prostate cancer treatment | Anova Cancer Care Denver | man on computerStereotactic body radiation therapy (SBRT) delivered by CyberKnife has distinct advantages over other treatments

Having performed more than 1,500 CyberKnife prostate cancer treatments, if I didn’t 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 (FDA) 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.

CyberKnife’s primary advantages relate to reduced damage to healthy tissue surrounding the cancerous prostate tissues. This is largely due to CyberKnife’s 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.

SBRT limits the field of radiation

CyberKnife is a form of stereotactic body radiation therapy (SBRT), which is a coordinated system to exactly locate the tumor and limit the field of radiation treatment. SBRT delivers a single high dose of radiation or a few fractionized radiation treatments.

There are various types of SBRT, and I believe CyberKnife is the best. CyberKnife utilizes a robotic arm to deliver radiation in different ways and at different angles.

Ever try to slice a grape? It almost seems to squiggle away from the blade, and can result in a poor cut or even a smashed grape. But if you hold that grape against the cutting board between two fingers so it doesn’t move, you can slice it precisely the way you want.

The tumor under prostate cancer treatment acts much like the grape: It squiggles away. That’s because the prostate moves unpredictably, caused by air passing through the rectum and by the filling and emptying movements of the bladder, not to mention the patient sneezing – or just breathing.

The CyberKnife Robotic Surgery System blends robotics, computer-processing power, advanced imaging and the surgeon’s skill to make instantaneous corrections in radiation delivery. This is possible despite any movement of the patient or the prostate cancer tumor being targeted.

We accomplish this by injecting 3-5 tiny, gold reference-point markers into the prostate to guide the radiation beams. The patient lies comfortably in a custom made body cradle that molds to his body and ensures the same positioning during each treatment. The robotic arm swivels around the patient and delivers radiation at the precisely targeted tumor from various angles.

The big 3 benefits of this prostate cancer treatment

Most often we use CyberKnife by itself in prostate cancer treatment to treat early stage cancer that only affects the prostate and not surrounding areas. We also use CyberKnife in conjunction with other treatments such as traditional radiation when the cancer has spread beyond the prostate.

Prostate cancer patients treated with CyberKnife realize three benefits. These three benefits, in order of importance, follow.

It works

Clinical experiences published about CyberKnife prostate cancer treatment show a 93 percent recurrence-free rate five years after treatment; 94 percent recurrence-free rate at four years after treatment; and up to 100 percent recurrence-free rate after 44 months. Results also show lowered prostate-specific antigen (PSA) levels, which are recoded before treatment and tracked afterward and are good indications of longer-term recurrence-free rates.

Fewer side effects

Less toxicity following prostate cancer treatment or any cancer treatment means fewer side effects. The primary side effects from radiation treatment for prostate cancer are erectile dysfunction due to genitourinary toxicity and damage to the bowels and urinary function from gastrointestinal toxicity. These are graded from 0-4, with 0 being no toxicity and 4 being extreme toxicity.

The clinical studies on CyberKnife show that toxicity from the treatment is low, with grade 2-3 levels at 20-60 months following CyberKnife ranging from 2-10 percent for urinary toxicity and less for bowel toxicity (0-5 percent). Erectile dysfunction ranged from 60 percent to 13 percent, depending on the stage of the cancer and whether the prostate gland was precisely located.

Fewer treatments in less time

Compared with standard radiation treatment, CyberKnife delivers 4 times the usual dose of radiation per day, but with half the overall radiation dose over the full course of treatment. That’s because CyberKnife allows the higher dose to be more accurately delivered to “hug the prostate tumor” and spare the surrounding healthy tissue.

That means each CyberKnife treatment only takes about 45 minutes per day for about five days. Normal radiation treatment takes longer per session and sessions go on from 6-8 weeks. For younger men 50-60, who are likely to be working still, this is a valuable convenience.

I urge all men with prostate cancer to consider CyberKnife for treatment. It’s not for every man with prostate cancer that needs to be treated, but it’s a great option for a lot of them.

Is CyberKnife right for your cancer?

stereotactic Radiosurgery | Anova Cancer Care | CO

The most accurate way to deliver radiation, upgrading a century-old treatment.

Just about everyone knows that radiation is a standard form of treatment for cancer. It’s been used since 1896 in the form of x-rays. As you would imagine, in the last 120 years it’s been substantially improved and is now provided in different forms, with x-rays still one of them.

