What side effects, if any, did you have with Cyberknife?

My age is 78 and Cyberknife 2 years ago. gleason was 3 + 4. psa 6.8 then. Today psa 1.1 and no thigh weakness here. ED is major. Two older brothers had prostate cancer. One died of it. All of us experienced major ED. No known other negative effects so far, but I'm still watching and waiting. Haven't heard of thigh impact from anyone.

I would argue that a PSMA PET scan is your most important. It will definitively (or as close as can be ascertained) whether you have metastasized. It is standard protocol after biopsy. Decipher, I don’t know how it works, but it is an estimate not like a PSMA, which tells you whether and where it has metastasized.

@janmcgoldrick, the general weakness and fatigue could be related to a variety of things. You might find helpful tips in these related discussions:

- Leg Issues Long After Radiation and ADT https://connect.mayoclinic.org/discussion/leg-issues-long-after-radiation-and-adt/
- Anyone had success regaining muscle strength with low testosterone? https://connect.mayoclinic.org/discussion/fatigue-low-testosterone/

Is your husband on any other treatment?

My experience with SBRT post prostatectomy has been very good. As I understand it, SBRT is being recommended as your first treatment.
The treatment seems to be improving with the wider use of PSMA PET, which can detect more micrometasis deposits. They can see more cancer at lower levels and can target it with SBRT.
Also, it's not clear whether your cancer is still organ confined. If it is, then SBRT, is still a good choice. If it's treated within the prostate itself, you'll be monitored to see if any has gotten out. If it has, SBRT may be a good therapy for that too.
Prostactomies are becoming increasingly safer and thorough.
But there are still risks of losing erectile function etc. And it's surgery after all.
But also, a prostatectomy may be a back up to the SBRT.
If SBRT doesn't work, prostatectomy may be good follow on.
Talk to your docs, and check the issue out by using AI on the internet. Just pose the question.
Good luck.

You said “ If SBRT doesn't work, prostatectomy may be good follow on.” And I am really wondering what you were talking about. If you have SBRT to the prostate You really can’t have a prostatectomy after, You can remove some excess tissue, but it’s been mostly eliminated.

Now, if you’ve removed the prostate, and you have metastasis come back that’s another story.

Mark Scholz who talks at all the PCRI Conferences, in the March conference, Talked about how he was strongly in favor of just using SBRT to treat metastasis. He talked in the last hour and a half of the conference If you want to see it on YouTube. He found that this works to give long term Remission to many of his patients.

In the recent PCRI conference, they mentioned the fact that the PSMA Pet cannot see Metastasis smaller than 2.7 mm. They have problems if they’re even 5 mm in some cases, reported a Doctor in a recent conference by UCSF.

SBRT radiation can handle smaller metastasis than 2.7 mm, If you can find them it can zap them.

We maybe talking about different things, but AIed the question and got this

AI Overview
Yes, a prostatectomy (radical prostatectomy) is a possible treatment option after attempting to treat intra-prostatic prostate cancer with stereotactic body radiation therapy (SBRT), especially if the cancer recurs or persists. However, it's considered a more challenging procedure than in a non-radiated prostate due to scar tissue and potential difficulties in defining surgical planes.

You are talking about “intra-prostatic prostate cancer with stereotactic body radiation therapy (SBRT)”. Not the normal SBRT that a person gets with around 5 radiation treatment To the prostate.

I’ve got to admit I never do hear about people having that done. What you’re talking about here is having minimal SBRT done to the prostate to remove lesions inside of it, but leaving most of the prostate intact. I think it’d be hard pressed to find a doctor that will do this, unless it’s something brand new, they’re doing.

The normal SBRT radiation is five doses, which actually close to disintegrates the prostate. There is no prostatectomy after that.

Sounds like you're much more in top of this than I am. I only tripped over the scenario wondering aloud if I might've been better off taking SBRT to the prostate. Turns out while my prosratectomy pathology report was 'aces', I still had BCR in about a year. Thus far I've kept the hounds at bay with only salvage RT, followed by IMRT w 6 month dose ADT, and SBRT MDT. I've managed to avoid more ADT, having enrolled in an NCI clinical trial that has me on enzalutimide.

Interesting clinical trial, They already did the Embark trial with Enzalutamide Alone and with Lupron. They must be Doing something different with you or maybe you are a different type of cancer case. That study required they be non-metastatic castrate sensitive.

Are you castrate resistant already or metastatic? With the BCR You don’t always show metastasis, especially when the salvation radiation killing micro metastasis..

They must’ve changed the study somehow.