I am UK based and have G3+4 stage T2c (Intermediate) with psa 2.9 and trying to decide on RP (Retzius + Nerve sparing with NeuroSafe), Bracchytherapy or SBRT (Cyberknife).
From the data I am seeing this is getting better Biochem Failure rates than any other treatment option - with lower side effects. Assumption is that Bracchy has at similar outcomes as RP - however there does not seem to be any randomised data on Cyberknife (PACE trials in UK will be too late for me). Swedish clinic claim 97% at 5 years for INT risk which is indeed impressive.
Has anybody had any experience of cyberknife either in the UK clinical trials / Europe or USA that can help make my decision? Thanks Antony
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Ant_Imony
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I had SBRT. I don't understand how a few anecdotes from random people (like me) improves your decision-making over data from the thousands who have been treated with it. Here is some real data:
You seem to have a very similar diagnosis to me - also in the UK and G3+4. I have been considering my options but trying to avoid surgery if at all possible. After reading about SBRT I did investigate the viability of having the treatment. I got in touch with the person leading the PACE trial and was told:
SBRT/Cyberknife is not currently available on the NHS and unfortunately is very expensive privately. The PACE trial is a randomised study between surgery and SBRT, so candidates have to be comfortable with both treatment arms.
I figure that rules it out for me. I wouldn't want to take part in a trial that could mean being selected for surgery. I'm now trying to weigh up my other options and am leaning towards HDR brachy as a monotherapy or HIFU. Speaking to a specialist at UCLH this week which will hopefully make things clearer. Good luck.
I have not considered HIFU or NanoKnife as a focal treatment because I have tumours in base both sides and a small amount in the apex - i.e. allover. These treatments seem quite successful in dealing with localised treatments though. These guys do the nanoknife - I believe for about €15k - and are a better option than anywhere in this country IMO.
Being only 52 I want to preserve Erectile capabilities / Continency and also have something that is hopefully one shot treatment with long term successful outcomes.
What concerns me about Cybeknife which is £23-£27k in UK or (15,500 Euro in Germany) is the options if it fails. I guess you can have more cyberknife or even Bracchy or a focal treatment.
However the reported incidence of SBRT failures seems low for intermediate risk - can probably expect 88% Biochemical free @ 10 years.
This is better than Bracchy (82%) or Prostatectomy (80-82%). However both of these are proven in the long term as they are better established.
Alarmingly approx 30% of the patients who have relapse after prostatectomy go on to have metastatic cancers. So after all the pain of the operation - there is no guarantee!
The studies of long term life expectancy based on comparison of surgery vs radiation (old delivery methods) seem to indicate better survival for surgery. However SBRT / Bracchy are different as much less radiation delivered outside the Prostate.
I am speaking with the cyberknife hospitals in the UK (Birmingham/Mt Vernon) and 3 in Germany (Hamburg / Mittle / Munich).
Not an easy decision - but hopefully decide this week.
When I was diagnosed I looked into surgery but was quickly put off by the potential side effects. I had 4+3=7. Gleason.
I ended up getting traditional radiation nut now wish I had chosen SBRT. Actually, were I seeking primary treAtment today, I would do Tulsa Pro hifu. It is available in Germany and Finland. Much better than traditional hifu due to the delivery method and real time imaging.
UK based too. I was 2Tc feb2015. 8 positive cores out of 14 all one side Gleason3+4.. PSA 5.1.MRI indicated 'contained'. Chose Davinci surgery with high volume surgeon. Unilateral nerve sparing.
Pathology came out as Pt3a with established EPE and PNI. Clear margins.
3+4 with tertiary 5. Added aRT to the mix. Didn't wait for salvage RT, because of extended travel plans. 51 months undetectable since and hoping to get to 10 years. ED an issue but Invicorp works well. Very minor continence issue as well.
Point of this is to consider that a 2Tc can sometimes be upgraded on pathology.
I spoke to a private consultant oncologist on Monday - who ruled out Bracchy - as the cancer was in the apex as well - which is hard to treat with Bracchy due to location and placement of seeds. He also ruled out standard radiation.
He now mainly does cyberknife at the Queen Elizabeth in Birmingham - and through because of my age (52) that surgery was a preferred option as the outcomes of surgery and SBRT were deemed similar. The main reason for RP was the expected length of life ahead of me - as complete removal of the prostate would prevent anything coming back in 10+ years and also prevent possible future cancers from radiation. He would be in line for considerable consultant fees if he took me on as a patient so I was really surprised with what he said.
He said that after radiation the prostate can regenerate which means that it can then recreate the potential to grow again.
As other people noted - then why the high failure rate of RP?
Is it because people who have RP are less likely to look after themselves (diet / stress / lifestyle etc) than people who have SBRT? Or is SBRT simply better. This is the dilemma.
SBRT morbidity benefits are clear winners over RP.
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