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 (SBRT) 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.

CyberKnife radiation for prostate cancer is given in 5 sessions over 2 weeks, typically every other day. The treatment is completely painless, lasting 20-40 minutes per day. Patients experience no immediate side effects, are able to drive themselves and continue their normal daily activities. While many patients have no side effects, some men may experience frequent or urgent urination typically lasting 2-4 weeks. On average, side effects experienced with CyberKnife SBRT are less severe and less frequent than those seen following “standard” daily radiation.

Comparison of CyberKnife Radiation Treatment and Other Options for Prostate Cancer

CyberKnife IMRT Radiation Brachytherapy
(radioactive “seeds”)		 Proton Beam DaVinci   Robotic Surgery
Treatment in 5 or fewer treatments Yes No Yes No Yes
Non-Invasive Yes Yes No Yes No
Continuous Image-Guidance During Treatment Yes No Yes No No
Does Not Require Anesthesia Yes Yes No Yes No
Does Not Require an Operative Procedure Yes Yes No Yes No
Cost $$ $$$ $ $$$$$ $$

 

Saint Francis is the only hospital in Connecticut to offer CyberKnife SBRT, IMRT radiation and brachytherapy (radioactive seed implantation) as options for treatment of prostate cancer.  Because of this, we can tailor treatments to each patient’s situation and preference.

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.
  • Simulation – You will need to have a special CT scan in the Radiation Oncology department to pinpoint the exact location of the prostate. The simulation appointment will also include a detailed education session with the CyberKnife nurse. The entire appointment should take 1-2 hours.
  • MRI Scan – Most patients will also undergo a prostate MRI scan. The scans will provide the CyberKnife the information it needs to pinpoint the exact size, shape and location of your tumor—and to avoid exposing the healthy surrounding organs and tissues to unnecessary radiation.
  • Computerized Treatment Planning – After all of your scans have been completed, your Radiation Oncologist will work closely with the CyberKnife Medical Physicists to develop a custom CyberKnife treatment for you using powerful computers and 3-D image reconstruction. This process can take up to a week.

During CyberKnife Treatment

  • During the treatment, you should lie still on the CyberKnife treatment table. The CyberKnife robot will move around your body focusing the radiation beams on your prostate.
  • You should not feel any discomfort, and nothing will touch you directly.
  • During your 20-30 minute treatment you may watch a movie on the flat screen TV on the ceiling.
  • You may drive yourself and return to your regular schedule immediately following the procedure.

After CyberKnife Treatment

  • Most prostate cancer patients will receive five CyberKnife treatments over the course of 1-2 weeks.
  • Following each treatment, you may drive yourself and immediately return to your normal daily activities.
  • By the end of the two weeks of treatment, some patients may develop urinary frequency, urgency or a slower stream. If this develops, you may be prescribed a medication to take for several weeks to help you urinate better.
  • Other less common side effects may include fatigue or mild diarrhea, which are generally less intense than with traditional radiation.
  • Normally, any side effects from the CyberKnife treatment should resolve within 2-4 weeks.
  • If you are concerned about any symptoms you may experience, contact your CyberKnife physician or nurse.
  • The best way to monitor the success of the CyberKnife treatments is with the PSA (prostate-specific antigen) blood test. It is important to follow-up with both your urologist and the CyberKnife radiation oncology physician. Patients are initially seen three months following treatment, then every six months afterwards, with a PSA test at each visit. PSA levels drop most dramatically during the first six months, but often continue dropping for up to 4-5 years following treatment.

“Many studies have demonstrated the effectiveness of CyberKnife® for early stage prostate cancer, with 93% of patients cancer-free after treatment. In addition, our patients appreciate the convenience of only five treatments, with minimal side effects. They are able to resume their normal activities immediately, without any recovery time needed.” –Richard Shumway, M.D., Director of the Connecticut CyberKnife® ® Center at Saint Francis