A friend of mine was recently treated for prostate cancer with the Cyber Knife which is a relatively new robotic method of delivering stereotactic radiation to ablate the cancer while preserving healthy surrounding tissue.
All I could find about it was on the website of the Cyber Knife Center in San Diego. It apparently evolved from the Gamma Knife used to deliver radiation to brain metastases and other solid tumors.
It been in use around two years with PCa so there's not a whole lot of data or experience around as far as I could tell. It seems to have its best application for patients who are either too old or to compromised with other health problems to undergo surgery or the protracted treatment regimens of High Dosage Brachytherapy,IMRT, EBRT or Proton Beam.
Cyber Knife is performed on an outpatient basis with or without sedation although my friend wishes he overode the radiologist's suggestion that he could do it with some local anaesthetic. He said the insertion of the needles was excruciating and he wouldn't go through it again without at least conscious sedation as with a colonoscopy.
Has anyone had experience with the Cyber Knife? Its not offered in the major cancer centers and is only available in a few private clinics and hospitals run by radiologists as far as I know. Its apparently reimbursed by Medicare. There's also been concerns expressed by other prostate surgeons and radiologists that it can't deliver the very high intensity targeted dosages of Brachtherapy,IMRT or Proton Beam and may therefore carry a greater risk of recurrance and/or positive margins. As such it may not be the most suitable treatment for otherwise healthy men with longer life expectancies. It might however be useful in treating recurrances from surgery and mainstream radiation.
Anything which can be added may be useful for newbies considering this new method.
Last edited by shs50; 10-01-2008 at 04:34 PM.
Reason: Spelling and word insertion
... There's also been concerns expressed by other prostate surgeons and radiologists that it can't deliver the very high intensity targeted dosages of Brachtherapy,IMRT or Proton Beam and may therefore carry a greater risk of recurrance and/or positive margins....
Thanks for starting this thread.
I have heard only a little about this method and was surprised by your comment about the dosing. I checked [url]www.pubmed.gov[/url] and found about eight papers on it. It appears the dose is in the neighborhood of 37.25 Gy, which is less than half the approximate dose now considered desirable for external beam radiation, and very much below the high dose areas that seeds can deliver.
Since studies have clearly demonstrated greater cancer control success as higher doses, close to about 80 Gy are delivered, I'm puzzled. There does seem to be enthusiasm for the technique from expert centers such as Stanford University, so maybe there is an explanation. Maybe the high concentration of the dose in just a handful of sessions makes it more effective.
My point exactly. I don't see how it can be effective except as a short term ablation for those too compromised to receive main stream treatments. My friend fell into this too compromised category having just recovered from colon cancer surgery that developed pulmonary embolisms which almost killed him immediately followed by acute staph and strep infections which required him to be put into a medically induced coma for 6 weeks during which he coded 3 times. He then was diagnosed with prostate cancer and obviously wasn't strong enough to undergo mainstream treatment. His 6 month post treatment PSA is 0.75 although it might not have reached nadir yet.
I was diagnosed with prostate cancer (PCa) in Aug. of 2007. My PSA was 4.0 ng/ml, a transrectal ultrasound-guided biopsy revealed a stage T1c adenocarcinoma involving the right mid to right apex with a Gleason score of 3+3; in 3 of 12 cores.
I discussed all treatment options with my family doctor, doctors at Stanford, Surgeons and Radiation Oncologists. I reviewed all options with my wife. As a father of a nine year old son, Business owner, treatment recovery time was an important consideration. I have a clogged artery which made the risk of surgery higher than I was willing to consider.
I selected SBRT/CyberKnife treatment option for prostate cancer at Stanford. Their clinical trial data, started Dec. 2003, was very encouraging with ZERO biological failures and minimal side effects (my research suggested the CyberKnife is at least as effective as IMRT). My CyberKnife treatment was five days of one hour sessions with no recovery time (IMRT is five days per week for eight weeks). I was advised of and understand the long term risk of radiation side effects and felt the advantages of SBRT/CyberKnife treatment far out weighted the long term risk.
I completed CyberKnife treatment (May 7, 2008) by Dr. Christopher King. Fourteen days post CK treatment there were minimal side effects. I continued to work every day during and after treatment.
