What Is Different About The Cyberknife
The key difference is the degree of accuracy achieved by the CyberKnife, as a result of x-rays being taken every 15 seconds. For prostate cancer patients, this is important because the prostate moves internally, even when the patient remains absolutely still.
The imaging we have from treatment so far has shown exactly how much the prostate can move without any external signs of movement, such as when gas passes through the rectum or as the bladder fills, says Dr El-Modir
When using traditional radiotherapy , oncologists plan treatments using margins of 515mm, to allow for natural movement and slight inaccuracy. The margins with CyberKnife are much smaller: just 02mm. Because of this confidence in accuracy, the CyberKnife can safely deliver much higher doses of radiotherapy in each session. This very high dose, delivered with such precision, is known medically as stereotactic therapy. With the CyberKnife the number of treatment sessions is just five, compared with 37 required for standard prostate cancer radiotherapy.
How Does Cyberknife Work
One of the major obstacles to treating prostate cancer is the fact that the tumors in and around the prostate can involuntarily and unpredictably move throughout treatment as much as 5 mm in as little as 30 seconds. These movements can be due to natural occurrences such as the bladder filling and gas in the bowel. The CyberKnife hurdles these obstacles. The CyberKnife System works by combining a robotic arm with an imaging system. The robotic arm is flexible and moves around the body ensuring precision by reaching your tumor at hundreds of different angles with its beams of high-dose radiation. The imaging system tracks your tumor during the entire treatment process and sends the information to the robotic arm to guide its every movement. With this range of motion, the CyberKnife System is able to avoid healthy tissue and form its emitted radiation to the exact shape of the patients prostate tumor.
This advanced stereotactic radiosurgery system is the most precise available. Instead of surgery, or targeting general regions with large doses of radiation, we are able to use pin-point accuracy within the thickness of a dime. CyberKnife also provides treatment without invasive surgery, within a weeks time and with minimal side effects. Our Orange County radiation oncology experts can work closely with your medical team to use the CyberKnife system for stand alone treatment as well as for treatment that complements other treatment options including surgery and/or chemotherapy.
Intensity Modulated Radiation Therapy
IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.
Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.
A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.
Recommended Reading: Noncancerous Enlargement Of The Prostate Gland
The Benefits Of Cyberknife Radiosurgery
Fortunately, with the painless CyberKnife® System of radiation therapy, there are few if any side effects. One reason is that CyberKnife uses image-guided robotics to precisely and non-invasively destroy cancerous and non-cancerous tumors and other lesions with multiple beams of high-energy radiation without affecting the organs and tissues surrounding the tumor.
In fact, the CyberKnife System is one of the safest cancer treatment options available. Despite its name, it doesnt involve any cutting. Because it is a totally non-invasive procedure, it doesnt pose the risks or complications associated with surgery, such as infection or hemorrhaging.
Also, the anesthesia used in the conventional radiation treatment for certain cancers can cause a lot of side effects, including nausea and constipation. However, there is no anesthesia whether general or local with the CyberKnife procedure, so there are none of these effects, and no recovery time is required.
The CyberKnife Radiosurgery treatment can often be completed in just one to five 30- to 90-minute sessions usually within a week or two as opposed to the dozens of grueling treatments lasting weeks or months with conventional radiation therapy.
An Effective Less Disruptive Treatment Option
The CyberKnife System offers a non-surgical, non-invasive treatment option that delivers proven results for a wide range of cancers and metastases. CyberKnife provides stereotactic body radiation therapy and stereotactic radiosurgery , closely related types of radiation therapy that involve delivering a relatively higher dose of radiation with extreme accuracy. The high level of precision of this approach also called hypofractionation enables a higher dose of radiation to be delivered to a tumor in significantly fewer treatment sessions, while also reducing the radiation exposure to surrounding healthy tissues.
Read Also: Robotic Operation For Prostate Cancer
Get Your Free Prostate Cancer Guidebook
Make an informed prostate cancer treatment decision. Our 40-page, comprehensive guidebook provides answers to our most frequently asked questions from men diagnosed with prostate cancer, and compares various treatment methods, cure rates and side effects. Our team can also connect you with one of our oncologists at no cost.
Fewer Treatments In Less Time
Compared with standard radiation treatment, CyberKnife delivers 4 times the usual dose of radiation per day, but with half the overall radiation dose over the full course of treatment. Thats because CyberKnife allows the higher dose to be more accurately delivered to hug the prostate tumor and spare the surrounding healthy tissue.
That means each CyberKnife treatment only takes about 45 minutes per day for about five days. Normal radiation treatment takes longer per session and sessions go on from 6-8 weeks. For younger men 50-60, who are likely to be working still, this is a valuable convenience.
I urge all men with prostate cancer to consider CyberKnife for treatment. Its not for every man with prostate cancer that needs to be treated, but its a great option for a lot of them.