The objective in all forms of radiation therapy is to alter the DNA of the cancer cells so they do not reproduce and lose fluids. That causes the tumor to shrink at the rate of the cancer cells’ growth.

The different forms of radiation and delivery are all aimed at accomplishing the same objective. But that’s approached differently according to the cancer type, stage and other variables.

One radiation treatment option is stereotactic radiosurgery (SRS). Anova Cancer Care uses the CyberKnife robotic surgical system to perform SRS. Even though it has “surgery” in its name, stereotactic radiosurgery is not surgery at all. It got that name because the effects in the targeted zone are so dramatic they are referred to as “surgical.” CyberKnife and all methods of SRS discussed below apply radiation.

Some basics on radiation therapy

Cancer treatments utilize ionizing radiation that creates ions in cells it passes through. The ions, electrically charged particles, can kill cancer cells and stop their growth. The two types of ionizing radiation are photon (uses x-rays or gamma rays) and particle (uses electrons, neutrons, protons, alpha particles and others).

High-energy photon beam, the same as used in an x-ray machine, is the most commonly used in radiation therapy for cancer. Photon beams affect all cells they pass through before exiting the body.

Proton beam is a type of particle radiation. Proton beam releases its energy only after travelling to its target, causing little damage to the tissues the beams pass through.

Both photon beams and proton beams can be produced by a linear accelerator. CyberKnife is a specialized type of linear accelerator and is one way to perform stereotactic radiosurgery (SRS). It also produces electron and particle beams used to treat skin cancers and tumors close to the skin.

The three forms of SRS are linear accelerator (CyberKnife), proton beam and Cobalt-60 based using photons. Each type uses different technology, instruments and sources of radiation. And each are appropriate for delivering high-energy radiation to treat certain cancers.

All forms of SRS differ from traditional radiation therapy, which delivers radiation to a wide tissue field and damages more of the healthy tissue. SRS more accurately targets the cancer tissues specifically. The difference is in how they do that.

Comparing stereotactic radiosurgery methods

Stereotactic radiosurgery merges 3-D computer-assisted delivery of radiation with a high degree of accuracy to target only the cancerous cells and not surrounding healthy cells. That accuracy used to be achieved by limiting treatment to areas of the head and neck that could be immobilized by placing the patient’s head in a form, or screwing a plate into the skull. That’s now changed.

Linear accelerator SRS (CyberKnife)

The CyberKnife Robotic Radiosurgery System is the specific type of linear accelerator Anova Cancer Care uses. Other manufacturers produce linear accelerators, such as the Novalis Tx machine. Linear accelerators have benefits over the other types of SRS.

  • One of the main advantages of the linear accelerator is that it can treat larger volume tumors by doing it over several sessions.
  • Treating over time like this is called fractionated stereotactic radiotherapy, and it allows a flexibility unmatched by other machines providing SRS.
  • Can be used on the head, neck and throughout the body.
  • Linear accelerators move around the patient, eliminating the need for restraining devices.
  • Delivering one large radiation beam that is split into many different arcs lessens the damage to healthy tissue.

Advantages of CyberKnife

In addition to the linear accelerator benefits above, CyberKnife has other specific advantages.

  • Uses proprietary software that adjusts for patient movement – even breathing – during radiation beam delivery. This real-time, 3-D respiratory motion adjustment is key to CyberKnife’s reduced damage to healthy tissue.
  • Image guidance compensates for the shifting of tumors during treatment and automatically adjusts to the location without pausing treatment. Tiny gold markers can be placed around the tumor to aid in this.
  • CyberKnife can move in 360-degrees on multiple planes, where most other SRS delivery systems are limited to clockwise and counter-clockwise directions. CyberKnife’s flexibility delivers the beam of radiation in hundreds of different angles to target the precise margins of the tumor.
  • Treatments can be completed in 1-5 days.
  • No pain, no anesthesia, no pain medications, no recovery time or rehabilitation needed.
  • Patient can go home right after treatment.

With rising PSA and a prostate cancer diagnosis, Gary now recommends CyberKnife to others

Read Gary’s story

Particle/proton beam SRS

The radiation oncologist directs the high energy of the proton beams in a 3-D pattern from each beam. The protons release their maximum energy when they reach the designated target. The major limitation of proton beam SRS is that there are only a few facilities in the nation, as each facility costs upwards of $100 million.