It is now over six months post CyberKnife treatment. I am 110% of pretreatment base line for all related functions. The plus 10% is from improved urinations. Before treatment I would get up 3-4 times a night now I typically get up once. My PSA at the six month follow up was 1.09 ng/ml. SBRT/CyberKnife has treated my prostate cancer and has improved my quality of life.
Thank you for the information. I had asked my husband's urologist about the CK. He was very against it. He said, The treatment with CK is experimental at best." My husband is opting for the DaVinci surgery. Good luck to you and keep us posted on your progress.
I was diagnosed with prostate cancer (PCa) in Aug. of 2007. My PSA was 4.0 ng/ml, ... stage T1c adenocarcinoma involving the right mid to right apex with a Gleason score of 3+3; in 3 of 12 cores... As a father of a nine year old son, Business owner, treatment recovery time was an important consideration...
I selected SBRT/CyberKnife treatment option for prostate cancer at Stanford. Their clinical trial data, started Dec. 2003, was very encouraging with ZERO biological failures and minimal side effects (my research suggested the CyberKnife is at least as effective as IMRT). My CyberKnife treatment was five days of one hour sessions with no recovery time (IMRT is five days per week for eight weeks). I was advised of and understand the long term risk of radiation side effects and felt the advantages of SBRT/CyberKnife treatment far out weighted the long term risk.
I completed CyberKnife treatment (May 7, 2008) by Dr. Christopher King. Fourteen days post CK treatment there were minimal side effects. I continued to work every day during and after treatment.
It is now over six months post CyberKnife treatment... My PSA at the six month follow up was 1.09 ng/ml. SBRT/CyberKnife has treated my prostate cancer and has improved my quality of life.
Hi Fred,
Congratulations on your good experience with CyberKnife and fine looking PSA result at the six month point!
I hope you will keep posting as I believe you are the first patient to have had CyberKnife, and you had it at one of America's and very likely the world's premier radiation treatment centers, Stanford. (By the way, how did you happen to pick Stanford?)
(For those many of us who do not know much about Stanford and radiation, they have a wide ranging and very active research program in radiation for cancer, including a vigorous effort for prostate cancer. They are very highly regarded. Stanford University is located in Silicon Valley, close to San Jose and San Francisco, a location that enables it to feed and benefit from the outstanding electronics and computer resources in that area, as well as feeding and benefiting from the medical resources (including radiation and imaging, such as the University of California at San Francisco. I'm confident they are a leader in SBRT (Stereotactic Body Radiation Therapy, a very awkward name that basically means giving the full therapeutic dose in a limited number of sessions, with five sessions often mentioned - with a much higher partial dose given in each session, known by the awkward term "hypofractionation").
It would be a substantial advance in convenience if the many weeks of IMRT, Proton Beam or similar external beam radiation therapy could be reduced to just one week, as it was for you, or perhaps two weeks (see below), with SBRT. I'm sure that longer course is a deal-breaker for IMRT or Proton Beam for many of us who cannot afford the money or time needed for a long course of IMRT. (Seeds, of course, is a one or two day commitment - very fast.)
As a savvy layman survivor, CyberKnife appears to have two of the key bases well covered: tentative clinical trial evidence of effectiveness against cancer is looking good at about the three year point - as good as seeds and IMRT , and short-term radiation toxicity does not seem much of an issue for most men - on par with other approaches (or better?) . (That said, the evidence for cure with IMRT, seeds or Proton Beam is far more solid as the follow-up in several important studies is much longer.)
The key base where the jury is out is long-term radiation toxicity, which is known to be a potential issue when higher doses of radiation are delivered in each session, based on what I heard at the support group meeting mentioned earlier in this thread. Would you mind telling us what the Stanford docs said about that? Did they give details? It is clearly far too early for their clinical trials to produce that data, but I'm very curious whether Stanford has some pioneering doctors who already have some long-term results from patients in their own practices. Dr. King may be one such doctor; after all, some kind of experience must have preceded the clinical trial. While that kind of "clinical series" data does not have the force of clinical trial data with many patients, it can be a treasure trove of suggestive information. (It's the kind of information I acted on in choosing to rely solely on intermittent triple hormonal blockade therapy for my challenging case - data from clinical series from the practices of individual physicians or groups of physicians, but without published clinical trial data.) The huge advantage of clinical series data is that we often get it many years before we get good data from clinical trials.
