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Old 11-12-2009, 05:31 AM   #1
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Best Philadelphia area CyberKnife center?

Hi, all:

I am 61 and I was diagnosed with PC, Gleason 3+3, positive in 3/12 biopsy samples @ 10% each, current PSA 6.4, this past August. I have a clean bone scan and a good MRI., 19.5cc prostate volume and a clear DRE. Basically I am at low risk at this point and fortunately able to select my treatment.

I have been to both the Univ of PA Urology (surgery center) and Radiology and after weighing all of the options, have pretty much concluded that the SBRT course is my choice of treatment. I have an appointment with Dr Williamson at the Capital Health Systems in Trenton (Part of the Univ of PA) next week. Since they are in network for me, I am covered by my insurance (AmeriHealth). I am looking for anyone who has had any experience with Capital Health or this doctor, or who has any experience with any CyberKnife centers in and around Philadelphia or southern New Jersey. A friend of mine who is an oncologist says that I have plenty of time to decide on treatment.

Any thoughts or experiences would be helpful. As I told the surgeon, I only get one shot at the initial treatment and I want it to be the right one for me.

Bob

 
Old 11-13-2009, 10:51 AM   #2
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Re: Best Philadelphia area CyberKnife center?

Hi Bob,

Welcome to the board! (Your numbers make me envious!)

I'll put some comments in green.


Quote:
Originally Posted by RJM3 View Post
Hi, all:

I've moved your first paragraph to the end of your post so I can address your questions first.

I have been to both the Univ of PA Urology (surgery center) and Radiology and after weighing all of the options, have pretty much concluded that the SBRT course is my choice of treatment. I have an appointment with Dr Williamson at the Capital Health Systems in Trenton (Part of the Univ of PA) next week. Since they are in network for me, I am covered by my insurance (AmeriHealth). I am looking for anyone who has had any experience with Capital Health or this doctor, or who has any experience with any CyberKnife centers in and around Philadelphia or southern New Jersey.

We had one CyberKnife (CK) fan on the board fairly recently, viperfred, and you can find posts about the technology and his input by searching the archives.

I learned what I believe is a critical point about CyberKnife during the time viperfred was on the board: while the typical SBRT (Stereo Tactic RadioTherapy) program involves just five days of radiation, a leading and pioneering CyberKnife research team at Stanford University discovered that patients treated on five consecutive days had a high risk (38%) of some "severe rectal" side effects. When they realized this after about 40 patients had been so treated, they switched to a program that included a day off between each treatment, and the serious rectal problems disappeared! You can read abstracts of this and related studies led by SBRT pioneer for prostate cancer Dr. Christopher (or Christian?) King by going to www.pubmed.gov (a site we can use on this board because it is Government sponsored) and entering this search string (without the quotes): " king c [au] AND CyberKnife AND prostate cancer ". I just did that and got six hits, including five with abstracts we can read by clicking on the hypertext title. The second hit, the interim results of Dr. King's clinical series, is probably the best information on CyberKnife results in the world. (If anyone knows of comparable or better results, I would like to know.)

This paper provides some key information to your informed choice of this therapy. First, it is clear that this therapy is still experimental, with techniques that have a major impact on patient welfare still being refined. I would bet that many CyberKnife centers are still wheeling their patients in and out on five consecutive days with no awareness of the high risk of severe rectal complications. It seems logical that you should ask potential CK providers if they skip a day between sessions. If not, I would probe their knowledge by mentioning the concern of Dr. King's team to see if they are keeping up with research. Personally, I would not want to run that 38% risk when many other options are available, including the every-other-day CK option. Other radiation doctors are disturbed by the high powered hype accompanying CK treatment; it could be professional jealousy, but their concerns strike me as well founded. In addition to rectal complications in some men, they are concerned that the CK SBRT practitioners have moved too fast in increasing the doses of radiation delivered per session without researching outcomes for at least five years. My own impression is that the CK SBRT doctors are moving boldly; whether they are moving wisely is still arguable.

That leads to the second concern: even in the pioneering work by the King team, their 2009 paper mentions a median (average) follow-up of less than three years! That's very short follow-up compared to other therapies for low-risk cases, kind of like taking a flier on a fast-talking rookie football coach. It's also disturbing to me that the leading research - by the King team - has basically documented only short-term success with only 21 patients; I'm not counting the 20 patients they treated first who experienced a 38% rate of severe rectal toxicity as I would say they were not successful with this group as a whole - 38% is a rather high problem rate. Also, consider that the median follow-up with the 21 later patients on every-other-day therapy would have had to be even shorter than the median follow-up of 33 months for the whole group.

