Cyberknife Procedure Update

Kongo said:

PSA NADIR WITH RADIATION
Larry, as you noted, Cyberknife leaves the prostate intact after radiation so there is always going to be some PSA. What they look for is a PSA nadir that is below 1.0. A biological failure would be a rising PSA after nadir. It sometimes takes 3 years to reach a nadir. I am unaware of any biological failures using Cyberknife.

bdhilton said:

Kongo,
As I have stated
Kongo,

As I have stated several times with you in the past and now, I am happy that you have chosen a process that you believe in and are moving forward in your journey. I also totally believe that lifestyle changes prior to and after surgery are critical for survival and keeping your health as good as you can…If fact I would call myself an “enthusiastic advocate” of diet and exercise.

Never once in my posts have I have stated that my procedure was the best, had the best results, etc… How and what we decide on as to treatment is a personal choice and the facts that are delivered here of all places should reflect the facts not manipulation of the facts or pure fantasy. Many of us have already had to sort through many “snake oil” salesmen to arrive to our treatment decisions. This whole PCa thing is enough to deal with without misrepresentation of outcomes or the realities of the specific treatments.

Based on my studies and consultations prior to my treatment selection, I found that there was some evidence to support as it relates to "CyberKnife" …”the idea of hypofractionation, but overall it cannot be denied that the procedure is experimental. Hypofractionation may well have merit, but long term (>10 year) results are not available for HDR Brachytherapy, which has been practiced since about 1997, and neither long nor short term (>5 year) peer reviewed results are yet available for CyberKnife.

Maybe in the long run, CyberKnife will prove to have similar (but possibly not better) outcomes vis-a-vis non-hypofractionated EBRT (External Beam Radiation Treatment), in which case, its selling point will be convenience.en it over methods with established records.”

Any man considering Cyberknife should make sure that his is a truly informed consent, and that he has chosen it over methods with established records….”

Sorry but counter to what you believe this individual has not stated the facts and this is a bit disturbing to me!

Best to you

viperfred said:

CyberKnife Studies
Hope all of remain free of PCa.

The CyberKnife is an economic treat to all other options. There are several published peer review studies that include the first patient treated(2003) at Stanford by Dr. Chris King. Last updated in 2009 and is in the process of being updated.

Stereotactic body radiotherapy for organ-confined prostate cancer
BMC Urology 2010, 10:1 doi:10.1186/1471-2490-10-1
Alan J Katz


Stereotactic Body Radiotherapy: An Emerging Treatment Approach for Localized Prostate Cancer
Technology in Cancer Research and Treatment
ISSN 1533-0346
Volume 8, Number 5, October 2009
©Adenine Press (2009)
by Jay L. Friedland, M.D.1
Debra E. Freeman, M.D.1*

Dr. Don Fuller has published studies and last time we spoke 4-21-2010 he had treated over 200 patients with no failures.


Zero recurrence for any therapy is unrealistic. Surgery can not remove cells they can not see, one PCa Stem Cell that survives any form of RT Chemo, Cyro or HIFU may result in a recurrence.

The number of patients with recurrence for the CyberKnife is low. From the three major studies combined I think the total number is less than 10. The expected 10 year cure rate is 98% or higher based HDR Brachy Therapy results. I like those odds.

I know two brothers that were diagnosed with PCa at about the same time. One was treated with the CyberKnife the other opted for surgery. Both felt they made the best choice for them.


The CyberKnife is no more experimental than surgery with robotics. The ASTRO leadership has misrepresented the CyberKnife in print and electronic media.

Based on my research and treatment outcome I am biased and believe the CyberKnife is the best option for localized PCa.

What is most important is for men to have the opportunity to make an informed choice after considering the risk and reward for each modality in conjunction with their doctors.

PCa patients must do their your own research and trust no one including me.

