When I sit down each and every week with prospective CyberKnife prostate cancer patients, I have to gently and professionally dispel a number of myths that they heard from other healthcare providers. I feel like that old Englishman Samuel Johnson who once said “Sir-I can give you the argument-but the understanding can come only from you.” So here we go.
1. CyberKnife treatment is done in 5 visits over 1 week, not 40 to 45 over 8-9 weeks. But do you know why this is better?
CyberKnife takes advantage of something called the alpha/beta ratio of prostate cancer, a basic biologic fact. The discovery that prostate cancer has a very low alpha/beta ratio has been the major, ground breaking finding of the past decade in the radiobiology of prostate cancer. Dr. Jack Fowler, the esteemed emeritus Professor of Radiobiology at the University of Wisconsin, did a statistical review of over 25,000 prostate cancer patients. Dr. Fowler and co-workers found that patients with low, intermediate, and even high-risk prostate cancer all had prostate cancers with low alpha/beta ratios. What does this means for you as a prostate cancer patient? It means that fewer, larger doses of radiation are better. Simply put, because of the low alpha/beta ratio of prostate cancer, CyberKnife can deliver better cure rates with fewer side effects. CyberKnife treatment has been an outstanding example of bringing research directly to patients with great results.
2. “If I have radiation therapy, I was told that I can’t have surgery.”
That statement may have been true a decade ago, but it’s not true now. I personally attended our professional society annual meeting (ASTRO) in September 2014 in San Francisco. At the session titled “Challenging Cases in the Management of Newly Diagnosed and Recurrent Prostate Cancer,” Dr. Peter Carroll, Professor and Chairman of the Department of Urology at the University of California San Francisco, stated that prostate surgery after radiation can now be performed safely with robotic techniques. Dr. Carroll has performed over 4,500 robotic surgeries and is a world expert. Dr. Carroll offered to the audience that any patient and their physician can call him to discuss their situation. Call me directly for more information.
- “If CyberKnife is so good, why don’t all hospitals have it?”
I believe that economics may play a big role in equipment selection by hospital administrators. Firstly, CyberKnife is much more costly than ordinary linear accelerator devices. In fact, it’s a $5 million investment. Secondly, CyberKnife is the only machine solely dedicated to stereotactic ablative body radiotherapy, SABR for short. Thirdly, CyberKnife radiosurgery costs 25-30% less than ordinary IMRT over 8-9 weeks for prostate cancer. So when a hospital administrator looks at CyberKnife, they see a device that costs more, treats fewer patients, and gets paid less than an ordinary linear accelerators. Hospital administrators base their decisions, in large part, on ROI (return on investment). At First Dayton Cancer Care, I carefully researched all of the available options and picked CyberKnife as the best. As a practicing radiation medicine specialist with 30 years of experience, I made the decision based on what I call RFP (Return for the Patient).
- “My other doctors told me CyberKnife is new, and follow-up results are short. It’s still experimental.”
There are now a number of publications from Dr. Katz in New York, with 7-year follow-up that showed superior PSA control rates with fewer complications. Importantly, the side effects with CyberKnife are less severe and of less duration than with IMRT. Thousands upon thousands of prostate cancer patients have been followed on national registries with the same results. Each of our own prostate cancer patients at First Dayton CyberKnife is enrolled in a national CyberKnife Registry so that we can monitor our results and compare with those at other centers of excellence. My team has performed over 1,500 CyberKnife treatments. Every week and I hear from patients who were told by urologists and other radiation oncologists that CyberKnife is new and experimental. Yet these same physicians rapidly embraced IMRT with only 5-year results. Enough said.
- “Why is First Dayton CyberKnife better than the hospital? “
It’s not just the technology. It’s all about the people-the expert team that I assembled at First Dayton CyberKnife. That expert team has enabled me to move CyberKnife from a high-tech medical device to a finally orchestrated, precision instrument. And patients get the time they need for personalized care. Recently, the medical physics team used the enormous computer capability and the exquisite precision of CyberKnife to develop a radiosurgical treatment plan that mimics our technique with temporary prostate implants. With this “HDR implant plan” I can deliver a radiation dose to the whole prostate but at the same time deliver extra dose to the sites of prostate cancer shown by biopsy. All the while, I can spare the normal tissues of rectum, bladder, and urethra. Dr. Donald Fuller of San Diego reported on similar methodology at the ASTRO meeting in 2014.
Additionally, I have 3 different radiation treatment suites with 3 different devices for patients with prostate cancer: the CyberKnife suite; the IMRT suite, and the temporary implant brachytherapy suite. At First Dayton Cancer Care, I have the luxury of tailoring the best treatment for each individual patient. Not every treatment is right for every person. I help my patients chose what is right for them. And that’s the First Dayton difference.