A CK SBRT User's Group meeting was held this spring, but I was disappointed that we heard no marked achievements from that meeting. I had hoped that the King group would have updated their series to around four or five years follow-up by then, but they did not do that, despite the apparent passage of time since an earlier report. If anyone has heard why, or has heard of an informal update by the King group at a conference, I would like to learn about it.

The bottom line: if you choose this CK therapy with SBRT dosing, you need to be comfortable with the clear fact that it is experimental and has a very short track record. On the good side, the earliest patients are now at least five years past their treatment, and some of them are doing very well. While five year success is not conclusive proof, it is a strong indicator that CyberKnife with SBRT dosing can be an effective and low-side effect treatment at least for some men.


A friend of mine who is an oncologist says that I have plenty of time to decide on treatment.

Your case characteristics are all consistent with a low-risk cancer, with one missing piece: do you know the velocity of your PSA in the past year or so? In the past half dozen years, we've learned that that is also an important indicator of risk.

Any thoughts or experiences would be helpful. As I told the surgeon, I only get one shot at the initial treatment and I want it to be the right one for me.

Okay, since you are receptive to other approaches, here are some more thoughts. You described your case this way:

[moved by Jim to the end of your post] I am 61 and I was diagnosed with PC, Gleason 3+3, positive in 3/12 biopsy samples @ 10% each, current PSA 6.4, this past August. I have a clean bone scan and a good MRI., 19.5cc prostate volume and a clear DRE. Basically I am at low risk at this point and fortunately able to select my treatment.

You might want to consider Active Surveillance (AS), and I'll provide some detail as doctors often neglect AS or push our emotional fear buttons by unreasonably implying that the cancer could grow and become threatening without our knowing it under AS. While that approach - basically putting the cancer on strict probation for a couple of years and, assuming success, a more relaxed probation after that - has been highly successful in well over half the very low risk patients who use it, and while those who are determined to need treatment appear to have lost no ground by delaying the treatment according to medical research, could work for you, there is at least one area of concern: PSA density (PSA divided by the prostate size in cc: yours would be 6.4/19.5 or .33; several centers consider a density more than 0.15 - too much cancer considering the size of the prostate - to indicate intermediate risk, and some kind of treatment would be better for intermediate risk patients.

Quite a few major prostate cancer centers have AS programs, and each has somewhat different criteria for qualifying potential AS patients, but with substantial overlap. Patients selection is key because you do not want to unduly delay treatment in patients where the cancer shows signs of potential aggressiveness. The Prostate Cancer Research Institute, a leader in patient education, has a "What's Your Type?" program to help men understand whether they are low-risk (no immediate treatment recommended by PCRI), intermediate risk, or high risk patients. They have six criteria, and you are low-risk on four, not low on the density, and with PSA velocity not known from what you have stated. You are okay on Gleason Score (your 6 is less than 7 for low risk); okay on % of biopsy cores with cancer (your 3 positive cores amounts to only 25% of the cores sampled, less than 34% in the criterion; okay with a PSA of 6.4 that is less than 10 in the criterion; and a clear DRE satisfying the "no nodule" standard for low-risk. If you had an infection that accounted for some of the PSA, you might be okay on the density criterion too. You may have noticed that PCRI does not include age; while some major AS programs are still concerned that men should not be too young - preferring men to be 70 or older, major centers in Toronto (any age) and the Netherlands (55 or older), and Dr. Charles Myers (substantial number of AS patients less than 40) are demonstrating that they approach can work well in younger men. Some experts also want to see the results of a color Doppler ultrasound done by an expert before recommending a patient use AS. The criteria are not a "majority rule" kind of deal: you want all your indicators to be low-risk.

You could use some nutrition and lifestyle tactics to see if you could halt or reverse and lower your PSA. These tactics are often effective in low-risk prostate cancer patients according to experts. (By the way, I'm a now savvy survivor but with no enrolled medical education.) You could also try some of the mild medications, like finasteride, Avodart, and a statin drug.

I'm sure that other board participants and I would be happy to answer any questions about AS and the other standard therapies, all of which are open to you from what I see.


