Kaiser Northern CA Therapy Options

hopeful111 · November 2010

LCB2 said:
SBRT CK
Thanks for the UCLA info. I did not know that Dr. King was there now. Might influence my decisions.

Presently I plan to get a 2nd opion on all treatment options and more specifically CK from either UCSF or Stanford. UC is more convenient. However, Stanford seems to have more experience with CK and PC treatment. UCLA is a third choice because of some potential insurance issues.

sbrt ck
In this thread, I don't see any comments about the non cyberknife
kind of imrt/igrt treatments - is that beause the kaiser does not
provide/offer those or because they are viewed as not as good
as cyberknife these days ? (or that with just a relatively small
number of posters that it was just not mentioned)
(I realize the imrt/igrt takes many weeks, but wondering if there
are other reasons it might not be viewed as good as cyberknife ?)

am new to the board, if my questions are not appropriate or belong
somewhere else, please let me know.

Kongo · November 2010

hopeful111 said:
sbrt ck
In this thread, I don't see any comments about the non cyberknife
kind of imrt/igrt treatments - is that beause the kaiser does not
provide/offer those or because they are viewed as not as good
as cyberknife these days ? (or that with just a relatively small
number of posters that it was just not mentioned)
(I realize the imrt/igrt takes many weeks, but wondering if there
are other reasons it might not be viewed as good as cyberknife ?)

am new to the board, if my questions are not appropriate or belong
somewhere else, please let me know.

SBRT or IMRT
hopeful, welcome to the forum. I hope you will share your background and experience with us and how you came to be here.

Although a bit off topic for this thread, you pose an interesting question in asking about the differences between SBRT such as CyberKnife and IMRT. In both methods, radiation is accurately delivered according to a rigorously developed radiation plan that delivers a high dose of radiation to the entire prostate gland. Both IMRT and SBRT are able to deliver much higher doses than earlier methods of radiation delivery because of advances made in how the radiation beams are focused minimizing the potential of damaging adjacent organs such as the bladder and rectum.

Both IMRT and SBRT deliver fractionating radiotherapy which increases the effectiveness of dose to the tumor while reducing the late effect side effects in normal tissue. The IMRT process typically uses 40 fractions (different sessions) of short duration to deliver the radiation. CyberKnife uses four or five fractions to deliver the radiation

In IMRT delivery, the prostate is localized every day by using fiducial markers (small gold pellets about the size of a grain of rice) inserted into the prostate before treatment or by abdominal ultrasound imaging. The position of the machine is then adjusted to account for the daily prostate position. CyberKnife uses gold fiducials to track the movement of the prostate in real time and continually adjusts beam positions for where the prostate actually is at any given time.

Since CyberKnife is more accurate in its ability to deliver dosage, there is a slightly reduced percentage of side effects associated with the procedure which tend to show up in urinary urgency or rectal toxicity but both delivery systems are highly conformal, highly accurate, and deliver about the same biological equivalent dosage. CyberKnife delivers an improved dose volume histogram (DVH) with respect to the bladder and rectum than does IMRT which basically means that there is less spillover radiation to those nearby organs. Both methods have shown to have very low percentages of any side effects.

A characteristic that determines how sensitive a given type of cancer is to different types of radiation is known as the alpha/beta ratio. Since prostate cancer cells are so slow growing, they have a low proportion of dividing cells at any given time (the alpha beta ratio) which means they are very susceptible hypofractionated dosages delivered by SBRT systems. The theory behind CyberKnife and other SBRT systems is that fewer fractions at a higher dose is very effective in several types of cancer but in particular, prostate cancer while reducing the impact on surrounding tissue.

Setting aside the technical jargon, CyberKnife at this point is really only appropriate for early stage, low risk cancer usually defined as Stage T1/T2, Gleason < 7, and PSA < 10 with a small involvement shown on biopsy cores. IMRT is widely used in early stage as well, but can also be used for intermediate and advanced PCa as well as a salvage treatment should PSA rise after RP. CyberKnife can be completed in five sessions (sometimes it is done in four sessions) each about 40-45 minutes long. IMRT takes several weeks.