To me, the existence of that kind of clinical series data with highly favorable results for long-term toxicity, especially from a leading radiation doctor, would practically make the case that SBRT is worth serious consideration for many of us even though it is still experimental. That said, it is fully understandable while many doctors would still reasonably term SBRT as "experimental at best" for prostate cancer; that will be the case until convincing clinical trial data are reported in a respected journal.
Based on your post, I suspected that Dr. Christopher King was probably a leader in SBRT. As such, he probably would be publishing research for other radiation therapists. Therefore, I used the search string " king c [au] AND stereotactic body radiation therapy AND prostate cancer " for PubMed ([url]www.pubmed.gov[/url]), a site we can refer to on this board because it is sponsored by the US Government. I found two hits for such studies involving Dr. King! The first (2008) is in the journal that is the key publication for radiation doctors; it is the publication of their association, ASTRO (American Society for Therapeutic Radiology and Oncology). (There are two key positions in the list of authors for each medical research paper - giving interim (2007) results of their Phase II clinical trial at Stanford, and he is listed first for one paper, and last for the other paper, in which they use two kinds of systems for SBRT, CyberKnife and Trilogy. That's pretty convincing evidence that Dr. King is a leader in SBRT at Stanford, if not "the" leader.)
Did Dr. King talk about their trial results with you? Are you now participating in their trial? Their tentative "cure" numbers look good, as you mentioned. The abstract for the paper even gives some early "late" toxicity results. While they use "greater than six months" as the definition for late term, they actually have nearly three years of follow-up on average, and the results look quite impressive . In my layman's understanding as a guy who is not so knowledgeable of radiation, it seems that you really would like to see results up to five years to get a firm handle on late-term toxicity (right?), but nearly three years is certainly encouraging.
His paper also notes that the Stanford group experimented with allowing a day of rest between each of the five sessions. (That's key, as rest typcially gives healthy cells enough time to recover from radiation while cancer cells cannot recover in that brief break.) They reported that 0% of every-other-day patients had "severe rectal toxicities" versus 38% of the patients having treatment on five straight days. Frankly, 38% is pretty off-putting! I sure know which group I would want to be in! On the other hand, 0% is a number that really grabs your attention! I think a lot of us would not mind spending just an additional week, making the investment two weeks total in contrast with many weeks for IMRT.
Are you part of the clinical trial? While your current PSA looks good, it will probably drop even lower as that paper also mentioned that PSAs in their patient group typcially continued to drop for three years. It also mentioned that 29% of their patients experienced a benign (but no doubt scarry ) bounce averaging .4%, typically around the 18 month point. Did Dr. King brief you about that? Any details? Without checking any references, those kinds of numbers for bounces sound fairly typical for other forms of radiation to me.
For others of us considering SBRT (with CyberKnife or other system), it is important to keep in mind that Stanford is a center of excellence; therefore, results elsewhere might not be as good . That's typical with other therapies.
Please give us any other information about SBRT or CyberKnife that you can. I'm hungry for more details, and I'm sure a lot of us would like to know more about your experience at Stanford.
Thank you for the information. I had asked my husband's urologist about the CK. He was very against it. He said, The treatment with CK is experimental at best." My husband is opting for the DaVinci surgery. Good luck to you and keep us posted on your progress.
I implore you to get another opinion for the sake of your husband. The CyberKnife is "the" method for the treatment of prostate. The are monetary interests, which in my humble opinion are working against this most effective and life saving treatment. All, I add, with almost NO side effects. The technical papers on CyberKnife are proving it to be far more effective treatment on prostate than is touted. DaVinchi's effective marketing campaign does not match the effectiveness of CyberKnife. Again, please do more research!!
Thank you for the information. I had asked my husband's urologist about the CK. He was very against it. He said, The treatment with CK is experimental at best." My husband is opting for the DaVinci surgery. Good luck to you and keep us posted on your progress.
Trace212--this is precious49,
I'm glad to see that you and your husband have made a decision. I know it wasn't easy. I hope you were able to read the story about how well my husband did with the procedure and I pray that your husband does as well and even better. I'll be praying for both of you. precious49
God Bless You and Yours Today and EveryDay
... The CyberKnife is "the" method for the treatment of prostate. ... The technical papers on CyberKnife are proving it to be far more effective treatment on prostate...
