Cyberknife Procedure Update

Kongo
Kongo Member Posts: 1,166 Member
edited March 2014 in Prostate Cancer #1
At age 59 I was diagnosed with PCa in mid-March after my PSA had risen from 3.8 to 4.3 in 18 months. 1 of 12 biopsy cores showed adenocarcinoma with 15% involvement. Gleason rating was 3+3=6. DRE was normal. Staged at T1c. I had a prostate volulme of 47 ml, a PSA velocity of 0.23 ng/ml/yr and a PSA doubling time of 9.3 years. There was no evidence of perineural invasion. A second opinion on the pathology slides confirmed the original reading of 3+3=6 Gleason score. Interestingly, after eliminating dairy and red meat from my diet my PSA score in mid-May had dropped to 2.8 which my doctor characterized as "great, but you still have cancer."

After several consulatations, a lot of study, and a careful investigation of surgery, various forms of radiation (both photon and proton), and active surveillance, I have elected to pursue treatment with the Cyberknife procedure.

Cyberknife uses a robot to deliver a high dose of radiation with sub-millimeter accuracy to the prostate. Four gold markers (called fiducials) -- about the size of a grain of rice -- are inserted into the prostate and detailed MRI and CT scans are used to track the movement of the prostate in real time so that the dosage is accurately delivered without damaging surrounding organs and tissue.

I had the fiducials implanted yesterday. It was a pretty simple procedue that inserted the fiducials into the prostaste via the perineum using a live sonagram video taken with a rectal monitor. Unlike the biopsy procedure where the needles are inserted transrectally, this procedure did not require enemas or antibiotics and there was no resultant blood in the urine or stool. Best of all, there was essentially no pain. I was sedated during the procedure and it was conducted without incident or after effect. Afterwards, an x-ray of the prostate was taken to ensure the fiducials were properly placed. There is a very slight soreness in the area of my perineum today but not enough to warrant any pain killers.

The next step is to build a detailed 3-D picture of the prostate using a detailed MRI scan so that the dosage parameters can be calculated. This will take place in about a week as they have to wait to be sure that the fiducials are not moving. They will also build me a customized pod to lay in while undergoing radiation treatment to minimize body motion.

After the radiation plan is developed, the radiation is delivered in five sessions that each last about 45 minutes while the robot rotates about the body in six-degrees of axis while it adjusts itself to prostate movement. The prostate can move up to several millimeters in a short period of time through normal respiratory function, bladder filling, and gases in the colon so adjusting the robotic x-ray placement is critical in avoiding radiation to surrounding tissue.

In most cases, the radiation is delivered in five consecutive sessions. I had read a recent Stanford study that suggested a protocol that skipped a day between sessions to allow better recovery of tissue near the urethra and my physician team was ameniable to this delivery schedule.

I expect to start the radiation within a few weeks.

Cyberknife has a very low incidence of follow-on urinary difficulties which are mostly a sense of urgency and more frequent urination that resolves itself within a few days. Skipping days between radiation treatments is supposed to alleviate this potential side effect. Post treatment erectile function with Cyberknife indicates that men who have no ED before treatment are 85% potent following treatment. Men who experience a decrease in erectile function following treatment are treated successfully with Viagra-like drugs.

Success with Cyberknife, like all radiation treatments, is measured by reaching a stable PSA nadir at some point following treatment. Studies have shown that the higher dosages that can be delivered with Cyberknife are instrumental in a rapid PSA drop following treatment and a nadir that is typically below 1.0 ng/ml with a statistically insignificant percent of biological failures for men with early stage PCa (PSA <10, Gleason < 7, and Stage T1.)

My Tricare insurance covered Cyberknife without blinking. I understand Medicare also covers it. I've read that some insurance plans and HMOs may not cover Cyberknife although the procedure was approved for cancer treatment by the FDA in 2000.

