Opinions re: CyberKnife

Just had a consultation with my Urologist.

PSA was 3.7 a month ago and had been increasing the last 2 years from
1.8-2.7.

DRE showed nothing . Had trans-rectal ultrasound with biopsies taken.
Detected Prostate Cancer. Have Gleason of 6 and TNM of T1c.

Dr. explained various approaches, rad. prostactectomy (no way!),
hormonal, radioactive seeding, radiation treatment and CyberKnife. He
is a surgeon by trade but says if he were in my situation he would take
the CyberKnife approach. Says it is very highly accurate and has
virtually no side-effects.

Anyone have experiences with CyberKnife treatment?

Thanks in advance.

Sy

"Sy" <stuttgart6@lycos.com> wrote in message
news:240820071501413926%stuttgart6@lycos.com...
>
> Just had a consultation with my Urologist.
>
> PSA was 3.7 a month ago and had been increasing the last 2 years from
> 1.8-2.7.
>
> DRE showed nothing . Had trans-rectal ultrasound with biopsies taken.
> Detected Prostate Cancer. Have Gleason of 6 and TNM of T1c.
>
> Dr. explained various approaches, rad. prostactectomy (no way!),
> hormonal, radioactive seeding, radiation treatment and CyberKnife. He
> is a surgeon by trade but says if he were in my situation he would take
> the CyberKnife approach. Says it is very highly accurate and has
> virtually no side-effects.

Sy,

Welcome the club no one asked to join.

'Tis time for you to take the bull by the horns and do some.... no, a lot!
.... of research. We have a great bunch of guys here who will answer any
questions you put to us, but your life is in your hands and you will have to
be making a huge decision soon.

Some the of criteria that goes into such a decision includes your age and
physical well-being. If you are older than 70, maybe that prostatectomy is
'no way.' If you're less than 50, prostatectomy is WAY! There is a good
age range for brachy and there is an age at which you probably can only
consider hormones.

Personally, if my body could take it (and most can now up to 75), I would
opt for the robotic laparoscopic prostatectomy, but we don't have enough of
your stats to even come up with an opinion.



--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04 (06/12/2007)
Non Illegitimi Carborundum

Thanks for the welcome to the "club".

I am 59 years of age and in good health otherwise. Am impressed with
what I've read about the CyberKnife approach. The Urologist said that
if I were to choose the CyberKnife treatments I would need to go on
hormones two months beforehand. Anyone have any idea what type of
hormones (brand name?) would be required?

I have read a plethora of articles. Gotta watch out for Manufacturers'
web sites masquerading as some "prostate information" site.

What other "stats" would I need to supply to be a "'member' in good
standing"?

Thanks,

Sy


In article <46d09625$0$16439$4c368faf@roadrunner.com>, Steve Kramer
<skramer@cinci.rr.com> wrote:

> "Sy" <stuttgart6@lycos.com> wrote in message
> news:240820071501413926%stuttgart6@lycos.com...
> >
> > Just had a consultation with my Urologist.
> >
> > PSA was 3.7 a month ago and had been increasing the last 2 years from
> > 1.8-2.7.
> >
> > DRE showed nothing . Had trans-rectal ultrasound with biopsies taken.
> > Detected Prostate Cancer. Have Gleason of 6 and TNM of T1c.
> >
> > Dr. explained various approaches, rad. prostactectomy (no way!),
> > hormonal, radioactive seeding, radiation treatment and CyberKnife. He
> > is a surgeon by trade but says if he were in my situation he would take
> > the CyberKnife approach. Says it is very highly accurate and has
> > virtually no side-effects.
>
> Sy,
>
> Welcome the club no one asked to join.
>
> 'Tis time for you to take the bull by the horns and do some.... no, a lot!
> ... of research. We have a great bunch of guys here who will answer any
> questions you put to us, but your life is in your hands and you will have to
> be making a huge decision soon.
>
> Some the of criteria that goes into such a decision includes your age and
> physical well-being. If you are older than 70, maybe that prostatectomy is
> 'no way.' If you're less than 50, prostatectomy is WAY! There is a good
> age range for brachy and there is an age at which you probably can only
> consider hormones.
>
> Personally, if my body could take it (and most can now up to 75), I would
> opt for the robotic laparoscopic prostatectomy, but we don't have enough of
> your stats to even come up with an opinion.

"Sy" <stuttgart6@lycos.com> wrote in message
news:250820071842062972%stuttgart6@lycos.com...
>
> Thanks for the welcome to the "club".
>
> I am 59 years of age and in good health otherwise. Am impressed with
> what I've read about the CyberKnife approach. The Urologist said that
> if I were to choose the CyberKnife treatments I would need to go on
> hormones two months beforehand. Anyone have any idea what type of
> hormones (brand name?) would be required?
>
> I have read a plethora of articles. Gotta watch out for Manufacturers'
> web sites masquerading as some "prostate information" site.
>
> What other "stats" would I need to supply to be a "'member' in good
> standing"?