Cobalt-60 SRS (Gamma Knife)

Cobalt-60 is a synthetic isotope of cobalt that produces gamma rays when it decays. It has been used to deliver radiation for the treatment of brain cancer since 1950, and that is still the cancer it is most often used on. The most well-known machine for delivering cobalt-60 is the Gamma Knife.

Gamma Knife doesn’t move during treatment so it can deliver high-energy radiation in a precise area of the brain. These machines are generally only located in dedicated neuroscience centers, and they are limited to treating brain cancers and some other smaller tumors.

Conclusion

CyberKnife is a specially advanced type of linear accelerator that has the versatility to effectively treat a wide range of cancers while greatly minimizing side effects commonly associated with radiation therapy.

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Satisfied patient | cancer treatment with Anova Cancer Care CO

Recent studies prove CyberKnife’s efficacy in preserving sexual health with little to no side effects.

As one of the global leaders in treating prostate cancer patients with the revolutionary CyberKnife Robotic Radiosurgery System, I recently teamed up with several oncologists to collect and report on clinical research conducted to evaluate the efficacy and toxicity of CyberKnife for treatment. In the study, called the Multi-Institutional Registry for Prostate Cancer Radiosurgery, I along with my co-authors, report that CyberKnife treatment is effective in preserving sexual health without any other significant side effects.

Men who have been diagnosed with prostate cancer have a variety of treatment options available. Deciding which treatment to pursue can often be difficult, as there are many aspects to consider. One of the most important, aside from efficacy of treatment, is their quality of life after treatment compared with before treatment. Because treatment of the prostate involves the areas governing bowel, sexual and bladder function, quality of life after treatment is a major concern for men.

What we found in our study, whose results were published in Frontiers in Oncology, is that CyberKnife treatment is minimally harmful. We reported the following key findings:

  • CyberKnife treatment produces low levels of toxicity that are superior to the level produced by other radiation treatment options including brachytherapy.
  • Preservation of sexual function was achieved for 80 percent of patients who were sexually potent prior to CyberKnife treatment and somewhat less in men over 70 years old.
  • The positive quality of life outcomes, low side effects, and brief duration of the CyberKnife treatment are particularly encouraging and significant for men weighing their many treatment options.

Retired surgeon chooses CyberKnife for prostate cancer treatment

Read Dr. Richards’ story

A proven radiosurgery therapy option

CyberKnife is a highly sophisticated type of stereotactic body radiation therapy (SBRT). 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 that’s 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 it’s inception in 1987. The first prototype, created by Dr. John R. Adler, a Stanford University Medical Center professor, was approved in 1999.

In 2001, the FDA approved SBRT-type therapies, including CyberKnife, for use throughout the entire body. In 2012, the American Society of Therapeutic Radiation Oncology (ASTRO) released a revised position on the use of radiosurgery in the management of prostate cancer, citing that these treatments “could be considered an appropriate alternative for select patients with low to intermediate-risk disease.” In 2013 the National Comprehensive Cancer Network (NCCN) recognized SBRT for prostate cancer as a standard treatment option.

I’ve personally treated more than 1,100 patients with the CyberKnife for prostate cancer and this is what I have seen:

  • Patients with the earliest stage and grade of disease experience zero failures and have 100 percent control of their prostate cancer.
  • In the next highest grade, patients enjoy over 99 percent control of the disease.
  • All of the patients I’ve treated over the last year, regardless of stage and grade of prostate cancer, have had zero delayed side effects.

How does CyberKnife treatment work?

CyberKnife radiosurgery uses stereoscopic image guidance techniques to deliver large doses of radiation to a certain precise area, such as the prostate, and tracks it while it is moving. The doses of radiation are much greater than with other types of radiation treatment and are more effective at killing the cancer cells. The entire course of treatment is given over just a few days compared with typical radiation therapy, which can include over 40 separate treatments.


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Patients who undergo CyberKnife treatment lie on a table under a robotic device that delivers beams of radiation. The radiation dosage applied is calculated based on the location, size, shape and density of the tumor.

A computer controls the robot that delivers the CyberKnife device’s radiation beams. Since the prescribed dose of radiation is only being applied to a specific area, the healthy parts of the body surrounding the tumor are not significantly affected. In addition, the CyberKnife automatically shifts its positioning to align with any movement of the tumor during the radiosurgery process, which occurs when the patient breathes, when muscles contract and relax, when the bowels fill, and as the bladder fills.