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Did you undergo prostate cancer treatment with the Cyberknife, and if so, what was your initial diagnosis (and PSA and Gleason etc). Also, what is your age and when were you treated (and what other alternatives did you consider)?
Thanks.
Last edited by Administrator; 12-29-2008 at 12:37 PM.
Reason: Don't tell members about what to comment.
Trace212--this is precious49,
I'm glad to see that you and your husband have made a decision. I know it wasn't easy. I hope you were able to read the story about how well my husband did with the procedure and I pray that your husband does as well and even better. I'll be praying for both of you. precious49
God Bless You and Yours Today and EveryDay
<deleted>
I have a bias against surgery as the risk of serious immediate side effects is very high50-75%. Read about the failure rate which also seems very high. Surgery has risk from dying 1-2%, infection, weeks of recovery time non of which is a risk with the CyberKnife.
Last edited by Administrator; 12-29-2008 at 12:38 PM.
Reason: removed inappropriate negative comments; posted disallowed website(s)
... Read about the failure rate which also seems very high. Surgery has risk from dying 1-2%, infection, weeks of recovery time non of which is a risk with the CyberKnife.
Hi Precious 49, Fred, and all of us,
That "risk of dying" of 1-2% associated with surgery that Fred mentions might unduly scare some patients who do not realize that the death comes not from the surgery itself but from prostate cancer after five years of survival.
Actually, that means the survival rate for surgery is in the 98% or better range, which to me and many of us is fine. That excellent five year no-recurrence rate seems to be typical of men whose cancer is caught early and who are ideal surgery candidates for success; key characteristics of such men are a PSA at baseline of 10 or lower, a Gleason of 6 or lower with no Gleason Grade 4 or 5, stage T2a or better, PSA velocity of 2.0 or less in the year prior to diagnosis, a low percentage of biopsy cores positive for prostate cancer, and usually a low percentage of cancer found in cores that are positive. Men with less favorable case characteristics do very well with modern therapy, but not quite as well as those with ideal characteristics.
Sometimes it helps to look at PubMed ([url]www.pubmed.gov[/url]), a site we are allowed to mention on this board because it is sponsored by the US Government, to check results at centers of excellence when we have questions like this. (Our taxpayer dollars at work! ) I just checked a very recent study from Johns Hopkins that resulted from this search string: " prostate cancer AND radical prostatectomy AND overall survival AND walsh p [au] ". (It was hit number three at the moment I searched.)
Biological recurrence, usually at Johns Hopkins meaning a rising PSA that reaches and then passes .2, for low-risk patients after Johns Hopkins RPs was .3% at 5 years, .9% at 10 years, and 1.3% at 15 years. Local recurrence was .1% at 5 years, .5% at 10 years, and .5% at 15 years. In the entire group there was NO death due to prostate cancer! Not bad at all!
This was from a group of 2,526 men in the Johns Hopkins RP database with Gleason Scores from surgery specimens (vice biopsy) confirmed to be no higher than six and whose stages were also confirmed from the pathological surgery specimen to be no higher than stage T2 - a low risk group. (PSA was not mentioned in the PubMed abstract, which means it could have been any value - not restricted for the study.) Follow-up ranged from 2 to 22 years and averaged 5 years; statistics used standard actuarial projection techniques. Key members of this research team are extremely highly respected, and many of us will recognize the names of Drs. Walsh, Partin and Epstein, well known for the heavy volume of research in which they are involved.
Here's the formal citation of the study: Urology. 2008 Jul;72(1):172-6. Epub 2008 Mar 4. Natural history of pathologically organ-confined (pT2), Gleason score 6 or less, prostate cancer after radical prostatectomy. Hernandez DG, Nielsen ME, Han M, Trock BJ, Partin AW, Walsh PC, Epstein JI.
(Fred: if you need references or leads to additional medical studies or widely available books for patients that describe these results I would be glad to provide them, and I'm sure other frequent posters would be happy to provide their own favorite leads. The book "A Primer on Prostate Cancer - The Empowered Patient's Guide, is a great source. By the way, the medical co-author, Dr. Stephen B. Strum, MD, is a "medical oncologist," which no doubt enhances objectivity, which you are concerned about. The book also backs up its statements with references to medical research studies; that greatly increases my confidence in what it says.)
