CyberKnife - need your experience

TREATMENT proposed :

Hormone therapy (likely bicalutamide 150mg once a day tablet, ) for 3months , then implantation of fiducial markers,MRI and CT scan to design treatment thenCyberKnife radiation for 5 days. Gel to be used to minimize effect on other immediate organs - Space OAR

Please need comments from people who have been treated with CyberKnife or know what to do /expect from this treatment. This is my first choice of treatment now after considering other treatment options.

Diagnosis: localized carcinoma of prostrate - October 2016. 3/8 affected .Gleason 3+4 (50%)2/3core, 3+4(30%)2/4core, 3+3(<5%)1/6core.DRE clear. MRI No extra-capsular disease, no evidence of lymphadenopathy. PSA 6.3 , Age 61 years, 53cc post biopsy gland
Medical history : Myocardial infract -16 years ago . One coronary artery sent and since then no issues. Check up with cardiologist regularly.
Erectile dysfunction - 4 1/2 years ago . Pills worked till this year. Injection recommended - (Edex) tried once and worked in physicians office but painful.

I have no direct experience with CyberKnife/SBRT. But I do know it is considered a very good treatment option and several here have had good experience with it. I'm sure they'll be along shortly.

FWIW, I agree with the comment on getting a second opinion on your biopsy slides.

I only hear good things about it and wish I'd been able to go that route 6 years ago.

Andrew

Hello Bui, Wish I didn't know you under these circumstances but welcome to the club. Today makes exactly 4 weeks since my last SBRT treatment. My treatment was not as smooth as most I have read about. I had some uncomfortable side effects during my treatment. I have explained these in previous posts. That being said with the exception of the effects of the Lupron, I am 99% back to baseline as far as everything else goes. Little Willy Nelson can get back on the road again, he just doesn't want to at this time. I believe that will correct its self after the Lupron. My RO said I would only be on it for 4 mo. I didn't have any kind of spacer just had to have a full bladder which is difficult to time. I do believe this to be the best treatment for me and I wouldn't do anything different if I had to do it over. The discomfort I experienced in my opinion is far less bothersome than most of the definite side effects of some of the other treatments. Its a tough decision so good luck and God bless.

Thanks for the comments
Does anybody know the side effects(SE) to expect medium and long term. I have an idea of the short term SE like urination urgency, bowel movement, fatigue , ED etc. These are supposed to go away likely with time.
The medium and long term SE ?
The CyberKnife I guess has been in use much earlier in the United Kingdom (U.K) than in the U.S.A. - think I read that. If that is true then there will be more people who have experienced the medium and long term SE in the U.K.
Some of the surgeons I spoke with while gathering information on treatment options told me that I should be very careful of medium and long term SE of radiation generally. Was not sure if that was to let me choose surgery!

"Late-term" effects is the proper term for the radiation issues that appear increasingly over time.

These are the basis for the rule-of-thumb which has been around for a long time for younger guys to avoid radiation below their belly.

One of the problems with the available data on radiation therapy for PC is that late-term effects are generally under-reported because a) they occur 5- or 10-years after treatment, and b) generally the patient doesn't go back to see his radiation oncologists when they occur, rather they go see another type of doctor who specialized in rectal issues, or impotence, etc. The under-reporting used to not be an issue because it was almost all older-guys who might have outlived the onset of their late-term effects, but now in what's known as the "PSA-era" younger-and-younger guys are getting "branded" as PC victims with smaller-and-smaller amounts of PC which used to be ignored (because they cause no harm). Today, radiation therapies are being marketed as a "convenient" approach for our busy lives...short-term thinking, in my humble opinion.

Post Edited (JackH) : 12/17/2016 10:23:20 AM (GMT-7)

This article by Allen shows excellent results for SBRT.

If you choose Bicalutamide monotherapy then 150 mg is the recommended dose. Since Bicalutamide will not reduce your testosterone I do not expect deterioration of your erectile function. As long as you do not go for a longer time without getting an erection, the erectile tissues will not be damaged.

George

Thanks for the response(s)

I am still holding it as my first choice.
I have options for doing it in the U.S.A & United Kingdom - not yet decided where to go
Wondering if people know medium/ long term side effects for CyberKnife treatment?

Bui, Cyberknife is a type of SBRT technology. The SBRT statistics should answer your questions.

Decided to go with CyberKife treatment after visiting U.K. And U.S. Hospitals/ consultants.
Started Bicalutamide (150mg/day) on 25th December , 2016.
Will take it for 3months then the treatment.
So far no noticeable side effect on the Bicalutamide - almost one month.
Hoping the CyberKnife treatment too goes with minimal side effect.
Will use fiducial markers, Gel., for the treatment.
Will keep you updated !

Could the bicalutamide be a U.K. protocol? It seems that they do some things differently over there (example - they drive on the wrong side of the road. . . ).

Just curious.

Two months now on Bicalutamide ( 150mg)- one month to go before treatment with markers / gel and CyberKnife radiation.
Noticed mild tiredness. Breast tenderness / enlargement also very mild. No other noticeable side effect .

Discussed this last week at visit to doctor - no need for extra medication since it is very mild and not bothering me.

Expecting advice / information from dietician team and physiotherapist to help with treatment.

PSA 5.9 two months ago now 3.45 last week.

I was on Lupron and Casodex for 3 years. No issues with gynecomastia that whole time. No tenderness, no growth, nothing.

However.... after stopping hormone therapy, I've had some tenderness and some growth. The tenderness has mostly cleared up, comes and goes. Growth was noticeable to me, but probably no one else. It seems that apparently one's body can grow used to the very low T environment, and then the return of "normal" T levels acts excessive. The excess is converted to estrogen, causing a growth issue. This same phenomenon happens to body builders on testosterone. They usually have surgery to correct it.

I mentioned my concerns to both my GP and my med onc, and they were clueless. My own research on line found some references to this. Yet another side effect of prostate cancer treatments.

So, for me, tamoxifen during HT would have provided no benefit. Radiation at the outset might have, since it would have also possibly prevented tenderness and some growth after the HT ended.