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Posted 12/7/2017 6:57 PM (GMT 0)
CyberKnife treatments have been completed as of 6 Dec 2017. SpaceOAR w/fiducials were implanted prior to the SBRT. Total dose ~ 37 Gy.

Side effects are minimal, but I'm on FlowMax and prednisone as a precaution. The only thing that I notice is reduced flow. But flow is still acceptable.

Would appreciate any comments/experiences with progression of side effects following CyberKnife.

Dr. Gearhead
Posted 12/7/2017 7:26 PM (GMT 0)
Dr. G, glad you made it through and are doing well. I had LDR Brachy so can't comment with personal knowledge of the SE progression but I'm assuming some of the SBRT grads will do so directly (or you can search HW and find some of the stories).

What I will do is predict based on what I've seen on HW for the past few years about SBRT:

1. You will be cured.
2. The immediate SE's will be tolerable and will subside over a fairly short period of time.
3. You will likely be free of long term SE's except for reduced ejaculate.
4. Unless you run into other health issues, life after your chosen PCa treatment will be good.

Best of luck and please keep us up to date on your progress.

Jim
Posted 12/7/2017 9:22 PM (GMT 0)
Dr. G. why did you chose Cyberknife over Brachy etc.?? Only knock I have heard on SBRT is its relatively short history (and a bunch of positive stories too). Best of luck on a speedy recovery and a great 2018!!
Posted 12/7/2017 11:53 PM (GMT 0)
dbell - Why are you so fixated on LONG history of a treatment's results? So far, Dr. Katz has published his 9-year results, and has the 10-year results in computation. If we all waited for 15-20 years of results, the newest technology some folks would accept would already be obsolete.

BTW - CyberKnife (and other SBRT applications) more closely match the dosimetry of HDRBT, rather than the long-used LDRBT. That HDRBT only has one or two more years of history in use as a monotherapy, so should be discount both HDTBT and SBRT?

Now, before you think I am trying to start a flame war, I apologize if I mis-interpreted your comment's "stress" level. If you were only "sayin'", then my apology is official. If you were really cautioning the OP against CyberKnife, then we disagree strongly.
Posted 12/8/2017 12:18 AM (GMT 0)
Congrats on finishing. Although I didn't have SBRT, my only real SE is also a reduced (but acceptable) level of flow. All the best to you as those bad guys start dying off...
Posted 12/8/2017 5:17 PM (GMT 0)

Paxton said...
dbell - Why are you so fixated on LONG history of a treatment's results? So far, Dr. Katz has published his 9-year results, and has the 10-year results in computation. If we all waited for 15-20 years of results, the newest technology some folks would accept would already be obsolete.

BTW - CyberKnife (and other SBRT applications) more closely match the dosimetry of HDRBT, rather than the long-used LDRBT. That HDRBT only has one or two more years of history in use as a monotherapy, so should be discount both HDTBT and SBRT?

Now, before you think I am trying to start a flame war, I apologize if I mis-interpreted your comment's "stress" level. If you were only "sayin'", then my apology is official. If you were really cautioning the OP against CyberKnife, then we disagree strongly.

Paxton, as you see I am a newbie here and definitely not trying to start a flame war here. I am not bashing Cyberknife etc. only stating what I was recently told by my specialist(s). I was advised by both that if treatment was necessary they would prescribe Brachy. I am just trying to get another perspective here (and learn and obtain more info.), not looking to cause a problem or bash SBRT etc. Curious why people chose surgery, cyberknife and HDRBT etc. I am gathering info. so I can make an intelligent decision someday!
Posted 9/26/2023 7:12 PM (GMT 0)
Long Term Update:

It's been nearly 6 years since SBRT treatment. My Pre-treatment info (as of Dec 2017) is shown below:
Age 71 (2017), VG Health
PSA: 11/04 1.0, 4/07 1.6, 4/08 1.3, 5/09 3.2, 11/09 2.5, 5/10 2.9, 7/15 5.1, 10/15 4.7, 4/16 5.0, 11/16 6.3, 2/17 6.2, 8/17 7.2
9/17 Gleason: 3 of 12 3+4<5%, 3+4~15%, 3+4~30%, T1C, N0, M0; (10/17 Negative CT and NM Bone scans)
Prostate 52gm
CyberKnife w/SpaceOAR completed 12-6-2017

Following the last report, shown above, my PSA decreased to 0.50 at a nadir of about 4 years.