Many years ago, back in the 80s and earlier, surgery itself was far more risky than today. Dr. Patrick Walsh, MD of Johns Hopkins achieved several breakthroughs that greatly increased the effectiveness of surgery, among other things, cutting the risk of death from the operation to a tiny fraction of a percent in competent hands, as I recall.
Fred, I'm glad to read your enthusiastic reporting of rapid recovery for SBRT (Stereotactic Body Radiotherapy) CyberKnife patients! In my view we'll have to watch this emerging option for some years before it is classed as a standard therapy, but what a breakthrough it might prove!
Precious 49, I'm glad your husband is doing so well! We've had programs on DaVinci robotic surgery in my support group, and numerous patients have been highly pleased with their results. Only one man had discouraging side effects. Surgeons who speak at our meetings say it is now so popular that they are now doing only a handful of conventional prostatectomies. Robotic surgery has been enthusiastically described by expert surgeon Ashutosh Tewari, Director of Robotic Prostatectomy at New York Presbyterian Hospital, Brady Urologic Health Center, at at least two of the National Conferences on Prostate Cancer, which are primarily directed toward patients.
Thanks to you both for sharing your experiences with these different therapies, now at different stages of acceptance.
I was diagnosed with prostate cancer (PCa) in Aug. of 2007. My PSA was 4.0 ng/ml, a transrectal ultrasound-guided biopsy revealed a stage T1c adenocarcinoma involving the right mid to right apex with a Gleason score of 3+3; in 3 of 12 cores.
I discussed all treatment options with my family doctor(referred me to local surgeon and Radiation oncologist), I referred myself to doctors at Stanford, surgeons and radiation Oncologists. I reviewed all options(Proton, IMRT various surgery options, ADT, and Cyro) with my wife. Treatment recovery time was an important consideration as a father of a nine year old son, small business owner. I selected SBRT/CyberKnife treatment(as a patient in a clinical trail at Stanford) option for prostate cancer at Stanford. Their clinical trial data, starting Dec. 2003, was very encouraging with ZERO biological failures and minimal side effects (my research suggested the CyberKnife is at least as effective as IMRT or any other option). My CyberKnife treatment was five days of one hour sessions with no recovery time (IMRT is five days per week for eight weeks). I was advised of and understand the long term unknown risk of radiation side effects and felt the advantages of SBRT/CyberKnife treatment far out weighted the long term unknown risk.
I completed CyberKnife treatment (May 7, 2008) by Dr. Christopher King. Fourteen days post CK treatment there were minimal side effects. I continued to work every day during and after treatment.
It is now almost 8 months post CyberKnife treatment. I am 110% of pre-treatment base line for all related functions. The plus 10% is from improved urinations. Before treatment I would get up 3-4 times a night now I typically get up once. My PSA at the six month follow up was 1.09 ng/ml. SBRT/CyberKnife has treated my prostate cancer and has improved my quality of life.
The first patient was treated with the CyberKnife in 1994 for a brain tumor. I met his first patient, a neurosurgeon who has ZERO side effects and is cancer free to date.
The high dose fractions for treating prostate cancer have 10 plus years of data published by Dr Jeff Demanes and Dr Alvaro Martinez . Do a goggle search with their names and HDR Brachytherapy to read their clinical data. The SBRT/CyberKnife dose plan is based on HDR Brachytherapy which has a long history of success. The CyberKnife is expected to have a cure rate and long term side effect profile equal to or better than HDR BT because the dose is mimicked with an external radiation source. The CyberKnife tracks the movement of the prostate during treatment allowing increased dose to the target which equals increased cure. The target tracking allows the radiation margin to be lower as no movement margin is required which results in less radiation to surrounding structures that equal fewer side effects.
There are many center across the country treating PCa with the CyberKnife. Over 2000 men have been treated with verify few biological failures. More data will be provided in Feb. 2009 from the CyberKnife users meeting. Do a search CyberKnife and add one of the following Doctors Alan Katz, Clinton Medbery III, Donald Fuller, Peter LaNasa, Jerome Spunberg and Debra Freemen. They all provide more than one option giving patient options to choose for radiation treatment.
