When a man is diagnosed with carcinoma of the prostate, his first reaction is one of fear. Primarily, his fear is that therapy will drastically alter his life by diminishing his urinary and sexual function. As a patient seeks treatment alternatives, he is faced with a myriad of choices, from various kinds of surgery to various kinds of radiation, and even things such as cryotherapy or Hifu. Standard radiation therapy involves 45 treatments, giving very small localized doses to the prostate with something called “intensity modulated radiation” or IMRT. Patients also have a choice of getting seed implantation.
Recently, a new form of radiation therapy has shown extremely promising results with up to five years of follow-up. This treatment is administered by the CyberKnife, which is a robotic arm with a linear accelerator, emitting x-rays at the end of it. The arm treats the patients from hundreds of angles and can give pinpoint accuracy and minimized dose to the surrounding tissues, such as bladder and rectum. Small gold seeds are placed within the prostate prior to the procedure and these are tracked during the treatment for sub millimeter accuracy. The advantage of this treatment is that it involves only five visits of approximately thirty minutes each. The treatment is completely painless and causes no significant side effects except for some acute, mild bowel and bladder irregularity. It has long been known that prostate cancer responds well to a short course of very high dose per fraction and CyberKnife allows us to take advantage of this unique radio biology.
There is now up to five years of data available from Stanford University showing a 97.5 percent control rate with a low level of late toxicity. I have personally treated the largest series of over 600 patients and have also followed my patients out approximately three to four years. The patients have had an extremely low level of recurrence and also a very low level of urinary and rectal side effects over that three to four year follow-up. Most importantly, there is good news for men who are very concerned about their potency.
While standard radiation leaves 50 per cent of men impotent, my results have reduced the impotence rate to 15 to 20 percent. Treatment is preceded by the placement of fiducial gold seeds, followed by CT scan and MRI, and then only five days of treatment. This treatment is readily available now at Flushing Radiation Oncology Center located at 40-20 Main St., 4th floor. Telephone: 1 (888) 880-6646 or on the web at flushingros.com.
Dr. Alan Katz is a board certified radiation oncologist and former director of Winthrop CyberKnife Center.