CyberKnife as Treatment

Swingshiftworker said:

Invasive Procedure?
Why do you call CyberKnife (CK) an "invasive" radiation procedure? My understanding is that brachytherapy is the only invasive radiation reatment for prostate cancer because they have to "invade" your body by placing seeds in the prostate. CK involves no "penetration" of the body. So, I don't understand why you'd call it "invasive." Please explain.

FWIW, CyberKnife, Proton Beam and Brachytherapy are on my short list of potentially acceptable treatments and I'm still doing research on each of them. They offer CK at the University of California San Francisco Medical Center and I have an appointment with the Director of Radiation Oncology (who does all of the CK treatments at UCSF) next month to discuss the treatment. I spoke by phone with a resident physician familiar with the use of CK and (of course) he says that it is as good as proton beam therapy (PBT) in terms of effectiveness and minimization of side effects (particularly impotence and incontinence) because of the precision -- in terms of location and dosage -- available in applying the radiation.

The risks associated w/the higher radiation dosage used in CK (which makes fewer treatments necessary) are offset by the precision of the technology but(like surgery) the precision is only as good as the person planning and administering the treatment. Also, since it's still a relatively new procedure, there isn't much data on in the use of CK to know if it really is "as good as" PBT (which now has a well-established track record). On the other hand, the limited number of PBT treatment sites and the much longer treatment period (2 months) and the number of treatments required (typically 40), which requires moving to the treatment site until treatment is completed, make PBT less convenient than CK as a form of treatment. However, effectiveness trumps convenience and, if I can't find enough information to assure me of the effectiveness and safety of the procedure, I may still opt for PBT (or Brachytherapy) when the time to make a choice arrives.

Swingshiftworker said:

Surgery is worse
Surgeons like to tell you that there are no options following radiation so that you'll agree to surgery, but that's simply not true.

Recent reports suggest that the side effects of radiation treatment are overstated and relate to past practices using EBRT which is kind of a "shotgun" approach to radiation and cannot be controlled like CyberKnife (CK), Proton Beam Therapy (PBT) and Brachytherapy (BT). Those reports also relate to older patients with high grade cancers who required higher doses which caused significant collateral tissue damage, particularly in the rectum. One of the other stories is that if you get radiation and still have full erectile function after the treatment (which most do), you could lose it later. Recent reports are that this is false and that, if you lose it later, it's more likely due to your age and not due to any prolonged effects of radiation.

That said, no radiation treatment is without the possibility of side effects. However, it is now also pretty well known (based on some studies and anecdotal evidence) that PBT, IMRT (which includes CK) and BT are more likely to be LESS HARMFUL than radical and/or robotic surgery. The reason more people are choosing some form of radiation (other than EBRT) now is because most people retain or regain erectile function and urinary control shortly following treatment. This is not the case with surgery.

When you get surgery, you are absolutely sure to be impotent and incontinent following the procedure. The recovery from ED is only around 50% -- that means you have about a 50% chance to be impotent for LIFE if you have surgery and, if you recover, erectile function it could take as long as 2 years to achieve it. Those are NOT good odds in my book! After surgery, you are also guaranteed to have a catheter shoved up your penis and a urine bag at your side. The catheter usually comes out after a few days, but you will be incontinent and will have to wear a diaper and or use pads for up to a year and maybe longer. This doesn't even take into account the potential for infection and mistakes (like a perforated rectum or bladder) or the scars that are left over following surgery.

Now, THAT is what I call invasive!!!

You can also end up wearing a catheter following BT, but is not common following IMRT or PBT. However, the problem with BT will more likely be the "inability" to pee -- not incontinence -- and you need the catheter to keep things flowing. If things go really bad w/BT, you'll develop a "stricture" or blockage in the urethra (where it's reattached to the bladder) and will need a follow up procedure to clear it. This is one of the reasons by BT is at the bottom of my short list of acceptable treatments. With PBT and IMRT, you'll probably have an "urgency" to pee (as reported by Marckini) but probably won't be incontinent.

Also it is not necessarily true that surgery cannot be performed following radiation treatment. In the past (before IMRT and PBT), the prostate and all of the surrounding tissue was zapped to oblivion by EBRT making followup surgery impractical because of all of tissue damage. Surgery in the past and now is also usually not recommended because, if the radiation treatment has failed, the cancer has probably spread beyond the prostate and cutting the prostate out would not "fix" the problem. Chemo and EBRT would be better treatments in that event. Another reason why surgery is not recommended following radiation treatment is that the remaining cancer may still contained within that prostate within a small and localized area, which would make it amenable to treatment by cyrosurgery (cold) or HIFU - high intensity focused ultrasound (heat) or readministration of BT, IMRT or PBT which would all still be better choices than surgery.

So, the bottom line is that surgery is really worse than radiation and IMHO there is NO reason to resort to surgery, unless your cancer is ADVANCED but still contained within the prostate AND your life depends on the immediate removal of the prostate to avoid the spread of your cancer to other parts of your body. In that case, concerns over ED and incontinence are only secondary. But, if you're not in that situation and your cancer is at an early stage and not immediately life threatening, radiation treatment (whether it's PBT, IMRT or BT) are clearly much better alternatives to surgery.

thinking about cyberknife score 6/7 .Would like more comments on people that have had cyberknife 5 plus yrs out. I was wondering if onset at that point of problems. Any radiation cancer to bladder or rectum from radiation to prostate.

Josephg was cyberknife offered for the prostate to you at that time? Is your Psa level good now?

Thank you for your input. I need al the information I can get.

Anyone with radiation cancer to other organs post procedure?

No. A prostatectomy was recommended at the time by a world class medical institution, and I took that recommendation. My PSA at the time of the positive biopsy was 5.2, and the initial PCA Gleason score was 3+4. After the prostatectomy, and the prostate was examined, the Gleason score was change to 4+3.

I have a relatively long history with fighting PCa (but not as long as some folks on this Board) which is now at 12 years and counting. Currently, my PSA is undetectable, but being a realist, I anticipate my PSA becoming detectable again at some time in the future. One day at a time.