Ha! There are no minimum qualifications.

Other Cyberknife patients that have visted here include:

rk012d1307@blueyonder.co.uk RAYMOND KING
taz92652@yahoo.com taz92652

ellis@invalid.jps.net Ellis


I don't know what HT they used. I think Raymond had Zoladex. Lupron or
Casodex are other possibilities, I guess, but I don't know.

At 59 and in good shape, I think you can consider the whole spectrum of
treatments. Surgery seems to have a slim advantage over radiation.

--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04 (06/12/2007)
Non Illegitimi Carborundum

Hello, Sy:

Check the archives for information about the Cyberknife and other high-dose
radiation treatments. There's one fellow who is going through it right
now; I think Steve Kramer, the newsgroup historian, has provided you with a
list.

The issue some here have with the Cyberknife is that it just has not yet
been used a lot in the US for this type of treatment, so your doc's
comments about side effects and effectiveness might be somewhat optimistic.
I hope it's true, and I think it could be, based on what little I know
about it. I've found a few things online about it; it seems to be in the
evaluation phase at several of the medical centers that have a Cyberknife.
At least check on what your insurance will cover before deciding on it as a
treatment.

Do a lot of research, and read up on all of your options. The authors
mentioned on this NG a lot are Scardino, Walsh, and Strum, though I always
like to put in a plug for Prostate Cancer for Dummies by Lange.

Don't cast aside surgery. With your numbers and your age you should keep it
in mind, as well as seeds and beam radiation. You have time to do the
research you need before making a decision.

The hormone treatment you will receive before the Cyberknife treatment is a
short-term androgen deprivation therapy (ADT). It's usually done with
Lupron or Eligard. Depriving the prostate of testosterone will shrink it,
and will also lock the tumor cells in a stage that will render them more
vulnerable to the effects of the radiation. Many of the radiation
therapies include something like this before the radiation is applied.

Funny thing ... one of my friends in this area is named "Si," appears to be
lurching towards a diagnosis of PCa, and has asked me about the Cyberknife
a few times. Coincidence? :-)

--charlie

--
6/2006 PSA 5.2, DRE suspicious
7/2006 Biopsy: *2 of 10 positive, Gleason 7(3+4)
11/2006 LRP: *Clear margins, N0M0
PSA < 0.01 on 1/2007, 3/2007, 6/2007
so far, so good ...

On August 25, Sy replied to Steve K:

> I am 59 years of age and in good health otherwise. Am impressed with
> what I've read about the CyberKnife approach. The Urologist said that
> if I were to choose the CyberKnife treatments I would need to go on
> hormones two months beforehand. Anyone have any idea what type of
> hormones (brand name?) would be required?

First and foremost: learn that urologists are surgeons, and very few of
them are trained in the treatment (tx) of prostate cancer (PCa) beyond
surgery.

The specific question about "hormones" can be answered: if the uro
failed to say WHY the "hormones" are required and WHAT "hormones," he is
not performing adequately.

However, I believe that the uro had in mind chemical reduction in the
size of the prostate gland. Among the meds used for that purpose are the
LHRH agonists such as Zoladex (goserelin acetate), Trelstar
(tiriptorelin pamoate), or Lupron and its various other incarnations
(leuprolide acetate).

There are also other meds such as Avodart (dutasteride) and Proscar
(finasteride).

And others.

> I have read a plethora of articles. Gotta watch out for Manufacturers'
> web sites masquerading as some "prostate information" site.

Don't dismiss such information as being all worthless.

> What other "stats" would I need to supply to be a "'member' in good
> standing"?

Well, there is no Membership Committee that considers and passes upon
the qualifications of newbies :-)

But it is helpful to know:
Age
General health, and other health issues (co-morbidities)
When diagnosed
PSA history for the years preceding diagnosis (dx)
Clinical stage (from DRE, digital rectal examination) Frex, T2a or such
Number of specimens taken at biopsy
Number of specimens that contained PCa cells, and the percentage of each
specimen
Where the PCa specimens were located
The Gleason score of each specimen
The validated Gleason score from a specialist lab*

And anyone who tells a patient that a particular tx has "virtually no
side effects" is blowing smoke....well you know where. What, exactly,
does "virtually" mean?

Lastly: I was not txd via RP, so I can objectively ask exactly why Sy
says "no way!" to RP.

Here is the encyclopedic source of PCa information: the Prostate Cancer
Research Institute (PCRI) at
http://prostate-cancer.org/index.html
Search on "Newly Diagnosed" for a start.

