Todays blog is going to start the discussion about the use of Cyberknife to treat prostate cancer. Because this is such a new and interesting modality to treat prostate cancer, I am going to break up the discussion into at least two sessions. The first will introduce the method of treatment and the particulars of the treatment itself. Further discussion will take place about my experience with Cyberknife in terms of its side effects, complications and results.
Cyberknife Stereotactic Radiosurgery (CKSRS) is one of the newest and fastest growing radiation treatment options for localized prostate cancer. While Cyberknife is being offered at a small handful of hospitals in Maryland, there is no question that Sinai Hospital of Baltimore has the largest experience with this exciting technology. There are multiple uses for Cyberknife, but given my specialty and this forum, we will only address its use in the treatment of localized prostate cancer. I am not aware of any other hospital locally that is offering CKSRS for prostate cancer, although this may have changed over the last few months.
Our group, Advanced Urology Associates, has by far, the largest experience of any urology group in the Mid-Atlantic region. As of the writing of this blog, it is my understanding that our group has the only urologists locally that are credentialed to perform CKSRS. In the last year, Drs. O’Reilly and I have treated over fifty men using CKSRS at Sinai Hospital. And while long term treatment success is impossible to gauge at this time, PSA results have followed that of seed implantation and the side effect panel has been minimal. In the interest of full disclosure, I do not own any portion of the Cyberknife machine nor do I own stock in the company which makes it. Finally, I am not an employee of Sinai Hospital. I became interested in Cyberknife as an alternative to seed implantation in the patient with significant voiding dysfunction putting them at higher risk of complications from my standard treatment.
CKSRS for prostate cancer is performed as an outpatient. It is similar to the high dose radiation model of seed implantation rather than the low dose multiple treatment model of external beam radiation or IMRT/IGRT. Typically each patient receives five one hour treatments given on a daily or every other day basis.
Typically my pre-surgical evaluation of the patient is limited to an initial consultation followed by a urinary flow test and measurement of post void residual urine. In those men in whom it is indicated, cystoscopy will be performed. After the patient has undergone consultation with the radiation oncologist they will be scheduled for placement of fiducial markers. These are four gold marker seeds that are placed at the base and the apex of the prostate on both the left and the right side under ultrasonic guidance. This procedure is done under a light sedative similar to what is used for colonoscopy. A small bowel preparation the day before the procedure insures an empty rectum and excellent ultrasonography allowing for precise placement of the gold fiducial markers.
Approximately one week after placement of the gold fiducial markers the patient undergoes a pelvic CT scan and MRI. Following these studies, the CT and MRI are merged by the Radiation Physicist at Sinai Hospital. The urologist then pulls up the studies and “contours” the prostate. Essentially, we create a three dimensional image of the prostate based upon the merged CT and MRI. The previously placed gold fiducial markers act as grid points allowing us the merge the two studies. Once the prostate and critical structures such as the bladder, rectum and urethra are contoured the Cyberknife computer generates a treatment plan for the radiation. The patient comes in for his five one hour treatments, again given either daily or every other day, and thus completes his treatment regimen.
As with seed implantation, an antibiotic is given prior to placement of the gold fiducial markers. In addition, I start all of my CKSRS patients on either Flomax or Uroxatrol to help with urination during the period of treatment and typically for a couple of months afterward. I have not had to use the steroid dose pack as I have done with the seed patients and post procedure pain has been handled with either a non-steroidal such as motrin or a very light narcotic such as hydrocodone.
In our next discussion I will go over treatment results in terms of side effects and short term PSA results.
I would be remiss if I did not mention how proud I was of my Baltimore Ravens this past weekend. To go into New England and lay the beating they did on the Patriots was nothing short of amazing. For all the criticism of the Ravens and their coaching staff this year, I think we can safely say that at a minimum this team has a lot of character. And that starts with the head coach, John Harbaugh. Kudos to the team on an impressive victory. Now go exorcise the demons of the Mayflower past, go into Indy and beat the tar out of the Colts. Go Ravens.
epwtxcmpht, Fda safety review of meridia, KQBMZNW, +jfinlay@meridia.org, DGnnanF, http://www.racejamestown.com/ Loss meridia pill weight, IUyEaLe, Vigrx plus info, JbYviUu, Vigrx plus in india, vgbbeXF, http://www.drykiln2000.com/ Enhance cock vigrx, nNOzrij, Phentermine and memory loss, vFEUeUK, Cheap phentermine online without prescription, NfhlGMk, http://www.electricricecooker.org/phentermine.html Difference between adipex and phentermine, wppIPEy, Purchase ambien online, zPBbMxD, Buy Ambien, NcTPgSG, http://greatbodyhealth.com/doctors-say.htm Buy ambien online, QgxCkdG, Buy valium without a prescription, wsPHAVN, Where can i buy valium in the uk, bJcFAEs, http://www.feersumennjin.net/ Valium shop europe buy, NdIpXVd, Buy valium in shantou china, IigcuFa, Buy valium at usarxsale, jlLlOny, http://www.lostcanyon.org/just_the_facts/cabins_rates.html Buy valium at usarxsale, jzMLpTW.