Bob
Take care and good luck,

Jim

 
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Old 11-14-2009, 08:18 AM   #3
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Re: Best Philadelphia area CyberKnife center?

Jim:

I do have some conflicting data which I am aware of and I know that time will ultimately tease out the truth.

First, what started this was a PSA of 8.0 back in May. Unfortunately my prior PSA test was several years back so I have no recent arc to rely on. Because of that 8.0 test I went for a biopsy and the results of that biopsy was a prostate volume of 27cc's according to the ultrasound. But a recent (last week) PSA test came back 6.4 which is a 20% drop-hardly likely without any life-style change or therapy so there has to be some explanation for the 8.0. Of course, I was never cautioned not to have sex 48 hrs prior to the test...don't know if I did but I am very active, so who knows. I've since seen a surgeon, who ordered the CT scan, MRI and radiology consult. The MRI came back with the 19.5 value which I take as more accurate, but that info I only found out when I picked up my records for my next consult, so that has to be explained. The MRI reading said that it could not distinguish between internal bleeding (I did bleed a lot) and any tumor site, but did note the possibility. Again, only time and another MRI will tease this answer out. The surgeon's DRE found no nodules or irregularities, other than one side being slightly larger than the other. The Radiologist felt that IMRT was very much an option after reviewing the CT and MRI, hence the exploration of CyberKnife. Had anyone said that surgery was the only way for me, I probably wouldn't be exploring this.

Yes, I am aware of SBRT's short-term track record and Dr. King's studies. The reason that I am looking into Capital Health in Trenton is that the head of its CyberKnife group, Dr. John Lipani was on staff and was trained by Dr. John Adler, who invented CyberKnife therapy at Stanford, so there is a good connection to that facility and this one. Plus, he has an active involvement with the CyberKnife Society and serves as an expert on three technical adviser review boards. I am certainly going to mention Dr. King's studies, but I would assume that the center has already reviewed them and their recommendations.

Yes, I am considering AS, although the surgeon suggested that I not wait too long to decide on therapy. I still haven't seen a Urological Oncologist with that specialty only (no radiation/surgery bias) so I don't have that point of view yet, but that consult will be in the works before this is all over.

I am trying to be as rational about this thing as I can as I am on a fact-finding mission right now. When I was younger I was a surgical scrub tech for a while, and curiously, urology was what I scrubbed so I've seen my fair share of the "business of medicine" on the other side. I know that each specialty has its well-deserved bias-after all, that's the expertise in which they are trained.

As stated, I have to make the decision, right or wrong. I can't abdicate that responsibility to anyone like I've seen so many people do. In the end I won't go with anything that I am not fully comfortable with. I do feel that the methodology of SBRT is sound. It's not the treatment length that is appealing-although that is a nice bonus-it's the fact that (as far as I have read to date) SBRT parallels HD Brachy's better outcome with more delivery accuracy and as such, offers the possibility, based on the method and control of delivery, of lower long-term side effects and better cure than IMRT.

Having said all this, I am still on a learning curve and realize that I can be proven wrong, so stand by for updates. At any rate, I am going to Capital Health next Tuesday, and I'll report my findings, for those who are interested.

Bob

 
Old 11-14-2009, 02:09 PM   #4
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Re: Best Philadelphia area CyberKnife center?

Hi again Bob,

I'm glad you know about Dr. King's study and that the doctor you are considering for CK SBRT has a connection with Stanford. I'll insert some comments in green.


Quote:
Originally Posted by RJM3 View Post
Jim:
...

First, what started this was a PSA of 8.0 back in May. Unfortunately my prior PSA test was several years back so I have no recent arc to rely on.

Prior PSAs might still be useful. They might help give clues to inner and outer bounds for likely PSAV; for instance, if the last PSA a couple of years ago was a 5, it would be more likely that your PSAV now was not greater than 2. (That said, it's possible that a very aggressive but still small cancer just kicked off within, say, the past year.)

Because of that 8.0 test I went for a biopsy and the results of that biopsy was a prostate volume of 27cc's according to the ultrasound. But a recent (last week) PSA test came back 6.4 which is a 20% drop-hardly likely without any life-style change or therapy so there has to be some explanation for the 8.0.

PSAs driven solely by prostate cancer have an exponential rising pattern. However, BPH also causes a rise, but not exponential, and infection can drive a PSA all over the place as it waxes and wanes. As I understand it as a layman, an up and down, etc. PSA is often a sign of an infection.

