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Choise between Cyberknife (SBRT) monotherapy vs HDR Brachytherapy+EBRT?

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User
Posted 28 Jul 2021 at 21:22

Sorry for making yet another thread, I just realised this is most suitable forum section for it.

 

M59, Gleason 4+3 (second opinion confirmed by Jonathan Epstein at John Hopkins), PSA7.8 average past 1 year, T2C stage. Haven't been operated or radiated before.

 

Currently  am being offered:

  1. 5 fraction Cyberknife (SBRT) therapy that is concentrated to the prostate.

  2. 1 time high dose rate Bracytherapy combined with 5 week EBRT radiation therapy.

None of docs believe ADT is necessary as of now.

 

I can't make the choice. 

 

On one hand, SBRT efficacy is often compared with level of Bracyhtherapy.

 

It is apparently very similar in results, but I'm worried if Brachy+EBRT won't be way more effective ensuring that pelvic lymph nodes are also captured in the beam?

 

After all my case has a rather high recurrence rate after Radical Prostatectomy according to nonograms, however if lymph nodes are radiated, doesn't that lower the risk dramatically?

 

And how can Cyberknife compared in efficacy when it radiates only the prostate?

 

There are some talks that SBRT high dose radiation is more effective in killing cancer, but it can't kill mets outside prosate, can it now? While EBRT can.

 

Cyberknife would be ideal solution and its close to home. Brachy+EBRT requires 5 week living in another country.

 

What do you think, which case would you choose in my situation?

 

Pros and cons of each?

 

What do you think of met risks with Cyberknife?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery in 2021. PSA rising after surgery. What to do next?

User
Posted 29 Jul 2021 at 00:42
HDR brachy with EBRT but no HT makes no sense; it is usually offered to men with intermediate or high risk PCa whereas RT without HT is considered suitable for low risk men.

Out of interest, are you writing in a second language or are you an English-speaking man who just happens to live in Estonia?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 29 Jul 2021 at 01:54

It has been shown that SBRT can be directed at mets outside the Prostate although this seems to be innovative at present. https://www.urologytimes.com/view/sbrt-safe-in-patients-with-prostate-cancer-and-multiple-metastases

But these have to be identified first and from what you say you don't even know you have any, yet alone know where they may be.

Edited by member 29 Jul 2021 at 02:00  | Reason: Not specified

Barry
User
Posted 29 Jul 2021 at 03:03
You have the same Gleason score as I had, and a low PSA, so why not find yourself a top-rated surgeon with a tame robot and have the cancer excised once and for all?

There are potentially some side-effects post-op, but they are not certain.

I’m three years cancer-free.

Best of luck.

Cheers, John.

User
Posted 29 Jul 2021 at 13:28
Well, I had a multi-disciplinary team of up to twelve medics of various specialities review my case, and they told me to go for surgery, as I am suggesting to you.

You can spend too long studying Nomogram prognostications of recurrence fifteen years after surgery, as I suspect you have, by which time you might have died of something else!

Surgery should remove your cancer with what they call ‘curative intent’. The other treatments you are looking into complicate matters if you should need a subsequent prostatectomy, as the gland will no longer be clearly defined, and may have deteriorated into what a surgeon called ‘mush’, making a clean excision much more difficult. Very few surgeons will attempt such an operation anyway.

It’s your life, and your problem to resolve. I’m pleased you are here researching every option, but it’s your choice, and I hope it works out well for you.

Cheers, John.

User
Posted 30 Jul 2021 at 09:36
2018. The MDT group were all from the same billion-pound super hospital in Coventry.

You can find the Professor who did my surgery if you Google ‘Santis Prostate’

Cheers, John.

User
Posted 31 Jul 2021 at 11:44

Also be mindful of early research findings which postulate that metastasis occurs much earlier than first thought. There are some very intriguing studies which elude to cancer cells coopting the immune system to migrate to distant locations. Key point here is get it treated as soon as you can plus things are not always what they seem from data in isolation.

 

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User
Posted 29 Jul 2021 at 00:42
HDR brachy with EBRT but no HT makes no sense; it is usually offered to men with intermediate or high risk PCa whereas RT without HT is considered suitable for low risk men.