Will keep you all posted as to the specifics of the treatment process and how it works for me.
«134

Comments

  • bdhilton
    bdhilton Member Posts: 803 Member
    I wish you well in your
    I wish you well in your journey with the best results.
  • mrspjd
    mrspjd Member Posts: 694 Member
    kongo
    Thanks for the update and for keeping us posted on your progress and journey. My brother (yes, both my brother and husband have PCa, increasing the chances of PCa for our three sons) had this procedure at UCLA with Dr. King and he seems pleased with the result.
    Wishing you all the best.
    Sincerely,
    mrs pjd
  • randy_in_indy
    randy_in_indy Member Posts: 496 Member
    Kongo
    Sounds great for the best outcome for you! I will be very interested in the progression following the procedure and so will many others. Question...have they tried to map out exactly where the cancer is within the prostate or will they be basically decimating the entire organ to be sure to kill all bad cells?

    thanks again for you candor and recap of your experience as there is nothing like real life case studies to help others in the tough decisions that have to be made with this beast.

    Randy in Indy
  • Kongo
    Kongo Member Posts: 1,166 Member

    Kongo
    Sounds great for the best outcome for you! I will be very interested in the progression following the procedure and so will many others. Question...have they tried to map out exactly where the cancer is within the prostate or will they be basically decimating the entire organ to be sure to kill all bad cells?

    thanks again for you candor and recap of your experience as there is nothing like real life case studies to help others in the tough decisions that have to be made with this beast.

    Randy in Indy

    Prostate Radiation
    Randy,

    Like most radiation treatments, the entire prostate is radiated. The impact of this is that there is reduced ejaculate but no dry orgasms. Nerves and the penile bulb are generally not affected in Cyberknife treatments because of the ability of the robot to deliver extremely accurate dosage placement. If you were potent before radiation you will most likely be OK afterward. For those who have difficulty achieving a usable erection after radiation, Viagra or Cialis have been shown to be almost universally effective. Although the entire prostate is zapped, the ability of Cyberknife to spare surrounding organs and tissue is well documented. Occasionally there is some rectal bleeding in about 5-10 percent of the cases but this can be addressed through out-patient surgery where the damaged blood vessels in the colon are essentially cauterized.

    I am happy to hear of your progress in recovery and the good news of your post-RP PSA readings.
  • 142
    142 Member Posts: 169
    Progress
    It sounds from all your posts that you have made a well-considered decision. I wish you the best results.
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    Good luck....cyberknife is a viable treatment option
    By the way, last night I watched a dvd of a lecture that don Fuller, a radiation onclolgist at the cyberknife center of san diego gave in april , 2009.

    Are you going to the this center?

    Ira
  • Kongo
    Kongo Member Posts: 1,166 Member

    Good luck....cyberknife is a viable treatment option
    By the way, last night I watched a dvd of a lecture that don Fuller, a radiation onclolgist at the cyberknife center of san diego gave in april , 2009.

    Are you going to the this center?

    Ira

    Ira
    Hi, Ira. I am actually going to the Cyberknife center in north county at Vista. I have corresponded briefly with Dr. Fuller and he is well respected in San Diego.
  • viperfred
    viperfred Member Posts: 20
    CyberKnife Procedure Update
    Hi Kongo,

    Fantastic evaluation of the treatment options. Dr. D. Fuller is a wonderful doctor with excellent results treating PCa with the CyberKnife.

    I was treated May 2008 for PCa with the CyberKnife at Stanford by Dr. Chris King (now at UCLA). Evaluated all options as you did and came to the same conclusion as you.

    Side effects were very short term, urgency and frequency for bowel and urination, returning to normal within two months and today have ZERO negative side effects. Urination frequency before treatment was 2-3 times/night and is now 0-once a night. PSA is now 0.55 ng/ml, initial PSA was 5.0 ng/ml.

    Glad your insurance company is covering the CK, many do not. In my case had to go to the CA Dept. of Managed Health Care and appeal the denial, the denial was overturned and two months later BS of CA added CK coverage for PCa.

    The CyberKnife uses a hypo fractionation dose which is high dose per session 7.25 Gy/session with the five day protocol and 9.5 Gy/session with the four day protocol, but much lower total dose than IMRT or Proton Therapy. Hypo fractionation (HDR Brachytherapy) has a very good cure history (around 15 years). Side effects for both protocols seem to be the same.