Now, lab work PSA reading on Sept 21, 2023 was 0.651. This was done in preparation for my yearly wellness visit with my primary care provider.

Today, 26 Sept 2023 another PSA reading was taken at a follow-up visit with my Radiation Oncologist. The PSA was1.15 (different lab). I am aware of watching the PSA doubling time, but surprised at the discrepancy between the readings of the two labs.

Presently waiting a call from radiation oncologist. Any thoughts/comments are appreciated.
Posted 9/26/2023 9:39 PM (GMT 0)
Hi

I would discuss with your RO and have another PSA test with the original lab, you may be having a bounce and the last reading could be due to the new lab, I stay with the same lab Nordx to minimize variables, other than the nadir of 0.5 what were your other readings? any bounces along the way.
Posted 9/28/2023 2:58 PM (GMT 0)
Turboz,
Table with dates and PSA readings (post SBRT) shown below. All of these readings were taken at "Health Care Facility M.", my RO's office.

Date PSA
03/30/2018 4.50
01/11/2019 3.81
07/03/2019 2.75
02/03/2020 2.02
08/03/2020 1.44
02/08/2021 0.81
08/09/2021 0.61
02/14/2022 0.51
08/30/2022 0.50
02/28/2023 0.61
09/26/2023 1.15

A PSA re-test was done on 09/27/2023, confirming the 1.15 reading. As mentioned in my previous post, a PSA reading of 0.651 taken on Sept 21, 2023 at "Health Care Facility A." This was at my primary care Dr's office as part of my yearly physical. That discrepancy caught my attention. However, my primary care Dr wasn't concerned about the discrepancy. So far he has not agreed to authorize a retest.

My RO has scheduled a PSMA in about 3 weeks from now. Keeping my finger's crossed.

As always, thoughts/comments are appreciated.

Dr Gearhead
Posted 9/28/2023 4:08 PM (GMT 0)
Hi Dr. G and a (late) Welcome to the Forum!

Even though there was the small increase from 0.50 to 0.61 before the latest 1.15, I don't see the harm in a confirmatory repeat test before going ahead with the PSMA. I think any unexpected PSA jump warrants a repeat (at some interval) to check that it wasn't an outlier (especially if a change in lab is involved). On the other hand, you might even see a further increase-- depending on the interval--if the high reading was legit.

It's a little curious that your primary care doc wasn't concerned enough to suggest a repeat test, whereas your RO wants to skip a retest and go ahead with PSMA.

Wishing you all the very best,

Djin
____________________
Hmmmm--I see that the Forum has made a BOLD move!

Post Edited (DjinTonic) : 9/28/2023 8:13:32 AM (GMT-8)

Posted 9/28/2023 5:04 PM (GMT 0)
"Hmmmm--I see that the Forum has made a BOLD move!"

Not really. Sometimes when someone does bold it carries on for subsequent posts. I would have thought the new platform would have fixed that. But did the new and exciting thing really happen?
Posted 9/28/2023 5:18 PM (GMT 0)
Djin,

Thank you for your comments. My RO did do a re-test that reported a PSA of 1.19, vs the 1.15 of a day earlier. I feel very good about his judgement. He has been super-supportive over the past 6 years that I've known him.

My primary care physician hasn't responded to my message regarding a re-test. It appears that something may be off about the PSA test methodolgy used by the 2 labs. They both can't be accurate.

It seems to be very unlikely that differences in assay brands could account for the discrepancy. I have found that this paper
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8627779/ to be very informative about PSAt differences among 3 different assays.

Dr Gearhead
Posted 9/28/2023 5:57 PM (GMT 0)

Dr Gearhead said...
Djin,

Thank you for your comments. My RO did do a re-test that reported a PSA of 1.19, vs the 1.15 of a day earlier. I feel very good about his judgement. He has been super-supportive over the past 6 years that I've known him.

