Kaiser Northern CA Therapy Options

hopeful and optimistic said:

lcb2
Your numbers are low, and you are an excellent candidate for every treatment option depending on your answers to these two questions. You state that your PSA is 5.7......what is your PSA history, is it stable, rising, etc. HOw many total cores were taken?

I agree with swing as far as Kaiser; if you have the resources to switch away, do so....how soon will you be 65 and eligible for medicare?

I was diagnosed for my 66 birthday, and my numbers are very similar to yours.......I was told by a surgeon that I have indolent cancer, that is not likely to spread and he refused to consider surgery with me....I am on Active Surveillance for the last year and half.....below is a copy of what I posted "about me" which is my experience. I hope that it will be helpful to you.
-------------------------------------
Active Surveillance
Diagnosed 3/09 for 66 birthday
By chance doc found a lipoma in the cavity , not on the prostate(which turned out to be non cancerous)
PSA's had been at 2.26/2.27 for a few years
Biopsy 3/09 Gleason 3+3=6 2 of 12 cores positive- 5 percent involvement in each
second opinion john hopkins
4/09 MRI(tesla 1.5) with spectroscopy, no nodule involvement, staged t1
Aureon molecular test on biopsy, 97 percent chance will not progressin next 8 years
PSA Jan 2.2, JUly 2.5, November 2.6, February 2010 2.0
Entered in a research study for active surveillance .
PSA , 5/24/10....different institution than had previously used (will go back to the other group that I had been going to better compare PSA's over time
June 2010 ...MRI(tesla 3.0)
June 2010.....Three dimensional targeted biopsy ( based on MRI and ultrasound ability from this biopsy)......15 cores of which 3 are targeted....no cancer found.
second opinion confirm no cancer

Here are some results of Lawernce Klotz,MD, well respected
new
active sureilance expert

protocol:

PSA and DRE every 3 months
Prostate ultrasound every 12 months
Repeat biopsy at month 12 and 36

After 8 years:

- 55% remain untreated with stable disease

- 36% decided to have treatment(eventhough they did not have progression)

- 9% treated with surgery or radiation for increase in psa or gleason score

- none have metastatic disease
< 1% men died of prostate cancer

---------------------------------------------------
Analysis of Bill Axelson by Lawernce Klotz, MD
Journal of clinical Onchology 2005

. lower gleason
. less than 1/3 cores and none >50%
. PSA < 10 and not rising
. PSA density < 0.15
. no palpable diesease
. early treatment for any progression

FOR LOW RISK, 100 SURGERIES WILL SAVE 1 LIFE 10 YEARS IN THE FUTURE




What types of treatment(s) have occurred?
In your situation of "Active Surveillance" where you have a small amount of cancer within the prostate capsule, you will would want to know if the cancer is aggrssive and would rapidly grow, and spread outside the capsule, or non aggressive, that your cancer has a very low chancd of growing. This can be critical to a treatment option decision.

There is a molecular test performed by a company Aureon, where they , I guess take samples from the slides from your biopsy and look for aggressive tumors...they then mathematically compare it with other factors such as PSA, gleason, etc to approximately 1000 men who have had radical protectemy, and come up with the likelyhood of the the cancer progressing 8 years in the future.

But be cautioned on the following; there is a sensitivity of 74percent and a a specificity of 64prcent. What that means is tat among 100 bad tuors, for example, they only can identify 75 of them. And among 100 good tumors, they identify as bad in 36. to be honest this is notmuch different than achieved withjust your psa and gleason and percent tumor.

I believe that you can contact Aeuron www.aureon.com or 1-888-797-7284

-----------------
MRI

There is an MRI scan for prostate cancer that is done with a special coil in the rectum. This are certain major hospitals that have a Tesla magnet. There is a 1.5 Tesla magnet, the effective resolution is limited to tumors 0.5cc or larger. There is also a 3 Tesla machine which may have a bit finer resolution.

The most effective MRI for the prostate is called a MRSI (MRI/MRS) and includes the ability to identify cancer metabolites using spectographic analysis.....Basically using the spectoscopy with the MRI provides more accurate results, both the MRI and the spectroscopy are done at the same time.

The MRI is generally covered by insurance, however the spectroscopy is considered investigational and is not covered by medicare which I use.

The test indicates if there is any nodule involvement, if there is involvement in one or two lopes , wll show size of prostate, any evidence of extracapular extension, will stage your disease.

