Low to intermediate risk

[Elizabeth185]

has anyone used a radiation therapy called CyberKnife? My boyfriend is recently diagnosed with intermediate risk PC which hopefully is confined to the prostate. We are focusing on next steps - trying to find a skilled radiation oncologist in the West Chester, PA area.

[Tall_Allen]

Philadelphia CyberKnife Center is in Havertown, PA.

[doc1947g]

I am 74 y.o. nd my PSA was 20.4 with G(4+3=7) Grade 4.I was put right away on Lupron Depot 45mg/24weeks and VMAT-RT 3Gy X 20 fx = 60 Gy.

So far my PSA went NADIR WITH psa <0.01 μg/L (2021/02/11) and went to 0.04 μg/L .

Next test on April 13, 2022. So far I feel not to bad.

BTW, his Intermediate Risk is with what Gleason Score.

G(3+4=7) is the LOW Intermediate Grade 2 with a LOW PSA and the

G(4+3=7) is the HIGH Intermediate Grade 4 with a HIGH PSA.

[Hidden in reply to doc1947g]

So you nadired at <.01 and when, in relation to completion of RT? But you are at <.04 now? Is that what you mean? And your testosterone is what?

[doc1947g in reply to Hidden]

My VMAT-RT was from 2020/06/06 to 2020/07/07 and my Lupron Depot from 2020/05/31 + 2020/08/24 Lasted 24 weeks starting the first injection I.M.My T went from :

*Testostérone*

*Pré-Hormonothérapie = 10.30nmol/L - 294.19ng/dL (2020/05/04), 15.2nmol/L - 438.04ng/dL (2020/05/27),

*Per-Hormonothérapie = < 0.2nmol/L - < 5.768ng/dL (2020/07/29),

*Post-Hormonothérapie = < 0.2nmol/L - < 5.7637ng/dL (2020/09/15), 0.3nmol/L - 8.6455ng/dL (2020/12/15), 0.4nmol/L - 11.5214ng/dL (2021/02/11), 6.6nmol/L - 190.2014ng/dL (2021/03/12), 6.4nmol/L - 184.4378ng/dL (2021/05/28)

*Prostate-specific antigen (PSA)*

*Pré-Hormonothérapie = 4.23μg/L (2001/07/18), 2.2 μg/L (2002/07/23), 1.8 μg/L (2006/07/04), 2.2 μg/L (2008/09/22), 2.4 μg/L (2009/05/20), 2.05 μg/L (2011/08/26), 2.25 μg/L (2012/08/13), 2.05 μg/L (2013/08/06), 2.77 μg/L (2014/07/28), 3.84 μg/L (2015/07/06), 1.97 μg/L (2016/06/30), 3.89 μg/L (2017/06/13), 6.8 μg/L (2019/09/10), 11.7 μg/L (2019/10/28), 13.7 μg/L (2020/01/08)

*Post-Biopsies*

16.7μg/L (2020/03/02), 20.4 μg/L (2020/04/06),

*Per-Hormonothérapie = 1.76 μg/L (2020/05/04), 8.58μg/L (2020/05/27), 0.18 μg/L (2020/07/29),

*Post-Hormonothérapie = 0.03 μg/L (2020/09/15), 0.01 μg/L (2020/12/15), <0.01 μg/L (2021/02/11), 0.04 μg/L (2021/05/28)

I am tested every 6 months now.

[Hidden in reply to doc1947g]

So your last PSA was May of 2021? Is there any significance to bounces from <.01 to .04? Or even higher? Reason I ask is the tests I get are <.1. I took one on my own at Quest that said .03. I’m wondering if there is any significance to movements in this range

[doc1947g in reply to Hidden]

My RO told me not to worry until PSA reach 2.0

[northshoreguy]

I had as salvage therapy after prostectomy. Spread to my pelvic bone and was zapped with cyberknife radiation. PSA has been undetectable since11/2020. I should also mention I was on lupron for3 months then Eligard for 3 months and Orgovyx for the last 11 months

[JWS13 in reply to northshoreguy]

Any side effects from the ORGOVYX (especially cardiac related-a-fib, increase pulse , etc.) thanks

[climb4blue]

I used Cyberknife for my primary treatment. I studied specs and treatment protocols for these linacs as part of my treatment decision: Varians TrueBeam, ViewRay MRIdian, and Cyberknife.

Do you have a specific question about Cyberknife?

[Elizabeth185 in reply to climb4blue]

thank you for your message! Is CyberKnife different than the other treatments you listed? CyberKnife is a marketing name and I don't know what it means. But trying to get my boyfriend to treat his cancer rather than ignore it and think it will go away on its own.

[climb4blue in reply to Elizabeth185]

Cyberknife is external beam radiation just like those other machines but is materially different in the way it is delivered.

Cyberknife uses a robotic arm moving in complete freedom rather than a fixed arc path like all VMAT machines.

Theoretically, this freedom of movement will hit the surrounding tissue outside of the prostate less often because it is not on the same trajectory each treatment time and could (theoretically) reduce toxicity to surrounding tissue.

Cyberknife uses intrafraction imaging more often (every 1 minute) to adjust for prostate movement during treatment so the treatment protocol has much tighter margins than VMAT machines (image every 2-4 minutes). The VMAT machine exception is the MRIdian, a new MRI-VMAT integrated linac machine, where a patient has to sit inside an MRI bore during each treatment session but its margins are similar not better than Cyberknife. Theoretically, tighter margins means less toxicity to surrounding tissue.

What sold me on Cyberknife was the "machine & team". I went the route of extreme hypofractionation with higher radiation dosages (fractions) than elsewhere in order to get more cell destructive radiation treatment, but with this comes more toxicity (aka side effects); choosing Cyberknife, with the tighter margins, was for the intent to minimize surrounding tissue exposure to radiation.

I hope your boyfriend will eventually come around to see that treatment sooner rather than later will offer a better chance for curative treatment.

[JWS13 in reply to climb4blue]

Cyberknife is "exactly" same as SBRT right?

[climb4blue in reply to JWS13]

Cyberknife is external beam radiation just like other machines.

[GSDF in reply to JWS13]

Exactly... Cyberknife IS Stereotactic Body Radiation Therapy

[redonthehead]

I had SBRT radiation therapy ( 5 treatments) for favorable intermediate prostate cancer done via a Cyberknife machine. The machine tracks the location of the prostate via 3 or 4 gold fiducial seeds placed into the prostate several weeks prior.

There is a potential advancement in SBRT treatment via machines that will track the prostate via MRI imaging done concurrently with the radiation. If I understand correctly this allows the RO to reduce the margin of treatment, thereby reducing side effects. Fiducials are not needed either. I am not sure I would have flown across the country today to have this over Cyberknife today, but would need more investigation.