More than 170,000 men are diagnosed with prostate cancer in the United States annually. It is the most common cancer in men and affects 1 out of every 8 men. The discovery of PSA in the late 80’s changed the landscape of prostate cancer entirely. Most men are now diagnosed after a routine blood test by a physician shows an increased PSA. In some cases men present with symptoms related to urination, bowel symptoms or bone pain.
Men with prostate cancer are classified based on risk factors into Low-Risk, Intermediate-Risk and High Risk prostate cancer. Treatment recommendations are based on what risk group classification you have. Treatment approaches for prostate cancer are numerous and include watchful waiting for the lowest risk groups, removing the prostate with a procedure called prostatectomy, conventional external beam radiation therapy, brachytherapy, combined external beam and brachytherapy, and CyberKnife. In certain cases, hormonal therapy or chemotherapy may be incorporated into your treatment.
This is a procedure where the prostate gland is removed and the bladder and urethra are reconnected. It is a major operation and requires several weeks of recovery. Immediately after surgery, a catheter must be left in place for days to weeks. Once it is removed there is usually a period of incontinence while retraining takes places to regain continence. Most men will require significant use of absorbent pads at the beginning of this period and decrease the amount used over time. Most men will have excellent to adequate continence 3-6 months after surgery. Generally, all men will experience impotence immediately after surgery and recovery can take up to year a year. Nerve sparing prostatectomies can be performed to preserve potency but this has to be weighed against leaving prostate cancer behind. On average, 50% of men will be able to sustain erections after prostatectomy with nerve sparing techniques.
This is an established radiation technique to treat used to treat prostate cancer. There are two methods of prostate brachytherapy low dose rate (LDR) brachytherapy where permanent radioactive seeds are inserted into the prostate or high dose rate (HDR) brachytherapy where temporary radioactive seeds are introduced into the prostate over several days. Brachytherapy can used alone to treat low risk prostate cancer and frequently in combination with external beam radiation therapy to treat intermediate risk and high risk prostate cancer. Using combination treatment, radiation doses are escalated beyond traditional external beam radiation treatments and have recently been shown to improve PSA recurrence by 20%.
Brachytherapy treatment requires a prostate volume study session, typical to a prostate biopsy session. The seeds are then inserted after careful planning in a second procedure. A third procedure is performed a few weeks after to seeds have been placed to verify the location of the seeds and how much radiation dose was delivered.
LDR brachytherapy is frequently performed by radiation oncologists at Precision Radiation Oncology and around the country. HDR Brachytherapy requires more time commitment and greater planning but is an extremely effective treatment for prostate cancer. It also requires brief hospitalization. As such, few institutions around the country still offer this treatment option today. Precision Radiation Oncology has regional expertise in HDR prostate treatments and continues to offer this type of treatment to patients. More 600 brachytherapy treatments have been performed to date. Brachytherapy while effective is not an appropriate treatment for every situation. Your physician will be able to guide you through decision making as to your choice of treatment.
External Beam Radiation Therapy (EBRT)
EBRT is the most common type of radiation treatment around the country and the world for treating prostate cancer. The radiation is delivered from outside the body using a radiation machine. Treatments are delivered on a daily basis, Monday-Friday for 40-44 treatments for 8 weeks. Often times a technique called Intensity Modulated Radiation Therapy (IMRT) or Volumetric Arc Therapy (VMAT) is used to shape the radiation beam to the prostate. Modern centers will use daily image verification prior to each treatment to verify the position of the prostate. This is known as Image Guided Radiation Therapy or IGRT.
CyberKnife for Prostate Cancer
CyberKnife is a robotic radiation machine capable of tracking tumors and delivering pin point radiation to any part of the body. The CyberKnife has been used to treat prostate cancer for more than 10 years. Radiation oncologists realized that unique properties of prostate cancer cells (low alpha/beta ratio) meant that these cells would be very sensitive to high doses of radiation. However, the rectum and bladder are very close to the prostate and would be injured by these high doses of radiation. Moreover, the prostate moves due to rectal filling with gas or stool and bladder filling with urine meaning you could not reliable predict its location which could lead to radiation ending up in the wrong place-disaster!
With the CyberKnife’s pinpoint accuracy these issues are resolved. Small gold markers are placed in the prostate prior to treatment with the CyberKnife. These markers allow the robot to track the location of the prostate at all times while dose radiation is delivered with ultra-precise accuracy. Radiation can then be delivered in 5 treatments saving significant time and resources compared to 8 weeks of daily treatment with conventional IMRT or VMAT. In the last 10 years data has continued to emerge showing more rapid decline in PSA with CyberKnife compared to conventional radiation, similar to improved erectile function and excellent PSA control in Low and Intermediate Risk prostate cancer.
Radiation Oncologists at Precision Radiation Oncology were early adopters of CyberKnife technology and are the most experienced CyberKnife users in the Philadelphia area. With hundreds of patients treated our experience in an invaluable asset to your health and helping navigate treatment for prostate cancer.
What is the best treatment for Prostate Cancer?
This is a difficult question. The short answer is it depends. Every patient is unique in our view and some patients won’t need any treatment for prostate cancer at all. Your needs will depend on your specific situation. We believe in personalizing your treatment recommendations after a thorough review of your history and treatment goals.
How effective is CyberKnife for Prostate Cancer?
The efficacy outcomes of CyberKnife treatment for prostate cancer have been comparable to other treatment outcomes at five years. Certain outcomes, such as bladder incontinence, have been greatly improved with the CyberKnife treatment as compared to surgery and other invasive prostate treatments. Follow-up with the radiation oncologist and primary care or urologist will involve measurement of serum prostate specific antigen (PSA) levels, which is the best measure of disease control. PSA levels may change, but over time the patient can anticipate the levels to trend lower or decrease, indicating that the prostate cancer has been ablated by the high-dose radiation.