PSA bounce is a characteristics of all forms of radiation. The biology of PSA and radiation is still a mystery. But it in general a patient is considered cured when their PSA is at .5 ng/mL or lower, which is expected to occur at 24-36 months.
A few Resources I think meet the posting rules and may be useful follow:
1 [url]http://www.joearrington.org/Prostate_article.pdf[/url]
2 [url]http://www.medicalnewstoday.com/articles/55980.php[/url]
3 [url]http://jnci.oxfordjournals.org/cgi/content/full/96/18/1358[/url]
4 [url]http://www.ncbi.nlm.nih.gov/pubmed/18164858?dopt=Abstract[/url]
5 Grills IS, Martinez AA, Hollander M, Huang R, Goldman K, Chen PY,Gustafson GS. High dose rate brachytherapy as prostate cancer monotherapy7
reduces toxicity compared to low dose rate palladium seeds. J Urol. 2004 Mar;171(3):1098-104.
6 Fuller DB, Naitoh J, Lee C, Hardy S, Jin H. Virtual HDR(SM) CyberKnife Treatment for Localized Prostatic Carcinoma: Dosimetry Comparison With HDR
Brachytherapy and Preliminary Clinical Observations. Int J Radiat Oncol Biol Phys. 2008 Apr 1;70(5):1588-97. [url]http://www.ncbi.nlm.nih.gov/pubmed/18374232?dopt=AbstractPlus[/url]
7 King CR, Lehmann J, Adler JR, Hai J. CyberKnife radiotherapy for localizedprostate cancer: rationale and technical feasibility. Technol Cancer Res Treat.
2003 Feb;2(1):25-30 [url]http://www.ncbi.nlm.nih.gov/pubmed/12625751[/url]
8 11 Hara W, Patel D, Pawlicki T, Cotrutz C, Presti J, King C. Hypofractionated stereotactic radiotherapy for prostate cancer: early results. Int J Radiat Oncol Biol Phys. 66(3)(supplement):S324-325, 2006.
9 King CR, Brooks J, Gill H, Cotrutz C, Pawlicki T, Presti JC. Stereotactic Body Radiosurgery for Localized Prostate Cancer: PSA results and Toxicity of a Phase
II Clinical Trial. Int J Radiat Oncol Biol Phys. 2008 in press.
10 Bill-Axelson A, Holmberg L, Ruutu M, Häggman M, Andersson SO, Bratell S, Spångberg A, Busch C, Nordling S, Garmo H, Palmgren J, Adami HO, Norlén
BJ, Johansson JE; Scandinavian Prostate Cancer Group Study No. 4. Radical
prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005 May 12;352(19):1977-84.
11 CTAF link to meeting: [url]http://www.ctaf.org/content/general/detail/700[/url]
... My CyberKnife treatment was five days of one hour sessions with no recovery time (IMRT is five days per week for eight weeks). I was advised of and understand the long term unknown risk of radiation side effects and felt the advantages of SBRT/CyberKnife treatment far out weighted the long term unknown risk....
The high dose fractions for treating prostate cancer have 10 plus years of data published by Dr Jeff Demanes and Dr Alvaro Martinez ... The SBRT/CyberKnife dose plan is based on HDR Brachytherapy which has a long history of success. The CyberKnife is expected to have a cure rate and long term side effect profile equal to or better than HDR BT because the dose is mimicked with an external radiation source. The CyberKnife tracks the movement of the prostate during treatment allowing increased dose to the target which equals increased cure. The target tracking allows the radiation margin to be lower as no movement margin is required which results in less radiation to surrounding structures that equal fewer side effects....
Fred,
Thank you for providing insight into the rationale for Stereotactic Body Radiotherapy (SBRT) with CyberKnife. It's especially useful to read about the thinking and observations of someone such as you who has undergone this therapy after researching it with care. In just a couple of days you have given me a much better idea of how SBRT with CyberKnife works, who the major players are, the research foundation, and why some some SBRT CyberKnife patients are so enthusiastic about it.
