Cyberknife Radiation Treatment For Prostate Cancer:
Options for management of localized prostate cancer range from active surveillance/watchful waiting to surgery and various forms of radiation, with or without hormone therapy. The most appropriate option depends on the extent and aggressiveness of the cancer as well as patient preference.
National guidelines recommend CyberKnife stereotactic body radiation therapy as an appropriate treatment option for men with low or intermediate risk disease. In addition, selected patients with Gleason 8 cancers may be candidates for CyberKnife radiation treatment for prostate cancer.
Low Risk Disease is defined as T1-2a, Gleason 6 cancer, and PSA < 10.
Intermediate Risk Disease is defined as T2c or less, and/or Gleason 7 cancer, and/or PSA 10-20.
CyberKnife radiation for prostate cancer has been successfully performed on tens of thousands of men over the past 15 years. No longer considered experimental, numerous studies have demonstrated excellent long-term cancer control with minimal side effects or risks. The CyberKnife system is considered the gold standard for performing prostate SBRT as compared to other radiation machines. Our center is one of the most experienced CyberKnife centers in the Northeast in treating prostate cancer. We have successfully treated hundreds of men with CyberKnife SBRT since 2006.
External Beam Radiation Therapy :
Radiation focused on the prostate gland from outside the body. EBRT is often used for earlier staged cancers or to help relieve symptoms like bone pain if the cancer has spread.
Within the EBRT category there are four types of external radiation:
Three-Dimensional Conformal Radiation Therapy : High energy photon radiation delivered typically in 42 treatments.
Intensity Modulated Radiation Therapy : An advanced form of 3D-CRT. Also typically delivered in 42 treatments.
Proton Beam Radiation Therapy: This therapy focuses beams of protons instead of photon beam. Typically delivered in 40 treatments.
Stereotactic Body Radiation Therapy : This therapy uses advanced image-guided techniques to deliver larger doses of radiation to a very precise area. Since the dose of radiation is larger, only five treatments are required over a few days as opposed to many more treatment sessions with other forms of radiation.
Protecting Healthy Tissue Protecting Quality Of Life
Despite the higher dose rate associated with SBRT, multiple studies have validated that there are no worse side effects with CyberKnife SBRT than with traditional radiation.1 Unlike any other radiation treatment, the CyberKnife System continually tracks the target and automatically adapts the radiation beam for movement of the prostate in real-time throughout the entire treatment session. With this automatic motion tracking and synchronization, the CyberKnife System enhances your treatment teams ability to maximize the radiation dose delivered to the target, while minimizing dose to surrounding healthy tissues to reduce negative side-effects on urinary, bowel, and sexual function that can impact a patients quality of life. The majority of patients can continue normal activity during and immediately after treatment.
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Technical Aspects Of Sbrt
Stereotactic body radiotherapy uses a 3-dimensional co-ordinate system utilizing internal fiducials or image guidance for tumour tracking and treatment delivery. Cyberknife has the advantage over other SBRT systems in that it is capable of tracking the co-ordinates in real time while the head of the accelerator re-aligns itself to accommodate fluctuations in target position. The delivery of SBRT generally utilizes multiple noncoplanar arcing fields directed at the radiation target. As a result, the dose gradient is much deeper than conventional radiation and irregularly shaped. The dose with SBRT is generally prescribed to the isodose line encompassing the target which allows for an inhomogenous dose delivery in which the core of the target receives a much higher dose. This may be especially advantageous when anticipating a hypoxic core that may harbour resistant clonogens. Stereotactic body radiation fractionation uses doses that may range from 5 to 30 Gy/fraction and often takes into consideration the BED offered by dose escalation.
Stereotactic body radiotherapy is the best tool for sparing parallel normal tissue, abutting planned large volumes. Even several tissues like lung, liver and kidney may benefit when functional subunits are maximally preserved by the deep dose gradients.
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You can eat various types of other meats. I suggest to eat chicken,turkey,& lots of fish. I buy all natural chicken, all natural turkey,& wild caught & fresh fish.
I eat as much as I want of these type meats. I never thought Id like grounded turkey. I can honestly say that a turkey burger is much better than any hamburger I ever ate. I wouldnt have thought so but it honestly is a better taste & health option.
I eat all the chicken I want. I suggest you to bake it & not fry it in oils. If you do fry then please use Extra Virgin Olive Oil. I add Mrs. Dash seasonings to all my meats. This is an all natural source for seasonings. There are many different flavors by Mrs Dash.
