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Boost therapy LDR Brachy vs HDR Brachy vs Cyberknife

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Posted 6/25/2016 1:00 AM (GMT 0)
I am currently on Lupron and Casodex for the last 2 months. Scheduled to begin 5 weeks of IMRT next week. My RT will also include a boost therapy. The MD has pretty much given me a choice of LDR Brachy, HDR Brachy or Cyberknife for the boost. I don't find much in the literature with regard to long term outcomes for the cyberknife boost. The other 2 have apparently been used with good outcomes albeit the usual range of side effects and risks. I would be interested in hearing others opinion on my choices and also from anyone who has used cyberknife as a boost therapy. Thanks in advance.
Posted 6/25/2016 1:41 AM (GMT 0)
ronjt-

I just addressed that very question on another thread:

www.healingwell.com/community/default.aspx?f=35&m=3656259

They are all good choices. The SBRT boost is experimental, but is convenient and unintrusive. You also have to have skilled radiation oncologists at each therapy.

- Allen
Posted 6/25/2016 3:24 PM (GMT 0)
Ronjt

I've just completed the treatment plan that you are undergoing, except, I didn't take casodex.

My RO is a very experienced LDR Brachi seed guy (over 3000 procedures). I wasn't offered any other alternatives like you.

So far, no major problems. Usual side effects from Lupron. Trying to keep my weight under control. I gained 7 lbs in the two weeks that I was inactive after seed implantation.

Looking forward to my next PSA test in August.

Good luck
Posted 6/26/2016 3:13 AM (GMT 0)
I think you can do well with any of those protocols. As a G9, I've done great (so far) with HDR brachy as my boost, but I likely would have done equally well with the other treatments you're looking at. You might want to think about who has the best programs of each treatment option in your area...
Posted 6/26/2016 11:36 PM (GMT 0)
I really like the idea of the SBRT boost over the other two options but my concern is that it is new enough to only have a 5 year track record. I am being treated at UCSF and they have used it quite a bit of late.

Thanks for those articles Tall Allen they were very informative.
Posted 6/27/2016 3:43 AM (GMT 0)
Can't argue with that concern- SBRT boost is certainly the new kid on the block. The way Gottschalk uses it is very similar to HDR brachy radiobiologically. There's nothing wrong with the tried and true HDR brachy boost - it's been used that way since the early 1990s, and UCSF has done a bunch of them with superlative results.

I was in a kind-of similar situation when I decided between HDR brachy and SBRT (which at that time had only 3 years of published results). I had the pioneers of both to choose from, so it wasn't an easy decision. Really, I could have flipped a coin and been happy, heads or tails. I liked the convenience (no anesthesia or hospital stay) and cost (free!- no co-pays) of SBRT, and I liked the appeal of "a better mousetrap," even though it had less of a track record (risk and reward go together sometimes). But that's me and the quirks of my personality. You have to assess yourself to determine what is the choice that you find most comforting. All the studies in the world won't tell you that.
Posted 8/11/2016 11:11 PM (GMT 0)
OK I ended up going with cyberknife for the boost. Worked out great. Had my final treatment today and I,m very glad we are done. I understand the side effects of the cyberknife may take some time to peak. Any words of wisdom from those of you who got a cyberknife boost? When were you able to start a normal diet instead of all the bland crap I am currently eating?
Posted 8/12/2016 12:14 AM (GMT 0)
The bland diet is usually just for during the treatments so your bowels don't move too much. Did they tell you to continue it afterwards?

My SEs peaked about 2 weeks after treatment and lasted about 2 weeks. I took Aleve and Flomax for that time.
Posted 8/12/2016 1:02 AM (GMT 0)
Hi ronjt...I can't answer your specific question about cyberknife boost, although in my case (IMRT with HDR brachy boost) I had some urinary urgency and burning, afterwards that gradually resided over the next few weeks.

BTW, I didn't realize that IMRT with SBRT boost was an option. There's a recently diagnosed Gleason 9 here that is looking at either IMRT or SBRT, but due to some previous surgery couldn't have brachy. I'm now wondering if IMRT + SBRT is an option for him...
Posted 8/12/2016 1:38 AM (GMT 0)
Hi Michael Here's an article written by docs at UCSF on Cyberknife boost outcomes
http://www.ncbi.nlm.nih.gov/pubmed/26792201. I think they have been doing it for several years now.

Thanks Allen, Unfortunately I'm still having GI symptoms so staying bland for a little while longer. Dietician says it may take a few weeks. Good to hear most of your SE were done by then. I am also on Advil and Flomax. I guess a little more patience is warrented.
Posted 8/12/2016 2:49 AM (GMT 0)
Michael-T,

I wrote an article about it comparing it to monotherapy and other therapies. It's still experimental. It had similar cancer control and less late term toxicity compared to LDR brachy boost or HDR monotherapy. In the Taiwanese boost study they were able to achieve similar results with much less toxicity, so there are clearly a lot of variables to sort out. We don't know yet if there's any advantage over SBRT monotherapy at higher doses (like the King study at UCLA). I wouldn't think so, but we won't know until he publishes probably next year. There are several ongoing clinical trials.

SBRT boost radiation therapy in intermediate- and high-risk prostate cancer
Posted 8/12/2016 3:27 AM (GMT 0)
Thanks Allen...just read your article. It intuitively makes sense to me--should be interesting to see the final data.
Posted 11/5/2016 12:46 AM (GMT 0)
It's been awhile so thought I would update the group on my progress. I did end up choosing cyberknife for the boost therapy and was happy with that decision. Have now been off ADT for 5 weeks. Still having hot flashes and I expect that will continue for another month or 2. Getting up at night 2-3 times to urinate. Flow is good. Had some numbness and tingling in both hands for awhile. That has resolved on the right but not quite on the left hand. Other than that I am symptom free. No pain, no bleeding, fully continent and physically active. Have not had a followup PSA yet. That is scheduled for December. For those of you in the moderate risk category as I am, I hope you find this helpful in choosing your therapy.

Age 69
2/2009 PSA 4.3 Biopsy negative

2009-2016 PSA climbed from 4 to 6

DRE all negative

2/2016 PSA 7.5

Ultrasound and DRE indicate nodule

Biopsy with 6 of 12 cores pos

Two 4+3 Four 3+3

5/11/16 Gold Markers Placed

5/5/2016 on Lupron and Casdex

IMRT started 7/2016 25 fractions 45Gy total

8/4/16 Flomax 0.4mg started

Cyberknife boost 8/9/16 2 fractions 19 Gy total

9/1/16 Last Dose of Casodex
Posted 11/5/2016 1:10 AM (GMT 0)
Thanks for reporting in. It took me several months for the hot flashes to go away and then six months until my T was high enough to have a meaningful PSA score. But all was well, once I got to that period.

Good luck and keep us posted!
Posted 11/5/2016 7:49 PM (GMT 0)
It's great to hear success stories. Thanks for that.
Posted 11/6/2016 12:32 AM (GMT 0)
As one can see from my signature below (I hope), I also had an SBRT boost with IMRT. As a Gleason 9 guy, I am extremely grateful for the (somewhat experimental) treatment that I received. So far, so good.
PS: I still have to figure out why some ROs do SBRT first and others IMRT first.
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