    Over four thousand patients have been treated for PCa with the CyberKnife and the results are very good. There are many who do not understand the CyberKnife and there are those who intentionally misrepresent the CyberKnife. The number of patients treated for PCa by year(2003-2009) are on my web site http://www.iprostatecancer.com/

    Good Luck,
  • bdhilton
    bdhilton Member Posts: 803 Member
    viperfred said:

    CyberKnife Procedure Update
    Hi Kongo,

    Fantastic evaluation of the treatment options. Dr. D. Fuller is a wonderful doctor with excellent results treating PCa with the CyberKnife.

    I was treated May 2008 for PCa with the CyberKnife at Stanford by Dr. Chris King (now at UCLA). Evaluated all options as you did and came to the same conclusion as you.

    Side effects were very short term, urgency and frequency for bowel and urination, returning to normal within two months and today have ZERO negative side effects. Urination frequency before treatment was 2-3 times/night and is now 0-once a night. PSA is now 0.55 ng/ml, initial PSA was 5.0 ng/ml.

    Glad your insurance company is covering the CK, many do not. In my case had to go to the CA Dept. of Managed Health Care and appeal the denial, the denial was overturned and two months later BS of CA added CK coverage for PCa.

    The CyberKnife uses a hypo fractionation dose which is high dose per session 7.25 Gy/session with the five day protocol and 9.5 Gy/session with the four day protocol, but much lower total dose than IMRT or Proton Therapy. Hypo fractionation (HDR Brachytherapy) has a very good cure history (around 15 years). Side effects for both protocols seem to be the same.

    Over four thousand patients have been treated for PCa with the CyberKnife and the results are very good. There are many who do not understand the CyberKnife and there are those who intentionally misrepresent the CyberKnife. The number of patients treated for PCa by year(2003-2009) are on my web site http://www.iprostatecancer.com/

    Good Luck,

    Your web site is a
    Your web site is a commercial for Cyberknife...
  • randy_in_indy
    randy_in_indy Member Posts: 496 Member
    bdhilton said:

    Your web site is a
    Your web site is a commercial for Cyberknife...

    Yes The web sight is nothing more than a Tainted AD...
    Not only that...the ratings for the other treatments are total and complete BULL Sh&t!! Saying incontience for surgery is 20-70% typical....BS.
  • viperfred
    viperfred Member Posts: 20

    Yes The web sight is nothing more than a Tainted AD...
    Not only that...the ratings for the other treatments are total and complete BULL Sh&t!! Saying incontience for surgery is 20-70% typical....BS.

    CyberKnife
    Randy look at the studies for surgery open or robotics. If you can provide studies with lower numbers send them to me and I will be glad to include them in my site and change the numbers.

    It is easy to make comments without data. Take time to look at the studies, I have!

    From my research and personal experience the CyberKnife is the best choice for localized PCa.

    Men need to look at all treatment options and make an informed choice they feel is best for them. Trust no one including me, let clinical data, science and your instincts be you guide in consultation with your doctors.
  • randy_in_indy
    randy_in_indy Member Posts: 496 Member
    viperfred said:

    CyberKnife
    Randy look at the studies for surgery open or robotics. If you can provide studies with lower numbers send them to me and I will be glad to include them in my site and change the numbers.

    It is easy to make comments without data. Take time to look at the studies, I have!

    From my research and personal experience the CyberKnife is the best choice for localized PCa.

    Men need to look at all treatment options and make an informed choice they feel is best for them. Trust no one including me, let clinical data, science and your instincts be you guide in consultation with your doctors.