I also eat all the fish I want. I suggest eating salmon,flounder,tilapia,pollack,catfish,trout,& many other fish. Try to eat the oily type fish. Salmon & trout are two of the top oily fish on the market. Here too I suggest baking instead of frying.
Now, I want to move onto another area of the diet. I will be discussing the importance 0f fruits & vegetables. Fruits was definitely a foreign word to me before prostate problems. I did eat limited amounts of veggies but not enough. I made that change as well in my life. Its very important to eat fruits & veggies to have a healthy diet. Disadvantages of Cyberknife for Prostate
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Common Short Term Side Effects
- Urinary bother: frequent urination, some burning, getting out of bed frequently to urinate, weak stream, dribbling
- Rectal irritation: more frequent bowel movements, some rectal mucous, hemorrhoid irritation
- Small amounts of blood in the urine
- Some blood and discomfort occurring during sex / ejaculation
More Than Two Decades Of Clinical Proof
The CyberKnife is commonly used for treating low- to intermediate-risk prostate cancer and is the only radiotherapy device supported by years of published clinical follow-up with a large number of patients.
SAFE AND EFFECTIVE
Prospective, multi-institutional study data supports the safety and efficacy of CyberKnife for men with low- and intermediate-risk prostate cancer.1, 2
EXCELLENT LONG-TERM OUTCOMES
Clinical studies report CyberKnife provides excellent long-term disease control for prostate patients.3, 4, 5, 6, 7, 8, 9
20,000+ PROSTATE CANCER TREATMENTS
More than 20,000 men have been treated with CyberKnife.
References:
1 Meier. R. et al. Five-Year Outcome From a Multicenter Trial of Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer. International Journal of Radiation Oncology Biology Physics, Volume 96, Issue 2, S33 S34.
2 Fuller D.B., et. al. 5-year outcomes from a prospective multi-institutional trial of heterogeneous dosing stereotactic body radiotherapy for low- and intermediate-risk prostate cancer. J Clin Oncol 35. 2017 6S 35.
3 Zelefsky M.J., Chan H et al. Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urol 2006 176:1415-9.
4 Cheung R., Tucker S.L. et al. Dose-Response Characteristics of Low- and Intermediate-Risk Prostate Cancer Treated with External Beam Radiotherapy. Int J Radiat Oncol Biol Phys 2005 61: 993-1002.
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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.
What Side Effects Will I Have
During your treatment, radiation must pass through your skin. You may notice some skin changes in the area exposed to radiation.
Your skin may become red, swollen, warm, and sensitive, as if you have a sunburn. It may peel or become moist and tender. Depending on the dose of radiation you receive, you may notice hair loss or less sweat within the treated area.
These skin reactions are common and temporary. Theyâll fade gradually within 4 to 6 weeks after you finish your treatment. If you notice any skin changes outside the treated area, tell your doctor or nurse.
Long-term side effects, which can last up to a year or longer after treatment, may include:
- A slight darkening of the skin
- Enlarged pores
- Skins feels more or less sensitive
- A thickening of tissue or skin
Other possible side effects of external beam radiation therapy are:
Tiredness. Your fatigue might not lift until a few weeks or months after you finish getting radiation therapy.
Lymphedema. If radiation therapy damages the lymph nodes around your prostate gland, the fluid can build up in your legs or genital area. That can bring on swelling and pain. Physical therapy can usually treat lymphedema, but it might not go away completely.
Urinary problems. Radiation can irritate your bladder, and that could lead to a condition called radiation cystitis. You might:
- Have to pee more often
- Feel like it burns when you pee
- Notice blood in your urine
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When Is Brachytherapy Alone The Right Choice
For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.
This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.
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
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Prostate Cancer: Surgery Vs Radiation Vs Cyberknife
An analysis of more than a dozen studies indicate that prostate cancer patients do better with surgery vs. radiation treatment especially men with localized prostate cancer.
Patients treated with radiation are twice as likely to die from prostate cancer,one a half times likely to die sooner than prostate cancer patients treated with surgery, exposure to radiation may end in secondary cancers such as bladder cancer and rectal cancer.
Dr. David Samadi explores the details.
When men are diagnosed with prostate cancer it can be extremely confusing at times picking the right treatment option as theres a lot of information out there.
Dr David Samadi says that with any cancer, surgery should be the first line of treatment.
With prostate cancer surgery patients get accurate staging i.e. how much cancer a patient has, has the cancer spread to surrounding tissues the PSA levels which has always got to be zero.
He says that patients are led to believe that radiation is a viable first line of treatment if the cancer comes back, it is extremely difficult to perform surgery after radiation.
