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Recently Diagnosed - Debating CK vs Surgery
Robert B.
Posted: Saturday, November 24, 2018 12:07 PM
Joined: 11/24/2018
Posts: 4


I have recently been diagnosed with prostate cancer. PSA 3.9 3+3 with two cores positive - localized to the prostate I'm 51, my urologist is pushing the DaVinci surgery that he also performs. He has been downplaying radiation and trying to steer me away from it. I have been trying to do large amounts of research and came across the CyberKnife program. I really like the short treatment time, results, and quick recovery. I've been concerned about long-term effects being similar or worse than surgery. Looking for some advice. Thanks!
Robert B.
SteveK364
Posted: Saturday, November 24, 2018 1:51 PM
Joined: 6/26/2018
Posts: 47


Hi Robert, I think most objective experts will tell you that the success rate between surgery and radiation is about the same. The big difference is in the side effects. CK is less invasive than surgery and usually has fewer side effects. I had CK about six weeks ago, and had some bad side effects (diahreea, anal pain, etc) but they only lasted a week or so. Today, I'm feeling pretty good, but my energy level is not quite where it was prior to CK, but that is improving. My PSA was 3.2. Gleason was 4+3. My urologist also pushed surgery, which of course, he happily offered to handle for me. Good luck with your treatment -- whichever type you choose! Steve

SteveK364


JAV
Posted: Saturday, November 24, 2018 3:58 PM
Joined: 10/29/2010
Posts: 781


Of course your uro wants to do surgery - urology is a surgical sub-specialty. But my advice to you is if you feel you are being pressured directly or in a more subtle manner, you need to find a new uro that will support whatever decision you make. Mine did. Since CaP is very slow growing, you have plenty of time ( months, not weeks ) to decide what you will do. So you have time on your side. Where are you located ? Is there a CK Center near you ? You can do a search at the Accuray website to find a Center. Here is the link : https://www.accuray.com/treatment-centers/ If you make an appt., ask them how many CaP cases they have done. I was about #26 back in 2011 at the CK Center I choose. Do your research, and keep asking questions. You are in control of your case - be educated. If you have a question for the Docs, usually you can get an answer the same day on this Forum. Good luck on your journey. Jim V.

Treated with CK 4-2011.  Gleason of 3+4 , PSA 3.7 , two cores positive, 5% & 12%
 PSA on 7-13 0.3  PSA on 11-13 0.3 PSA on 5-14   0.3  
PSA on 7-14   0.2 PSA on 11-14  0.2 PSA on 3-15 0.2
PSA on 7-15, 0.2 PSA on 7-17 0.1 PSA on 1-18 0.13
Robert B.
Posted: Saturday, November 24, 2018 7:18 PM
Joined: 11/24/2018
Posts: 4


There's one in Philadelphia about 2 hours away I'm looking into. Someone I know near me used CK for their treatment. I was worried about the long- term side effects of the treatment.
Robert B.
JAV
Posted: Sunday, November 25, 2018 7:05 AM
Joined: 10/29/2010
Posts: 781


Robert: Is your acquaintance having problems ? I essentially had no short term or long term side effects. I just had a little burning upon starting urination after my second or third treatment . That lasted about a week. And some mild fatigue after working outside in the yard. I discovered if I took a short break and hydrated, that would pass. I must admit I'm a big chicken when it comes to surgery. And I have heard stories of CaP patients that had back problems after RP. You are on the table that is at an angle for at least 3 hours. A local 72 y/o guy I know had RP using the robot a few months ago. He said he was on the table for 6 hours. No post-op back problem, but I noticed cognitively he was having some problems. He finally admitted he was having short term memory problems and decided to retire. He couldn't remember customers he had done business with just a few weeks before. Maybe he had a lack of oxygen sometime during surgery - general anesthesia is always a risk. There is always some risk of any medical procedure, including CK, but it seems to me RP is barbaric compared to CK - just my opinion. And BTW, surgery doesn't mean there is no possible chance of re-occurance - that's a fallacy. Did the Uro bring that up ? Not all the prostate is removed and there may be cancer cells already outside the prostate, too small for a scan to detect at this point. But CaP is very curable if caught and treated early, with any type of treatment. Jim V.

