshiftworker said:

What is Focal Therapy?
According to the abstract: "Focal therapy (FT) is another organ-preserving strategy applying energy (cryotherapy, laser ablation and/or high-intensity focused ultrasound) to destroy tumors while leaving the majority of the organ, surrounding tissue and structures unscathed and functional."

So, it's not one particular type of treatment but one of a number which apparently are used to focus only on the tumor thereby leaving the remainder of the prostate intact. Not sure how they can do this because I don't think they can pinpoint the location of the cancer that precisely.

I don't know what laser ablation is and don't don't know how effective it is, but I assume that it's a method of applying heat in the form of of a laser beam at a particular location in the prostate. I assume that the laser beam can be very precisely focused, but how well the tumor and any rivulets can be identified is the question.

I've heard a lot about Cryotherapy and all of it has been bad -- resulting in the greatest likelihood of collateral tissue damage leading to ED and incontinence. So, that would be a no-go for me regardless of the ability to locate and focus on the tumor.

On the other hand, a lot of people are turning to HiFu for PCa treatment with reported success. However, I believe that the HiFu specialists are applying it to the entire prostate (as is done w/CK) but again I don't know how you can properly identify the source of the cancer w/sufficient precision in order to negate any doubt about whether "all" of the cancer w/in the prostate has been treated. As it was explained to me, that's why ALL of my prostate was treated w/CK.

An endorectal MRI and MRSI can be used to identify the locus of PCa with some precision if the mass is of sufficient size, but it cannot find it all -- particularly the rivulets of cancer extending (if any) extending from the mass. So, I really question whether focal therapy is really a suitable adjunct to Active Surveillance in lieu of full (rather tha focal) treatment of the prostate w/CK, HiFu or other less damaging treatment methods.

.

.

Swingshiftworker said:

What is Focal Therapy?
According to the abstract: "Focal therapy (FT) is another organ-preserving strategy applying energy (cryotherapy, laser ablation and/or high-intensity focused ultrasound) to destroy tumors while leaving the majority of the organ, surrounding tissue and structures unscathed and functional."

So, it's not one particular type of treatment but one of a number which apparently are used to focus only on the tumor thereby leaving the remainder of the prostate intact. Not sure how they can do this because I don't think they can pinpoint the location of the cancer that precisely.

I don't know what laser ablation is and don't don't know how effective it is, but I assume that it's a method of applying heat in the form of of a laser beam at a particular location in the prostate. I assume that the laser beam can be very precisely focused, but how well the tumor and any rivulets can be identified is the question.

I've heard a lot about Cryotherapy and all of it has been bad -- resulting in the greatest likelihood of collateral tissue damage leading to ED and incontinence. So, that would be a no-go for me regardless of the ability to locate and focus on the tumor.

On the other hand, a lot of people are turning to HiFu for PCa treatment with reported success. However, I believe that the HiFu specialists are applying it to the entire prostate (as is done w/CK) but again I don't know how you can properly identify the source of the cancer w/sufficient precision in order to negate any doubt about whether "all" of the cancer w/in the prostate has been treated. As it was explained to me, that's why ALL of my prostate was treated w/CK.

An endorectal MRI and MRSI can be used to identify the locus of PCa with some precision if the mass is of sufficient size, but it cannot find it all -- particularly the rivulets of cancer extending (if any) extending from the mass. So, I really question whether focal therapy is really a suitable adjunct to Active Surveillance in lieu of full (rather tha focal) treatment of the prostate w/CK, HiFu or other less damaging treatment methods.

.
.