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Prostate Cancer Treatment Options

Discover your options for treating Prostate Cancer

*Cyberknife and TrueBeam Prostate tumor treatments are covered by Medicare and most all insurances.

What Sets CyberKnife Apart? 

Prostate Cancer Charts & Graphs – Insurance, Clinical Outcomes, and Medicare

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CyberKnife Stereotactic Radiosurgery
For Prostate Cancer

At Spokane CyberKnife® Center we offer the most advanced radiation treatment technologies available – the Cyberknife M6 and Truebeam, for the treatment of Prostate Cancer. Our Cancer Experts encourage patients to explore all their options for the treatment for their Prostate Cancer. There is not one single treatment or surgery that is best for all prostate cancers. The appropriate treatment depends on the stage of the cancer, biopsy (Gleason score), PSA (Prostate Specific Antigen) at diagnosis, age of the patient, overall health of the patient, and patient preference.

 

 

Our Board-Certified Radiation Oncologists at Spokane Cyberknife Center provide the most advanced cancer treatment center for Prostate Cancer offering the latest and most advanced, alternatives to surgery via radiation technologies for treating prostate cancer

Prostate Cancer Treatment
At Spokane CyberKnife

1. How Does The CyberKnife System Treat Prostate Cancer open

Cyberknife Prostate Treatment Cyberknife is the only dedicated robotic radiosurgery device that shows outstanding results in the treatment of prostate cancer. It is a non-invasive form of radiation treatment that delivers hundreds of targeted beams directly into the target area. Cyberknife’s targeting accuracy is due to its ability to track and continually adjust to the position of the prostate throughout the treatment. Cyberknife's robotic mobility, combined with the continuously updating tracking feature, allows Cyberknife to wrap high doses of radiation around the prostate, sparing healthy tissue.

Cyberknife Prostate Treatment Advantages

2. How Does TrueBeam Treat Prostate Cancer? open

Spokane Cyberknife is pleased to announce the arrival of the new TrueBeam™ system to Spokane. TrueBeam™ is an advanced radiotherapy technology for treating cancers throughout the body, including prostate cancer. Spokane Cyberknife is the only center in the United States with not one, but the two most advanced Radiation Treatment Technologies in one center – Cyberknife M6 and Truebeam. Your Cancer Experts at Spokane Cyberknife work with your unique condition to personalize the most effective treatment plan, that at times involves multiple technologies and methodologies, and only Spokane Cyberknife can offer this with the Cyberknife M6 and Truebeam from one center.

TrueBeam can be used for many forms of advanced radiation treatment techniques including:

Because of this, patients can receive the treatment that is best suited for their specific clinical circumstances. Opening up treatment options for patients with cancers of the spine, it targets tumors with accuracy measured in millimeters. With its power and flexibility, our cancer experts can develop treatments that are best suited for patients’ individual circumstances. 

Advanced Features of the leading edge Radiation Therapy Truebeam system:

3. What is Radiosurgery? open

What is Radiosurgery?

Radiosurgery = Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT)

Many cancers cannot be completely eradicated with traditional radiation therapy (RT) techniques. The goal of radiation treatment has always been to maximize the delivery of radiation to tumors while minimizing the amount of radiation to normal tissue. The higher the radiation dose delivered to a tumor, the greater the chance of tumor destruction. Likewise, the lower the radiation dose delivered to surrounding normal tissue, the less destruction. Historically, the available technology, found at other centers, was unable to accurately deliver high dose radiation to a tumor without also affecting the surrounding tissue. To minimize collateral damage to the surrounding tissues, radiation oncologists traditionally deliver radiation over many sessions, giving low doses each day over usually several weeks, (25 to 45 days). Following each fraction of radiation the normal tissue cells can recover better than many cancerous cells. Over many sessions, the hope is that more tumor cells die than normal tissue cells. Unfortunately, this strategy is often unsuccessful.

