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Cyberknife Prostate Cancer Erectile Dysfunction

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How Effective Is The Cyberknife System In Treating Prostate Cancer

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Since 2002, peer-reviewed journals have published over twenty articles about studies involving the CyberKnife Radiosurgery System and its treatment of prostate cancer.

The largest study took place in 2013 and involved 1,100 patients throughout eight medical centers. This study showed that 93% of patients who were treated by the CyberKnife System did not have a prostate cancer relapse in the five years following their treatment.

Another study that also took place in 2013, looking at 304 patients who had undergone CyberKnife Treatment for prostate cancer, showed similar results at the six year mark.

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.

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What Are The Side Effects Of Cyberknife Treatment

At Orange County CyberKnife, were proud to be one of the premier providers of radiation therapy treatments in the Orange County area. Our flagship treatment is CyberKnife: a revolutionary cancer treatment system that uses high-dose radiation to eliminate cancer cells and tumors. In many patients, CyberKnife produces almost no side effects but as with any radiation therapy treatment, side effects are possible. If youre curious to learn the side effects of CyberKnife, we can help.

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Is There A Knife Or Any Cutting Involved In The Treatment

CyberKnife does not use a knife! It is called that because it is a computer robot-guided treatment that is an alternative to surgery. It was originally used as an alternative to brain surgery, but is now used as an alternative to surgery for tumors in many parts of the body including brain, lung, liver, spine, and prostate.

The only invasive part of the treatment is when the gold marker seeds and SpaceOAR gel are placed. This is done a single time under anesthesia and takes 20 minutes. We use needles to inject the marker seeds and to inject the gel. There is no cutting.

Who Is Suitable For Treatment With The Cyberknife

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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.

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How Do You Know The Cancer Is Cured

There is no test to prove the cancer is cured. We monitor the PSA blood test every 3 6 months, and it will usually drop over several years, often getting as low as 0.1 0.2 by five years after treatment. As long as the PSA drops like it is supposed to then the cancer is considered to be in control, and the longer it is in control the higher the chance it is cured.

Ask Your Doctor About Solutions

Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.

While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.

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Do I Need To Come Back For Followup Visits And Psa Blood Tests

We usually do the first followup visit 3 months after the treatment. The PSA is typically down to 1 2 at that visit, but will eventually drop to 0.1 0.2 by the five year mark. After the first visit, PSAs can be checked every 6 months, provided the PSA is dropping like expected. If the PSA is not responding well or is rising then we may recommend you get the PSA checked every 3 months.

You can get your PSAs and followups done with your local family doctor or urologist if you wish to. You can also email me your PSA value anytime.

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CyberKnife is a type of external radiotherapy called stereotactic body radiation therapy that directs radiation in very high doses to the exact location of your tumor. Its flexible robotic arm can focus hundreds of laser-like beams of radiotherapy that can be adjusted in diameter and moved at almost any angle for the highest degree of precision. The ability to target only the prostate and not harm the surrounding nerve bundles and organs, such as the rectum and the bladder, is extremely important in maintaining the proper functioning of these vital organs and preventing erectile dysfunction.

One of the primary challenges of treating prostate tumors with radiation is that the prostate gland moves unpredictably throughout the course of treatment. The CyberKnife System continually tracks and automatically corrects for the movement of the prostate and the tumor in real time. This unique capability ensures that radiotherapy continually hits only the intended target without interruption. Four to five tiny slivers of gold are inserted into your prostate to determine the exact location throughout treatments. These help guide the CyberKnife system as your tumor moves.

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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.

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Can Radiation Be Repeated If It Does Not Work

No. It is a one time treatment. We can radiate tumors in other areas of the body but we cannot radiate the prostate gland a second time after CyberKnife. The reason is because radiation creates some long-term scarring in the prostate area, and additional radiation would worsen the scarring creating a risk of serious rectal damage or urine leakage.

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External Beam Radiation Therapy

In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.

You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment takes longer.

Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.

How Does Cyberknife Treat Prostate Cancer


The CyberKnife System is a non-surgical treatment that delivers high doses of radiation directly to the prostate tumor while avoiding surrounding areas using Stereotactic Body Radiation Therapy or SBRT. In fact, the CyberKnife system is so precise that it can automatically track natural organ movement of the prostate and adjust the treatment accordingly, which allows us to significantly reduce the side effects that accompany radiation therapy.

Our nationally-recognized and board-certified physicians deliver individualized treatment with the CyberKnife System. Radiation sessions typically last between 20 and 45 minutes, with most patients requiring four or five treatment sessions.

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What To Expect With Prostate Cancer Radiation Therapy

With each of these treatments, there are often side effects that can include short-term complications including urinary and bowel problems. However, depending on the treatment, side effects can be minimized.

The Risk of Long-Term Complications with Radiation Therapy is Low Less Than 5% According to the Prostate Cancer Foundation.

The risk of cancer recurring after receiving radiation treatment for prostate cancer is less than 1%.

With more precise treatments, side effects are lower than ever, but you must make sure the treatment center you choose has highly-skilled radiation oncologists, physicists, and radiation therapists like those at the CyberKnife Center of Miami.

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Prostate Cancer Definition Symptoms And Complications

What is prostate cancer?

The prostate is a small gland in the male reproductive system that produces seminal fluid. The prostate is located just below the bladder and in front of the rectum.

Cancer beginning in the prostate occurs when abnormal cells begin to grow out of control in the prostate tissue, often first detected as an unusual lump in the tissue. The tumors beginning in these organs can spread to lymph nodes, tissues and other organs in the lower abdomen as the cancer progresses.

