HealingWell
Search Close Search
☰

CyberKnife

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
12
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 2/17/2022 10:26 PM (GMT 0)
I've been reading about CyberKnife and similar RT.
Have had recommendation from men on HW.
I going to bring up the subject to my RO to see if he thinks I am a candidate for it as well as the PROs/CONs.

Anyone here have personal experience having the RT with it?

Thanks
Posted 2/18/2022 12:14 AM (GMT 0)
Many on this forum have had SBRT and reported good outcomes. I was in a clinical study where SBRT was one component of the treatment protocol. You can see the fun that I had in my bio below.
More in general, published studies show that SBRT is the way to go for low-Gleason patients. There are 10-year data by now, so there's isn't anything 'experimental' about SBRT for routine cases. Of course, competency of the radiation team is of utmost importance.
If I look at your background, SBRT should enter the conversation. Be aware though that this conversation should be with a radiation oncologist who has SBRT experience.
Posted 2/18/2022 2:13 AM (GMT 0)
IIS, Cyberknife is a brand name for a specific version of SBRT. There have been a number of guys in here who have gone that route, and I don't think anyone regrets it. It seems to give as good or better long term results compared to IMRT, with 5 treatments over 2 weeks as opposed to 40+ treatments over 6 weeks.

And the same or lower side effects.

As I may have said earlier, if I had felt comfortable with the state of SBRT 7 years ago, I would have seriously considered it.
Posted 2/18/2022 4:46 AM (GMT 0)
Perhaps if it is for lower Gleason scores it was not suggested to me as I have Gleason 8. (?)
Posted 2/18/2022 7:36 AM (GMT 0)
G8 is probably pushing it for SBRT as most practitioners stop at the unfavorable intermediate phase (G7-4+3).

Since it is simply hypofractionated external beam IMRT, you should have an assessment by a radiation oncologist that uses SBRT, as they will also use the traditional dose of about 1.8 gy per fraction which takes about 45 fractions (daily procedures) over a 9-10 week period.

Do find a RO that uses High Dose Rate brachytherapy. For you a combination of HDR-BT and external beam IMRT has shown to be the most effective for high risk men like you and myself. I used the combination 11 years ago for high risk PCa and continue to be PSA undetectable and have no negative treatment side effects. One or two HDR-BT procedures are combined with usually 25 IMRT fractions (about 6 weeks) and normally with some period of ADT (6-18 months). For high risk the IMRT often also targets the pelvic lymph nodes as that is a common path for initial PCa spread.

Where are you located? With that knowledge, we can be more helpful. While HDR-BT is very effective, it is not as common as permanent seeds brachytherapy as it requires additional hardware and expertise.

PCa is one of the few cancers that responds better to high dose radiation rather than low dose. HDR brachytherapy was started in about 1980 and is used for many cancers in addition to PCa. In the 1990’s the hypofractionated radiation (SBRT and trade name CyberKnife) were started for certain cancers particularly head and neck and some juvenile cancers. In the early 2000’s practitioners started using it for PCa based on the good results of HDR-BT.
Posted 2/18/2022 11:12 AM (GMT 0)
JNF, I am in St Louis and have elected to get treatment at Siteman Cancer Center/Wash Univ Med School which is said to be the “gold standard” here.
Posted 2/18/2022 1:14 PM (GMT 0)
Doc messaged and says their evaluation team feels I am a good candidate for proton therapy (w/24 months ADT). I think originally they thought I was not a good candidate for Brachy due to the size of my prostate (volume of 69). (Not sure what measurement they use for that.)

Now the question will be if sucky Medicare Advantage PPO will cover it.

Next election I’m voting for Liz Warren. Medicare for All! Not just seniors should have to deal with this crap!
Posted 2/18/2022 3:50 PM (GMT 0)
Regarding the size of your prostate, I'm not sure if that's only an issue with low dose brachy (seeds), but not high-dose brachy (HDR), which JNF mentioned. If you were eligible for HDR brachy, I would also presume it would need to be in combination with IMRT, particularly due to the lymph node issue.
Posted 2/18/2022 4:08 PM (GMT 0)
Wash U/Siteman works with a committee reviewing each patient so I think there is less chance of a doc with just one area of expertise (ie surgery) steering you in that direction. I guess I’m pretty much at the point of trusting the Docs.