With the development of SRS & SBRT, physicians are now able to deliver lethal (surgical) doses of radiation to a tumor with sub-millimeter (surgical) accuracy, in 1 to 5 treatments. This methodology maximizes the amount of radiation going directly to the target tissue (and thus maximizing tumor response rate) while minimizing the radiation exposure to surrounding tissue. This is evidenced in the studies that compare the clinical treatment volume (CTV) to the planning treatment volume (PTV). With SRS & SBRT, unlike RT, the CTV and PTV are more closely aligned, which means that SRS & SBRT is able to precisely deliver lethal doses of radiation to the target tissue. By minimizing the impact on healthy tissue, SRS & SBRT shortens patient recovery time and decreases complication rates.

As technology has continued to evolve advancements have enabled physicians to apply SRS & SBRT to lesions in the body, as well as to lesions in the cranium, head, and neck. Procedures were originally performed on cranial tumors because the technology at the time required a frame, which can easily be screwed into the skull, as with the Gamma Knife. Attempts to develop body frames were cumbersome and unsuccessful. As a result, initially, no technological solution was available to accurately deliver lethal doses of radiation to tumors below the head without also destroying normal tissue.

Then came CyberKnife, the first and only dedicated robotic, SRS & SBRT treatment technology. And for the first time we now have a technology that allows for real time tracking of a tumor regardless of where it is in the body. Physicians are now able to achieve sub-millimeter (.3MM) accuracy in the head, without the frame, by using the anatomical markings of the skull and taking advantage of the stable relationship between the skull and an intracranial tumor. In the same manner, we are now able to use the anatomical markings of the spine to treat spinal lesions. For other tumors in soft tissue throughout the body, we are able to track, in real time, small gold fiducials placed in the tumor to accurately deliver radiosurgical doses.

Over the last 17 years, SRS & SBRT has case study data proving the clinical effectiveness in treating intra-cranial, extra-cranial neck, and body tumors. In many cases SRS & SBRT provides a clinically superior alternative to either surgery or traditional RT for head and body lesions. In some cases, SRS & SBRT is the only effective option. The SRS & SBRT approach allows for dose escalation, hypo-fractionation, and

heterogeneity of dosage within the tumor volume, and improved conformality and accuracy. As a result, SRS & SBRT delivers unique benefits to the patient, including improved tumor response, higher cure rates, improved pain control, success against tumors that had been radio-resistant or had exceeded tolerance levels, reduction in organ damage, and improved tolerance. These unique benefits apply to tumors regardless of their location in the head/neck or body.

Prostate Cancers and Tumor Information

1. Prostate Symptoms open

Prostate cancer may not have any symptoms, but the common symptoms include:

If you have any of these symptoms, see your physician so that problems can be diagnosed and treated. Most often, these symptoms are not due to cancer but are caused by BPH, an infection, or another health problem.

2. How is Prostate Cancer Detected? open

Prostate cancer is usually detected with a combination of a PSA test, in which the levels of a protein in the blood are assessed, and digital rectal exam (DRE), where the doctor feels for any enlarged, irregular, or firm areas on the prostate. The PSA test and DRE can detect a problem in the prostate, but they cannot detect if the problem is cancer or a less serious condition. If your results are abnormal, your physician can suggest additional tests to make a diagnosis. These tests may include other lab tests, such as a urine test to detect blood or an infection. Other test procedures may include:

If cancer cells are found, the testing pathologist reports the grade of the tumor. This grade indicates the difference between the tumor tissue and normal prostate tissue. Tumors with higher grades tend to grow faster than those with lower scores, and they are also more likely to spread. This “Gleason score”, along with your age and other factors, is used to suggest appropriate treatment options. Gleason scores range from 2 to 10. 

