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Is cyberknife a good choice for me.(2)
rajumd33@gmail.com
Posted: Friday, May 10, 2013 2:42 PM
Joined: 5/10/2013
Posts: 12


Age 72.PSA5.99. Biopsy positive for cancer.Gleason3:3.Left lobe involved with 3 core positive. 20% Prostate involved.

Rectal examination revealed a nodule.

Considered Active Survellience for six months.Because of the presence of the nodule and rising PSA from 4 to 5.99 in six months considering Cyberknife.Please advise.


JAV
Posted: Friday, May 10, 2013 2:57 PM
Joined: 10/29/2010
Posts: 650


Do you mean the pathology report of your biopsy reported a Gleason of 3+3 = 6 ?? If so, I would say you are a candidate. A Gleason of 6 and the other results means you fall into the low-risk group, meaning low risk for the CaP also being outside the prostate at this time. Please wait for a definitive response from one of the great R.O.'s that contribute on this site, and Good Luck on your journey. JAV ( not a MD, DO, or PhD )

Treated with CK 4-2011 Gleason of 3+4 , PSA 3.7 PSA at 1-13 , 0.4
radsrus
Posted: Saturday, May 11, 2013 6:21 AM
Joined: 10/10/2008
Posts: 4155


You should be a candidate, although the nearest CK center would need to review everything. It would be a good choice for you in all likelihood, although there are several good choices for men with low-risk prostate cancer

 

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

 


alan katz md
Posted: Saturday, May 11, 2013 9:29 AM
Joined: 10/10/2008
Posts: 463


You are definitely a candidate. I just published a paper this week showing 97% control of your type of cancer at five years with low morbidity. It appears that 35 Gy in five fractions is the optimal dose. Higher dose showed no better results with more side effects. It will be available in Radiation Oncology next week, online for free

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


alan katz md
Posted: Monday, May 13, 2013 11:32 AM
Joined: 10/10/2008
Posts: 463


http://www.ro-journal.com/content/8/1/118 Here is the link to the article

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


Jon N
Posted: Monday, May 13, 2013 11:22 PM
Joined: 6/7/2012
Posts: 67


Dr. Katz, Good paper! Wish I had it when I was appealing my insurance for CK treatment, although it probably would have made no difference. It was obvious from the comments of their in-house 'board certified radiologist' in the original denial, and their 'out house' 'independent board certified radiologist' in the final denials, the denials would only have been affected by NCCN 'approval' of SBRT for prostate cancer. The several levels of denials never acknowledged any of the numerous supporting studies I provided in my appeals. Fortunately I was able to switch to a Cigna affiliate in last November's Open Season and get approval and have CK treatment this March. For the sake of future patients seeking insurance approvals, I hope the upcoming review of NCCN guidelines for prostate cancer will finally recognize CK. What are the odds?

Jon N


alan katz md
Posted: Tuesday, May 14, 2013 12:31 PM
Joined: 10/10/2008
Posts: 463


With my paper coming out and the change in ASTRO policy, I think the odds are good

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


billwx1
Posted: Wednesday, May 22, 2013 4:46 AM
Joined: 5/22/2013
Posts: 6


Found out with Biopsy had PC in March 2013.  Three samples Gleason scores of 3+4=7  2 with 3+3=6.  PSA was 3.8 at that time.  Just had a steady increase in the last year so a biopsy was ordered.  Two brothers and father had PC so we were watching closely.   Had decided on Robotic for June 18th, but having second thoughts since it seems it is confined (Bone Scan and CT scan are clear)  I am wanting to see if Cyberknife is the better choice.  Live in Chattanooga, TN where Erlanger Hospital does the treatment.  Feel I have a very good surgeon, but am still wanting to find an alternative if a good candidate.  Hoping for consultation in next 2 weeks.  Post surgical side effects are a big concern, although not dying from cancer is the first priority.  Thanks for the forum. 


Bill
billwx1
Posted: Wednesday, May 22, 2013 5:03 AM
Joined: 5/22/2013
Posts: 6


Oh, also have Blue Cross Tennessee as insurance, so not sure if they will even approve it yet. 

Bill
Jon N
Posted: Wednesday, May 22, 2013 8:55 AM
Joined: 6/7/2012
Posts: 67


Anthem Blue Cross in the West does not yet cover CK. A call to Erlanger Hospital should be able to find out if Blue Cross Tennesee will cover CK. IF the upcoming NCCN review of guidelines for treating prostate cancer will reconize CyberKnife, Blue Cross may end up changing their position. I'm not sure of your treatment priorities. If there was evidence that the cancer was NOT confined, then robotic or RP surgery alone would not be a logical first choice compared to surgery + radiation or CyberKnife alone. For a PSA of less than 20, there is plenty of evidence that a bone scan is useless. And, depending upon the details of your biopsy, a CT scan also may not have much utility. You may have early intermediate-risk disease that would end up with similar low probabilities for progression for any treatment, including at this time Active Surveillance. In other words, your first priority of not dying of prostate cancer should not be of such concern that you rush into any specific treatment at this time. Other staging issues to consider. What percentage of each of the 3 positive cores were cancer? What percentage of the cancer in the 3+4 core was pattern 4? Where in the prostate were the positive cores? What is your PSA density (PSA divided by prostate size in grams or cc's)? There are a number of respected and objective Web sites that can help you better understand your staging. Among them www.PCRI.org and http://www.nccn.org/patients/patient_guidelines/prostate/index.html As far as full consideration of treatment side effects is concerned, things to consider include your age, your relative health, your life-style preferences. All current treatment options have side effects. Unless there is some factor among those above you need to consider, your current PSA and biopsy results suggest that the odds of 'dying' from your current prostate cancer are very low irrespective of what treatment you select. So, calm down, take some time, do more homework before jumping into any specific treatment.