Of course, I was never cautioned not to have sex 48 hrs prior to the test...

I still can't understand why family doctors/GPs ordering PSA tests do not routinely advise patients not to have sex (or any ejaculation) within 48 hours of PSA tests. That instruction should be routine, but clearly is not!

don't know if I did but I am very active, so who knows.

That possibility suggests a bit more likelihood that your August PSA of 6.9 is an upper bound of the "true" PSA - the daily average PSA for you at this time that is uninfluenced by sex or infection, at times known only for certainty by God.

I've since seen a surgeon, who ordered the CT scan, MRI and radiology consult.

Just FYI, the American Urological Association published its "Prostate-Specific Antigen Best Practices Statement" this past April. In it, they said "Computed tomography or magnetic resonance imaging scans may be considered for the staging of men with high-risk clinicaly localized prostate cancer when the PSA is greater than 20.0 ng/mL or when locally advanced or when the Gleason score is greater than or equal to 8." Basically they said that CTs and MRIs were not useful staging procedures for low-risk men. I have seen on this board and have heard in conversations with new fellow survivors that some urologists have already taken these cost-saving, anxiety sparing recommendations to heart. If you get a copy of the AUA publication, the information is on pages 35 and 36.

The MRI came back with the 19.5 value which I take as more accurate,

I'm not well versed in the subtleties of the effects of different prostate volume measuring technologies (here TRUS vs. MRI) on the estimate of volume, that that difference between 19.5 cc (MRI) and 27 cc (TRUS) seems quite large. Also, I suspect the PCRI density criterion of .15 or lower is based on TRUS measurement research. All of this makes me think, with both your prostate volume and PSA level not determined with high confidence, that you could well have a true PSA density of .15 or lower. Did the urologist talk at all about trying to smoke out whether you had an infection that might be the main driver behind the PSA?

...

I am certainly going to mention Dr. King's studies, but I would assume that the center has already reviewed them and their recommendations.

After nearly ten years as a survivor, and having now heard stories from many survivors and their loved ones about their doctors, I'm now a firm believer that "assume but verify" is the sound approach. It's amazing to me what doctors can overlook.

Yes, I am considering AS, although the surgeon suggested that I not wait too long to decide on therapy. I still haven't seen a Urological Oncologist with that specialty only (no radiation/surgery bias) so I don't have that point of view yet, but that consult will be in the works before this is all over.

I am trying to be as rational about this thing as I can as I am on a fact-finding mission right now. When I was younger I was a surgical scrub tech for a while, and curiously, urology was what I scrubbed so I've seen my fair share of the "business of medicine" on the other side. I know that each specialty has its well-deserved bias-after all, that's the expertise in which they are trained.

Your experience is likely to be useful and has already been so as is clear from your research.

As stated, I have to make the decision, right or wrong. I can't abdicate that responsibility to anyone like I've seen so many people do.

AMEN!

In the end I won't go with anything that I am not fully comfortable with. I do feel that the methodology of SBRT is sound.

It sure looks great on paper - lot's of fine theorizing why it should work well, and also with some impressive short-term results. Of course, as you are no doubt aware, theories sometimes do not work out well in practice. We already have seen that disturbing hiccup of the rather high severe rectal percentage in the King study's first 20 patients. That was obviously not predicted. I would dearly like to see Dr. King's group report some five year results, even if it's only in a small subgroup that has reached that point. Possibly you or your CK doctor could call Dr. King or his group and get an informal update. (I'm really curious why they did not update their median followup results beyond the 33 month point, which they had also reported many months earlier. That kind of omission gives me an uneasy feeling, not for the first time. I'm also eager to see longer followup on proton beam and Radiation Clinics of Georgia (RCOG) patients that to me is overdue. From a human perspective, we are eager to let the world know when things are going well, and vice versa.)

It's not the treatment length that is appealing-although that is a nice bonus-it's the fact that (as far as I have read to date) SBRT parallels HD Brachy's better outcome with more delivery accuracy and as such, offers the possibility, based on the method and control of delivery, of lower long-term side effects and better cure than IMRT.