Swingshiftworker said:

I Opted Out
I was a NorCal Kaiser member too; had been for life until I opted out during open enrollment in April 2010. My stats were 59 (at time of treatment), Gleason 6, PSA 4.8, neg DRE and Stage T1c; only 1 small (less than a mm) piece of one core found in the biospy; excellent health otherwise but father had PCa too.

The only choices given to me at Kaiser were the same as those given to you: Active Surveillance (AS), Brachytherapy (BT) and Surgery (open or robotic). I talked w/3 Kaiser urologist/surgeons in the SF Bay Area (and didn't think that any of them had enough experience to work on me and wouldn't recommend any of them), did the BT orientation and prostate mapping/screening in Roseville and did 3 months of independent research on all available treatment methods available, their side effects and track record and decided that the choices available to me at Kaiser were unacceptable.

Surgery presented too many risks and side effects for me to even consider it, unless there was no other choice available -- continued erectile function and avoidance of catheters and diapers following treatment were high priorities for me and surgery presents way too many problems (documented on this forum) in this regard -- some people can recover quickly, some not and some never -- too much of a crap shoot for me. BT appealed to me initially but decided that I didn't want to be "radioactive" for the 1 yr 1/2 life of the seeds and didn't want all of those seeds buried inside me for life afterward. BT also can require the use of a catheter for a short time following treatment and improper seed placement can cause serious collateral tissue damage. Active surveillance was a viable choice for the short term but if the PCa developed further I'd have to do something about it eventually. If the only choice was to do nothing or do surgery, I'd would have opted to do nothing (namely, AS), but if there was a less detrimental alternative, which there was (see below), then I felt that no real good could come from waiting.

In my research, I found out that the UCSF Med Center (which is one of the premier medical school/hospitals in the nation) through the Helen Diller Family Comprehensive Cancer Center located on Divisadero only a block away from Kaiser on Geary in SF offered CyberKnife (CK) SBRT - sterotactic body radiation therapy for prostate cancer. IMHO, CK is currently the MOST advanced and precise method of radiation treatment available for prostate (and other cancers), which dramatically minimizes potential side effects normally experienced following surgery and other radiation treatments resulting from radiation damage to collateral body tissues and organs, particularly the rectum, urethra, bladder and the vascular bulb (which feeds blood to your penis).

CK is appropriate for early stage PCa patients and can deliver radiation with a degree of precision in dosage and location that far exceeds all other radiation treatment methods -- including BT, IMRT and EBRT. I also found out that CK was covered by CA Blue Shield which was available to me through my retirement health care program during open enrollment, so I switched and, if you can switch to CA Blue Shield to get CK, you should consider doing so too.

I got treated at the end of September with absolutely NO side effects -- no ED, no urinary incontinence, no bowel or bladder irritation, no fatigue . . . just a little bit of urinary urgency which should resolve itself in time. The jury is still out on the overall results but I can wait -- it's kind of like waiting for PSA results during AS but, in this case, I've already been treated and expect to see the PSA levels drop rather than worrying about whether the readings are going to go up or not due to the lack of treatment. First followup PSA test is in December and the nadir is not expected for at least 5 years, but reports from men who have received treatment beyond 2 years indicate that PSA levels below 1 can be expected in that time period. So, I'm optimistic. However, like other radiation treatments, there can be a "bump" in the PSA along w/some bowel and/or urinary complications 18months to 2 years out, but not everyone experiences this. Kongo (4 months ago) and ViperFred (over 2 years ago) are 2 others on this board who have received CK treatment.

Good luck in finding the treatment option BEST for you -- not just the best treatment available to you at Kaiser!!

Swingshiftworker said:

I Opted Out
I was a NorCal Kaiser member too; had been for life until I opted out during open enrollment in April 2010. My stats were 59 (at time of treatment), Gleason 6, PSA 4.8, neg DRE and Stage T1c; only 1 small (less than a mm) piece of one core found in the biospy; excellent health otherwise but father had PCa too.

The only choices given to me at Kaiser were the same as those given to you: Active Surveillance (AS), Brachytherapy (BT) and Surgery (open or robotic). I talked w/3 Kaiser urologist/surgeons in the SF Bay Area (and didn't think that any of them had enough experience to work on me and wouldn't recommend any of them), did the BT orientation and prostate mapping/screening in Roseville and did 3 months of independent research on all available treatment methods available, their side effects and track record and decided that the choices available to me at Kaiser were unacceptable.