    Viper
    There are 3 surgeons in Indianapolis that have from 2-5% incontinence in there patients over the last 3 years in Dr. Scott, Dr. Hollensbe and Dr. Koch. These are there success rates - I am one that is fully continent from Dr. Hollensbe. Your figures from studies are outdated when compared to the surgeons at the forefront of the Robotic surgery. Mani Manning in Michigan, Atwari in NY, Burnett at John Hopkins...The group here in Indiana.....none of these guys even come close to 20% incontinenc with their patients....your website is a blatant AD for Cyberknife (Which is probably a very good procedure and outcome) However the figures you throw around for other treatments seriously downplay the success that has been achieved in other treatments....Please show me the exact studies that qualify you to say:

    o Incontinence, 20 to 70% risk typical

    Who were the surgeons, When were the surgeries?

    Your information is misleading to a person who has not researched the large body of evidence.

    Sorry, you cannot make me think anything other than that...I call it like I see it and I am usually correct.

    Randy in Indy
  • viperfred
    viperfred Member Posts: 20
    bdhilton said:

    Your web site is a
    Your web site is a commercial for Cyberknife...

    CyberKnife
    There are many treatment options for localized PCa, and many treatments continue to improve with advancements in technology. There are no studies that show any treatment is better than any other.

    The following link includes an article about the CyberKnife and comments from many stakeholders excluding the insurance companies. http://blogs.wsj.com/health/2008/11/28/is-cyberknife-ready-for-prime-time-in-prostate-cancer/

    May Your PSA Never Increase!
  • randy_in_indy
    randy_in_indy Member Posts: 496 Member
    viperfred said:

    CyberKnife
    Randy look at the studies for surgery open or robotics. If you can provide studies with lower numbers send them to me and I will be glad to include them in my site and change the numbers.

    It is easy to make comments without data. Take time to look at the studies, I have!

    From my research and personal experience the CyberKnife is the best choice for localized PCa.

    Men need to look at all treatment options and make an informed choice they feel is best for them. Trust no one including me, let clinical data, science and your instincts be you guide in consultation with your doctors.

    Hey Viper you asked for a study...here it is
    Here is a link to one of the largest studies done on Robotic. Check out these numbers...better update your web page:

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

    Here's a small recap of the findings:

    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.


    Randy in Indy
  • bdhilton
    bdhilton Member Posts: 803 Member

    Viper
    There are 3 surgeons in Indianapolis that have from 2-5% incontinence in there patients over the last 3 years in Dr. Scott, Dr. Hollensbe and Dr. Koch. These are there success rates - I am one that is fully continent from Dr. Hollensbe. Your figures from studies are outdated when compared to the surgeons at the forefront of the Robotic surgery. Mani Manning in Michigan, Atwari in NY, Burnett at John Hopkins...The group here in Indiana.....none of these guys even come close to 20% incontinenc with their patients....your website is a blatant AD for Cyberknife (Which is probably a very good procedure and outcome) However the figures you throw around for other treatments seriously downplay the success that has been achieved in other treatments....Please show me the exact studies that qualify you to say:

    o Incontinence, 20 to 70% risk typical

    Who were the surgeons, When were the surgeries?

    Your information is misleading to a person who has not researched the large body of evidence.

    Sorry, you cannot make me think anything other than that...I call it like I see it and I am usually correct.

    Randy in Indy

    Randy… This guy is a
    Randy… This guy is a “Troll” plain and simple. He makes Cyberknife sound like a magically cure and this is really unforgivable with guys coming in here looking for real guidance…So in my eyes this guy has no credibility. It could be the next best thing since sliced bread but I have yet to find any real studies on cyberknife except by the manufacture for PCa….Sorry that is how I see it…and I love you retort "I call it like I see it and I am usually correct..." amen

    Best to you
  • randy_in_indy
    randy_in_indy Member Posts: 496 Member
    bdhilton said:

    Randy… This guy is a
    Randy… This guy is a “Troll” plain and simple. He makes Cyberknife sound like a magically cure and this is really unforgivable with guys coming in here looking for real guidance…So in my eyes this guy has no credibility. It could be the next best thing since sliced bread but I have yet to find any real studies on cyberknife except by the manufacture for PCa….Sorry that is how I see it…and I love you retort "I call it like I see it and I am usually correct..." amen

    Best to you

    LOL - i usually am right
    Notice he has not commented on the largest study ever done on robotics that blows his retarded statistics away that he pushes on his web site.