The patient has to live or die with the choice they make. Make is wisely!

bdhilton said:

Kongo,
As I have stated
Kongo,

As I have stated several times with you in the past and now, I am happy that you have chosen a process that you believe in and are moving forward in your journey. I also totally believe that lifestyle changes prior to and after surgery are critical for survival and keeping your health as good as you can…If fact I would call myself an “enthusiastic advocate” of diet and exercise.

Never once in my posts have I have stated that my procedure was the best, had the best results, etc… How and what we decide on as to treatment is a personal choice and the facts that are delivered here of all places should reflect the facts not manipulation of the facts or pure fantasy. Many of us have already had to sort through many “snake oil” salesmen to arrive to our treatment decisions. This whole PCa thing is enough to deal with without misrepresentation of outcomes or the realities of the specific treatments.

Based on my studies and consultations prior to my treatment selection, I found that there was some evidence to support as it relates to "CyberKnife" …”the idea of hypofractionation, but overall it cannot be denied that the procedure is experimental. Hypofractionation may well have merit, but long term (>10 year) results are not available for HDR Brachytherapy, which has been practiced since about 1997, and neither long nor short term (>5 year) peer reviewed results are yet available for CyberKnife.

Maybe in the long run, CyberKnife will prove to have similar (but possibly not better) outcomes vis-a-vis non-hypofractionated EBRT (External Beam Radiation Treatment), in which case, its selling point will be convenience.en it over methods with established records.”

Any man considering Cyberknife should make sure that his is a truly informed consent, and that he has chosen it over methods with established records….”

Sorry but counter to what you believe this individual has not stated the facts and this is a bit disturbing to me!

Best to you

randy_in_indy said:

LOL - yes Kongo, I go to the
Mat when I feel I am right about something.

This prostate thing is pretty tricky sometimes...but then again it seems simple if you have very little involvment and catch it early....I am guessing that those who catch it early and very little involvement will have pretty much a 95-99% cure rate no matter what treatment choice is selected....There really needs to be studies done by many different variables like:

Age
fitness
volume of cancer
gleason
lifestyle
diet
family history
mental health status
surgeon skill level
Oncologist skill level

for starters...I am sure many other factors could and should be considered besides these few off the top of my head...but think if they could categorize much of this and then take them against the treatment choice a more definitive path could be created for cure.


A guru on Prostate Cancer should be organizing a database to collect all this data and crunch it for better prostate cancer care.

my two cents

Randy in Indy

viperfred said:

HRD Brachytherapy
HDR Brachy therapy has been used for over 19 years not "5"


http://www.cetmc.com/ Started HDR Brachy therapy in 1991

http://linkinghub.elsevier.com/retrieve/pii/S0302283804006219 1992-2001 First patient in this study was treated in 1992

http://www.springerlink.com/content/tarm2hj0h1ff583v/ 2002-2003 HDR BT treatment

Science of Hypo fractionation:

Int. J. Radiation Oncology Biol. Phys., Vol. 52, No. 1, pp. 6–13, 2002
Copyright © 2002 Elsevier Science Inc.
DIRECT EVIDENCE THAT PROSTATE TUMORS SHOW HIGH SENSITIVITY
TO FRACTIONATION (LOW / RATIO), SIMILAR TO LATE-RESPONDING
NORMAL TISSUE
DAVID J. BRENNER, PH.D., D.SC.,* ALVARO A. MARTINEZ, M.D., F.A.C.R.,†
GREGORY K. EDMUNDSON, M.SC.,† CHRISTINA MITCHELL, R.N., B.S.N.,† HOWARD D. THAMES, PH.D.,‡
AND ELWOOD P. ARMOUR, PH.D.†
*Center for Radiological Research, Department of Radiation Oncology, Columbia University, New York, NY; †Department of
Radiation Oncology, William Beaumont Hospital, Royal Oak, MI; ‡Department of Biomathematics, M. D. Anderson Cancer Center,
Houston, TX