Out of interest, are you writing in a second language or are you an English-speaking man who just happens to live in Estonia?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 29 Jul 2021 at 01:54

It has been shown that SBRT can be directed at mets outside the Prostate although this seems to be innovative at present. https://www.urologytimes.com/view/sbrt-safe-in-patients-with-prostate-cancer-and-multiple-metastases

But these have to be identified first and from what you say you don't even know you have any, yet alone know where they may be.

Edited by member 29 Jul 2021 at 02:00  | Reason: Not specified

Barry
User
Posted 29 Jul 2021 at 03:03
You have the same Gleason score as I had, and a low PSA, so why not find yourself a top-rated surgeon with a tame robot and have the cancer excised once and for all?

There are potentially some side-effects post-op, but they are not certain.

I’m three years cancer-free.

Best of luck.

Cheers, John.

User
Posted 29 Jul 2021 at 07:00

Originally Posted by: Online Community Member
HDR brachy with EBRT but no HT makes no sense; it is usually offered to men with intermediate or high risk PCa whereas RT without HT is considered suitable for low risk men.

Out of interest, are you writing in a second language or are you an English-speaking man who just happens to live in Estonia?

 

That is strange. Doctor who offered the treatment without hormones was very confident about it and he is leading head of department in a large University Hospital.

I'm writing in second language.

 

Originally Posted by: Online Community Member
You have the same Gleason score as I had, and a low PSA, so why not find yourself a top-rated surgeon with a tame robot and have the cancer excised once and for all?

There are potentially some side-effects post-op, but they are not certain.

I’m three years cancer-free.

Best of luck.

Cheers, John.

Surgery is more invasive, higher recurrence rates and more side effects.

That is the main reason. What are your main arguments FOR surgery?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery in 2021. PSA rising after surgery. What to do next?

User
Posted 29 Jul 2021 at 13:28
Well, I had a multi-disciplinary team of up to twelve medics of various specialities review my case, and they told me to go for surgery, as I am suggesting to you.

You can spend too long studying Nomogram prognostications of recurrence fifteen years after surgery, as I suspect you have, by which time you might have died of something else!

Surgery should remove your cancer with what they call ‘curative intent’. The other treatments you are looking into complicate matters if you should need a subsequent prostatectomy, as the gland will no longer be clearly defined, and may have deteriorated into what a surgeon called ‘mush’, making a clean excision much more difficult. Very few surgeons will attempt such an operation anyway.

It’s your life, and your problem to resolve. I’m pleased you are here researching every option, but it’s your choice, and I hope it works out well for you.

Cheers, John.

User
Posted 29 Jul 2021 at 13:59

Originally Posted by: Online Community Member
Well, I had a multi-disciplinary team of up to twelve medics of various specialities review my case, and they told me to go for surgery, as I am suggesting to you.

You can spend too long studying Nomogram prognostications of recurrence fifteen years after surgery, as I suspect you have, by which time you might have died of something else!

Surgery should remove your cancer with what they call ‘curative intent’. The other treatments you are looking into complicate matters if you should need a subsequent prostatectomy, as the gland will no longer be clearly defined, and may have deteriorated into what a surgeon called ‘mush’, making a clean excision much more difficult. Very few surgeons will attempt such an operation anyway.

It’s your life, and your problem to resolve. I’m pleased you are here researching every option, but it’s your choice, and I hope it works out well for you.

Cheers, John.

Thank you, what year did you get your surgery done? Was the doctor council from single hospital?

________________________

59M, Gleason 4+3, PSA7.8, T2C.

DaVinci Surgery in 2021. PSA rising after surgery. What to do next?

User
Posted 30 Jul 2021 at 09:36
2018. The MDT group were all from the same billion-pound super hospital in Coventry.

You can find the Professor who did my surgery if you Google ‘Santis Prostate’

Cheers, John.

User
Posted 31 Jul 2021 at 11:44

Also be mindful of early research findings which postulate that metastasis occurs much earlier than first thought. There are some very intriguing studies which elude to cancer cells coopting the immune system to migrate to distant locations. Key point here is get it treated as soon as you can plus things are not always what they seem from data in isolation.

 

 
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