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Joined: 10/21/2009
Posts: 4
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Trying to post, see if this works! Like most of us I am trying to make a decision, again! Age 68, good health, psa 3 to 6.7 over 5 years. Gleason 3+3, 12 samples none over 10%. Urinary QOL score 11 I was all set to iodine seeds with the top doc in the Northwest. On the internet I came accross a new study here in Vancouver, WA and am intrigued. In trying to weigh the pros and cons, it's almost impossible to get an oobjective opinion, everyone has a vesterd interest. My vested interest is to be cured of prostate cancer. I see positive of seeds, long history, top doc, closest control of radiation, 1 treatment and your done. Negatives, general anesthesia, some urinary problems, difficult if not impossible salvage. I see positive of CyberKnife, short period of relatively comfortable treatment with quick or no need for recovery, close control of radiation, reasonable chance of salvage if cancer returns. Negative, relatively short history, some greater chance of rectal problems, radiation passing through additional parts of body. Answer, coin flip and of course prayer! Thanks for comments. Mel
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Joined: 10/10/2008
Posts: 379
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Hi GZZZZR,
Good work! sifting through the risk and benefits.
You came to the same conclusion I did HDR BT or CK best chance for cure. With a high cure chance the consideration for salvage gets less consideration in my view.
The surgery aspect of HDR has no benefit over CK but and has risk.
Regarding increased rectal risk with CK, I believe this is overstated and likely wrong based on the published and unpublished data. Risk comes from radiation exposure to the rectum which is controlled as good as or better with CK than any other RT option. If the short term results show a low rate of rectal toxicity it seem logical that the longer term will follow the same trend.
X-rays pass through the body matter if they emanate internally or externally. Tissue toxicity is minimized with the CK from the number of available angles and beams.
From the studies CK side effects are no worse than any other option and lower than those reported by many studies. The larger group studies and longest study seem to have similar results at along the same time line. The outcome repeatability from CK treatment center to center is very impressive.
My interpretation of published studies suggest CK has lower risk for urinary and rectal complications and best chance of retaining normal sexual function.
If CK had higher risk for long term failure similiar to surgery IMRT, proton therapy or HDR BT I would still choose CK for the ease of treatment and ED advantage.
Doctors please comment on the fine points and correct errors.
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Joined: 10/10/2008
Posts: 2347
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Seeds don't give the closest control of the radiation dose. HDR or CK will do that.
Don't concern yourself with salvage. It is not very good for any primary method of treatment except the small number of people who have surgery and have a VERY small PSA recurrence with no evidence of metastatic disease, and even then it is only 60%.
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 10/11/2008
Posts: 928
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Remember that with seeds you go home radioactive and remain that way for months.
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 379
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If you do international travel, Homeland Security will have a discussion with you. It takes 6-12 months to clear security.
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Joined: 10/10/2008
Posts: 355
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I added some comments in red font "I see positive of seeds, long history yes, top doc yes - there are a few of those in the northwest, closest control of radiation no - HDR or CK control the distribution better, 1 treatment and your done yes. Negatives, general anesthesia not a big deal, some urinary problems occasionally very severe and permanent, difficult if not impossible salvage" same goes for any radiation treatment method. I see positive of CyberKnife, short period of relatively comfortable treatment yes with quick or no need for recovery usually the case - not always, close control of radiation yes, reasonable chance of salvage if cancer returns - theoretically this should be so but actual experience is minimal. Negative, relatively short history - but with some powerful PSA response data predicting good long term response, some greater chance of rectal problems - disagree with this assertion- risk of rectal injury w CK is low, radiation passing through additional parts of body - yes this is a CK disadvantage relative to seeds - a larger segment of the lower body is exposed to low dose radiation w CK. And on goes the debate!
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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Joined: 10/11/2008
Posts: 928
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Dazzled by all that red ink!
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/10/2008
Posts: 355
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Really??
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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Joined: 10/11/2008
Posts: 928
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Now that is going too far..You are showing your true colors.
Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828 Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717
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Joined: 10/21/2009
Posts: 4
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Hey, you guys are having too much fun on my post! From your experience, what should ball park cost of CK be, from consult to mapping to finish? From a physician perspective what drives the skill level as a physician grows with CyberKnife. Thanks,GZZZZR
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Joined: 10/10/2008
Posts: 2347
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It is too variable to say how much the cost would be. It is less than IMRT and far less than protons.
Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org
Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102
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Joined: 10/10/2008
Posts: 355
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The more cases you have done, the better you deal with unusual situations (e.g. - Diffficult imaging, unusal prostate anatomy, unusual medical course after treatment, etc . . ). More experience also translates to more dose molding tricks if necessary.
Donald B. Fuller, M.D. Radiation Oncologist CyberKnife Centers of San Diego 477 N El Camino Real, Ste D101 Encinitas, CA 92024 (760) 230-6706 dfuller@rmgmed.com
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Joined: 10/10/2008
Posts: 379
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GZZZZR,
The cost for CK and IMRT, etc have a large range. Some centers discount patient pay some do not. Some discount for patient hardship some do not.
If you are not covered by insurance then it is a good idea to start looking around for a center that offers lower cost patient pay.
Experience is a very good thing as pointed ouy by Dr. Fuller.
CK has a big treatment process repeatability advantages over all other options target tracking.
Good Luck!
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