Surgery presented too many risks and side effects for me to even consider it, unless there was no other choice available -- continued erectile function and avoidance of catheters and diapers following treatment were high priorities for me and surgery presents way too many problems (documented on this forum) in this regard -- some people can recover quickly, some not and some never -- too much of a crap shoot for me. BT appealed to me initially but decided that I didn't want to be "radioactive" for the 1 yr 1/2 life of the seeds and didn't want all of those seeds buried inside me for life afterward. BT also can require the use of a catheter for a short time following treatment and improper seed placement can cause serious collateral tissue damage. Active surveillance was a viable choice for the short term but if the PCa developed further I'd have to do something about it eventually. If the only choice was to do nothing or do surgery, I'd would have opted to do nothing (namely, AS), but if there was a less detrimental alternative, which there was (see below), then I felt that no real good could come from waiting.

In my research, I found out that the UCSF Med Center (which is one of the premier medical school/hospitals in the nation) through the Helen Diller Family Comprehensive Cancer Center located on Divisadero only a block away from Kaiser on Geary in SF offered CyberKnife (CK) SBRT - sterotactic body radiation therapy for prostate cancer. IMHO, CK is currently the MOST advanced and precise method of radiation treatment available for prostate (and other cancers), which dramatically minimizes potential side effects normally experienced following surgery and other radiation treatments resulting from radiation damage to collateral body tissues and organs, particularly the rectum, urethra, bladder and the vascular bulb (which feeds blood to your penis).

CK is appropriate for early stage PCa patients and can deliver radiation with a degree of precision in dosage and location that far exceeds all other radiation treatment methods -- including BT, IMRT and EBRT. I also found out that CK was covered by CA Blue Shield which was available to me through my retirement health care program during open enrollment, so I switched and, if you can switch to CA Blue Shield to get CK, you should consider doing so too.

I got treated at the end of September with absolutely NO side effects -- no ED, no urinary incontinence, no bowel or bladder irritation, no fatigue . . . just a little bit of urinary urgency which should resolve itself in time. The jury is still out on the overall results but I can wait -- it's kind of like waiting for PSA results during AS but, in this case, I've already been treated and expect to see the PSA levels drop rather than worrying about whether the readings are going to go up or not due to the lack of treatment. First followup PSA test is in December and the nadir is not expected for at least 5 years, but reports from men who have received treatment beyond 2 years indicate that PSA levels below 1 can be expected in that time period. So, I'm optimistic. However, like other radiation treatments, there can be a "bump" in the PSA along w/some bowel and/or urinary complications 18months to 2 years out, but not everyone experiences this. Kongo (4 months ago) and ViperFred (over 2 years ago) are 2 others on this board who have received CK treatment.

Good luck in finding the treatment option BEST for you -- not just the best treatment available to you at Kaiser!!

Swingshiftworker said:

I Opted Out
I was a NorCal Kaiser member too; had been for life until I opted out during open enrollment in April 2010. My stats were 59 (at time of treatment), Gleason 6, PSA 4.8, neg DRE and Stage T1c; only 1 small (less than a mm) piece of one core found in the biospy; excellent health otherwise but father had PCa too.

The only choices given to me at Kaiser were the same as those given to you: Active Surveillance (AS), Brachytherapy (BT) and Surgery (open or robotic). I talked w/3 Kaiser urologist/surgeons in the SF Bay Area (and didn't think that any of them had enough experience to work on me and wouldn't recommend any of them), did the BT orientation and prostate mapping/screening in Roseville and did 3 months of independent research on all available treatment methods available, their side effects and track record and decided that the choices available to me at Kaiser were unacceptable.

Surgery presented too many risks and side effects for me to even consider it, unless there was no other choice available -- continued erectile function and avoidance of catheters and diapers following treatment were high priorities for me and surgery presents way too many problems (documented on this forum) in this regard -- some people can recover quickly, some not and some never -- too much of a crap shoot for me. BT appealed to me initially but decided that I didn't want to be "radioactive" for the 1 yr 1/2 life of the seeds and didn't want all of those seeds buried inside me for life afterward. BT also can require the use of a catheter for a short time following treatment and improper seed placement can cause serious collateral tissue damage. Active surveillance was a viable choice for the short term but if the PCa developed further I'd have to do something about it eventually. If the only choice was to do nothing or do surgery, I'd would have opted to do nothing (namely, AS), but if there was a less detrimental alternative, which there was (see below), then I felt that no real good could come from waiting.

