Patient Forum

The CyberKnife Patient Forum is designed to provide a place for people who have been diagnosed with cancer, their family and friends, to exchange useful information and provide support to one another. The Forum may also help people find answers to questions they have about the CyberKnife treatment experience. Accuray strives to facilitate these exchanges and encourage discussions. Recently we have experienced some aggressive or inappropriate spam postings. We are diligently working to resolve this issue and thank you in advance for your patience.

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Starting treatments in a week
JohnB
Posted: Sunday, December 16, 2018 7:20 AM
Joined: 12/3/2018
Posts: 17


Age 65, Diagnosed in October with 3+4, PSA 5.7. MRI first , tumor found, then fusion guided biopsy. In clinical trial at UPMC in Pittsburgh for Cyberknife. Had fiducials placed 2 weeks ago.Doing 5 treatments every other day, 36.25. Decision was hard and most nervous I have been in my life. long term side effects biggest concern but odds in my favor. Forum very helpful in making decision.
JB
SteveK364
Posted: Sunday, December 16, 2018 8:41 AM
Joined: 6/26/2018
Posts: 69


Hi John, All the best on your journey. I just finished my treatments in mid October in Ann Arbor, Michigan. They're a breeze. I did end up having a bout of proctitis a few days after my final treatment, but I've been pretty much OK since that time, except for some urinary frequency as well as some urinary urgency from time to time. Did you have the SpaceOar implanted? I did, but ended up with proctitis anyway, so that was a bit of a dissapointment. I will go for my first post-PSA and exam in mid January. My baseline PSA is 3.2. I had a Gleason of 4+3. Good luck and keep us posted. Happy holidays!

SteveK364


JohnB
Posted: Sunday, December 16, 2018 8:55 AM
Joined: 12/3/2018
Posts: 17


Thanks Steve.. I have been following you and glad to hear you are doing good. The space oar is not in the trial at UPMC and not clear to me why it is not being use, Dr. Dwight Heron is the director of radiation oncology and my doctor, I trust his choice to not to offer it in the trial so I am in his hands. I am where you were short time ago and struggling with process.
JB
SteveK364
Posted: Sunday, December 16, 2018 5:42 PM
Joined: 6/26/2018
Posts: 69


Sure thing, John. You will probably be fine without the SpaceOar. I've read many accounts of folks who didn't have it and are doing well. One of them is a member of this forum -- "JAV." I believe it has been about six or seven years since he completed his treatment and he's doing great. He will probably weigh in here shorty, as he's a frequent poster. Also, if you have any specific questions about your treatment. there are various radiation oncologists on this forum who respond to some of the questions. Cheers!

SteveK364


JohnB
Posted: Monday, December 17, 2018 5:02 AM
Joined: 12/3/2018
Posts: 17


Hi All I had MRI and CT with contrast in bladder through catheter and body form made after fiducial placement, they also placed marks on skin around pelvic area. Question is if I have markers in prostate what would marks on skin be for? Thanks and Happy Holidays

JB
JohnB
Posted: Monday, December 17, 2018 7:55 AM
Joined: 12/3/2018
Posts: 17


I find it interesting that centers vary so much on prep, 6 fiducials, 4 fiducials, I had 3, I had CT with catheter and contrast into bladder, some no catheter. Maybe the doctors could opine. Thanks
JB
radsrus
Posted: Monday, December 17, 2018 8:02 AM
Joined: 10/10/2008
Posts: 4435


A minimum of three fiducially is required to get the most accurate three-dimensional tracking. A lot of centers put in 4 in case one becomes unusable for some reason (there are several reasons why this can occur). When we started we put in 6 fiducially, mostly operating on the principle that if 3 was good then 6 had to be better. That was incorrect. The more you have, there likely that they will interfere with one another in the imaging. If a seed overlies another seed in the live images, or even gets too close, BOTH become unusable. I think the best recommendation is for 4 fiducials. You can do fine without SpaceOAR, but with that addition the risk of rectal injury is greatly reduced. Part of the preparatory work differences depend on the MRI. On a 3-Tesla machine you can usually see the urethra without a catheter. Most MRI machines, however, are 1.5T or less, and then you need a catheter.

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
JohnB
Posted: Monday, December 17, 2018 8:13 AM
Joined: 12/3/2018
Posts: 17


Thank you Dr. Medbery, you are a voice of reason.
JB
JAV
Posted: Monday, December 17, 2018 3:19 PM
Joined: 10/29/2010
Posts: 800


I think the treatment process has evolved since my walnut was roasted back in 2011. I had 5 fiducials placed by a local urologist my Center used in the St. Joe medical office building. He sent me for an x-ray after the placement and then showed me his handi-work. Four fiducials described the four corners of an almost a perfect rectangle and the 5th was dead-nuts in the center of the rectangle. I was impressed. Not sure if he also showed the x-ray to the cute female internal medicine resident that observed the placement.

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
SteveK364
Posted: Monday, December 17, 2018 4:54 PM
Joined: 6/26/2018
Posts: 69


I had six fiducials, which seemed like a lot to me, based on the limited research I had done on the topic prior to treatment. And now, after reading Dr. Medbery's comment about the downsides of using six, I wonder if it may have contributed to my getting proctitis? (I also had the SpaceOar.)

SteveK364


JAV
Posted: Monday, December 17, 2018 5:58 PM
Joined: 10/29/2010
Posts: 800


Steve : Good question for your follow-up appt. You deserve an answer. Who inserted your fiducials ? 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
SteveK364
Posted: Monday, December 17, 2018 7:26 PM
Joined: 6/26/2018
Posts: 69


I believe my radiation oncologist inserted them -- with some assistance. Of course, I was under sedation, so I can't be 100% sure.

SteveK364


JohnB
Posted: Tuesday, December 18, 2018 4:20 AM
Joined: 12/3/2018
Posts: 17


I am curious to know if the trial I am in at Hillman Cancer Center at UPMC Pittsburgh has a protocol for 3 fiducial for the study or can it vary within the study for each patient? I will ask and post as soon as I get answer.

JB
JohnB
Posted: Tuesday, December 18, 2018 4:50 AM
Joined: 12/3/2018
Posts: 17


I believe UPMC is using the M6 Cyberknife, has anyone here been treated with this version? I guess it a newer model but no info I can find if any better than previous model.

JB
radsrus
Posted: Tuesday, December 18, 2018 5:06 AM
Joined: 10/10/2008
Posts: 4435


No, that would not contribute to getting proctitis. The full explanation is too long, but suffice it to say that it is a technical thing and if they were able to track then the number of fiducials is unimportant.

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
 

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