Int. J. Radiation Oncology Biol. Phys., Vol. 48, No. 2, pp. 315–316, 2000
Copyright © 2000 Elsevier Science Inc
TOWARD OPTIMAL EXTERNAL-BEAM FRACTIONATION FOR
PROSTATE CANCER
DAVID J. BRENNER, D.SC.
Center for Radiological Research, Columbia University, New York, NY


Int. J. Radiation Oncology Biol. Phys., Vol. 57, No. 4, pp. 912–914, 2003
Copyright © 2003 Elsevier Inc
HYPOFRACTIONATION FOR PROSTATE CANCER RADIOTHERAPY—WHAT
ARE THE ISSUES?
DAVID J. BRENNER, PH.D., D.SC.
Department of Radiation Oncology, Center for Radiological Research, Columbia University, New York, NY


Int. J. Radiation Oncology Biol. Phys., Vol. 52, No. 1, pp. 3–5, 2002
Copyright © 2002 Elsevier Science Inc.
THE PROSPECTS FOR NEW TREATMENTS FOR PROSTATE CANCER
JACK F. FOWLER, D.SC., PH.D.,* RICK J. CHAPPELL, PH.D.,† AND MARK A. RITTER, M.D., PH.D.*
Departments of *Human Oncology and †Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI



Int. J. Radiation Oncology Biol. Phys., Vol. 60, No. 4, pp. 1241–1256, 2004
Copyright © 2004 Elsevier Inc.
A CHALLENGE TO TRADITIONAL RADIATION ONCOLOGY
JACK F. FOWLER, PH.D., D.SC., WOLFGANG A. TOMÉ, PH.D., JOHN D. FENWICK, PH.D.,
AND MINESH P. MEHTA, M.D.
Department of Human Oncology, Medical School of the University of Wisconsin, Madison, WI




Acta Oncologica, 2005; 44: 265/276
REVIEW ARTICLE
The radiobiology of prostate cancer including new aspects of
fractionated radiotherapy
JACK F. FOWLER
Emeritus of Medical School of Wisconsin University, Department of Human Oncology, University of Wisconsin-Madison,
USA


Published in final edited form as:
Semin Radiat Oncol. 2008 October ; 18(4): 249–256. doi:10.1016/j.semradonc.2008.04.007.
Rationale, conduct, and outcome using hypofractionated
radiotherapy in prostate cancer
Mark Ritter, M.D., Ph.D. [Professor]
Department of Human Oncology and Medical Physics, University of Wisconsin School of Medicine
and Public Health, 600 Highland Avenue – K4/B100, Madison, WI 53792, ritter@humonc.wisc.edu


Trust no one, do the research and you will maximize the chance for cure and minimize risk.

randy_in_indy said:

Viper
When are you going to update your rediculous advertising web site to include the latest and probably the largest study results of Robotic surgery results. Your page is grossly wrong for the average person using a dart board to pick their urological surgeon.

http://nyp.org/news/hospital/robotic-prostate-surgery-study.html


Robotic Prostate Surgery Study Finds 5-Year Outcomes Favorable
One of Largest Studies of Its Kind Led by Dr. Ketan K. Badani, Newly Appointed Director of Robotic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center
NEW YORK (Dec 18, 2007)

Prostate cancer patients receiving robotic prostatectomy—an advanced procedure to remove the prostate using a surgical robot—have excellent outcomes five years after surgery.

The results of what may be the largest and longest study of its kind are published in a recent issue of the journal Cancer, and led by Dr. Ketan K. Badani, the newly appointed director of robotic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of urology at Columbia University College of Physicians and Surgeons. Previously, Dr. Badani was a clinical fellow in robotic and laparoscopic urologic oncology at Henry Ford Hospital in Detroit, where the 2,766 procedures followed in the investigation were conducted over a six-year period.

Dr. Badani says, "We found that in highly experienced hands, the results after robotic surgery are outstanding for cancer control, with minimal complications and few side effects of urinary incontinence and sexual dysfunction."