    "• Side effects
    o ED, 20 % to 80% risk typical
    o Incontinence, 20 to 70% risk typical"

    TOTAL and COMPLETELY MISLEADING the NEWBIE's

    Sorry VIPER you have been exposed.

    Randy in Indy
  • Kongo
    Kongo Member Posts: 1,166 Member
    viperfred said:

    CyberKnife Procedure Update
    Hi Kongo,

    Fantastic evaluation of the treatment options. Dr. D. Fuller is a wonderful doctor with excellent results treating PCa with the CyberKnife.

    I was treated May 2008 for PCa with the CyberKnife at Stanford by Dr. Chris King (now at UCLA). Evaluated all options as you did and came to the same conclusion as you.

    Side effects were very short term, urgency and frequency for bowel and urination, returning to normal within two months and today have ZERO negative side effects. Urination frequency before treatment was 2-3 times/night and is now 0-once a night. PSA is now 0.55 ng/ml, initial PSA was 5.0 ng/ml.

    Glad your insurance company is covering the CK, many do not. In my case had to go to the CA Dept. of Managed Health Care and appeal the denial, the denial was overturned and two months later BS of CA added CK coverage for PCa.

    The CyberKnife uses a hypo fractionation dose which is high dose per session 7.25 Gy/session with the five day protocol and 9.5 Gy/session with the four day protocol, but much lower total dose than IMRT or Proton Therapy. Hypo fractionation (HDR Brachytherapy) has a very good cure history (around 15 years). Side effects for both protocols seem to be the same.

    Over four thousand patients have been treated for PCa with the CyberKnife and the results are very good. There are many who do not understand the CyberKnife and there are those who intentionally misrepresent the CyberKnife. The number of patients treated for PCa by year(2003-2009) are on my web site http://www.iprostatecancer.com/

    Good Luck,

    Viper
    Viper,

    Thanks for the encouraging report on your personal experience with Cyberknife. I’m hoping for similar results. I have read your many posts on the Cyberknife Discussion Forum and know that you are a knowledgeable and enthusiastic advocate of the procedure.

    My personal studies and analysis covered the same scope and reached similar conclusions as what you outlined on your website, although I’m always reluctant to take too much stock in success statistics regarding side effects because of the great disparity of how they’re set up and the definitions they use. Many studies on ED define potency as the ability to achieve an erection sufficient for penetration at least once a month. To me, that’s not very potent. Similarly, incontinence covers the gamut of zero bladder control and permanent catheter use to an occasional sense of urgency or increase in frequency of urination.

    In the study that Randy cited in his post, it’s pretty clear that the excellent results described in this 2007 report out of New York Presbyterian Hospital, were a function of a highly skilled and experienced surgeon (they emphasized that point more than once in the paper). I believe that the studies that show a much lower success rate with respect to incontinence and ED following surgery are a result of less experienced surgeons. Randy had excellent results with his DaVinci procedure, but it wasn’t just luck. Randy did a disciplined, deliberate, and wide-ranging study like you and I did then made a decision which was best for him. He then sought out one of the finest DaVinci surgeons in the country to do his procedure and he’s now a poster boy for DaVinci.

    Unfortunately, not all men have the same experience as Randy for a variety of reasons. I personally believe that a man’s pre-treatment physical condition and lifestyle play almost as much as role in post-treatment outcome as the treatment team. None of the studies I’ve read normalize age, physical condition, stage, lifestyle, and so forth in establishing the study group.

    Another thing about studies…the results are easily skewed based on the selection of the cohort. In Cyberknife, for example, the men included in the studies must meet a strict protocol that includes stage T1/T2, PSA < 10, Gleason less than 7, minimal involvement from biopsy cores, and prostate contained. (I know this because I'm in a study myself and had to qualify using this criteria) I’m happy to be in that category but frankly, for someone with my pathology, just about any treatment protocol has an extremely high likelihood of success. I don’t have any idea of the restrictions on the cohort group in the study that Randy cited, but I’m sure there was some.

