Proton or Cyberknife for me?

I have decided between these 2 treatments - pencil beam proton with Dr. Rossi at California Protons or Cyberknife with Dr. Gottschalk at UCSF.

I would much appreciate help in making a decision. Insurance will cover both. I would have to temporarily stay in San Diego for proton treatment which is an added expenses for housing etc. and is inconvenient but work and life can accommodate this.

Of course side effects are very concerning for me, as is curative success.

I am 58 years old. PSA 3.9 at DX. PSA has remained stable since DX 6 months ago. MP MRI performed. Biopsy results - 1/12 cores positive located right apex at 3+4 Gleason (57% involvement, 10% at 4). One other core had Gleason score too small to grade.

Thanks Tall Allen. I've seen your thoughtful, fact-based, reasoned responses and read your blog so your opinion has a lot of weight for me.

The proton regimen Dr. Rossi recommends is 28 treatments and I think 5 treatments by Dr. Gottschalk for Cyberknife, but still all thing being somewhat equal 28 treatments vs 5 and temporarily relocating is something to think about.

Thanks hrpufnstuf.

I think I can handle the PSA fluctuations. At least that's what I predict.

Dr. King gets really good reviews here. Anyone have an opinion about Dr. Gottschalk and the Cyberknife program at UCSF?

While I'm at it, any opinions about Dr. Rossi at California Protons (formally Scripps)?

From what I can tell, they're both good. Gottschalk uses a kind of SBRT called "heterogeneous planning" which more closely simulates HDR-BT. I thought he only used 4 fractions, but ROs sometimes change their protocols. King prefers "homogeneous planning," avoiding hot spots or cold spots. They both publish good results. I'd do whichever is most convenient.

I've only heard good things about Rossi, too. I like that he is offering hypofractionated protons - it worked well for X-rays, so I can't see why it wouldn't work for protons. i know there are ongoing clinical trials.

/pcnrv.blogspot.com/2016/08/proton-hypofractionation.html

Well done Skeeter. Glad to see your success. The cyclotron was being built when I was a student at IU. You were among the last to receive proton therapy as they shut down the clinic several years ago for a lack of patients. Not many use proton today for PCa, but it is used more appropriately for many other cancers.

To JNF: Actually the IU Proton Center operated for at least a couple of years after I finished my treatment. One thing to note--when the decision to close the facility was made, it was not because of the lack of patient care or the quality of the treatment. Those were found to be outstanding. It was closed due to an aging cylotron that needed updating, and the cost of doing so could not be justified at the current patient level.

To Saipan Paradise: Sorry, but Dr. Ko was not my RO. I was treated by Dr. Theresa Oldham, who at the time I was there handled most of the PCa patients. Imho, she was an outstanding RO whom I trust completely.

Without getting into a lengthy discussion in this reply, I would disagree that proton is not being used much as a current treatment method for PCa. At the time I was treated at IU, there were only 9 active proton centers in the USA. Now there are 28, with at least a dozen more scheduled to come online soon. To best of my knowledge, all will include treatment of PCa as part of their provided services. The good thing about proton treatment is that it continues to be recognized for its value in treating other areas of the body without doing collateral damage, which imho is the whole reason for using it to treat PCa.

Post Edited (SkeeterZX22v) : 5/10/2018 8:48:29 AM (GMT-6)

I don't have any specific knowledge to add here, but...if as you say the side effects are equal, why spend the extra month of treatment for protons? Given your diagnosis, I'd assume that either treatment has an excellent chance of curing you.

That is, if the side effects are equal. Physics will tell you that protons do less damage than photons, regardless of how they are administered. Take a good look at all the areas that protons are being utilized today. There is a reason protons are the preferred radiation treatment for those cases.

SkeeterZX22v said...
That is, if the side effects are equal. Physics will tell you that protons do less damage than photons, regardless of how they are administered. Take a good look at all the areas that protons are being utilized today. There is a reason protons are the preferred radiation treatment for those cases.

My urologist at MD Anderson (Assistant Professor of Urology at UT Med School) told me that "radiation is radiation" when I asked which would be better, photon or proton radiation.

Thank you hrpufnstuf! Helpful info.

Well said. Maybe it really doesn't matter in the overall scheme of life and PCa treatment, but given the choice, I'd much rather be radiated with a proton beam than a photon beam.

After much deliberation, I have decided to move forward with pencil beam proton therapy at California Protons in San Diego. I start later this month.

Thank you very much everyone for all the helpful input!

Oh my, your treatment center is only about a mile from the Ballast Point Brewery. Your biggest challenge will be avoiding weight gain from their great food and beer! Congrats on reaching your decision, and best wishes.

Jim