Could you transfer $1000 from my current account to my deposit account? http://emutuqidet.centerblog.net “]Lolita Pthc
[/url] 
P
Hello! dcfekcd interesting dcfekcd site! I’m really like it! Very, very dcfekcd good!
Hello! cdgebed interesting cdgebed site! I’m really like it! Very, very cdgebed good!
Anything you stated made a lot of sense. But, think about this, what happens if you added a little content? I mean, I shouldn’t tell you how to run your site, but imagine if you included a little something to maybe get peoples attention? As being a training video or simply a picture or two to obtain people excited about what youve got to mention. I think, it will make your weblog become more active a bit more.
Could I make an appointment to see ? http://upcoming.yahoo.com/user/1370337 “]Pthc Torrent Download[/url] 835945
What’s the exchange rate for euros? http://www.flickr.com/people/57238903@N03 “]preteen nude lolita model nymphet pthc hussyfan
[/url] 
)
Have you got a telephone directory? http://jarikecety.page.tl “]little teen thong[/url] 108811 http://obyiaof.page.tl “]gay little kids[/url] =-PPP http://obiidehyd.page.tl “]sexy men bikini[/url] 95677 http://eceninoj.page.tl “]pedo mari[/url] =P http://qujulehom.page.tl “]bikini melissas picture[/url] 409 http://obamobau.page.tl “]kidnude[/url] 8D http://dofapycumy.page.tl “]free cp tgp[/url] jehin http://tycodysey.page.tl “]little beaver creek[/url] 0420 http://yjutegaje.page.tl “]kid bbs nude[/url] pmv http://gegebiotu.page.tl “]sexy memorial bikini[/url] 61790
I’m doing a masters in law http://www.bebo.com/oaebn “]Hussyfan Download
[/url] dhmekk http://www.bebo.com/ahoaj “]Young Ymfun Hussyfan
[/url] =-OOO http://www.bebo.com/hyuyty “]13yo Hussyfan
[/url] :DD http://www.bebo.com/tugifucii “]Pthc Hussyfan Cp Child Porn Bbs Underage Girls
[/url] aeezby http://www.bebo.com/bupydioa “]Hussyfan Video
[/url] 41309 http://www.bebo.com/esugyher “]Flurl Hussyfan
[/url] %))) http://www.bebo.com/qipyqoroa “]Links To Hussyfan Pics Blogs
[/url] nnf http://www.bebo.com/jigopubuh “]Hussyfan Kids
[/url] maiu http://www.bebo.com/ohynirep “]Newsgroups Hussyfan
[/url] 8375 http://www.bebo.com/ejykeqt “]Underage Hussyfan Cp
[/url] ith http://www.bebo.com/sucahycoo “]Kingpass Pthc Preteen Hussyfan Babyshivid
[/url] dll http://www.bebo.com/gaqabou “]Pthc New Hussyfan
[/url] hun http://www.bebo.com/kysufono “]Search Lolita Hussyfan
[/url] 8-( http://www.bebo.com/oboliniry “]Hussyfan Pedo Pthc Sex
[/url] jmpult http://www.bebo.com/gunotyo “]Lolita Pthc Hussyfan Incest Pedo Real 12yo Illegal Secret Website
[/url] 040 http://www.bebo.com/aroye “]Hussyfan R@Ygold Nude
[/url] kaxrau http://www.bebo.com/opemimoq “]Pedo Hussyfan Pertersburg
[/url] 14267 http://www.bebo.com/cydecumui “]Ray@Gold Hussyfan
[/url] 0812 http://www.bebo.com/amykigefs “]Hussyfan Preteen
[/url] :[[ http://www.bebo.com/buugugy “]Hussyfan Non Nude Pics
[/url] hmea
What provisioons are made in the event a patient needs to urinate during that one to two hour cyberknife treatment?
What provisioons are made in the event a patient needs to urinate during that one to two hour cyberknife treatment?
The CyberKnife delivers essentially the same treatment as another treatment called High Dose Rate Brachytherapy (surgery combined with radiation). There is almost 30 years of accumulated data, and the results for prostate cancer are the best in the literature. CyberKnife data is predictably paralleling this. ASTRO has repeatedly demonstrated a conflict of interest whenever they are asked for comments, and Trailblazer is ignoring this. Trailblazer also pays for proton therapy, which has far less data supporting it. Men with prostate cancer in florida radiation oncology , cyberknife south florida, New Mexico, and Texas are rightfully outraged that they are denied this treatment when Medicare covers it in 36 states including Wasington D.C.. I applaud Congressman Gonzalez efforts, he is standing up for the patients in his district and throughout the Trailblazer coverage region.
We also take great pride in the high quality, personalized support that patients receive at our center. Education, ACS support classes, emotional support, as well as transportation services are available to patients and their families (in most of our surrounding communities) throughout diagnosis, treatment and recovery.
FEATURED JOBS
Comments (31)
PP 
) 
( 
((