    Viper, I see that you are new to this forum. The regulars here are very sensitive to any perception of hype associated with pushing one treatment over another. The general protocol here is to cite one’s personal experience and provide unbiased information as a means of helping others who must face similar treatment decisions. In the recent past there have been posters on this forum who had a hidden agenda and were using this discussion board as marketing tool for one treatment over another. As I know a bit of your background from the other forum, I don’t believe you’re pushing Cyberknife over anything else, but be cognizant of the general sensitivity. Most of the regular posters are highly conversant with the nuances of PCa, the relevant studies associated with the treatment options, and have a great deal of experience with the side effects of treatment.

    Randy and BD: I think you should give our PCa brother, Viper, some slack here. Based on what I know of Viper from another forum I am pretty confident he’s not a “troll” like some of the recent other intruders we’ve seen here.
  • lewvino
    lewvino Member Posts: 1,010
    viperfred said:

    CyberKnife
    There are many treatment options for localized PCa, and many treatments continue to improve with advancements in technology. There are no studies that show any treatment is better than any other.

    The following link includes an article about the CyberKnife and comments from many stakeholders excluding the insurance companies. http://blogs.wsj.com/health/2008/11/28/is-cyberknife-ready-for-prime-time-in-prostate-cancer/

    May Your PSA Never Increase!

    I've been following this
    I've been following this thread and have not commented yet. There are two comments in your most recent link which were interesting to me.
    If you want to have an honest approach to help others when you direct them to your initial website link you should make sure and include these two comments along with links to the study that Randy posted.

    1. “This is really pushing the envelope....... But it could turn out to be a disaster. No one knows.”
    2. At least one study that followed patients for several years suggests the device is safe and effective, the WaPo says.
    But that single study isn’t enough to provide clear evidence.

    These two comments reinforce to me that I did make the right choice for my Gleason 7. I have actually looked into CyberKnife to learn more about it and I'm glad that CyberKnife appears to have worked for you and wish you many years of health. I as others on here researched extensively the different options before selecting treatment. It breaks my heart to read of those that just jump into whatever option their Doctor suggests. I'm glad my Doc encouraged me to research and he would back me with my choice.

    The one thing that we each have to remember is that EACH CASE IS UNIQUE. My dad had proton with great success, I have a friend at Church that had Seed implants with great success.
    I along with others on the forum have had great success with Davinci. I know of others that have had traditional Surgery with Great Success.

    There are so many factors that affect each of us and our treatment outcomes such as PSA, Gleason Score, Free PSA, etc. etc. plus our own lifestyles, individual weight, exercise patterns, eating habits.

    It is also interesting that you point out that your PSA is "now 0.55 ng/ml, initial PSA was 5.0 ng/ml." My PSA Pre-surgery was 5.3 and now is 0.
    For surgery having a follow up PSA of .55 would indicate that I would need further treatment.
    I realize that with Surgery the prostate is gone...and with the Cyberknife the prostate is zapped but still in you and which I believe would give you the .55 reading.

    I'm glad Randy calls it as he sees it and hope that each of us can help other men that come down this path behind us and learn from our shared experiences.

    Larry
  • Kongo
    Kongo Member Posts: 1,166 Member
    lewvino said:

    I've been following this
    I've been following this thread and have not commented yet. There are two comments in your most recent link which were interesting to me.
    If you want to have an honest approach to help others when you direct them to your initial website link you should make sure and include these two comments along with links to the study that Randy posted.

    1. “This is really pushing the envelope....... But it could turn out to be a disaster. No one knows.”
    2. At least one study that followed patients for several years suggests the device is safe and effective, the WaPo says.
    But that single study isn’t enough to provide clear evidence.

    These two comments reinforce to me that I did make the right choice for my Gleason 7. I have actually looked into CyberKnife to learn more about it and I'm glad that CyberKnife appears to have worked for you and wish you many years of health. I as others on here researched extensively the different options before selecting treatment. It breaks my heart to read of those that just jump into whatever option their Doctor suggests. I'm glad my Doc encouraged me to research and he would back me with my choice.