My wife’s cousin (44yo) just had a double lung transplant at Wash U. Left the hospital in less than 2 weeks. They do amazing things!
Posted 2/19/2022 3:45 PM (GMT 0)
I agree with JFN about the advisability of SBRT with your G8 (4+4) biopsy, cribriform pattern identified, and a PSA just under 10. The optimal total dose and fractionation schedule for SBRT is still being worked out, and there isn't much longer-term data on SBRT for high-risk disease.

For example:

Robotic Stereotactic Body Radiotherapy (SBRT) for Low- and Intermediate Risk Localized Prostate Cancer. Feasibility, Outcome and Toxicity. (2022)

"SBRT is a comfortable and cost-effective treatment approach. It shows very good tumor control and self-limiting, medically manageable toxicity. Based on meta-analyzed data from prospective comparative trials like HYPO-RT and PACE-B, we propose SBRT as a primary option for selected pts. with localized low to intermediate-risk prostate cancer."

Have you had a bone scan yet? Has any other imaging shown any enlarged regional lymph nodes?

Djin
Posted 2/19/2022 4:55 PM (GMT 0)
I was low risk and successfully treated with SBRT and have no problem recommending it for a lot of men. I also always recommend finding the best practitioner and team that you can for any PCa treatment. Although the RO leads the team he depends on urologists, dosimetrists, PA’s, RN’s, and a whole support cast of radiation technicians to deliver the radiation precisely. Seek out the very best you can find even if it’s not convenient.

Although you’re diagnosis is a lot tougher than mine I certainly would investigate if SBRT is appropriate for your situation. Cyberknife, Precise, SABR are all very similar with minor differences regarding the equipment. I’m five years post treatment and RT is ever changing. Terry
Posted 2/19/2022 5:42 PM (GMT 0)
It appears the plan is for proton therapy which appears to have less SE.
Posted 2/19/2022 6:13 PM (GMT 0)

IsItSerious said...
It appears the plan is for proton therapy which appears to have less SE.

Evidence?

PS: Proton therapy may well be a good choice for you. It typically requires a lot of sessions and is expensive (either to you or 'the system').

Post Edited (Sr Sailor) : 2/19/2022 11:25:00 AM (GMT-7)

Posted 2/19/2022 7:19 PM (GMT 0)
IIS, For PCa Proton has not proven to be better than photon…just much more expensive. For the last seven years Medicare and most commercial insurers won’t reimburse because they have determined it does not offer any benefit compared to photon and won’t cover the additional cost of 2-3 times. The official position of ASTRO the main society for radiation oncologists is that for PCa Proton should only be used in clinical trials comparing it to other treatments. Mayo Clonic is absorbing the additional cost so it gets covered. I don’t know of any others that offer such a deal, but yours might. Most are just not using it for PCa.

Will be interesting to see if your Advantage plan will. A good way to find out is to call them and ask.

Unfortunately, it appears many men are suggested for Proton by an institution and when they can’t get a reimbursement determination they say, well since you are here we will just use photon. Kind of a bait and switch situation, in my opinion. As SR Sailor mentions Proton is usually the same 45 or so fractions that normal fractionated photon uses. There are some suggesting Proton for hypofractionated similar to SBRT/CyberKnife, but that probably isn’t on the table for you due to risk factors.

Regarding prostate size, 68cc is not a problem for HDR-BT. Plus a few months of ADT will reduce the size by 35-50% making it an ideal target of brachytherapy. You asked how they know the size, it is measured by the ultrasound used with the biopsy and any other scans (CT or MRI) that you had.
Posted 2/19/2022 7:21 PM (GMT 0)
I considered Proton; however, SBRT was more convenient and the 2.5 hour ride was doable with only five fractions. Proton was newer, the travel greater, and likely pay out of pocket so I went with easy, effective, and practical for a low risk guy. With Gleason 8; I’d focus on success rate and the experience level of the RO team with PCa. Terry
Posted 2/19/2022 10:03 PM (GMT 0)
My profile is very close to yours. Gleason 8, cribriform, pni and low PSA. I had numerous consultations. One recommended cyberknife. Several recommended against cyberknife. Honestly, some of that could have been commercial positioning.

Ultimately, I couldn’t find enough long term data on cyberknife for high risk pca. I decided to do the triple play of hdr + imrt + adt.

Started adt in December. Finished hdr on Feb 16 (so far recovery has been better than expected). Start imrt Monday.

