Cyberknife Procedure Update

randy_in_indy said:

Marge
Ovbiously, you did not go to Viper's "info Ad" web site which grossly characterizes other forms of therapy in a rediculous light of sad statistics that are outdated and plain WRONG. Especially to a newbie that has not done his own research. Statistics he posts on his website for both Open and Robotic must be from the surgeons of podunk town USA...certainly not any statistics from the plethera of very good surgeons in the US. I can give out probably 12 surgeons from accross the country that would blow his numbers to pieces with both incontinence and ED percentages. Please research more. Interesting you say your doctor says 60% incontinence after surgery - I would say he's not to up on the reality of what is happening today....Wow then I guess the thousands who were under this doctors care were REALLY lucky

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

"...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.

This studied 2,766 patients over 6 years....What kind of study is your doctor quoting his 60% incontinence from...hopefully it's not his surgeries...if so...better look for another surgeon. I don't mean to be mean..but give me a bloody break....the stats on Viper's site are just plain pointedly WRONG and a horrible dis-service and this is not to say Cyberkinfe is a bad procedure because I will never say that and hope it becomes the gold standard..but please do not put false and incorrect info regarding the statistics of other treatments to point a golden finger towards the one of your own personal preference = that is worse than no information at all in my honest opinon.



Randy In Indy

randy_in_indy said:

No Don't you see????
Please post anything I have posted in my 400 posts on this site as "selling surgery" Sorry, you cannot be I have not. It is absolutely proposterous that you claim I have sold surgery to BD Hilton..I am sure he will have something to say about that himself...besides he did not even have robotic....Name calling...hmmmm HiFu Gal...is that name calling...You are simply very, very humorous for everyone reading here to see....I call it like I see it. What I wish is that I could identify IP Addresses....now that would be funny to see who has posted under what ID's - there are not many multiple ID posters on this site but Marge...I really believe in my heart...you are.

Where is your picture by the way....please post one so I can see who I am jousting with...lol

Randy In Indy

viperfred said:

Search for the truth!

Tried to find the clinical study referenced as " the latest and probably the largest study results of Robotic surgery results" The link provided PR for
NewYork-Presbyterian Hospital on their web page.


The following link is to an abstract by :
Ketan K. Badani, MD Sanjeev Kaul, MD, Mani Menon, MD

The number of patients is 2766 so it seems likely this is the subject study.

http://www3.interscience.wiley.com/journal/116322982/abstract

Results in quotes:

"The mean age of the patients was 60.2 years and the mean prostate-specific antigen (PSA) level at time of diagnosis was 6.43 ng/mL; 42.4% and 64.2% of patients, respectively, had a biopsy and pathologic Gleason sum of 7. The mean surgical and console time was 154 minutes and 116 minutes, respectively. Estimated blood loss was 100 mL; 96.7% of patients were discharged within 24 hours of surgery. At a median follow-up of 22 months, 7.3% of men had a PSA recurrence. The 5-year actuarial biochemical free survival rate was 84%. "

What I find interesting is the recurrence rate at a median of 22 months is 7.3% and 5 year biochemical free survival is 84% . The NewYork-Presbyterian Hospital ad runs the sentence with 7.3% recurrence into the sentence "Less than one percent (0.5%) of patients died during 71 months of follow-up." When I read the "ad" I thought the 71 months follow-up had a recurrence of 7.3% which would not be unexpected from an experienced surgeon. However at 22 months 7.3% is less than exceptional and at 5 years 16% seems poor compared to other modalities.

I would like to have the complete paper to see the peer reviewed data for incontinence etc.

http://jama.ama-assn.org/cgi/content/short/302/14/1557?home This study in JAMA, Oct. 2009 shows a different result than the older NY Presbyterian 2007 "ad"

Here is an article in the NY Times http://www.nytimes.com/2010/02/14/health/14robot.html form Feb 2010.

Men need to take time to understand all treatments so they can make an informed choice.

Trust no one!


There are none so blind as do not wish to see.[1]


[1] Darwin, E. (1794). Zoonomia: or the Laws of organic life. Vol. II, p.244. Third edition (1801). J.Johnson, London

marge said:

Here's another article from
Here's another article from PubMed (I edited out some mish mash)

Radical prostatectomy reduced disease recurrence at 5 years compared with external-beam radiation therapy in 1 small, older trial (14% vs. 39%)

No external-beam radiation regimen was superior to another in reducing mortality.

The Prostate Cancer Outcomes Study reported that urinary leakage ... was more common with radical prostatectomy (35%) than with radiation therapy (12%) or androgen deprivation (11%). Bowel urgency occurred more often with radiation (3%) or androgen deprivation (3%) than with radical prostatectomy (1%). Erectile dysfunction occurred frequently after all treatments (radical prostatectomy, 58%; radiation therapy, 43%; androgen deprivation, 86%).