Modern IMRT, especially Image Guided Radiation Therapy, can be accurate within a couple of millimeters in good hands. It's really got a fine record at centers of true excellence, leaving not much opportunity for CK SBRT to demonstrate superiority. As you are probably aware, Fox Chase in Philadelphia is one of the premier national centers for treating prostate cancer with radiation. (Have you thought of a consult there?) However, CK SBRT obviously has a huge advantage in convenience with just the five radiation sessions. I hope it proves out. If those early results on effectiveness and side effects stand up, CK SBRT will be an extremely attractive therapy option!

Having said all this, I am still on a learning curve and realize that I can be proven wrong, so stand by for updates.

Been there, done that: decided on radiation in early 2000 from Johns Hopkins; rejected! ; after a surprising, essentially negative ProstaScint at Hopkins (and negative CT and bone scans), was offered external beam radiation ("small likelihood of cure, but a fighting chance"), and went through all the preps prior to tatooing for targetting; but, doing very well on hormonal blockade as prep for the radiation, decided to stick with it, but worked successfully to get the enhanced triple blockade version I was learning about around May 2000. I knew very little about the disease in the early days, like most of us.

At any rate, I am going to Capital Health next Tuesday, and I'll report my findings, for those who are interested.

Bob

We'll look forward to seeing your updates.

Take care,

Jim

 
Old 11-18-2009, 06:07 AM   #5
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Re: Best Philadelphia area CyberKnife center?

Ok, where to start? The meeting that I had yesterday at Capital Health was good. Very good. I was impressed with Dr Williamson and the radiology team. Since they are doing a study which I would become a part of, they are right on top of all of the current thinking. Dr Williamson was familiar with Dr King's study and while she hasn't seen his latest results, she is going to inquire for me. She did say that there was a Radiology meeting in Feb. and she was expecting to see his most current report then.

We had a long talk. The entire appointment took over 2 hours-when was the last time ANY doctor spent that much time just meeting with you?! We went over everything in complete detail. We discussed my PSA difference-not uncommon, could have been for any number of reasons, she concluded. Her only concern was that there was not a rapid rise, indicating a more aggressive from of PC. As far as prostate volume goes, she explained that since ultrasound is less precise than MRI there can be a tendency to overstate volume. Also, based on all of the results of all of the tests done so far, a ProstaScint scan was not needed which was something that I was wondering about.

At the end of the day (and after yet one more DRE) She feels that I am very good candidate for this procedure and study. My staging is T1C, with no apparent lymph or bone involvement-the two dark horses that can cause failure down the road. We discussed doing this on the M-W-F weekend off M-W schedule (Dr King's schedule) and she was fine with that. The total dosage over the 5 days would be 36.25 Gy. She explained that this dosage works out to over 90Gy equivalent (she said it exactly but I didn't write it down-my bad) for IMRT. To me this is good since my research showed that earlier lower dosage routines in the 70Gy range led to higher biological failure incidents. So far her study (2 years old) has had no failures. My research (which she agrees with) shows that since it's delivered over a short period, the PC cells have no opportunity to recover. The treatment would include a 5mm border around the outside of the prostate to insure a "clean kill"-my words, not hers. Her experience with her patients is that most get no real post-treatment symptoms. Some get the expected tiredness and the sensation to void or have a bowl movement which goes away rather quickly. Weak urinary stream (caused by temporary swelling of the urethra) is another possible symptom which disappears.

Now, what will I go through? First the four gold fiducials are placed in the prostate via two needles and she showed them to me. They are maybe slightly thicker than a mechanical pencil lead, maybe 1/4" long each and tied together by a dissolving thread (train-style) that allows two of them to be inserted via a hollow needle and this leaves them separated by maybe an inch. This is a lot of guessing since I was looking at a clear pack with the fiducials inside. After being punched 12 times with biopsy needles, two doesn't sound too bad. I can deal with this. They wait approximately 12 days for the fiducials to heal into place and stabilize and for the thread to dissolve. Then I go in for an MRI and CT to accurately locate the fiducials in the prostate and get a detailed picture of the prostate. They also use a catheter that is radio opaque (I guess) to accurately place the urethra so that it is spared during dosage, taking two images, one with and one without the catheter. Once all of the images are taken, Dr. Williamson will sit down with her team, merge the images, outline the areas to be treated and avoided (very important!!!) and develop a computer model for the CyberKnife equipment to follow.