    The one thing that we each have to remember is that EACH CASE IS UNIQUE. My dad had proton with great success, I have a friend at Church that had Seed implants with great success.
    I along with others on the forum have had great success with Davinci. I know of others that have had traditional Surgery with Great Success.

    There are so many factors that affect each of us and our treatment outcomes such as PSA, Gleason Score, Free PSA, etc. etc. plus our own lifestyles, individual weight, exercise patterns, eating habits.

    It is also interesting that you point out that your PSA is "now 0.55 ng/ml, initial PSA was 5.0 ng/ml." My PSA Pre-surgery was 5.3 and now is 0.
    For surgery having a follow up PSA of .55 would indicate that I would need further treatment.
    I realize that with Surgery the prostate is gone...and with the Cyberknife the prostate is zapped but still in you and which I believe would give you the .55 reading.

    I'm glad Randy calls it as he sees it and hope that each of us can help other men that come down this path behind us and learn from our shared experiences.

    Larry

    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
    bdhilton Member Posts: 803 Member
    Kongo said:

    Viper
    Viper,

    Thanks for the encouraging report on your personal experience with Cyberknife. I’m hoping for similar results. I have read your many posts on the Cyberknife Discussion Forum and know that you are a knowledgeable and enthusiastic advocate of the procedure.

    My personal studies and analysis covered the same scope and reached similar conclusions as what you outlined on your website, although I’m always reluctant to take too much stock in success statistics regarding side effects because of the great disparity of how they’re set up and the definitions they use. Many studies on ED define potency as the ability to achieve an erection sufficient for penetration at least once a month. To me, that’s not very potent. Similarly, incontinence covers the gamut of zero bladder control and permanent catheter use to an occasional sense of urgency or increase in frequency of urination.

    In the study that Randy cited in his post, it’s pretty clear that the excellent results described in this 2007 report out of New York Presbyterian Hospital, were a function of a highly skilled and experienced surgeon (they emphasized that point more than once in the paper). I believe that the studies that show a much lower success rate with respect to incontinence and ED following surgery are a result of less experienced surgeons. Randy had excellent results with his DaVinci procedure, but it wasn’t just luck. Randy did a disciplined, deliberate, and wide-ranging study like you and I did then made a decision which was best for him. He then sought out one of the finest DaVinci surgeons in the country to do his procedure and he’s now a poster boy for DaVinci.

    Unfortunately, not all men have the same experience as Randy for a variety of reasons. I personally believe that a man’s pre-treatment physical condition and lifestyle play almost as much as role in post-treatment outcome as the treatment team. None of the studies I’ve read normalize age, physical condition, stage, lifestyle, and so forth in establishing the study group.

    Another thing about studies…the results are easily skewed based on the selection of the cohort. In Cyberknife, for example, the men included in the studies must meet a strict protocol that includes stage T1/T2, PSA < 10, Gleason less than 7, minimal involvement from biopsy cores, and prostate contained. (I know this because I'm in a study myself and had to qualify using this criteria) I’m happy to be in that category but frankly, for someone with my pathology, just about any treatment protocol has an extremely high likelihood of success. I don’t have any idea of the restrictions on the cohort group in the study that Randy cited, but I’m sure there was some.

    Viper, I see that you are new to this forum. The regulars here are very sensitive to any perception of hype associated with pushing one treatment over another. The general protocol here is to cite one’s personal experience and provide unbiased information as a means of helping others who must face similar treatment decisions. In the recent past there have been posters on this forum who had a hidden agenda and were using this discussion board as marketing tool for one treatment over another. As I know a bit of your background from the other forum, I don’t believe you’re pushing Cyberknife over anything else, but be cognizant of the general sensitivity. Most of the regular posters are highly conversant with the nuances of PCa, the relevant studies associated with the treatment options, and have a great deal of experience with the side effects of treatment.

    Randy and BD: I think you should give our PCa brother, Viper, some slack here. Based on what I know of Viper from another forum I am pretty confident he’s not a “troll” like some of the recent other intruders we’ve seen here.

    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