After skin cancer, prostate cancer is the most common cancer among people assigned male at birth and one of the leading causes of cancer death among men in the United States. This is largely because many prostate cancers are detected late, when treatment is most difficult. With early detection, prostate cancer is very curable.

The risk of developing prostate cancer increases with age. Regular screenings are vitally important. Screening also increases the likelihood of catching prostate cancer in its earlier stages, when it is easier to treat.

What are the symptoms of prostate cancer?

  • Frequent urination
  • Trouble starting the flow of urine
  • Trouble emptying the bladder completely
  • Pain or burning while urinating
  • Pain in the back, hips, or pelvis that doesnt go away

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Stereotactic Body Radiation Therapy Delivered By Cyberknife Has Distinct Advantages Over Other Treatments

Having performed more than 1,500 CyberKnife prostate cancer treatments, if I didnt know better I would think that this technology was created specifically to treat this disease. It is completely suited to the specific challenges of prostate cancer treatment. Yet CyberKnife was first used mostly as a treatment for head, neck and spine tumors that were very difficult to reach.

The Food and Drug Administration opened the door in 2001 to the use of CyberKnife to treat other cancers in the body. Since then urologists and oncologists are turning more and more to CyberKnife, as are patients.

CyberKnifes primary advantages relate to reduced damage to healthy tissue surrounding the cancerous prostate tissues. This is largely due to CyberKnifes ability to precisely target a tumor in the prostate without radiating healthy tissue. Damaging healthy tissue is the leading cause of side effects from radiation treatment.

Q: What Are The Specific Steps Of The Cyberknife Treatment

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  • The doctors will require a PSA level test that will provide a basis for interpreting the results of the treatment.
  • Next up, the doctor will insert fiducial markers into the prostate, through an ultrasound guided needle. This will help the CyberKnife® System with locating the exact position of the prostate along the treatment.
  • The patient will undergo a CT scan that will detect the exact size, location and shape of the prostate and, if necessary, a MRI scan to fully visualize the prostate and its environment. During the scanning and the treatment, the patient will lay on a custom moulded cradle that will enable him to maintain the same position during the entire time.
  • Upon consulting the CT scan and MRI results, the medical physicist and the patients doctors will devise a treatment plan with optimal radiation delivery.
  • The treatment will entail that the patient stays still on their custom body cradle. The CyberKnife systems Computer-controlled robot will trace the position of the prostate and move around the patients body to administer precise radiation.
  • After the session is complete, the patient can go about their day in a normal way and return for additional treatment as indicated by their doctor.
  • Upon completion of the treatment, the patient will be scheduled for follow-up appointments and have PSA level tests and digital rectal exams as indicated by the doctor.
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    When Can I Start The Treatment And How Long Does It Take

    We first must wait for approval from your medical insurance company before we can start the process. The entire process can then be done in as little 16 days, and here is an example schedule:

    Thu Day 1: Pre-op visitsFri Day 2: Placement of gold marker seeds and SpaceOARMon Day 5: Mapping with CT-Simulation and MRI prostateThu Day 8: First CyberknifeFri Day 9: Second CyberknifeMon Day 12: Third CyberknifeWed Day 14: Fourth CyberKnifeFri Day 16: Fifth CyberKnife. Can go home immediately after.

    Note that Cyberknife treatments are done approximately every second day. We treat only on weekdays. Each treatment takes about 1 hour in length. There is a minimum 3 day gap after gold marker seeds are placed before we do the mapping, to allow the seeds to settle. There is a time gap after we do the mapping to give us time to create the computer treatment plan.

    What Is The Best Treatment For Me

    Prostate cancer is unique because there are a dozen different ways to treat it. Everyone wants a treatment which will cure the cancer, but is not overkill and will not result in unnecessary side effects such as urine leakage or erectile dysfunction As a result, it can be gut wrenching to decide on the best treatment. Specialists tend to promote the treatment which they themselves perform. There can also be a difference in results depending on the expertise of the physician. There is very little research which compares one treatment to another. Oftentimes all we can say these two treatments are in the same ballpark for cure rates. It is possible that CyberKnife has a higher cure rate than surgery. Or perhaps surgery has a higher cure rate. The 10 years results for CyberKnife are fantastic and I would happily put them up against surgery or other forms of radiation.

    It often boils down to personal choice. What makes the most sense to you? Patients often ask me which treatment I would choose but the right choice for me may not be the right one for you!

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    Why Use Cyberknife For Prostate Cancer

    Cyberknife is a good option for prostate cancer because:

    • Treatment is convenient and complete in fewer fractions 5 compared to 44 fractions in traditional radiation.
    • It spares more normal tissue.
    • It is more accurate than traditional radiation.
    • There are fewer side effects.
    • Treatment is performed as an outpatient procedure.

    In addition, prostate cancer is a slower-growing tumor. Because prostate cancer cells are growing slowly, they may be more sensitive to higher doses of radiation per fraction than other cancers. This means that delivering radiation in larger doses in fewer treatment sessions may improve outcomes.

    How Do You Prepare For Cyberknife

    Dr. Gautam Dethe

    Youll need to go through a few steps before treatment can begin.

    With ultrasound as a guide, a urologist will use long needles to place gold markers in your prostate. This will be similar to when you had your biopsy. CyberKnife will use the markers to track the tumor during treatment.

    Then youll need some imaging tests to assess the location, size, and shape of the tumor. This data is sent to the CyberKnife software, so the proper dose, exact location, and number of treatments can be determined.

    Your doctor will fill you in on details before you begin so you can plan accordingly.

    Youll likely need one to five treatments on consecutive days. This can all be accomplished on an outpatient basis.

    Theres no need for anesthesia or other medications, so you can eat and take medications as usual. Avoid lotions and powders on the area to be treated, and wear comfortable clothing. No further preparation is needed.

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