Once the treatment plan is finalized, I will be set up for the actual treatment. On my part, I have to follow a special diet prior to each treatment to minimize intestinal gas which can cause excessive bowl movement during treatment throwing things out of alignment. Oh, and yes, they will be a cradle to hold me still. The sessions will run 1-1/2 hour the first time, and about 1 hr thereafter. The entire thing will be about a month, from fiducials placement to the last treatment.

So, do I have faith in this? Well, we discussed that at length. Dr Williamson does it all-btw, she set up the CyberKnife center in the V.I.-including IMRT and as an experienced radiologist, her take on the procedure is that she fully expects this to become the gold standard for radiological prostate treatment for people in my category. Her reading is that the early indicator are so good that she would be very surprised if the studies didn't conclude well.

So, after a good deal of time with her talking about the procedure, the studies and discussing her background I have come away with about as much confidence as any person can realistically place in this facility and procedure. Is there a component of "wishful thinking" here, probably-we all have it-but I try to push that to the background.

Well, we will see what becomes of this. Next stop is insurance approval and then the timetable can be set up. Franky, I feel pretty confident at this moment that I am making the best informed decision that I can. So stay tuned.

Bob

 
Old 11-18-2009, 11:40 AM   #6
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Re: Best Philadelphia area CyberKnife center?

Hi Bob,

I'll put some comments in green to an excerpt of your post just before this one, but the bottom line is I believe you are in excellent hands and have touched the bases you should have before committing yourself.


Quote:
Originally Posted by RJM3 View Post
Ok, where to start? The meeting that I had yesterday at Capital Health was good. Very good. I was impressed with Dr Williamson and the radiology team. Since they are doing a study which I would become a part of, they are right on top of all of the current thinking.

Thank you (in advance) for being part of research that will illuminate the potential of this therapy.

Dr Williamson was familiar with Dr King's study and while she hasn't seen his latest results, she is going to inquire for me.

That should be really helpful. While the King group would be reluctant to publicize their results before the big meeting (stealing or diluting their own thunder), your doctor will probably get a good feeling for any major problems that have developed when she calls. Based on what I'm seeing, it's unlikely there will be any, but we really need the research to nail that down!

She did say that there was a Radiology meeting in Feb. and she was expecting to see his most current report then.

If she learns why the King group did not update its findings beyond 33 months median followup at the February 2009 meeting, I would like to know.

We had a long talk. The entire appointment took over 2 hours-when was the last time ANY doctor spent that much time just meeting with you?! We went over everything in complete detail.

Another reason for confidence!

... Also, based on all of the results of all of the tests done so far, a ProstaScint scan was not needed which was something that I was wondering about.

That's in line with what I've seen too. The payoff is so extremely low with low-risk cases that it's not worth it.

... We discussed doing this on the M-W-F weekend off M-W schedule (Dr King's schedule) and she was fine with that. The total dosage over the 5 days would be 36.25 Gy. She explained that this dosage works out to over 90Gy equivalent (she said it exactly but I didn't write it down-my bad) for IMRT.

I've heard IMRT and TOMO therapy/Trilogy radiation doctors, who had reservations about CK SBRT, say the same thing - that's not one of their reservations about CK SBRT (covered in earlier post - basically, the relatively short track record). The radiation docs have formulas that enable them to relate dosage, scheduling, and number of sessions (perhaps other important factors too) to calculate equivalent dose delivery.

To me this is good since my research showed that earlier lower dosage routines in the 70Gy range led to higher biological failure incidents.

Yes. Modern EBRT is looking for a dose close to 80 Gy (or even higher if it can be delivered safely, I think, though around 80 Gy is considered fine).

So far her study (2 years old) has had no failures.

That's encouraging and consistent with other reports of CK SBRT that I've seen and heard.

My research (which she agrees with) shows that since it's delivered over a short period, the PC cells have no opportunity to recover. The treatment would include a 5mm border around the outside of the prostate to insure a "clean kill"-my words, not hers.

That's important, because, when prostate cancer escapes beyond the capsule, typically it hasn't gone far beyond - just one to a few millimeters, less than 5 - as a rule. That's something surgery cannot do as I understand it.

...

So, do I have faith in this? Well, we discussed that at length. Dr Williamson does it all-btw, she set up the CyberKnife center in the V.I.-including IMRT and as an experienced radiologist, her take on the procedure is that she fully expects this to become the gold standard for radiological prostate treatment for people in my category. Her reading is that the early indicator are so good that she would be very surprised if the studies didn't conclude well.