You have given those of us who don't know this therapy a lot to think about. I especially like the way SBRT is based on High Dose Brachytherapy results; that let's us tie in to a substantial amount of research involving published results going back quite a few years. To me, that evidence does a lot to indicate that this therapy will have good long-term curative results.
But that same tie-in does not help me become less concerned about SBRT CyberKnife's potential for severe rectal side effects, as reported in Dr. King's research. The reason is that High Dose Brachytherapy radiation can be reliably designed to stay within the prostate: radiation from the temporarily inserted highly radioactive seeds does not have to go through the rectum or significantly expose it to radiation, as I understand it (though I'm no expert on HD seeds, just generally familiar and I recall that Intel's Andy Grove was a big advocate for that approach about a decade or so ago.) On the other hand, unlike High Dose Brachytherapy, SBRT external beam high energy doses do pass through tissue outside the prostate, including some rectal tissue, on their way to the prostate. You and the rest of the 62% of the King group's SBRT CyberKnife patients succeeded in avoiding severe rectal side effects, probably due to the target tracking techniques that you mention. That's encouraging, proving that such side effects can be avoided, at least up to about the three year point. But clearly that target tracking technology was not enough for the 32% in the King group research who did have severe rectal side effects. To me, the jury is still out on this very important point of greatly lowering the odds of substantial rectal side effects, especially severe effects! Maybe some of the references you provided can reassure us here; I'll try to touch some of those bases. It will be interesting to see how much attention is given at the February CyberKnife users meeting to the King group's finding that allowing a day of rest between doses reduced serious rectal toxicity to zero. If you can, please keep us posted about news from the users meeting.
You are correect that rectal issues are the biggest concern. But comapred to all other options was of less concern to me. One important consideration is that Dr. King is also improving the planning as are all the other centers. What treatment option can compare its very first use for treating PCa to the CyberKnife with equal results?
Surgical death is from surgey complications and not long term biological failure. Do a Goggle search for "biological failure" for all options(Surgery, IMRT, HDR Brachytherapy, Brachaytherapy with seeds and Proton Therapy) and compare results 3-5 years.
I'm inserting some comments in green in an extract of your post so it's easier to tell who is posting what.
Quote:
Originally Posted by viperfred
Hi Jim,
... What treatment option can compare its very first use for treating PCa to the CyberKnife with equal results?
I'm impressed with the reports I'm reading about Stereotactic Body Radiotherapy with CyberKnife (basically meaning only five or ten radiation sessions with no rest or one day of rest between at much higher doses than usual for external beam therapy) at this fairly early stage of its development. I'm guessing that it probably is doing better than at least some other therapies did early on, including surgery, cryosurgery, and radiation, though with only three years of substantial data for SBRT CyberKnife, it is partly a leap of faith at this point.
But you are clearly a pioneer as major issues in the approach are still being worked out, and some key outcome results will not be known for years. I think that's why many patients will feel more comfortable with approaches where the major issues have been worked out and where long-term results information is now available.
For the patient choosing what way to go, it's sort of like picking the quarterback to start for your team with a critical game on the line: the fine looking rookie with a lot of promise but a lot to learn, or the aged veteran who reliably produces good results.
I like pioneers. I'm one myself with intermittent triple hormonal blockade (only) for high risk men, despite risks of leaving some cancer tissue intact and unradiated; also with using low-dose thalidomide to extend off-therapy periods, despite what I consider reasonable risks of blood clots, peripheral neuropathy, and cognitive difficulty, among others. I'm also enthusiastic about my approach. (By the way, I initially chose surgery but was rejected (in my circumstances, thank God!), and I then chose radiation but changed course when blockade was clearly working well and it was clear I had a low chance for cure with radiation.)
Surgical death is from surgey complications and not long term biological failure.
I see that you really meant death from the surgery itself when you mentioned earlier that the rate was 1 to 2%. I can certainly see why surgery was not an option for you! Fortunately, those numbers are far higher than the numbers for current results that we run across for the past two decades and perhaps even earlier. For instance, there is a well known book "100 Questions & Answers about Prostate Cancer" by Pamela Ellsworth, MD, John Heaney, MD and Cliff Gill. On page 95, it states: "The mortality rate associated with radical prostatectomy is less than 0.1%" My impression is that the rate is virtually zero with well experienced surgeons. It is well known that surgical mortality was significant in the early days, but it gradually was reduced to nearly zero, especially after the innovations by Dr. Patrick Walsh became commonplace.