Dr. Samadi also explain why it is extremely important to weigh in the experience of the surgeon as working with the right doctor would ensure a better and faster recovery.
Dr. David Samadis patients have a continence percentage of 95% 97% regular sexual functionality in about 80% of prostate cancer patients.
Some prostate cancer facts:
How Is The Cyberknife System Different From Other Stereotactic Radiosurgery Systems
The CyberKnife system uses the combination of a robotics and image guidance to deliver concentrated and accurate beams of radiation to intracranial and extracranial targets, many of which are inoperable with sub- millimeter accuracy. The robotic arm is highly flexible, allowing access to tumors in difficult-to-reach locations.
The CyberKnife, unlike other stereotactic radiosurgery systems, is able to locate and track the position of the tumor without the use of an invasive stereotactic head frame or stereotactic body frame. The system compensates for the patients respirations and movement during treatment, constantly ensuring accurate targeting for the delivery of radiation beams.
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What Is A Cyberknife
The first thing prostate cancer patients should know about ground-breaking CyberKnife Radiotherapy Treatment, is that it doesnt involve a knife or any surgical procedure. Patients rest on a manoeuvrable seat or table each fifteen seconds their x-rays are taken, as a robotic arm manoeuvres around them, accurately delivering beams of radiotherapy from numerous angles.
Traditionally, radiotherapy treatments allow for a small margin of error this is due to basic inaccuracies or unavoidable movements of the prostate or patient. The CyberKnife vastly reduces this margin of error, bringing it down from between five and fifteen millimetres to just two or less with this high level of precision.
Patient Liable For Cyberknife Treatment For Prostate Cancer
Cyberknife is typically used for patients with
- Early-stage disease.
- Localized disease
- A prostate volume of less than 80-100 cm
- A lesion or tumor that is untreatable by surgery or other radiation modalities.
Most people with enlarged prostates may be given hormone therapy and try to shrink the prostate to be able to get cyberknife treatment for prostate cancer. Patients who are considered high risk for spread to the lymph nodes or have cancer in the lymph nodes are not good candidates for cyberknife treatment for prostate cancer.
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Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
Candidates For Cyberknife Radiotherapy Treatment
CyberKnife is suitable for all patients with a small or medium-sized prostate those with localised T1 or T2 stage prostate cancer, have a Gleason score of seven or lower, or a PSA score below twenty are also appropriate candidates. Claustrophobic patients can usually be accommodated, due to the free, open design of the machinery used.
Due to its use of MRI scanning, unsuitable candidates also include patients with implants such as pacemakers or metal plating patients who have had both hips replaced are also unsuitable candidates . CyberKnife is also unsuitable for severe urinary symptoms.
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Clinically Proven Alternative To Conventional Radiation Therapy
CyberKnifes image-guided radiation technology has been in use and clinically proven for more than 30 years. It has been used by hundreds of thousands of patients worldwide, and many clinical studies published in medical journals have confirmed its safety and effectiveness.
Cleared by the U.S. Food & Drug Administration in 2001, the CyberKnife system has perfected an effective way to treat tumors and lesions anywhere in the body without pain, unintended damage to organs or tissue, or unnecessary side effects.
Side Effects Of Prostate Cancer Radiotherapy
Radiotherapy to the prostate can cause some side effects, such as loose or watery poo and passing urine more often.
Side effects tend to start a week or 2 after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so after treatment finishes
Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned.
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What Is Involved In Cyberknife Treatment
CyberKnife® Machine
You will see a urologist a week or two before treatment. This doctor will place gold markers, known as “fiducials”, in your prostate as a way of marking the target. This is done under ultrasound guidance, similar to the procedure for prostate biopsy. The tumor position will be tracked during the Cyberknife treatment using the fiducials.
After the gold markers have been placed, a CT simulation is performed. During this CT scan, you will be positioned in the same way you will be positioned during the actual treatments. The physician uses this scan to outline the treatment area and organs or tissues to be avoided. This information is used to create the treatment plan.
The number of treatments and the amount of radiation per fraction can vary. Each fraction is a higher radiation dose than is used with traditional radiation, but fewer fractions are given. Typically, treatments include:
- Four or five fractions .
- Treatment is given over 1-2 weeks.
- The total dose in the mid to high 30 Gray range.
- Each treatment session is 30 to 90 minutes .
While you are being treated, the machine takes pictures of the tumor, which are compared in real-time to the images from the CT simulation. The CyberKnife robot moves around you to deliver precise treatment that can be adjusted as the prostate moves when you breathe.