Recently diagnosed with prostate cancer.

S103462 said:

Thanks for all the information.

That article mentions “…the need for accuracy when delivering very high daily doses using SBRT is essential.” The radiology oncologist (RO) I saw yesterday indicated that the 5 CK treatments are very high radiation dosages and that if anything goes wrong at those high levels, it goes very, very wrong; and that the 39 treatments of IMRT was not as high dose (but, many more treatments). He also said that both IMRT and CK track for prostate motion and adjust for it. (Again, I was prompting him about all possible scenarios. Maybe too much information is not necessarily better?)

Anyway, great reading material about CK. It’ll give me a few more questions to ask the CK doctor when I see him next.

The various blogs I’ve read related to prostate cancer as well as comments from my urologist and the RO mention that once treatment (whatever type) is done, that my outlook is good – perhaps 15+ years. That doesn’t sound very good – since I’m 56 right now – I was hoping for way more than 71 years old. (But, we’re only promised three-score and 10, right?) Is that simply them being conservative, is that all the data supports, or is that really all this buys me?

Again, thanks.

CK Is VERY Precise
You're welcome for the info on CK.

CK is based on a high series of dosages and designed to emulate the delivery of radiation via HDR BT (high does rate brachytherapy)

http://www.cyberknife.com/uploadedFiles/For_Your_Doctor/500345 B HDR Whitepaper.pdf

and the precision needed to properly control the delivery is built into the technology.

CK is, in fact, currently offers the MOST precise method of delivering radiation to the treatment site. SUB millimeter accuracy is claimed -- which beats any other method of treatment out there -- and the technology is also able to adjust for both body and ORGAN movement during treatment (which minimizes the possibility of collateral tissue damage to the bladder, rectum and urethra which can result in ED, incontinence and other problems). This level of precision is simply unavailable with any other method of radiation treatment currently out there, including BT (LDR or HDR), IMRT, IGRT or 3DCRT.

When I received my CK treatments, they actually paused the radiation delivery one day because they could "see" a gas bubble moving through my colon which was causing the prostate to move. You really can't get any more precise than that!!!

I have had NO side effects whatsoever following treatment -- NO ED and NO incontinence, nor any other problems (such as rectal bleeding) commonly reported following other radiation treatments. Others here have reported the same good results and even been post-PSA results than I have.

Of course, I'm biased but I think you can rest assured in the precision of radiation delivery offered by CK.

As for the long term expectations for treatment, there haven't been many studies beyond 10-15 years for anything, except perhaps surgery. Things are changing rapidly in the treatment of cancer and you really can't wait until the "long term" data is in. All you can do is make the best assessment of the currently available technologies and decide which offers you to best chance of a cure NOW (not later) because you have PCa NOW.

I chose CK because the 5 year data (and anecdotal information) available convinced me that it offered me as good a chance of surviving the cancer as any other method of treatment currently available (including surgery) without the significant risk of ED and incontinence that commonly accompanies surgery and the possible risk of ED, incontinence and collateral tissue damage also associated w/LDR BT (low dose rate brachytherapy). Surgery and LDR BT were the only other choices available to me at the time.

I chose CK because it offered me that same probability of a "cure" while also offering me the greatest probability of maintaining my quality of life. So far, that choice has proven to be the right one for me.

I hope it works out as well for you!

S103462 said:

Thanks for all the information.

That article mentions “…the need for accuracy when delivering very high daily doses using SBRT is essential.” The radiology oncologist (RO) I saw yesterday indicated that the 5 CK treatments are very high radiation dosages and that if anything goes wrong at those high levels, it goes very, very wrong; and that the 39 treatments of IMRT was not as high dose (but, many more treatments). He also said that both IMRT and CK track for prostate motion and adjust for it. (Again, I was prompting him about all possible scenarios. Maybe too much information is not necessarily better?)

Anyway, great reading material about CK. It’ll give me a few more questions to ask the CK doctor when I see him next.

The various blogs I’ve read related to prostate cancer as well as comments from my urologist and the RO mention that once treatment (whatever type) is done, that my outlook is good – perhaps 15+ years. That doesn’t sound very good – since I’m 56 right now – I was hoping for way more than 71 years old. (But, we’re only promised three-score and 10, right?) Is that simply them being conservative, is that all the data supports, or is that really all this buys me?

Again, thanks.

Kudos
S1,

Welcome to the PCa forum. I admire the independent research you’re doing and the knowledge and level of questions you bring to this forum so soon after your PCa diagnosis. You seem to have a good understanding of the many complex issues surrounding PCa. Kudos to you for that.

