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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
Mechanism Of Radiobiological Damage
Evidence has been obtained that large radiation doses induce endothelial cell damage causing microvascular dysfunction enhancing the killing of tumour cells. The instigation of apoptosis for these cells triggers translocation of endothelial cell acid spingomylinase into the plasma membrane where it is hydrolyzed to sphingomyelin.10 This results in the generation of ceramide, which acts as a second messenger for apoptosis.
The radiobiological effectiveness of a plan is usually predicted by the Linear Quadratic model. The validity of this model to quantify the risk of late effects has been questioned as it has been derived from data acquired through in vitro cell survival assay of cancer cell lines. Therefore, this tool may overestimate the potential for cell kill, and may underestimate the in vivo risk of toxicity. Nonetheless, there is growing evidence that tumours with low alpha/beta value may actually achieve superior biological equivalent dose with hypofractionation and patients are maximally benefitted by this treatment. Carcinoma prostate and other slowly proliferating tumours such as chordomas, chondrosarcomas, meningiomas, acoustic neuroma, etc. all fall into this category. The converse is however also true regarding normal tissues which also have lower alpha/beta ratio and may manifest injury if they receive high dose per fraction.11,12
Patient Liable For Cyberknife Treatment For Prostate Cancer
Cyberknife is typically used for patients with
- Early-stage 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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Possible Risks And Side Effects Of Brachytherapy
Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.
There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.
These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.
Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.
How Is Cyberknife Treatment Different From Standard Prostate Cancer Surgery From Conventional Radiation Therapy
The CyberKnife evolved from brachytherapy, which also delivers very high doses of cancer-killing X-ray into prostate cancer. But brachytherapy is invasive and requires taking patients to the operating room and inserting many long needles deep into the pelvis, which will stay there for many hours on the day of treatment. The main difference: CyberKnife is completely non-invasive. The end result is similarly excellent outstanding prostate cancer cure rates and only four or five treatment sessions over a week, in comparison to conventional radiation for prostate cancer, running typically to 38-45 treatment sessions over the course of two months or more.
Compared to surgery, the most apparent difference for a patient is, again, CyberKnife is non-invasive and has no recovery time.
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Does Msk Offer Proton Therapy For Prostate Cancer
Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.
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.
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What Does Treatment Feel Like And How Long Does It Take
Treatment is painless. You will not feel anything as the radiation is delivered. You may hear and see the CyberKnife machine moving and setting up for the next position in treatment. Relaxing is the best thing you can do, while lying still. You can bring a CD of relaxing music to listen to during your treatment.
Time of treatment will vary, depending on the area being treated. Each stage or fraction, typically lasts one hour. You may need only one fraction, while others require up to 5 fractions for most effective treatment. Your doctor will tell you how long the treatment will take.
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!
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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.
What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer
Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.
There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective
Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.
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Indications For Cyberknife Treatment And Current Clinical Scenario
As of now the majority of Cyberknife treatment has been delivered to adult patients. Only 2 studies have reported its use in children between 5 months and 16 years.15 The majority of studies are also concentrated on palliative settings, although currently increasing interest is being focused on curative intent for early small volume disease, especially in benign conditions, AV malformations, trigeminal neuralgia, acoustic neuroma, meningiomas and pituitary adenomas.
What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
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Cyberknife Reduces Bladder Side Effects In Prostate Cancer Patients
New data from the Prostate Advances in Comparative Evidence trial indicate that Accurays CyberKnife robotic radiotherapy platform is superior to conventional linear accelerators in reducing the incidence of late grade two or higher bladder toxicity associated with prostate cancer stereotactic body radiation therapy treatments.
The two-year follow-up data presented at the European Society for Radiotherapy and Oncology annual congress showed that bladder side effects were experienced half as often with CyberKnife SBRT as with conventional linear accelerator delivered SBRT.
This data suggest that men treated with CyberKnife SBRT are less likely to experience long-term side effects that can impact them over the course of their lives compared with men receiving conventional linear accelerator delivered SBRT.
SBRT treatments involve the delivery of very high doses of externally administered radiation over a small number of sessions, unlike conventional radiation therapy that requires substantially more treatment sessions. In the PACE trial, SBRT was delivered in five sessions, while conventional radiation therapy was delivered in 20 or 39 sessions. SBRT treatments increase patient satisfaction by reducing discomfort and scheduling inconvenience versus conventional radiation treatments and can minimize patient out-of-pocket costs.
A Proven Radiosurgery Therapy Option
CyberKnife is a highly sophisticated type of stereotactic body radiation therapy . SBRT focuses radiation beams and tracks an exact area of the body while the patient rests comfortably on the treatment couch.
The CyberKnife Robotic Radiosurgery System is the most advanced system for the delivery of radiosurgery therapy. And thats the system we use exclusively.
Radiation therapy has been used for decades to treat prostate cancer with varying degrees of success. The goal of any radiation therapy for prostate cancer is to deliver the appropriate dose of radiation needed to kill the cancer cells, while not harming the surrounding healthy tissues and organs, which is what causes side effects.
The CyberKnife is one of the most recently developed tools for delivery of a high dose of radiation in a short time period, however high dose radiation for prostate cancer has been around for 30 years. The CyberKnife radiosurgery treatment has been recognized as a breakthrough system of cancer treatment since its inception in 1987. The first prototype, created by Dr. John R. Adler, a Stanford University Medical Center professor, was approved in 1999.
Ive personally treated more than 1,100 patients with the CyberKnife for prostate cancer and this is what I have seen:
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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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The Initial Causes Cyberknife Prostate Patient Reviews
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
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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.