She sounds like the kind of person you would want for this therapy.

So, after a good deal of time with her talking about the procedure, the studies and discussing her background I have come away with about as much confidence as any person can realistically place in this facility and procedure. Is there a component of "wishful thinking" here, probably-we all have it-but I try to push that to the background.

Personally, once I am committed to a course, I'm a big believer in positive thinking. Nothing wrong with that!

Well, we will see what becomes of this. Next stop is insurance approval and then the timetable can be set up. Franky, I feel pretty confident at this moment that I am making the best informed decision that I can. So stay tuned.

Bob

You've touched the right bases, are aware of the risks as well as the benefits, and have found what appears to be a fine doctor for this therapy. Good luck with the next steps.

Take care,

Jim

 
Old 01-03-2010, 03:26 AM   #7
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Re: Best Philadelphia area CyberKnife center?

Well, as an update to this post, here it is Jan 3rd. and I am waiting for my therapy schedule. I had the fiducials placed in early December. They were done in the same manner as a biopsy, but this time with two needles. Unfortunately I lost one-and now I now have a souvenir-because of a slight nick by the needle of the urethra during positioning. The fiducial worked its way into the urethra and popped out the next day at Sam's. Oh well, back for a repeat performance. This time everything took. That set me back a week, but other than having to go through the procedure twice, it was no big deal.
The next step after a week of healing was the C/T and MRI scans. That was a fun day. First thing, they make a cradle for your legs out of a plastic bag (yes, a big black garbage bag) and a mixture of expanding, hardening foam which is the same stuff that you can buy at Home Depot to fill cracks in walls and around windows, etc. This cradle extends from mid-thigh to, and including your feet, about 1/2 way up the sides of your legs. The cradle guarantees that your legs are in the same position throughout the scans and during the therapy. It wasn't uncomfortable to make and you very
quickly forget about it as you lie there. The C/T involved getting scanned with and without a radio opaque catheter. That was slightly uncomfortable, but only temporarily. The MRI turned out to be a bit more than I bargained for. I have had one done before but this time the equipment was much more powerful and the opening into the machine quite a bit smaller, it seemed. I didn't bother with any sedation, having gone through it before and although I can sometimes be be a bit claustrophobic, felt ahead of time that it wasn't worth the effort. Hmmm...maybe not such a good idea this time as I barely fit and got my arms caught on the sides as they slid me in. I felt myself panic a bit and said "No, this won't work" so they backed me out and I opted to have my arms resting over my head on a couple of pillows. That worked somewhat better and once I closed my eyes and they slid me in, I settled down. Then came the news: "This scan runs 45 minutes and if you move, we will have to cancel and reschedule for another day..." Oh great. I have to lie there and not move for almost an hour with my arms over my head. I counted the minutes barely breathing... Fortunately the scan went well so there was no need to repeat.

So now everything has been completed on my part as of Dec 23rd, and the planning phase for my treatment has begun as they meld the C/T and MRI scans together. I was told that it could take a couple of weeks, given the holidays so I am now waiting patiently for a call to let me know the schedule. Hopefully it will be this week.

Bob

 
Old 01-10-2010, 05:51 AM   #8
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RJM3 HB User
Re: Best Philadelphia area CyberKnife center?

All:

I spoke with Capital Health on Friday. The C/T and MRI images have been fused into one image, and for those that don't know the technology, that means that during treatment the reference beams that lock onto the prostate's location (via the C/T image) at the instant of delivery are in sync with the MRI scan which is used to identify the exact parameters of the prostate. It's so wonderfully high tech! Basically it's GPS for the body. Now that this has been done, the real work of planning the beam entry points and the dosing can be done. Tentatively it looks like the week of the 18th is when I'll start treatment, which is good timing, as I plan to be in Key West for a week starting on the 27th of Feb. My doc has assured me that I will be past any issues by then. Stay tuned!

Bob

 
Old 01-31-2010, 07:58 AM   #9
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Tortugajake HB User
Re: Best Philadelphia area CyberKnife center?

No side effects or infections from the urethra "nick" ?

 
Old 02-01-2010, 02:56 AM   #10
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RJM3 HB User
Re: Best Philadelphia area CyberKnife center?

Quote:
Originally Posted by Tortugajake View Post
No side effects or infections from the urethra "nick" ?
Nope. It all healed up just fine.

Bob

 
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