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Davinci versus Cyber knife

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Prostate Cancer
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Posted 5/25/2014 12:21 AM (GMT -5)
I am unsure if I shoudl do the Da vinci method or try out the Cyberknife SRBT radiation,. I hear horror stories about salvage post op treatments due to failures and urinary problems.

Age 49
Gleason 7
PSA 10.6
5 of 12 nodes positive
50% chance of extracapsular extension with two nodes 90%, one next to side wall
CT scan and bone scan negative
Posted 5/25/2014 7:25 AM (GMT -5)
The horror stories are the exception not the rule. If they were, no one would do them. Surgery is very low risk as is any treatment performed by an expert. The choice is yours.
Bob
Posted 5/25/2014 8:04 AM (GMT -5)
Coleyman, welcome to HW.

Both options have high cure rates if the cancer is contained within the prostate. With a 50% chance of escape, SBRT might be a better choice to avoid chances of reoccurance. SBRT also offers a better chance of avoiding onerous SE's. Your case also looks like HDR brachy might be an option.

My recommendation is to consult experts in the various protocols, do lots of research and then choose a doctor with considerable experience as studies have shown that experience does count a lot for both cure and SE's.

Jim
Posted 5/25/2014 12:30 PM (GMT -5)
So I was thinkiong about taking a hormone shot to stop the cancer while I had my DNA sequenced. I heard it costs about $2800 and could tell me more information about the cancer that I have. It takes three weeks for the results. During that time I could get an MRI.
When they say it's contained, that's just a guess in my opinion because I feel that it could be in the early stages of spreading, therefore it won't show up anywhere. With a Gleason score of 4+3 = 7 in two nodes, I have to be careful.
One luxury I have is that I can go to the Mayo Clinic and see a leading expert that has published many papers on nerve sparing techniques. That part is great but the recurrance makes me wonder if the radiation route is better. Then I am also wondering if IMRT is still better than Cyberknife since the concentration is so high.
If it has spread then I still end up with radiation correct?
Posted 5/25/2014 1:20 PM (GMT -5)
Coley, we have a member (Tall Allen) that has great knowledge on SBRT. I will email Allen and ask him to weigh in on this.

Jim
Posted 5/25/2014 1:39 PM (GMT -5)
Coley, Most studies that have been done with SBRT show no advantage to hormone treatments. SBRT alone has been just as effective. I had cyberknife treatments about a month and half ago and have not enough side effects to even mention. With low risk prostate cancer success over 8 years have been about 97%, and with intermediate risk its been about 93%. Good luck with your choice. Do your homework.
Posted 5/25/2014 2:42 PM (GMT -5)
Hi Coleyman,

I agree with Jim and Farmerboy. With known extracapsular extension, your risk of failing RP is higher. Radiation treats a margin outside the prostate, so your chances of curative treatment are improved. Salvage radiation after surgery increases the side effect profile. You are much better off treating once than treating twice.

I chose SBRT based on its very low rate of side effects, and I haven't been disappointed 3 1/2 years later. I have no lasting urinary or rectal side effects, and remain fully potent. Some guys I know even retained the ability to produce ejaculate at orgasm, although I wouldn't expect that. Younger men, like yourself, do even better than the average. Of course, that is true of all therapies.

As Farmerboy said, there has never been shown to be a benefit in SBRT outcomes to pre-treating the cancer with hormone therapy. In fact, it may increase the rate of side effects.

I can't think of a single benefit to IMRT over SBRT in a case like yours. SBRT has lower rates of side effects and higher cure rates. See the link in my signature for the latest 6-year results.
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