CONCLUSION: Assessment of the comparative effectiveness and harms of localized prostate cancer treatments is difficult because of limitations in the evidence.

PMID: 18252677 [PubMed - indexed for MEDLINE]


Summation of post RP:
recurrance is 14%
incontinence is 35%
ED is 58%

These figures fit into my own life experience of RP/RRP

Randy is a salesman, he states he has 30 years of experience. We all appreciate Randy's story, but it doesn't mean everyone will have his outcome, it's high time he stop attacking new people here with stories he doesn't know about. I appreciate viper's story, let's not kill the messenger, we need everyone, isn't that what a forum is all about, where else can we learn about the newest treatments??

Good luck to kongo!!!

Kongo said:

Marge
Marge, thanks for the encouragement.

One thing about all of these studies which I find enormously frustrating is that most never seem to make head-to-head comparisons of treatment options, as indicated in the conclusion for the study you referenced. In the study you cite, for example, you can’t really draw a relevant conclusion because we don’t know the experience level of the surgeon, the state of urinary or ED functionality before treatment, the age of the patient, the staging of the cancer, and so forth. We can’t statistically normalize the study. What we have is basically: A bunch of guys had many different forms of treatment someplace and there were differing results with respect to side effects.

Randy has cited a study in this thread that shows a much different outcome for RP side effects out of NY Presbyterian done in 2007 where the patient cohort had a continence rate of over 90% and sexual function of nearly 80 percent. The caveat is that these were highly experienced surgeons using the Da Vinci machine. Of course, we really don’t know how they defined continence or sexual function but giving them the benefit of the doubt, those are certainly encouraging results for those considering RP.

Outside of NY Presbyterian, some of the large studies that draw upon the VA or Medicare databases show higher rates of RP side effects with respect to incontinence and ED. My personal belief on this is that the experience of the surgeon is the critical factor. As RP has only been approved for PCa treatment for about five years and the number of facilities offering it is growing dramatically, there is obviously a learning curve that comes into play, and Randy has always maintained that a man considering Da Vinci should seek out the most experienced surgeon available. (I heard a commercial on the radio this morning on the way to work touting a new Da Vinci machine at a local hospital – I wondered to myself how much experience the surgeon who fires that baby up for the first time will have had.) If I was going the RP route, I would be on a plane to the most expensive, most highly acknowledged, and most experienced surgeon I could find.

In Cyberknife, for example, my doctor took great pains to tell me that men who have poor sexual function before treatment will have ED issues afterward and those men with enlarged prostates or urinary issues before radiation will have a more difficult recovery than men without symptoms. I suspect there is a similar analog to RP. So, if you look at a VA or Medicare study with men at a more advanced age possessing incumbent ED and urinary issues, the study will report more side effects. I think the studies should pay much more attention to pre-treatment diet, health, and vitality and the impact it has on successful outcomes. BDHilton has made some good points on the importance of diet and exercise to recovery in other threads.

Just about any personal opinion about PCa or treatment options can cite some study or another for justification. I personally believe that flaming someone who cites a particular study that doesn’t fit your personal view of the world is unproductive and stymies the free exchange of information about subjects which many are seeking. A more civilized approach, in my opinion, would be to tactfully disagree and cite your own study and explain why you think it may be more relevant to a particular cancer situation. Personal attacks are not only against website rules; they tend dampen the free exchange of information which might turn out to be instrumental in helping someone find the right path for them. And at the end of the day, I don’t think any specific study is totally authorative by itself -- It’s just another piece of the puzzle we all have to put together as we sift through the myths, folklore, lies, and damn lies on the road to recovery.

I’ve completed all of my preparatory work and start Cyberknife treatment on June 21.

randy_in_indy said:

Marge I am sorry but you way misunderstood my posts
More than I misunderstood yours. What I object to is the web site statistics that Viper represents on his web site...I would challenge anyone to refute what I say about his typical risk pointing everyone away from surgery when in FACT there are many thousands that have benefited from surgery with exceptional results....based on the fact everyone needs to do their own research and find the person that is best for the surgery. People who do not and just take the next bloke that happens to be the doctor they go to and end up in a mess...then shame on them...I did not go with two urologists that examined me...and did a biopsy on me...because I was bound and determined to find the best for Randy...because that is what I always do and always will. Viper's statistics stink... and that is a obvious FACT. Again...I have said not one word agains Cyberknife as a treatment and never will but when someone trys to mislead away from other treatments the way the "WEBSITE" he proclaims as his...I will fight for the truth to the end. You are really funny about the comment you state about incontinence...prior to surgery....you must be in your 30's....I have a brother and mother that both have issues and are exceptionally healthy people of the age of 55 and 78. You need to get out more and talk frankly with other people....it's an everyday very pervasive occurance in our aging population.