"In addition, blood loss is far less than with traditional surgery. This, along with minimizing trauma to the body tissues, translates into short hospital stays, and more importantly, quick recovery—allowing patients to resume their regular activities, whether that means going for a run or playing 18 holes of golf," adds Dr. Badani, who has personally performed more than 700 of the robotic procedures.

Specific study findings include the following:
•Ninety-three percent (93%) of patients achieved normal urinary function, with a median time of complete control of three weeks.
•Only slightly more than seven percent (7.2%) of patients had recurrence of prostate cancer symptoms (presence of prostate specific antigen, or PSA). Less than one percent (0.5%) of patients died during 71 months of follow-up.
•Nearly 80 percent (79.2%) of patients reported normal sexual function.
The study also compared clinical outcomes of the first 200 patients with that of the final 200 patients to see if there were improvements. They found a reduced amount of blood loss and fewer cases of positive surgical margins (4 percent, down from 7 percent)—when the initial cut does not cut away all of the cancerous tissue. The surgery also was performed faster (131 minutes vs. 160 minutes).

"With five years of follow-up, we can now see that, not only is robotic prostate surgery safe and effective, but it continues to improve," says Dr. Badani. "As with any highly technical operation, the study points to the importance of experience. With the knowledge and practice of many procedures, outcomes for patients improve. NewYork-Presbyterian/Columbia is one of only a few premier centers that can offer this level of specialized surgery to patients."

Dr. Badani has helped pioneer novel techniques to preserve sexual potency in men undergoing robotic prostatectomy while optimizing cancer control. He has performed live robotic demonstrations at both national and international meetings and has lectured and published extensively on outcomes of patients undergoing robotic surgery. He received his medical degree from Case Western Reserve University School of Medicine in Cleveland, Ohio, and completed both his urologic residency and fellowship in robotic and laparoscopic urologic oncology at the Vattikuti Urology Institute at Henry Ford Hospital in Detroit.

The Cancer study is co-authored by Drs. Sanjeev Kaul and Mani Menon—both of the Henry Ford Hospital in Detroit.

NewYork-Presbyterian/Columbia offers a comprehensive urologic surgery program with robotic surgery available for robotic prostatectomy, robotic nephrectomy (kidney), robotic cystectomy (bladder) and robotic adrenal gland surgery. In addition to Dr. Badani, members of the robotic urologic surgery team include Drs. Mitchell C. Benson, James M. McKiernan, Erik Goluboff and Carl A. Olsson.

Robotic Prostatectomy
During robotic prostatectomy, the physician makes five to six small incisions in the abdomen, through which surgical instruments and a tiny stereoscopic camera are inserted. The camera improves visibility, and robotic arms make for easier suturing.

Robotic prostatectomies make use of Intuitive Surgical's da Vinci™ Surgical System, which has been approved by the FDA for a number of innovative clinical procedures employed at NewYork-Presbyterian Hospital.

Prostate cancer is the second most common cancer death after lung cancer. Each year, over 200,000 Americans are diagnosed with prostate cancer, and as many as 32,000 will die from the disease.

lewvino said:

Randy, I'll be looking
Randy, I'll be looking forward to reading your post in 10 years. My dad is at about year 14 following Proton treatment. As you say his was caught early and had great success.

It was interesting when I talked to the guy in Atlanta that at least he was honest with me. When he asked if I was ready to select my treatment I said no. I have one more Doc i'm seeing up in Nashville. He then said are you Seeing Dr. Smith at Vanderbilt? I said yes, he then told me "he is one of the best you will find, give him my regards when you see him."

So glad you found a great surgeon also.

Did you listen to that lecture by Dr. Mulhall? SOmeone posted a link on another thread.
Very good lecture. Again I'm so glad I chose Davinci over radiation for first line of treatment. It seems that with radiation you won't start getting some of the side effects till 5 years down the road. That is exactly what happened with my dad. I thought at 54 I'm young and can fight any side effects now and win the battle. So far it has worked for me.

Larry