Treated with CK 4-2011.  Gleason of 3+4 , PSA 3.7 , two cores positive, 5% & 12%
 PSA on 7-13 0.3  PSA on 11-13 0.3 PSA on 5-14   0.3  
PSA on 7-14   0.2 PSA on 11-14  0.2 PSA on 3-15 0.2
PSA on 7-15, 0.2 PSA on 7-17 0.1 PSA on 1-18 0.13
Robert B.
Posted: Sunday, November 25, 2018 5:20 PM
Joined: 11/24/2018
Posts: 4


Thanks. The urologist started giving me some horror stories of long term after effects of radiation. Wasn't sure if I would have worsening conditions several years after the CK - incontinence/erectile issues. I also am concerned if I ever need additional radiation down the line for something if this would put me at risk.
Robert B.
radsrus
Posted: Monday, November 26, 2018 3:48 AM
Joined: 10/10/2008
Posts: 4429


Usual urologist scare tactics

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
JAV
Posted: Monday, November 26, 2018 6:15 AM
Joined: 10/29/2010
Posts: 781


Robert: You may have erectile problems after RP. , also. Did the uro. say there was no chance of that with RP ? Ask questions - you are in charge of your case, not the Dr.'s. You are the responsible party. Here is a link to a recent journal article : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304365/ And there is a load of information at : https://pcri.org/ Hope this helps, Jim V.

Treated with CK 4-2011.  Gleason of 3+4 , PSA 3.7 , two cores positive, 5% & 12%
 PSA on 7-13 0.3  PSA on 11-13 0.3 PSA on 5-14   0.3  
PSA on 7-14   0.2 PSA on 11-14  0.2 PSA on 3-15 0.2
PSA on 7-15, 0.2 PSA on 7-17 0.1 PSA on 1-18 0.13
Robert B.
Posted: Monday, November 26, 2018 8:05 AM
Joined: 11/24/2018
Posts: 4


Thanks for the links! The urologist said there was a big chance of that with the surgery. I'm learning it depends on the skill of the surgeon. Chances are better for recovery depending on the ability of the surgeon to spare nerves and to rehabilitate after the surgery. Seems like it could take up to 2 years to be back to normal if all the right conditions are met. Not sure what the outlook or percentages are with CyberKnife.

Robert B.
Rick in IL
Posted: Monday, December 03, 2018 2:23 PM
Joined: 10/18/2018
Posts: 9


Robert, You are doing yourself a dis-service by not speaking with someone about CK, Brachy and AS. A lot of information with outcomes at or better than RP. I could not find results of any true random trials between the options of IBRT, SBRT, Brachy and RP, but there are good stats for all, if you can read them properly to use them to compare. The CK physician I have met with has been the most honest about the benefits and risks of all options. He is the only one who did not just diss his competitors, but spoke to what he knew. However, it is exhausting to find physicians, get referrals if needed, make appointments weeks out, wait and pay out of pocket for whatever insurance won't cover. I am still on the fence. Good luck to you

Rick
viperfred
Posted: Wednesday, December 05, 2018 11:15 PM
Joined: 10/10/2008
Posts: 842


Hi Robert B. At your age I would think ED might be a concern? There in no treatment with lower ED risk. There is no treatment with better cancer control. There is no treatment with better quality of life outcome. I was treated with the Cyberknife over 10 years ago an would make the same choice today. In my opinion to many urologist have become masters of fear and misinformation for profit. Prostate cancer patients are not treated like anyother cancer patient. Other cancer patients are given their treatment options(In many cases a tumor board) and the benefits and risk of each. The urologist has a conflict of interest he meets the patient to deliver the biopsy results, then sells his treatment and then misrepresents the other options. All driven by economics and not the best interest of the patient. I know the script all to well "Bad news your have prostate cancer, good news I can remove it. The only way to get rid of the cancer is surgery. There are other option like radiation but if you have radiation I can not do surgery. I can do open or robotic surgery. Robotic surgery has lower blood loss risk" What he fails to tell you is that he makes more money with robotic surgery. Suggest you read my comments to Rick from IL. Then take time to know the truth about all options and their risk and benefit. The last time I researched this topic Surgery risk of ED was 50-70% with only cyrotherapy therapy has higher ED risk. In my opinion you will do well to run as fast as you can from an urologist who paints radiation with a broad brush. The highest biological cure based on 40 years of data is extreme hypofractionation which is what High Dose Brachytherapy and the Cyberknife deliver. IMRT and seeds are low dose therapy which is less effective because of the radiobiology. My understanding as a patient (no formal medical training) the higher dose fractionation from HDB and Cyberknife is more effective at destroying the cancer cells than the lower dose over a longer term. This is why the Cyberknife dose of 35-39Gy over 4-5 days is more effective than IMRT dose of 78-84Gy over 39-45 days. Make an informed choice, you will have to live with it! Fred Completed Cyberknife May 8, 2008
 

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