Can’t give you any long term experience. But it was surprising the similarities in diagnosis. Sounds like your in good hands in STL.
Posted 2/19/2022 10:45 PM (GMT 0)
IIS With your upgrade to G9, i think Cyberknife/SBRT is likely out of the question.
I would at least be asking, about HDR Brachy/ADT/IMRT (triple play). JNF may have mentioned it above not sure i am bit rushed for time right now, but i know he had very good success with it, and he was a G9 (of course your mileage may vary)
Posted 2/19/2022 11:12 PM (GMT 0)
Some reading material on proton vs. photon/IMRT. Nothing is clear…

https://www.cancernetwork.com/view/proton-beam-vs-intensity-modulated-radiation-therapy
Posted 2/20/2022 6:51 PM (GMT 0)
ISS: The upgrade from Epstein may change the plan a little; but, knowledge is power. I’m glad your treatment is at Siteman since I firmly believe the very best can make a huge difference. I hope you’ll keep us all posted on your progress since we don’t have a lot of info posted here with Proton treatment. Wondering if Siteman has considered or recommended any ADT treatment with the upgrade. Have they requested to look at your biopsy slides? When I was evaluated at Cleveland Clinic they requested I bring my slides with me. It was reassuring to have several additional opinions and assurances as to what was present in the biopsy. Terry

Post Edited (Terry's Cellar) : 2/20/2022 11:57:51 AM (GMT-7)

Posted 5/3/2022 9:21 PM (GMT 0)

Somebody said...
When I was evaluated at Cleveland Clinic they requested I bring my slides with me

@Terry’s Cellar, Can we request the slides from our lab? I didn’t know anything about this. The biopsy was done earlier of February, is it too late now?
Posted 5/4/2022 12:05 AM (GMT 0)
Terry—just saw your questions.
Siteman did not request the slides. They had pathology from St Luke’s Chesterfield (St Louis) and John Hopkins.

I started Cosodex (oral) for 30 days and got my first injection of Eligard (6-mo) which is planned for 24 months.

Seven of nine weeks completed of the proton radiation therapy. Fatigue and body/muscle aches are most notable SE. No additional urinary issues. Still have problems with extreme urgency (2-minute warning). More frequent BM but no diarrhea. Some weight gain and weakness likely due to loss of muscle mass. Need to be more diligent on getting to the gym but struggling with apathy (or maybe it’s mild depression).

LOVE my RO Doc at Siteman (Randall Brenneman) and the proton lab crew. The doc is never hurried. Ask a question and he can quote/site the latest study/research paper on the subject. Gotta admit I’ll be glad when I don’t have that 5am alarm for my 7am appointment every day.
Posted 5/6/2022 1:12 AM (GMT 0)
I finished SBRT November 30th 2021 and pretty much healed well after 3 or 4 months but recently I'm having urgency again and a dull pain when I sit and if the chair is hard, I feel an urge to urinate.

Just saw the urologist after I had a Ct scan ( I had blood clots and blood in my urine) Well anyway he told me that it's not uncommon to have some symptoms for as long as a year! I was a little taken aback but such is the nature of Pca I am not sure a RP would not have similar results but after 3 or 4 months of feeling "normal" it stinks to have symptoms again.
I can live with the symptoms I just wanted my cake and eat it too.

Glen
Posted 5/6/2022 1:19 AM (GMT 0)
BTW I choose SBRT because I have severe low back pain and while I did start IMRT I got urinary retention so I stopped and had Greenlight laser to open me up so I'd not get retention again (It was bad because when I had a catheter put in, it was not placed well and I got a paraphimoisis which was hellish, The foreskin started to turn black. Lucky for me my urologist "unwound" the damage and I was okay.
I then decided on SBRT because I would not have to be on my back so many times.

Glen
Posted 5/7/2022 6:11 PM (GMT 0)
I've read some of your updates and have to note my cores were eight positive all G6 but one was upgraded to G7 by John's Hopkins so I'm not sure if SBRT is still an option.
To be clear even though I'm annoyed with the symptoms coming back, they are not that big a deal.
I've had Total urinary blockage or as it's called-Retntion. Been catherized and developed a paraphimosis that was close to necrotic and lots of bleeding and clots so mild discomfort in the perineum area and mild irritation while peeing is nothing compared to those affore mentioned symptoms.
Bottom line is if SBRT is an option, I'd recommend it.
If nothing else it's very fast and one does not have to deal with the bladder being filled, holding the water in and sitting or lying on the darn table 50 plus times.

Glen
Posted 5/7/2022 11:41 PM (GMT 0)
I have 6 more proton treatments to complete the total of 44. Approaching 2 mo since Eligard injection. I’m anxious to get past the RT and see if my fatigue lessens. Now it’s going to be a long 3 months to wait to get labs for PSA and Test levels.
✚ New Topic ✚ Reply
12