Study, Learn, Take Charge!

Regards,

Steve J

"Empowerment: taking responsibility for and authority over one's own
outcomes based on education and knowledge of the consequences and
contingencies involved in one's own decisions. This focus provides the
uplifting energy that can sustain in the face of crisis."
--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled
"The Empowered Patient's Guide."







>
> Thanks,
>
> Sy
>
>
> In article <46d09625$0$16439$4c368faf@roadrunner.com>, Steve Kramer
> <skramer@cinci.rr.com> wrote:
>
>> "Sy" <stuttgart6@lycos.com> wrote in message
>> news:240820071501413926%stuttgart6@lycos.com...
>>> Just had a consultation with my Urologist.
>>>
>>> PSA was 3.7 a month ago and had been increasing the last 2 years from
>>> 1.8-2.7.
>>>
>>> DRE showed nothing . Had trans-rectal ultrasound with biopsies taken.
>>> Detected Prostate Cancer. Have Gleason of 6 and TNM of T1c.
>>>
>>> Dr. explained various approaches, rad. prostactectomy (no way!),
>>> hormonal, radioactive seeding, radiation treatment and CyberKnife. He
>>> is a surgeon by trade but says if he were in my situation he would take
>>> the CyberKnife approach. Says it is very highly accurate and has
>>> virtually no side-effects.
>> Sy,
>>
>> Welcome the club no one asked to join.
>>
>> 'Tis time for you to take the bull by the horns and do some.... no, a lot!
>> ... of research. We have a great bunch of guys here who will answer any
>> questions you put to us, but your life is in your hands and you will have to
>> be making a huge decision soon.
>>
>> Some the of criteria that goes into such a decision includes your age and
>> physical well-being. If you are older than 70, maybe that prostatectomy is
>> 'no way.' If you're less than 50, prostatectomy is WAY! There is a good
>> age range for brachy and there is an age at which you probably can only
>> consider hormones.
>>
>> Personally, if my body could take it (and most can now up to 75), I would
>> opt for the robotic laparoscopic prostatectomy, but we don't have enough of
>> your stats to even come up with an opinion.

Here are the specialist path labs that I neglected to cite in my
previous post:

Bostwick Laboratories [800] 214-6628
Dianon Laboratories [800] 328-2666 (select 5 for client services)
Jon Epstein (Hopkins) [410] 955-5043 or [410] 955-2162
David Grignon (Michigan) [313] 745-2520
Jon Oppenheimer (Tennessee) [888] 868-7522
UroCor, Inc. [800] 411-1839

Regards,

Steve J
Red-faced

On Aug 24, 2:01 pm, Sy <stuttga...@lycos.com> wrote:
> Just had a consultation with my Urologist.
>
> PSA was 3.7 a month ago and had been increasing the last 2 years from
> 1.8-2.7.
>
> DRE showed nothing . Had trans-rectal ultrasound with biopsies taken.
> Detected Prostate Cancer. Have Gleason of 6 and TNM of T1c.
>
> Dr. explained various approaches, rad. prostactectomy (no way!),
> hormonal, radioactive seeding, radiation treatment and CyberKnife. He
> is a surgeon by trade but says if he were in my situation he would take
> the CyberKnife approach. Says it is very highly accurate and has
> virtually no side-effects.
>
> Anyone have experiences with CyberKnife treatment?

I am one of the very few here that has cyberknife equivalent (Elekta
Synergy S) and high-dose too. I enrolled in a treatment study and so
far so good. The only SE is grade 1 rectal bleeding (ocasional and
persistent (6 months, and still have occasional blood stripped stool).
No problem with urinary or erection. PSA slowly going in a downward
trend, and I did not use any hormone treatment.

On Aug 24, 3:01 pm, Sy <stuttga...@lycos.com> wrote:
> Just had a consultation with my Urologist.
>
> PSA was 3.7 a month ago and had been increasing the last 2 years from
> 1.8-2.7.
>
> DRE showed nothing . Had trans-rectal ultrasound with biopsies taken.
> Detected Prostate Cancer. Have Gleason of 6 and TNM of T1c.
>
> Dr. explained various approaches, rad. prostactectomy (no way!),
> hormonal, radioactive seeding, radiation treatment and CyberKnife. He
> is a surgeon by trade but says if he were in my situation he would take
> the CyberKnife approach. Says it is very highly accurate and has
> virtually no side-effects.
>
> Anyone have experiences with CyberKnife treatment?
>
> Thanks in advance.
>
> Sy

Listen, read and consider all of this information. These guys have
been the most helpful resource to me over the past several months.

Sy wrote and asked:

> Anyone have experiences with CyberKnife treatment?

I had an appointment - stressed "seeds" when making it - with a urologist.

