Speaking of CyberKnife, has anyone chosen to have it? It seems to promise the benefits and cure rate of traditional radiation therapies with some likelihood of fewer side effects due to better targeting, technology, etc. But again, as applied to prostate treatment, it seems a bit early to draw any firm conclusions.
In answer to your question, Mac, about CyberKnife...I have had it recently and could not be happier with the outsome. I was diagnosed with low risk PCa in March with a PSA of 4.3, 1 of 12 biopsy cores positive, Gleason 3+3=6, and stage T1c. DRE was normal with no history of prostate (or any other) cancer in my family.
After meeting six different specialists and considering surgery, brachy, proton, AS, HIFU, and cyro, I elected to have SBRT via the CyberKnife delivery system in July, consisting of 5, 40-minute sessions. Work up included the placement of four gold fiducials in order to track the prostate movement in real time.
I have had zero side effects...no ED, no fatigue, no urinary urgency or incontinence, no nothing. My 3 month post treatment PSA was down to 1.3 which was on track with the expected decline slope.
SBRT (sterotactic body radiation treatment) is offered by several procedures but its most commonly known by the manufacturer of the equipment (such as CyberKnife or Varian) which essentially mounts a linear accelerator on a robotic arm that moves about your body adjusting for prostate treatment in real time delivering a hypofractionated dosage equivilant to about 95 Gy delivered extremely accurately.
You may wish to read http://www.tcrt.org///mc_images/category/4309/04-katz_tcrt_9_5.pdf which is an excellent paper that summarizes all of the CK studies to date and was published this month.
CyberKnife was developed by a team of researchers at Stanford University led by Professor John Adler in the late 1980s as a frameless alternative to stereotactic radiation systems that used a linear accelerator (LINAC) that was in use at the time such as Gamma Knife. Gamma Knife delivers very accurate radiation does to brain tumors but requires the head to be bolted to a frame to hold it in place. What Adler and his team did was to basically move the LINAC from the frame to a highly maneuverable robotic arm that could move about the body and did not require rigid placement of the skull. Later developments integrated real time tracking systems that enable treatment of cancers in organs that move such as the lung. The FDA approved CyberKnife for treatment of brain tumors in 1999 and for treatment of tumors throughout the body in 2001. The prostate has been treated with CyberKnife since 2004 after fiducial tracking systems were developed in 2003 that allowed for real time tracking of prostate movement and software to enable the system to compensate dynamically, thus minimizing radiation to surrounding tissue and organs.
I have corresponded with several men who have had CK treatment and they too have had virtually zero side effects.
Picking the right treatment is a difficult choice and one that is highly personal. For me, quality of life was a much higher priority than quantity of life. Others may have differing views, but for me, I wanted an option that had a very high potential for curative effect while minimizing potential side effects that exist with any treatment. For me, CK was the right answer but it may not be for everyone, but you should check SBRT as an option to IMRT or brachy and make your own choices if you decide to go toward radiation.
Best of luck to you as you sort through this.