Also Check: How Do You Treat An Enlarged Prostate
Don’t Miss: Living With Metastatic Prostate Cancer
The Side Effects Of Cyberknife
As with any cancer treatments, side effects can vary greatly from patient to patient. The potential side effects of CyberKnife depend on the type of cancer being treated, the amount of radiation required, and the location of the radiation treatment and they can range between everything from minor skin irritation to serious injury or even death.
Some of the most common side effects of CyberKnife include:
- Skin irritation or rash at the site of radiation delivery
- Changes in bodily functions like salivary function or urination
- Specific problems in the area being treated
While these side effects are possible and may range in severity, for most patients, CyberKnife is a remarkably noninvasive treatment. Normally, CyberKnife produces few to no side effects in patients and offers one of the most attractive treatments available.
Are There Side Effects Of The Combination Approach
There is a slightly higher chance that patients who receive the combined therapy will have rectal irritation or urinary side effects. This is common with prostate cancer radiation therapy because the radiation can damage cells in the tissues surrounding the prostate. But at MSK, we routinely use sophisticated computer-based planning techniques that help us reduce the dose given to normal tissues such as the rectum, bladder, and urethra, lessening the chances of side effects and complications. We have also found that, when treating with the combined approach, using the high-dose-rate brachytherapy compared to low-dose-rate brachytherapy may have less in the way of side effects.
In addition, at MSK, we routinely use a rectal spacer gel, which we inject between the prostate and the rectum while the patient is under mild anesthesia, to create a buffer between these two tissues. By creating this space, we can further reduce the dose of radiation the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and dissolves on its own within the body after a few months.
Read Also: Side Effects After Prostate Surgery
Implications Of Implementing Mrgrt
There are challenges associated with fundamentally changing the workflow and the treatment we deliver. With constant MR imaging and the ability to change the plan daily, there is a risk of over-intervention. For example, if the small bowel sits close to the target on the daily image we may reduce coverage to the PTV in order to keep within our usual reference plan constraints. However, by the time the treatment is delivered the bladder will have filled and the bowel may have lifted, resulting in unnecessary under-dose to the target. We must remember that we have been safely delivering a single plan across a whole treatment course since the inception of fractionated radiotherapy and toxicity rates from prostate external beam radiotherapy are already low.
Replanning daily has significant implications for the workforce. Our current workflow requires two physicists, two radiographers and a clinician to be present for each fraction. Current research is focussed on streamlining this process and stratifying patients into those who do versus those who do not require daily adaptive replanning. We are also investigating the dosimetric impact of radiographer-led contouring. Our early work in an offline environment indicates a high concordance between radiographer and clinician contours .
Also Check: How Do They Scrape The Prostate
Are There Cyberknife Patient Organizations I Can Contact For More Information
The CyberKnife Patient Support Group, is a non-profit organization established in July 2001 and dedicated to helping others by sharing the personal experiences of patients who have undergone CyberKnife procedure. Note that the group has moved to a new home that has been redesigned and updated with new information and functionality. All of the old posts are also available in the new Patient Forum under Archived Posts. Please visit to see whats new!
You May Like: How To Determine Enlarged Prostate
What Happens During The Procedure
Youll be placed in the proper position on a table. Then, a computer-controlled robot will move slowly around the table, targeting radiation where its needed. The software will adjust radiation for your breathing pattern and any movement of the tumor.
This is a noninvasive, painless procedure. Each session will last anywhere from 30 to 90 minutes. Once its over, you should be able to get up and resume your normal activities right away.
Large Study Reveals Long
WASHINGTON A large, national study examining a radiation treatment for prostate cancerpopular because it delivers a high dose of therapy in a very short time framesupports its routine use.
The study, conducted at cancer centers around the United States including at Georgetown Lombardi Comprehensive Cancer Center, looks at long term follow up data for stereotactic body radiotherapy used to treat more than 2,100 men with prostate cancer that had a low or intermediate risk of recurring.
The results were published Feb. 8 in the journal JAMA Network Open.
At MedStar Georgetown University Hospital, the therapy is delivered by a system called CyberKnife, which delivers high doses of radiation precisely aimed to minimize the involvement of healthy surrounding tissue.
Radiation oncologist Sean P. Collins, MD, PhD, says curative treatment is a shared goal along with maintaining a persons quality of life. Side effects, including impotence, can occur with all treatments for prostate cancer and can happen years after treatment.
While it is necessary to observe these men for decades, our interim seven-year data show that survival and side effects are comparable to other forms of radiotherapy, says Collins, director of the CyberKnife Prostate Program at MedStar Georgetown University Hospital and an associate professor of radiation medicine at Georgetown University.
Don’t Miss: Dog Prostate Cancer When To Euthanize
Who Is Suitable For Treatment With The Cyberknife
CyberKnife is suitable for the following patients with prostate cancer:
- Localised prostate cancer .
- Gleason score up to seven and PSA less than 20.
- No severe urinary symptoms or previous TURP . If you are unsure how severe your urinary symptoms are, try this IPSS symptom score. Men scoring more than 20 would be considered severe and not suitable for CyberKnife treatment.