Do a Goggle search for "biological failure" for all options(Surgery, IMRT, HDR Brachytherapy, Brachaytherapy with seeds and Proton Therapy) and compare results 3-5 years.
Results for three to five years are, fortunately, not very helpful. I use the word fortunately because results are so good, especially for low-risk patients, that nearly everyone does well. Even guys like me with multiple high risk features (initial PSA 113.6, GS 3+4=7, all cores positive, most 100% cancer, etc.) have an extremely good chance to survive to the five year point.
Recurrence rates are another useful indicator, but those rates are also very high for low-risk patients across established therapies in the three to five year window. We are not supposed on this board to encourage shotgun internet searches; that may at first seem like a nuisance, but it greatly reduces clutter for readers and lets readers get right to the point or data you want to present because you have to state it. But if you have key papers to call attention to, usually they are abstracted in PubMed, [url]www.pubmed.gov[/url], and you can give a useful search string to get to the abstract. If you have specific papers that indicate SBRT CyberKnife's numbers look favorable in comparison at the three to five year points to current three to five year survival numbers for established therapies, a lot of us would like to know about them.
I am seriously considering "CyberKnife Robotic Radiosurgery." My reasons: This version is frame-less and has accuracy of 0.2mm. At 70+ with hypertension and early stage III CKD, I feel I don't have the strength for other surgical techniques. CK as I understand it, kills cells in place; that's probably what the brain is trying to do anyway. Quality of life is of utmost importance to me; as a beginning law student, I need 3 years without disgusting "side effects" to complete my studies. I also would like to do some traveling free of recurring check-up schedules.
I understand that CK is relatively new. I feel its OK to be part of the data accumulation process. There are 1000 year old techniques that no one would even dream of trying. The logic and power of science in CK point in the direction of rapid development as a preferred cancer killer.
I understand that CK is relatively new. I feel its OK to be part of the data accumulation process. There are 1000 year old techniques that no one would even dream of trying. The logic and power of science in CK point in the direction of rapid development as a preferred cancer killer.
Preferred for you...that's what is important!
There's an old saying that we've all heard that applies here for the vast majority of low risk cases..."one size does not fit all." The immediate-term convenience of a treatment plan sounds like it's a very important consideration factor for you...and if so, Cyberknife will rank high on your list of options. You also emphasized that quality of life is of utmost importance to you. Where does cancer control rank?
Anyhow, welcome, ekanemer, to the board! I didn't notice any 'question marks' in your posting, so I guess you were just posting an "update." If you wouldn't mind, could you add info on your age and your cancer case characteristics? Might be best, however, to start your own separate thread.
From published literature the CyberKnife is the best of all Worlds, non-invasive easy and fast therapy. very hi rate of cure, low rate of side effects are reported. A study with 5 year data is in publication. Its has been accepted by the RADJ a leading publication for radiotherapy. The principle author is Dr. Chris King who treated the first PCa patient (and me in 2008) with the CK in Dec 2003 at Stanford. He is publishing his data plus the results from Naples FL.
Some may be concerned or critical that there is not ten year data, there will be in ten years. The available data today is better than any other option in my opinion and personal experience as a patient.
I'm sure that longer course is a deal-breaker for IMRT or Proton Beam for many of us who cannot afford the money or time needed for a long course of IMRT. (Seeds, of course, is a one or two day commitment - very fast.)
I sure know which group I would want to be in! On the other hand, 0% is a number that really grabs your attention! 
I think a lot of us would not mind spending just an additional week, making the investment two weeks total in contrast with many weeks for IMRT.
Fortunately, those numbers are far higher than the numbers for current results that we run across for the past two decades and perhaps even earlier. For instance, there is a well known book "100 Questions & Answers about Prostate Cancer" by Pamela Ellsworth, MD, John Heaney, MD and Cliff Gill. On page 95, it states: "The mortality rate associated with radical prostatectomy is less than 0.1%" My impression is that the rate is virtually zero with well experienced surgeons. It is well known that surgical mortality was significant in the early days, but it gradually was reduced to nearly zero, especially after the innovations by Dr. Patrick Walsh became commonplace.
