Completed SBRT - what happens next

My last CyberKnife treatment at Winthrop Hospital in NYC was May 26.
I will be taking hormone deprivation therapy (Eligard) for another 6 months.

What should I expect in the next 6 months to 1 year?

My first follow-up appointment with Dr. Haas will be tomorrow, June 21.

Are there any specific follow-up tests that I should be getting? How do I tell how effective the treatment has been. The HDT treatment will mask the PSA tests for a while.

The radiation dosage was 36.25 gr ( 5 x 7.25). I think the margin was 5 mm + 4 mm laterally.

It was about 20 minutes per radiation session, preceded by getting Amifostine rectally to reduce radiation damage and waiting 20 minutes for it to be absorbed. Each visit lasted about 1 hour All the people were helpful and very nice.

Tall Allen,
Did Dr. Katz publish anything about the use of Amifostine?

I got the impression that Dr. Haas and Dr. Katz still actively communicate with each other.

I met and compared notes with several other people who were getting treated at the same time. Interestingly, several had been referred to this Winthrop location by Dr. Alan Katz who used to be associated with Winthrop. I suspect this was because this location (Manhattan, 66th St. & Amsterdam Avenue) is a more convenient location for many people.

The recent poster presentation by Dr. Katz on high risk prostate and SBRT said the outcome was the same for patients with or without HDT.
It was a small study, 50 patients with HDT and 50 without. Not really conclusive.

Dr. Haas at Winthrop was neutral on the choice. He said he would treat me either way and left the decision up to me. I decided to go with HDT since I had Gleason 8 or 9 and thought it might help. Dr. Haas said that the 2 months before would shrink the prostate and possibly improve the effectiveness of the treatment. I am not sure if I made the right decision. Maybe.

There is one thing Dr. Haas said about high Gleason and CyberKnife.

He stated that in their experience, Medicare never covers it. He referred us to Winthrop's financial assistance group and that in the worst case, we would be responsible for no more than $5000. That is what happened. We paid Winthrop $5000 for the CyberKnife treatment and had Winthrop send the bill to Medicare and our secondary health insurance. Actually, that is not very expensive. I have heard that Proton Beam therapy bills around $80,000 but is covered by Medicare. The copay on that would be around $16,000.

Tall Allen,

That communication about Amifostine is definitely interesting.
I suspect there is no downside to using it. The issue is that it may not improve outcomes.
In any case, Winthrop & Dr. Haas does use it.

The bigger question is whether hormone deprivation adds anything to outcomes.
Dr. Haas suggested, but did not insist, that 2 months before and 6 months after was his recommendation. He said he would do CyberKnife even if I did not choose HDT.

When I consulted with the radiation oncologist at Columbia P&S, he suggested 2 months before and 2 years after. Plus 4 weeks radiation of pelvic region followed by additional 5 weeks radiation of prostate. That seemed like the conservative recommendation but overkill.

I also consulted at Memorial Sloan Ketttering. In that case, she totally dismissed CyberKnife as unproven and suggested 2 months HDT before radiation followed by about 15 months after.

My assessment here was that MSS dismisses anything anyone else does. They may be good but also a little arrogent. They also insisted on doing a reading of the biopsy cells after the consultation even though I was not going to use their treatment. They trust no one but themselves. I previously had the biopsy interpreted by both Columbia P&S where the biopsy was done and by Johns Hopkins.

The other difficulty with Dr. Katz's study is that it combined 2 types of high risk prostate cancer to increase the number of participants. High PSA ( >20) with high Gleason (8+). Those are both high risk but different.

With his small samples, I think he said that there was a more significant biological recurrence rate with the high PSA group vs the high Gleason group.

I think we have to look at the limited data and just try to make a best judgement guess.

I am going to see Dr. Haas in an hour or so and see what he says based on my case & side effects so far.