Jon N


JAV
Posted: Wednesday, May 22, 2013 1:00 PM
Joined: 10/29/2010
Posts: 650


Hi Bill : You have assumed organ-confined, intermediate risk CaP ( Gleason of 7 ). Even if you have surgery, there is still a risk that some CaP cells are already outside the prostate and the CaP will rear it's ugly head down the road. Any cells outside the prostate are microscopic at this point and won't show on the scans. This risk is the same if you have surgery or CyberKnife for treatment. Somewhere around (2-4) % , I believe. But the short & long term complications of CK is much, much less compared to surgery. CK is a very effective treatment - and much better than conventional IMRT. The only side effect I had was slight burning upon urination that started after my third treatment and then lasted for about 7 days after my last treatment - no meds were necessary. Good luck on your decision. I have been very satisfied with CK. JAV ( not a MD, DO, or PhD )

Treated with CK 4-2011 Gleason of 3+4 , PSA 3.7 PSA at 1-13 , 0.4
ChicoXXX
Posted: Wednesday, May 22, 2013 3:05 PM
Joined: 10/10/2008
Posts: 382


Bill, Please remeber that many of us who contribute to his forum have gone through the PCa process up to and including CK . We are empathetic and have done a lot of researh on the subject BUT WE ARE NOT MDs OR PROFESSIONALS . Drs Katz and Clinton A. Medbery , to my knowledge, are among the few, if not the only MDs, rececntly posting on the forum. You will note JAV's disclaimer on the professional issue.
hopeful and optimistic
Posted: Wednesday, May 22, 2013 7:52 PM
Joined: 7/9/2012
Posts: 11


FYI ...Anthem Blue Cross covered the cost of SBRT to treat Prostate Cancer at UCLA approximately six months ago.
billwx1
Posted: Thursday, May 23, 2013 1:28 AM
Joined: 5/22/2013
Posts: 6


Thank you for the comments...  having consultation today with CK Doctor today.   One thing I am learning, you can't assume anything with cancer. 


Bill
JAV
Posted: Thursday, May 23, 2013 5:33 AM
Joined: 10/29/2010
Posts: 650


Bill : If you have to have a cancer, IMHO, prostate cancer is a good one to have, if caught early. It's very effectively treated. At this point it was only a bump in the road for me. Good luck with your consult. Please keep us posted. JAV ( not a MD, DO, or PhD )

Treated with CK 4-2011 Gleason of 3+4 , PSA 3.7 PSA at 1-13 & 5-13, 0.4
alan katz md
Posted: Thursday, May 23, 2013 12:37 PM
Joined: 10/10/2008
Posts: 463


Agree with the above. I would treat you with 35 Gy with a 95% chance of control at 5 years with low morbidity

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


billwx1
Posted: Friday, May 24, 2013 2:42 AM
Joined: 5/22/2013
Posts: 6


Had my consult on Thursday.  MRI today and then will decide if good candidate.  It all seems that we will be going forward with CK.  Very relieved that am looking at this option.  Was thinking, why MRI now and not before before surgery.  Is MRI best way to find if anything has spread to other parts of the body?  If so, why did we just do CT and Bone Scan before?  Anyway, grateful for this forum, which also helped me move to other options.  I will continue to update...  MRI at 9:30 this morning. 


Bill
ChicoXXX
Posted: Friday, May 24, 2013 6:35 PM
Joined: 10/10/2008
Posts: 382


Bill, We are all pulling for you to have good results. You have friends on this forum who want you nothing but the best results.
billwx1
Posted: Monday, May 27, 2013 5:47 AM
Joined: 5/22/2013
Posts: 6


MRI shows that the cancer in prostate is close to one of the seminal vesicle. Possible may have intruded a mm or two. Still not sure.. would this mean that CK is not a treament option?

Bill
Allen_E.
Posted: Monday, May 27, 2013 10:01 PM
Joined: 8/8/2010
Posts: 540


They just zap the SVs too - they zapped mine.

- Allen (not an MD)
alan katz md
Posted: Tuesday, May 28, 2013 5:38 PM
Joined: 10/10/2008
Posts: 463


Agree with Allen E

Alan J Katz MD JD

Flushing Radiation Oncology

40-22 Main St  Flushing NY

akatzmd@msn.com

 


billwx1
Posted: Tuesday, May 28, 2013 9:00 PM
Joined: 5/22/2013
Posts: 6


Ok... last of images of mri looking better... seems all is confined... alrhough still close to seminal vesical... CK seems to be in play for sure....

Bill
 

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