The only thing he talked about was the CyberKnife. Handed the wife and me a
small pile of literature and URL's.

Turned out the URL's were directly to CyberKnife and its press released,
thumping its own chest about the marvels of the machine.

The press release that stunned the wife and me stated CyberKnife was
developed for brain tumors, and later approved by the FDA for breast cancer.
It has only been recently approved for treatment of PCa.

AND, the local CyberKnife this urologist wanted to send me to had been
installed only the week before. I was possibly the first victim....er,
patient.

This was all in June 2005. I have no idea how many men have been treated
with CyberKnife in 2 or 3 years, but there just isn't enough data to prove
it's more or less effective than older methods.

OH! The literature states it's "non-invasive" but somehow they have to
plant "marker seed" in the prostate.

"El Woody" <beckett@gkbaum.com> wrote in message
news:1188215317.982484.177280@r34g2000hsd.googlegr oups.com...


>
> Listen, read and consider all of this information. These guys have
> been the most helpful resource to me over the past several months.
>

Buenos dias, Sr. Woody.

When last you checked in, as I recall, you had yet to select a treatment or
treatment date. Have you yet? Or are you waiting to see if the Phillies
can make up those five games first.

--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04 (06/12/2007)
Non Illegitimi Carborundum

Like you, my reaction to surgery was "no way". I had once had a
botched knee surgery that left me in pain for years and my
emotional reaction to another surgery was - never again would I
let someone put me to sleep and then cut me open, unless there
was no other choice. I opted for a combination therapy in a
clinical trial including ADT, high dose rate brachytherapy, and
external beam radiation.

So far, 3-1/2 years later, I'm satisfied with my treatment. That
might change if my PSA goes up. However I've learned a lot more
since then and I no longer have the same visceral reaction
against surgery that I had at the beginning. Unfortunately,
there are butchers in every field, radiation oncology as well as
surgery. So you could have a bad experience with any treatment
modality. There is also a certain element of luck in any
treatment. That too can lead to unfortunate results.

In my (in this case informed I think) opinion, the experience,
skill and commitment of the practitioner is every bit as
important as the specific treatment modality. I think I'd rather
have a very good surgeon than a mediocre radiation oncologist,
and vice versa for a good radiation oncologist and a mediocre
surgeon.

You've got some time. Your PSA and Gleason ratings are still in
the "low risk" category and may not become dangerous for as long
as several years (but heed Steve Jordan's advice about a second
opinion on the Gleason score.) This doesn't mean you shouldn't
get treatment because, at your age, it's very likely that the
cancer WILL become dangerous before you die of something else and
the chances of successful treatment are generally higher with
early treatment than late treatment. However you do have time to
research and think out the options.

I think you have two areas of research to pursue. One is to look
at treatment modalities - various types of surgery vs. various
types of radiation (of which Cyberknife is one) or possibly even
other alternatives like HIFU or cryosurgery. The other area of
research is to find the best practitioners available to you.

I would look for a doctor that specializes in treating prostate
cancer (not a urologist whose specialty is female incontinence,
or a radiation oncologist whose specialty is brain cancer.) I
would want a guy who answers questions patiently, plausibly and
honestly, not one who gives glib answers like "None of my
patients develop incontinence", "My cure rate is 99%" or "Don't
worry about impotence, it won't happen".

Talk to doctors and nurses in your area if you can and find out
who they would send their fathers or husbands to. Make
appointments for consultations with the best people you can find.
Prepare a ton of written questions and bring your notebook with
you when you go to see them.

Best of luck.

Alan

I can't say a thing about cyberknife for PC but I had it done for something
entirely different. I had neurosurgery this spring and they used cyberknife.
You are welcome to email me about what I had done as it would be off topic
for this group.

I do know that cyberknife for PC is new. Real cutting edge technology (LOL)
there's no cyber or knife in cyberknife. It's about the same as looking for
the ham in hamburger.

I'll stand behind brachytherapy 100%. I know it works.
Bev


"Sy" <stuttgart6@lycos.com> wrote in message
news:240820071501413926%stuttgart6@lycos.com...
>
> Just had a consultation with my Urologist.
>
> PSA was 3.7 a month ago and had been increasing the last 2 years from
> 1.8-2.7.
>
> DRE showed nothing . Had trans-rectal ultrasound with biopsies taken.
> Detected Prostate Cancer. Have Gleason of 6 and TNM of T1c.
>
> Dr. explained various approaches, rad. prostactectomy (no way!),
> hormonal, radioactive seeding, radiation treatment and CyberKnife. He
> is a surgeon by trade but says if he were in my situation he would take
> the CyberKnife approach. Says it is very highly accurate and has
> virtually no side-effects.
>
> Anyone have experiences with CyberKnife treatment?
>
> Thanks in advance.
>
> Sy