My primary care physician hasn't responded to my message regarding a re-test. It appears that something may be off about the PSA test methodolgy used by the 2 labs. They both can't be accurate.

It seems to be very unlikely that differences in assay brands could account for the discrepancy. I have found that this paper
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8627779/ to be very informative about PSAt differences among 3 different assays.

Dr Gearhead

By coincidence, I posted a link to that same paper on calibration methodology a few days ago here! I also posted my take on uPSA testing here.

I'm not so sure that 1.19 and 1.15 on consecutive days is out of the unusual for normal for a 2-decimal PSA test, considering all the factors. My uro mentioned that when PSA was first discovered, they did daily testing on some men and found levels can vary day to day. I think he said it was as much as 20%. Then you have to figure in all the test-related sources of variability, and there are many.

I just asked Mr Google and found this:

"Variations in PSA like yours aren't particularly remarkable. In fact, fluctuations in PSA of up to 36% from one day to the next may have nothing to do with cancer. "

"What does a fluctuating PSA mean?" Harvard Health (2009)

(On one hand that's reassuring; on the other it's bonkers for us who are trying to monitor our levels.)

Also see: Limit of Blank, Limit of Detection and Limit of Quantitation

This is my "go-to" paper for the Labcorp/ROCHE 3-decimal uPSA test:

The significance of reporting to the thousandths place: Figuring out the laboratory limitations

Djin

Post Edited (DjinTonic) : 9/28/2023 10:29:01 AM (GMT-8)

Posted 9/28/2023 10:15 PM (GMT 0)
Dr. G….I too was treated with SBRT about the same time (June 2017) as yourself. Seems like a distant memory now and as best I can tell I have no significant side effects. I had an endorectal balloon placed prior to each radiation treatment. SpaceOAR was still relatively new. My urinary and sexual function are very satisfactory and about the same as prior to treatment. I thought I’d include my post PSA results including the dates and post treatment months.

09/17 1.1 3 Mo.
12/17 1.2 6 Mo.
02/18 1.1 8 Mo.
05/18 0.9 11 Mo.
08/18 1.8 14 Mo.
02/19 2.7 20 Mo.
08/19 1.0 26 Mo.
02/20 0.3 32 Mo.
08/20 0.6 38 Mo.
02/21 0.8 44 Mo.
08/21 0.4 50 Mo.
08/22 0.4 62 Mo.
06/23 0.2 70 Mo.

You can see I’ve had bounces at 20 and 44 months post treatment. I get my PSA checks currently about once a year. My radiation team says not to be concerned unless I exceed 2.2. It’s possible your PSA is still bouncing. Radiation guys still have their prostate and it will still generate PSA for any number of reasons. My advice is to continue to track and stay vigilant. Best wishes…Terry
Posted 9/28/2023 10:27 PM (GMT 0)
A PSMA scan is warranted if the PSA is over the nadir+2 level (after SBRT).
Since this is not the case, I suggest that frequent PSA tests are the way to go for now.
A prostate MRI is another option.

Post Edited (Sr Sailor) : 9/29/2023 5:19:21 AM (GMT-8)

Posted 9/29/2023 3:29 PM (GMT 0)
Terry,

Your PSA progression looks very good. The fact that you resumed your downward trend despite having a couple of bounces makes me feel hopeful. My RO decided to set up a PSMA despite PSA being far less than nadir + 2. The decision about the PSMA was totally his, without any request from me.

In my case I still have radiation induced proctitis, despite using SPACEOAR. Very minor bleeding with about 25% of the bowel movements. That is the only side effect that I can attribute to the SBRT.