In my research, I found out that the UCSF Med Center (which is one of the premier medical school/hospitals in the nation) through the Helen Diller Family Comprehensive Cancer Center located on Divisadero only a block away from Kaiser on Geary in SF offered CyberKnife (CK) SBRT - sterotactic body radiation therapy for prostate cancer. IMHO, CK is currently the MOST advanced and precise method of radiation treatment available for prostate (and other cancers), which dramatically minimizes potential side effects normally experienced following surgery and other radiation treatments resulting from radiation damage to collateral body tissues and organs, particularly the rectum, urethra, bladder and the vascular bulb (which feeds blood to your penis).

CK is appropriate for early stage PCa patients and can deliver radiation with a degree of precision in dosage and location that far exceeds all other radiation treatment methods -- including BT, IMRT and EBRT. I also found out that CK was covered by CA Blue Shield which was available to me through my retirement health care program during open enrollment, so I switched and, if you can switch to CA Blue Shield to get CK, you should consider doing so too.

I got treated at the end of September with absolutely NO side effects -- no ED, no urinary incontinence, no bowel or bladder irritation, no fatigue . . . just a little bit of urinary urgency which should resolve itself in time. The jury is still out on the overall results but I can wait -- it's kind of like waiting for PSA results during AS but, in this case, I've already been treated and expect to see the PSA levels drop rather than worrying about whether the readings are going to go up or not due to the lack of treatment. First followup PSA test is in December and the nadir is not expected for at least 5 years, but reports from men who have received treatment beyond 2 years indicate that PSA levels below 1 can be expected in that time period. So, I'm optimistic. However, like other radiation treatments, there can be a "bump" in the PSA along w/some bowel and/or urinary complications 18months to 2 years out, but not everyone experiences this. Kongo (4 months ago) and ViperFred (over 2 years ago) are 2 others on this board who have received CK treatment.

Good luck in finding the treatment option BEST for you -- not just the best treatment available to you at Kaiser!!

Kongo said:

Welcome
LCB,

Welcome to the forum and I'm sorry that you found it necessary to be here. None of us are happy with a diagnosis of PCa but I think you will find this forum useful in sorting through potential treatment options based on the experience of others.

As Swing suggested in his post, you may wish to consider options outside the Kaiser HMO. Many HMOs, including Kaiser, offer a fairly limited range of options to treat prostate cancer and as new advances are appearing every day, I am sure you want the flexibility to choose what YOU think is best for you rather than having to settle for the choices your insurance provider gives you.

While brachytherapy is a common and successful method of treatment, there are other newer forms of fractional external radiation such as IMRT and SBRT that may be even more effective but are not covered within your HMO. Proton therapy is another option that Kaiser does not cover. If you choose surgery, either open RP or robotic, you will want to put yourself in the hands of the most experienced surgeon available and that person might not be in the Kaiser network.

Given your age and approaching Medicare eligibility you may want to consider following a path of active surveillance as Ira suggested, at least until you have the ability to choose more options. Given the statistics you described regarding your pathology it does not appear that there is a big rush to make a near term treatment decision and many studies suggested that delaying treatment with low risk cancer (PSA < 10, Stage T1c, Gleason 6 or less) will not adversely affect follow on options.

Like Swingshift, I was diagnosed with low risk PCa and elected to be treated with SBRT via the CyberKnife system and have had zero side effects. I was pretty much unrestricted in my treatment options and based my treatment decision on curative potential coupled with low risk of side effects. If I had been restricted in my choices based on insurance coverage, I would not have been able to obtain a treatment consistent with my individual priorities.

Best of luck as you sort your way through this.

=======================
Diagnosed in March 2010 (Age 59) based on an increase in PSA to 4.3. DRE negative. No family history of prostate cancer. Biopsy had 1 of 12 cores positive with 15% involvement. Gleason 3+3=6. Stage T1c.

Treatment with SBRT via CyberKnife in July 2010. Zero side effects with respect to urinary discomfort, rectal toxicity, or ED. 3 month post treatment PSA was 1.35, which is on the predicted post treatment glideslope as the PSA approaches nadir.