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Post Cyber Knife PSA - what to expect?

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Posted 1/5/2017 8:28 PM (GMT 0)
It's been several months since last posting about my Dad's PC dx in the summer. To quickly recap, my Dad is a young and healthy 71 and was diagnosed with 2cm contained pc area during a fusion biopsy. His pre dx PSA was 6.9 but since he is on Finasteride his Dr. considers that number to be doubled for accuracy - so his pre dx PSA was closer to 14 and had doubled in the previous year.

He chose to have the Cyberknife treatment and finished his 5 treatments in October. Next Wednesday, he goes for his first appointment to find out his PSA post treatment.

Luckily, he had few if any side-effects and is anxious to find out his PSA.

My question is - what should be expected in terms of numbers? I've read where there could be a bounce or little change until 6+ months after treatment.

Has anyone had the Cyberknife and if so, what have been the results?

Thanks in advance!!! Happy New Year to all!

M
Posted 1/5/2017 9:42 PM (GMT 0)
Yes, there will be some PSA.

Likely lower.

How much lower is a guess.

I would think it's a little early to see a bounce.

It's the waiting that's the killer.

Andrew
Posted 1/5/2017 10:04 PM (GMT 0)
I agree with the above. Since your reference number ('close to 14') is fuzzy anyway, I wouldn't get (too) concerned about Wednesday's result. In the long run, the trend should be down.

As you probably know, after the radiation, cancer cells will continue to die and generate PSA.
Posted 1/5/2017 10:06 PM (GMT 0)
I'm still in the waiting phase for my first post-treatment PSA as well. As far as I know, they don't have a specific target number, just that they hope to see a decrease the first time, and then hopefully a steady trend downward for a while until PSA reaches nadir (its lowest point). From nadir, they watch to ensure that if there is any increase greater than a "bounce" that you are adequately advised how to decide if and when any further treatment should be considered.

My CyberKnife clinic told me that they do a first PSA at about 6 weeks post-treatment, as they usually see a "significant" decrease by that time. (I sure hope mine does that.)

You don't mention dad's Gleason score from his biopsy, but most CyberKnife patients were low to favorable intermediate risk patients. These groups have very high success rates in the published CK results studies, so I would just wait and see.
Posted 1/6/2017 12:52 AM (GMT 0)
Thank you all for your input.

Paxton - My Dad's Gleason was a G7 (4+3). The RO recommended the Cyberknife as the one he would opt for if it was him. Classified his PC as intermediate due to the (4+3) Gleason.

Sr. Sailor - it appears by your stats that your CyberKnife treatment has proven successful so far.

I will keep the forum posted after Wednesday.
Posted 1/6/2017 1:25 PM (GMT 0)
Good morning, Like your dad my Gleason was 4+3 which as I understand puts us in the unfavorable intermediate group. My RO as well as my URO said that the standard of care was to use ADT along with some other form of treatment, in my case I chose SBRT which I believe was the right choice for me. My initial PSA was 8.98 in April 2016 then after 1 month on Lupron, in Nov 2016 it was 4.71 and one month after my last SBRT treatment which was Nov 16th, it was <.1 I will be taking my last 3 mo shot of Lupron on Jan 19th. I am not sure there is a lot of info on PSA after treatment and ADT (at least I haven't seen it). Hopefully this will give you a little more info on this journey.
Good luck to you and dad.
Perry
Posted 1/6/2017 6:17 PM (GMT 0)
Perry -thank you for comments. It sounds like it's so far, so good with your treatment. That is great news for you! You are correct with your assessment of the G (4+3), however, both the RO and Dad's Urologist felt good recommending the CyberKnife and believe it will be a successful as a solo treatment. They did follow up by stating that since it is so relatively new, that long-term studies on the success rates and mortality from disease had not been tracked.

I will update this thread with his 3 months post radiation/cyberknife results after Wednesday. Fingers crossed!
Posted 1/6/2017 7:31 PM (GMT 0)
M - Just for the record, CyberKnife may be relatively new, but there is at least one published study of its results over 9 years. Tall Allen has a link to this study in his signature. The study is large enough to be statistically reliable, and it shows excellent disease control - much like HD Brachy. TA also has a link to a 7-year (IIRC) Quality of Life study on CK patients, again showing excellent results.

I could go on ranting about this, but you don't need that. Let me just say that I always bristle when doctors warn us that something is too new to seriously consider, yet there are already studies published. It just shows me that they are more than willing to preach what they know, but they aren't always focused on keeping up to date. Although I am tempted to ask them how long the research studies ran for IMRT when that became standard of care. I think it was only about 11 years. We now have 9 years' data on CK. The 2 year difference didn't change my choice.

P.S. The RO who warned you that there is not any long-term data on CyberKnife. . . wasn't the one who delivered the CY treatment, was it? Most docs can tall you all about what they can do, but not much about what they cannot deliver.
Posted 1/6/2017 8:01 PM (GMT 0)
Paxton - Thank you for the suggestion. I will look at Tall Allen's signature for the study.