There is published data to support the information that your radiation oncologist (RO) gave you on June 6th re CK (CyberKnife is the manufacturer’s name for one brand of SBRT delivery technology). Last year, the respected American Society for Radiation Oncology (ASTRO) released a summary paper titled “Quality and Safety Considerations in Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation (SBRT) Therapy.” The document was commissioned by ASTRO and approved by their Board of Directors to address patient safety. ASTRO’s executive summary paper states: “Given that very high-dose fractions of radiation are delivered, the margin of error for SRS and SBRT is significantly smaller than that of conventional radiotherapy and therefore special attention and diligence is required. A small error in target localization for any 1 fraction risks under treatment of portions of the tumor by 20% or more, and inadvertent over dosage of adjacent normal tissues could escalate the risk of serious injury to a much greater degree than an equivalent treatment error in a course of radiotherapy where a substantially lower dose per fraction is used [IG/IMRT].” Of course, as with any cancer treatment, the skill & expertise of the treating medical doctor/team are critical. I’ve previously posted about this. If you’d like more info, please LMK.

I don’t know if there is any study data to indicate that PCa in African-American populations is or should be TREATED more aggressively (or differently) than in Caucasian populations—tx decisions are personal and largely dependent on the patient and cancer risk level and clinical Tumor staging. However, according to data from the CDC and Johns Hopkins: “African American men are both more likely to be diagnosed with prostate cancer and to die from prostate cancer than are white men, although the reasons for this are not clear. African-American men have considerably higher incidence rates (234.6 cases per 100,000 African-American men in 2003-2007) than white men (150.4 cases per 100,000 white men in 2003-2007). In the period from 2003 to 2007, mortality rates were 22.8 cases per 100,000 white men, and 54.2 cases per 100,000 African-American men. Some studies found that even when income and education are controlled for, African-Americans have much higher rates than whites. Further studies are examining the impact of a wide variety of potential risk factors, including dietary and other lifestyle differences, occupational exposures, and hormonal and genetic differences.” IMHO, you are wise to be taking a very proactive approach to learning as much as possible about your dx.

Although you indicated there is no history of PCa in your family, you mentioned a history of uterine and ovarian cancer for female family members. Prostate, breast & ovarian cancers are all hormone sensitive cancers. I do not wish to alarm you, but it’s important for you to know that a recent study from the UK indicated that men who carry the mutated BRCA1 gene have a four times greater chance of developing prostate cancer than other males. The mutated BRCA1 is found in people with a family history of not only breast cancer, but ovarian cancer as well. MEN with the mutated BRCA1 gene are also more susceptible to the very aggressive form of prostate cancer. Only genetic testing followed by genetic counseling can determine if you or other family members are carriers of this gene. I am not a medical doctor, so please check with a knowledgeable PCa oncologist about this. Also, as others have stated, I strongly recommend that you obtain a 2nd opinion analysis of your biopsy core samples from a pathology lab that specializes in reviewing PCa specimens, such as Johns-Hopkins, prior to making any tx decisions. The info in the 2nd opinion path lab report will assist you in better evaluating your tx options and may even be helpful in determining if add’l diagnostic testing may be indicated. It did for my husband.

With your early dx, I believe your chances for a successful treatment outcome are excellent. I have no doubt that your continuing research, thoughtful questions and multiple medical specialty consults will lead you to a tx decision that will be right for you. Good luck and best wishes to you and your wife.

mrs pjd
wife of a T3 PCa Survivor

S103462 said:

Spent time yesterday speaking with the doctor at the local CyberKnife (CK) facility. Talked at length about my diagnosis, treatment, the CK process, outcomes, side-effects, short- and long-term expectations, his experience, and results that they've seen. We talked about my concerns, how I heard about CK, why I was considering it -- a real thorough discussion from all angles.

He did recommend that I get a 2nd opinion of the biopsy pathology, and recommended Johns Hopkins, and recommended the same name (Epstein) that you and others have mentioned.

He did let me know that my insurance carrier (Anthem) would not cover the CK treatment -- that they would cover everything else -- scans, MRI, whatever -- all the way up to and after the CK treatment, but not the CK itself. He indicated that the cost of the CK would be somewhere between $8K - $10K. My wife says to not let that impact the decision -- if it will provide the outcome that I'm looking for, then go for it. We'll see.

Only $10K for CK?
If they are actually offering CK treatment for only $10K, that's an incredible deal!!!

Are you sure that for all 4-5 treatments or just 1? Reason I ask is that I was quoted $70k for insurance billed and $60K for self-pay for 4 CK treatments) by UCSF where I received CK. Fortunately, Blue Shield covered it and I didn't have to pay anything.

If you're only talking $10K, I agree w/your wife that you should not let the cost affect your decision about whether to go w/CK or not. However, if it's closer to what I was quoted, you'll obviously have to take your finances into account.

Let us know what you finally decide. Good luck!