I don’t think there is a right or wrong answer here…it depends on the stage of cancer, what your insurance will cover, what your personal preferences are with respect to treatment, and your risk aversion to the potential side effects of either method.

Never having been in the Kaiser HMO I can't comment on the specifics of what this system does or does not cover although I do believe they do not cover CyberKnife.

Swingshiftworker · November 2010

hopeful111 said:
sbrt ck
In this thread, I don't see any comments about the non cyberknife
kind of imrt/igrt treatments - is that beause the kaiser does not
provide/offer those or because they are viewed as not as good
as cyberknife these days ? (or that with just a relatively small
number of posters that it was just not mentioned)
(I realize the imrt/igrt takes many weeks, but wondering if there
are other reasons it might not be viewed as good as cyberknife ?)

am new to the board, if my questions are not appropriate or belong
somewhere else, please let me know.

IMRT/IGRT vs CK
CK is major advancement over IMRT/IGRT, which was actually based on those technologies.

I believe that Novalis (which is similar tobut not the same as CK) actually uses an IMRT device modified for use for PCa to emulate CK but is not as good as CK. With CK, both the table and arm move to correct for body/organ movement and can achieve margins as small as 0.5mm. I also believe that the Novalis table is stationary and requires the use of a body cast (like Proton Beam Thearpy) in order to prevent body movement during radiation treatment, but still cannot achieve the same degree of precision as CK. A body cast is not required for CK. Also, FYI, CK is offered by Kaiser but NOT for use w/PCa.

I think the reason we are focusing on CK (as opposed to IMRT/IGRT)is not only because it is a BETTER form of treatment than IMRT/IGRT but also because the original poster had a diagnosis of "early stage" PCa and because the "small number" of posters (including me) also had early stage PCa and chose (after considerable research and consideration, including information on IMRT/IGRT))to received CK for treatment.

CK is not used for "late stage" and advanced PCa and I don't think that CK would have been mentioned by anyone if that was an issue. Later stage cancers require other forms of treatment -- which possibly includes IMRT/IGRT -- that I do not have (and hope to never have) any experience with and I leave it to others better informed than I am to comment about the treatment of more serious forms of PCa.

rch · November 2011

LCB2 said:
SBRT CK
Thanks for the UCLA info. I did not know that Dr. King was there now. Might influence my decisions.

Presently I plan to get a 2nd opion on all treatment options and more specifically CK from either UCSF or Stanford. UC is more convenient. However, Stanford seems to have more experience with CK and PC treatment. UCLA is a third choice because of some potential insurance issues.

Didyou get any treatment or still in AS ?
Hi LCB
I read the thread , but did n't see any further updates since Nov 7,2010. Did you get any treatment or still on AS? Did you switch from Kaiser to another carrier? I'm with Kaiser in N.Cal, and on AS but sooner or later would need to make some tough decisions.I have Kaiser Senior advantage. I'm 66. I'm not too unhappy with Kaiser except that my choices are limited to Brachy or RP ( RALP or open). My Urologist with Kaiser stated that CK did not have enough track record > 5 yrs to justify it's use for operable CAP. Kaiser N. Cal has one of the best Brachy Centers as well as open RP Urologists , but has only mediocre RALP program which started only since 2007.

jerrybs · January 2012

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
I was told Kaiser offers CK in the south san sf. location. I have a consult with Dr Sung on the 23rd. Kaiser does farm out radiation theraphy(imrt) as they do not perform in house. I am very interested in CK, your report covers the reasons I am interested.

Thanks

Jerry

Swingshiftworker · January 2012

jerrybs said:
swingshiftworker
I was told Kaiser offers CK in the south san sf. location. I have a consult with Dr Sung on the 23rd. Kaiser does farm out radiation theraphy(imrt) as they do not perform in house. I am very interested in CK, your report covers the reasons I am interested.