I probably should have re-phrased my reply earlier. Actually, both of my dad's doctors, his Uro and RO recommended the CK! They did not warn him, they simply followed up by stating that since it is the newer of the PC treatments, there are not as many published follow-up studies. My Dad of course asked a lot of questions and wanted some kind of statistic for treatment results. This is when the RO said it was VERY successful, but he was unable to provide as much data for long-term results simply because it hadn't been around as long. His doctors were both very encouraging about their recommended course of treatment with the CK even though they provided ALL of the options. They left it to my Dad to ultimately decide. Both Dr.'s said if they had to choose a treatment for themselves they would opt for the CK. I cannot say enough about the ease of the treatments.
Posted 1/6/2017 8:45 PM (GMT 0)
M - You don't have to remind me how easy the treatments were ;-)). For my treatments, I basically spent almost an hour lying on a firm "bed" covered by a warmed blanket (they had a blanket warmer - really!), listening to music of my choice on a pretty good stereo system. I actually slept through part of each of the treatments.

I do miss my naps. I don't miss the short-term side effects (urinary and rectal junk), but by about 3 weeks after the final treatment, most of them subsided. Almost completely back to normal now.

Here's hoping that we are all among the 95-97% who are "once and done" patients.
Posted 1/6/2017 10:21 PM (GMT 0)
Paxton - Glad to hear you also experienced the "ease of treatment". smile Let's hope you and my Dad are in the 95-97%! I'll be keeping you in my thoughts for a successful outcome.

M
Posted 1/8/2017 9:14 AM (GMT 0)
The links are down there V

Dr Kang said they'll have a 10-year f/u sometime in 2017. That will make it the longest-running external beam study, and with a sample size much larger than the MSK IMRT study. I think that when some ROs wake up to it, they think it's new. Dr King has been doing it since 2003.
Posted 1/8/2017 11:57 AM (GMT 0)
All sounds very encouraging at a time when I personally can use the boost of confidence.
Having my markers placed by Dr Zelefsky at MSKCC in 10 days and then off to the races.
Hope I experience the same "ease of treatment" and anticipated cure that you all allude to.
Posted 1/9/2017 1:20 PM (GMT 0)
Ummm. . . Bosco, markers are fun NOT! Be sure to ask the doc for something to "take the edge off" and for any pain meds they feel comfortable using. My marker implant was much more uncomfortable than my biopsy, as the docs who did the markers do not use a prostatic nerve block, and they did the implant via transperineal method. The good thing was that once they were finished, there was literally no residual pain and no side effects for me. I was just a bit groggy from the valium and oral pain meds, so wife drove me home.

After the markers heal, the last pre-treatment circus was the CT scan. Needed to have a catheter in place for that one, but by my age and after the various surgeries I've had, these things just aren't that big a deal to me.

That's about it. If you're going SBRT, it will be just a few treatments and then you're released on your own recognizance. I think you'll do fine. SE's aren't that bad, either (so far). Just follow instructions as well as you can and tell the docs about anything unusual going on.
Posted 1/9/2017 3:31 PM (GMT 0)
Allen - thank you for posting the links for the studies. All great points you make about the treatment.

Bosco - Paxton is correct about the markers. According to my Dad, that was the most difficult part of the whole ordeal...and even that was not bad at ALL! Just be sure you have a prostatic nerve block and you will be fine.

Thankfully, all the tips and recommendations I learned through this site, helped Dad to know what to ask his doctor. This forum has been a blessing to us both! Thanks again!
Posted 1/11/2017 4:12 PM (GMT 0)
Just an update on my Dad's 3 month post-CyberKnife PSA. This morning his doctor delivered the great news that his PSA dropped to 0.61! It is down from 6.9 in May 2016. The RO said he was really pleased with the significant drop. Great news!!! smile
Posted 1/11/2017 5:06 PM (GMT 0)
Congrats! I love these stories!
Posted 1/12/2017 12:17 PM (GMT 0)
Paxton, Mermaid,

If my marker placement is being done under IV sedation is the prostatic nerve block still suggested ?
Obviously in this case it would be for post op pain management rather than intra-op.
Thanks
Posted 1/12/2017 1:14 PM (GMT 0)
If they are doing your marker placement under full sedation, you wouldn't need the nerve block at all. My RO sort of offered sedation, but for that to be done, I would have had to have the markers placed at the main hospital OR, and my RO prefers that they do them in their office. Also, if I did them at the RO's office, it was a quick in-and-out deal. With sedation, it would have been a longer stay, more complicated, etc.

For me, there was actually no pain once the instruments were all removed. There was only pain while they were "in there" working on me. I was back up and at normal activities that afternoon.

I got through it by reminding myself that "This is the worst of it. After this, it is all downhill with a tailwind." You'll be fine, trust me. I was very anxious. They gave me valium for that. In hindsight, I probably didn't even need it.
Posted 1/12/2017 2:44 PM (GMT 0)
Bosco,
My Dad's fusion biopsy was much more involved than the marker insertion. Even though we were there with him for the markers, he actually insisted on driving home after the procedure. smile It was not at all painful for him. Of course everyone has a different experience and threshold for pain. Because Dad was not under full sedation, he had the prostatic nerve block (which was recommended on this forum by someone and I made sure he asked his Dr. for this). During the entire experience, the fusion biopsy was by far, the most invasive and "uncomfortable" part.

....I'm trying to get Dad familiar with this forum, as I know he would enjoy reading and sharing his experience with others. I'm sure the community here would welcome him gladly, if I can convince him to sign on! smile
Posted 1/12/2017 2:59 PM (GMT 0)
Interesting because I didn't find my 16 core fusion guided Bx uncomfortable at all. I actually did drive home from that myself.
I'm sure I'll be fine with this too.
Posted 1/12/2017 3:10 PM (GMT 0)
That is interesting, Bosco! I am sure you will be fine. smile
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