Dr Gearhead
Posted 9/29/2023 7:43 PM (GMT 0)
My PSA never reached 2.0 after CR.
But my PSA went from nadir of about 0.18 to 1.41 in a matter of 2 months.
My Onco thought it best to have the PSMA scan.
I am glad you have it scheduled.
Posted 10/7/2023 3:36 PM (GMT 0)
Update as of 07 Oct 2023:

Recent Total PSA tests:
21 Sept 2023 - PSA=0.651 (taken for annual wellness visit at Advent Health, Hendersonville, NC)
26 Sept 2023 - PSA= 1.15 (taken at RO's office, Mission Health, Asheville, NC)
27 Sept 2023 - PSA=1.19 (re-test at RO's office, Mission Health, Asheville, NC)
==> RO ordered PSMA PET scan (for 19 Oct) based on suspected BCR.

PCP at Advent health declined request for a re-test.

05 Oct 2023: I went to Labcorp (on my dime) for total PSA test (CPT 84153) ----> PSA=0.60

Labcorp results in agreement with Advent Health PSA. Although Labcorp used Roche ECLIA methodology, I'm not sure of their PSA calibration (HybriTech or WHO). Methodology unknown at Advent and Mission.

On Monday will call RO to inform about Labcorp results. I don't know if he still would recommend the PSMA. It appears that something may be erroneous about the Mission test results.

As always your thoughts/comments are appreciated.

Dr. Gearhead
Posted 10/7/2023 4:19 PM (GMT 0)
There can be significant variability between PSA test results alone and there can be significant variability between labs and test equipment. Overall reliability is the two multiplied together so the swings can be significant. So, you try to control what you can by using one lab, testing at the same time of day, behaving the day before, and so on. RT leaves an injured prostate behind so probably affected by similar items of an intact prostate if not completely dead.

https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8627779/

Either way, you are in the range of PSMA testing if it can be justified.
Posted 10/7/2023 6:30 PM (GMT 0)
Dr G.

In case there's something of concern with the Mission Health PSA testing, I'll share my recent experience with their lab.

I had SBRT four years ago (36.25 Gy) and have had followup PSA tests with Mission Health every six months since. My current nadir is 0.24. Last week I had a blood draw for my annual wellness visit with my Primary, which included PSA testing, and my result was 0.4. During my visit with the RO a few days ago, I asked about a possible bounce (I had one at 18 months), but he thought the timeline for a bounce was unlikely. I always view my results prior to the office visit on my patient portal and noted that this latest test didn't include any assay information as all the previous test results have. I asked the RO about this and he said that the lab has recently changed testing machines and he seems to feel that PSA results have been coming back a little higher. He's not concerned with my results right now and noted that my DRE is what he expected after four years. I'm scheduled for another test in March '23 with my URO, but the RO wants me to call him with my results, good or bad.

I wouldn't have thought much about this until I read your post. Now I'm curious if there's a hardware issue with Mission Health Lab.
Posted 10/7/2023 7:12 PM (GMT 0)
e.noont,
I echo your thoughts about a possible change at Mission. On Friday I called a nurse in the Cancer Center about the current calibration standard. She called me back after contacting the lab, and told me with whomever she spoke also didn't know. I'll follow-up on Monday.

Dr. G
Posted 10/7/2023 7:29 PM (GMT 0)
e.noot BTW, I checked my PSA results on my Mission portal. All tests prior to 09/26/2023 were performed using the Abbott Architect Methodology (Chemiluminescent Microparticle Immunoassay (CMIA)). No methodology specified for 09/26 and the 09/27 re-test!

Dr. G
Posted 10/8/2023 9:51 AM (GMT 0)
Dr. G,

My previous tests show the same assay.
Posted 10/8/2023 11:52 PM (GMT 0)
Had SBRT with gold fiducials and Spaceoar just about two years ago.
I'm doing well with PSA but have suffered urinary stricture which was dilated three months ago and urine flow is good with some pain on voiding.
The near retention was pretty scary with massive blood clots and hematuria.
So far after dilation all is well except I'm trying to get my urologist to prescribe testosterone which I've been going to a clinic for but it's expensive.
Told me he'd consider it at the two years post radiation time

Good luck

Glen aka the swan
Posted 10/9/2023 4:23 PM (GMT 0)
I'd add that the stricture didn't start until well after the radiation. Maybe a year after SBRT
I've read that side effects can occur months to years after treatment.

Glen
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