- Small to medium size of prostate.
CyberKnife is not suitable if:
- you have artificial hips on both sides, but may be possible if on one side only
- you have any medical condition or an implant that prohibits having a MRI scan.
Prostate Cancer Causes & Symptoms
Unfortunately, the exact cause of prostate cancer is not always known. Some recent discoveries have linked prostate cancer to changes in DNA and also to high levels of certain male hormones.
Prostate cancer is not, however, linked to an enlarged prostate gland, a condition also called benign prostatic hyperplasia or benign prostatic hypertrophy. An enlarged prostate gland is not cancer and does not cause cancer.
The symptoms of prostate cancer are also the same type of symptoms shared by many non-cancerous conditions. Therefore, it is very important to have a doctor determine the source of the problem for men who experience changes in their urinary functions.
It is also possible to have prostate cancer and not have prostate cancer symptoms.
Prostate Cancer Symptoms may include:
- Problems with urination
Also Check: Methods Of Treating Prostate Cancer
Recommended Reading: What Is The Male Prostate
Cyberknife May Reduce Side Effects Of Prostate Cancer Treatment
Stereotactic body radiation therapy is a type of external beam radiation therapy in which the radiation therapy is given in five or fewer treatments. Conventional radiation treatment for prostate cancer consists of 39 to 45 treatments. With SBRT, a higher radiation dose is delivered with each treatment compared to conventional treatment.
The Power of CyberKnife
External beam radiation therapy consists of high energy X-rays delivered from a linear accelerator targeting the tumor. The CyberKnife machine at UofL Brown Cancer Center is a lightweight linear accelerator with a robotic arm that delivers radiation to the tumor precisely and accurately. Additionally, the CyberKnife can track the motion of the tumor during the treatment delivery, which allows for a higher amount of radiation to the tumor and less to the surrounding normal tissue.
CyberKnife technology can be used to treat several types of cancer while minimizing side effects for eligible patients including brain, kidney, liver, lung, ocular/orbital, prostate, pancreatic and spinal tumors, as well as metastatic cancer. It is also used to treat acoustic neuroma, arteriovenous malformation and trigeminal neuralgia. For more information about CyberKnife, visit www.louisvilleck.com.
Lets take a closer look at using CyberKnife for prostate cancer.
Prostate cancer patient eligibility
Technology to reduce side effects
PSA levels after treatment
Side effects of SBRT with CyberKnife for prostate cancer
What Happens If The Cancer Comes Back
Usually the first sign of a problem is that the PSA begins to rise. PSA levels can bounce up and down a little day to day, so if it rises the first rule is to not panic and to simply recheck it in 3 months. If it rises on 3 consecutive occasions and/or if the PSA rises to 2 points above its post-treatment minimum value then there could be a cancer recurrence.
If the PSA trend is concerning then we will do CT scans and a bone scan to look for prostate cancer in the bones or lymph glands. If the cancer is coming back in the bones or lymph glands then it is usually no longer curable and the treatment will be long term hormone therapy such as Lupron. If the scans are normal we may do a biopsy of the prostate gland. If the cancer is found in the prostate gland and not in the bones or lymph glands, then you may be referred for cryotherapy or HIFU.
Recommended Reading: What To Expect After Robotic Prostate Surgery
Finding The Prostate Cancer Treatment That Works For You
Do you want to select a prostate cancer treatment based on convenience or cure rates?
You should also ask your radiation oncologist if this treatment method will eliminate prostate cancer cells around the prostate that may have escaped through microscopic capsule penetration.
If you have been recently diagnosed with prostate cancer, its critical to personally research prostate cancer treatment options to make an informed decision that is best for you and your family. With few exceptions, your first treatment generally gives you the best chance for success.
You May Like: Best Oncologist For Prostate Cancer
Preparing For Cyberknife Treatment
Your team of trained specialists at Saint Francis will help you understand every step of CyberKnife treatment.
Before you have CyberKnife treatment, you may need:
- Fiducials Fiducials are tiny gold seeds that guide the CyberKnife tools to the exact location of your tumor. In preparation for the CyberKnife treatments, a Urologist will implant four rice-sized fiducials through a needle into your prostate during an outpatient procedure, similar to the prostate biopsy procedure.
- Patients will need to do an enema immediately before the fiducial placement procedure.
- Patients will need to take antibiotics for three days after the fiducial procedure.
Read Also: Treatment Plan For Prostate Cancer
Don’t Miss: Where’s My Prostate Located
Side Effects Of Cyberknife For Prostate Cancer Patients
Cyberknife is considered a minimally invasive procedure. While there are some side effects, most patients only experience them for a short time, and they are minimal. However, some patients experience severe side effects in the rectum or bladder wall. Some of the side effects include:
-
Erectile Dysfunction
You may return to normal activities, but your doctor may minimize some physical activity on a case-by-case basis.