 

3. How Is Prostate Cancer Treated? open

Men with prostate cancer have many treatment options. For patients with early stage prostate cancer, cancer that is localized within the prostate itself, your doctor can describe your treatment choices and the expected results of each along with possible side effects. You and your doctor should work together to explore these options and develop a treatment plan that meets your medical and personal needs.

Surgical Options: 

Minimally Invasive Options: 

Side effects of minimally invasive options include: 

 

4. Prostate Cancer Treatment Options open

Radiosurgery – also called Stereotactic Body Radiotherapy (SBRT) – Radiosurgery is a non-invasive radiation treatment option for the ablation of prostate cancer tissue. The Cyberknife robotic Radiosurgery system is the only dedicated system available. Cyberknife combines the unique robotic design – approaching a tumor from any angle, with real-time image guidance and intelligent tumor tracking – throughout treatment. This unique combination of software and technology offers the advantages of:

Surgical Options

Radical Retropubic Approach: An incision is made in the lower abdomen and the entire prostate and surrounding tissue are removed. Side effects include:

Minimally Invasive Surgical Options:

Laparoscopic Prostatectomy: A thin, lighted tube (a laparoscope) removes the prostate through several small cuts in the abdomen rather than through a single long cut.

Robotic Laparoscopic Prostatectomy: Robotic laparoscopic surgery is similar to regular laparoscopic surgery, but involves a laparoscope and a robot to remove the prostate. A surgeon guides robotic arms to the prostate by a handle below a computer screen.

Side effects of minimally invasive surgical options include: 



Radiation therapy (radiotherapy) Options

Radiation Therapy uses high-energy rays to kill cancer cells in a specific treatment area. It is a non-invasive option for men with any stage of prostate cancer and is frequently used instead of surgery. It can also be used as a combined approach or follow up to treat prostate cancer following a surgery.

Non-Invasive Radiation Treatment Options:

External Beam Radiation - Radiation is delivered from a large gantry designed machine, called a linear accelerator or ‘linac’ that targets the cancer. Before treatment, CT and MRI images are taken to determine the exact location of the prostate and surrounding structures. A treatment plan is developed to deliver precise radiation to the affected area and the some of the tissues that surround it. Since the position of the prostate varies significantly because of gas in the rectum and fluid in the bladder, it is necessary to treat some of the nearby healthy tissue. Treatments are usually on an outpatient basis, delivered five days a week for seven to 10 weeks. Side effects:

3-D Conformal - Tumors are not regular — they come in different shapes and sizes. Three-dimensional conformal radiation therapy, or 3D-CRT, uses computers and special imaging techniques to show the size, shape and location of the tumor. Computer assisted tomography (CT or CAT scans), magnetic resonance imaging (MR or MRI scans) and/or positron emission tomography (PET scans) are used to create detailed, three-dimensional representations of the tumor and surrounding organs. A Radiation Oncologist can then precisely tailor the radiation beams to the size and shape of your tumor with multi-leaf collimators or custom fabricated field shaping blocks. Because the radiation beams are very precisely directed, nearby normal tissue receives less radiation and is able to heal quickly.

IMRT - Intensity modulated radiation therapy, or IMRT, is a specialized form of 3D-CRT that allows radiation to be more exactly shaped to fit the tumor. With IMRT, the radiation beam can be broken up into many “beam-lets,” and the intensity of each beam-let can be adjusted individually. Using IMRT, it may be possible to further limit the amount of radiation that is received by healthy tissue near the tumor. In some situations, this may also allow a higher dose of radiation to be delivered to the tumor, potentially increasing the chance of a cure.

IGRT – Image Guided Radiation Therapy, is used to treat tumors in areas of the body that are prone to movement, such as the prostate gland, as well tumors located close to critical organs and tissues. IGRT involves conformal radiation treatment guided by imaging, such as CT, ultrasound or X-rays, taken in the treatment room just before the patient is given the radiation treatment. All patients first undergo a CT scan as part of the planning process. The imaging information from the CT scan is then transmitted to a computer in the treatment room to allow doctors to compare the earlier image with the images taken just before treatment. During IGRT, doctors compare these images to see if the treatment needs to be adjusted. This allows doctors to better target the cancer while avoiding nearby healthy tissue. In some cases, doctors will implant a tiny marker in or near the tumor to pinpoint it for IGRT.