Thanks

Jerry

CK for PCa at Kaiser?
Jerry:

Did you get an appt for a consultation for CK for PCa at the Kaiser CK facility in SSF? If so that'll be the 1st time I've heard that.

Did you get a referral from your primary care physician there and do they understand that you are looking to get CK treatment for PCa?

Let us know what happens after your appt w/Dr. Sung (whoever he is).

Thanks!

jak30022 · May 2012

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!!

Current Status
Swingshiftworker -

It appears that it has been almost 18 months since your treatment. How do things stand at this point? Many physicians don't want to consider this treatment an option because of the lack of data. Interested in your thoughts.

thanks.

uretski · March 2015

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!!

Hello,

My dad was diagnosed with stage 1 PC a few days ago and I am doing research to better understand treatment options offered to him at Kaiser San Francisco. He had a consultation with his urologist and was recommended the SBRT "CyberKnife" treatment, a total of 5. They do it at Kaiser now, at the South San Francisco Campus. Basically, I am trying to locate people that underwent this procedure to get first–hand info on the side effects they experienced, both short- and long-term. Having read about the possible side effects, I am very worried about my dad's quality of life after the procedure. Another option given to him is laparoscopic surgery, although his urologist seems to lean towards cyber knife for my dad.

My dad is 69 and has serious health issues (advanced heart disease, diabetes w/kidney disease). I think his medical history might be the reason behind his doctor's recommendation to do cyberknife instead of surgery.

If you don't mind sharing your experience – I'd greatly appreciate feedback. Thank you!

VascodaGama · March 2015

Why does he need a treatent

Uretsky

Welcome to the board.

I would suggest you to start a newer thread with the questions and information on your dad's case. It will be easier for survivours to find your post and help you.

I wonder why his doctor suggested treatment if he is a T1 patient and got several other health issues. Can you share details of his diagnosis? What is the Gleason score, PSA, DRE, symptoms, etc ?

Best wishes

VG

Swingshiftworker · March 2015

uretski said:
Hello,

My dad was diagnosed with stage 1 PC a few days ago and I am doing research to better understand treatment options offered to him at Kaiser San Francisco. He had a consultation with his urologist and was recommended the SBRT "CyberKnife" treatment, a total of 5. They do it at Kaiser now, at the South San Francisco Campus. Basically, I am trying to locate people that underwent this procedure to get first–hand info on the side effects they experienced, both short- and long-term. Having read about the possible side effects, I am very worried about my dad's quality of life after the procedure. Another option given to him is laparoscopic surgery, although his urologist seems to lean towards cyber knife for my dad.

My dad is 69 and has serious health issues (advanced heart disease, diabetes w/kidney disease). I think his medical history might be the reason behind his doctor's recommendation to do cyberknife instead of surgery.

If you don't mind sharing your experience – I'd greatly appreciate feedback. Thank you!

Do it!

If you father is eligible for CK and can get it done at Kaiser, DO IT!!!

It's news to me that Kaiser NorCal now offers CK for PCa. Wish they had offered it 5 years ago. Would have saved me a lot of trouble if they did. There are numerous threads here posted by me chronicaling my experience with CK which (despite some PSA inconsistencies) was entirely successful.

I was treated w/CK in Sept 2010 at UCSF under Blue Shield (had to opt out of Kaiser to go there) and I am now entirely cancer free and have had absolutely NO side effects -- no ED, no incontinency, nothing!!!!

There are other members on this forum who have reported similar positive results. Too early to know what the long term results are; the most you'll find will be 10 years out but all that I have heard have been positive as well.

Good luck!!!!

BTW, since you're local to me, if you send me a private mesage w/your phone number, I would be happy to call and speak w/you and your father about CK.

Kaiser Northern CA Therapy Options

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