 

Minimally-Invasive Radiation Treatment Options:

LDR Brachytherapy - In low dose rate (LDR) brachytherapy, 40 to 100 radioactive seeds are placed into the prostate through a needle. This procedure is done using spinal or general anesthesia to relieve the pain and may require overnight hospitalization. When needles are removed, the seeds are left inside the prostate to give off radiation for several weeks or months. The seeds don’t have to be removed once the radiation is gone. LDR brachytherapy results in a high rate of long-term survival, ranging from 85-94% in published reports.

HDR Brachytherapy - High Dose Rate (HDR) brachytherapy involves high doses of radiation over a short period of time. During the procedure, 12 to 20 hollow needles containing catheters are inserted through the skin into the prostate. Once the catheters are in place, a CT scan and/or and MRI are taken to confirm the exact location of the catheters, prostate and surrounding tissues. A treatment plan is developed, a radiation source is placed into the prostate through the catheters. The radiation source remains in place in the prostate for five to fifteen minutes. When the amount of time determined by the physician has passed, the radiation source is removed. Frequently, the treatment happens over several days and the catheters are removed after the last treatment is complete. Studies have shown that HDR brachytherapy results in excellent control rates (89-98% in 3-6 years after treatment).

 

Patient Testimonial
Prostate Cancer Treatment – Cyberknife Patient

 

 

 

Learn More About What Spokane CyberKnife Can Do For Prostate Cancer

Spokane CyberKnife M6 - Exclusive Robotic Feature

Prostate Cancer Radiation Treatment Options Comparison

Warren's Cancer Chronicle- The Story of a CyberKnife Patient:

Prostate - Clinical and Cost Comparison - Radiation Therapy 

CyberKnife Comparisons

1. CyberKnife vs. Surgery open

CyberKnife vs. Surgery

This is in contrast to laparoscopic surgery or a traditional prostatectomy that involves incisions and associated risks. Surgical procedures usually involve general anesthesia which may last up to several hours. As with any surgical procedure, potential risks include bleeding and infection and, depending on a patient’s overall health condition, other complications including incontinence and/or erectile dysfunction. In addition, surgery requires mandatory hospitalization and catheterization. Cyberknife Robotic Radiosurgery is completed in an outpatient setting – Cyberknife is non-invasive and pain free – Cyberknife clinical benefits outweigh surgery.

2. CyberKnife vs. HDR and LDR open

Cyberknife vs. HDR and LDR

Compared to High-Dose-Rate brachytherapy (HDR), CyberKnife prostate cancer treatment delivers the same dose of killing radiation to the prostate, but does so without the insertion of multiple catheters. HDR typically involves a hospital stay, over a 24 hour period, and places 15-20 catheters into the prostate, through the perineum. Through these catheters a machine pushes a single highly radioactive iridium seed into the catheters one by one.

Low-Dose-Rate, or LDR brachytherapy (also known as seed brachytherapy) is also an invasive procedure in which dozens of radioactive seeds are permanently implanted in the prostate with needles inserted through the perineum to deliver radiation over many weeks.

3. CyberKnife vs. Conventional Radiation open

Cyberknife vs. Conventional Radiation

4. CyberKnife vs. Da Vinci Robotic Surgical Prostatectomy open
 

CyberKnife vs. Da Vinci Robotic Surgical Prostatectomy

CyberKnife Case Studies

Cyberknife Long-Term Outcomes Prostate Cancer Treatment
Stanford University Medical Center – Case Study

Combining SBRT with IMRT for Prostate Cancer Treatment
University of California San Francisco – Case Study