The treatment does not cause pain so an anesthetic is not needed and the patient can go home immediately after the procedure. Quite often patients will fall asleep, enjoying a nice nap on the comfortable, softly padded table during treatment. The primary patient benefits are:

  • No incision
  • No pain
  • No hospital stay

CyberKnife treatment is a safe alternative to surgery for the treatment of cancerous and non-cancerous tumors anywhere in the body – including the prostate. Although there is always some risk of radiation exposure to areas of the body outside of the tumor, the instances of this occurring during CyberKnife treatment are significantly lower than with other radiation therapy treatments.

“An individual’s quality of life is an important aspect of having a fulfilling future. And the side effects of cancer treatment shouldn’t rob patients of this.”

At Anova Cancer Care, we treat patients with CyberKnife exclusively so they can return to life as they know it after cancer treatment. The majority of my patients say the same thing after being treated at Anova Cancer Care, “Why would anyone go anywhere else?” My patients’ lives are practically uninterrupted by the treatments that they receive.

Read our patient stories and testimonials to learn more about what they think about the treatment they received.

If you or someone you love or know needs to know more, I encourage you to reach out. Contact Us

Blood sample with PSA (Prostate-specific antigen) positive | Anova Cancer Care

 

CyberKnife provides men with prostate cancer treatment that doesn’t result in the consequences of surgery, nine weeks of daily radiation therapy or the surgical implanting of radioactive seeds.

Until the mid-1980s men diagnosed with prostate cancer were most likely detected at advanced, and often incurable, stages. A few men were diagnosed earlier when the cancer was discovered during surgery to relieve problems associated with urinating, but as a young doctor I saw countless men in misery with advanced prostate cancer that caused disabling and crippling bone metastases, urination problems, bleeding and swollen lower body parts—all due to the out of control growth of prostate cancer. We treated them by removing their testicles, giving them female hormones and delivering course after course of radiation to try to relieve their suffering.

In the mid-1980s it was discovered that prostate cancer was frequently associated with elevated levels of prostatic specific antigen (PSA). A PSA blood test was developed and it was the beginning of a revolution. Over the following years, the PSA test provided earlier detection of prostate cancer, which allowed for potentially curable treatments. As a result, the number of men who died of prostate cancer over the years has decreased tremendously.

Why did the PSA guidelines change?

Despite such an incredible difference the PSA test has made in the lives of millions of men over the last 30 years, the United States Preventive Services Task Force (USPSTF) recommended against using it to screen men for prostate cancer in 2011. The task force comprised of 16 volunteer clinicians including family physicians, general internal medicine physicians, nurses, obstetrician-gynecologists, occupational medicine physicians and pediatricians. There were no urologists or radiation oncologists directly involved in the recommendation.

The task force stated that they evaluated evidence on whether primary-care practitioners should recommend PSA screening. One of their concerns was the chance of a false-positive reading and the potential stress it could cause for patients. While this is a valid consideration, many physicians believe it is best for patients with elevated PSA levels to be under the care of a urologist to monitor their PSA levels and determine if they have prostate cancer.

I remember reading about the final recommendation of the USPSTF and predicted there would be unfortunate consequences for men, and this has proven true. The 2015 American Society for Clinical Oncology (ASCO) Genitourinary Cancers Symposium reported that since 2011, there has been an increase in the proportion of men diagnosed with higher-risk prostate cancers. With 233,000 new cases of prostate cancer every year, this means 14,000 more of them will be diagnosed with prostate cancer that is less likely to be cured.

The American Urologic Association, ASCO and the National Comprehensive Cancer Network—all specialists in treating prostate cancer—disagree with the USPSTF PSA screening recommendation.

European and American randomized studies have also shown a survival advantage for men who undergo screening compared with those who do not because prostate cancer is very curable when it is diagnosed early and classified as low risk. It is less curable when it is classified as intermediate and high risk.

I do not know how a stronger case can be made for PSA screening for prostate cancer.


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I’ve been diagnosed with prostate cancer, now what?

After a prostate cancer diagnosis, there has been a trend for some patients to watch, wait and not treat until the prostate cancer gets worse. One reason for this approach is that the side effects of treatments like radical prostatectomy surgery, nine weeks of daily radiation therapy or surgical seed implants may have more negative consequences than actively watching the cancer.

Patients have an alternative – stereotactic body radiation therapy (SBRT) using the CyberKnife system. CyberKnife is a specialized radiation device attached to a robotic arm that allows us to “paint” the tumor with radiation and with extreme accuracy. This allows us to place the radiation on the prostate gland where it is needed and avoid the surrounding critical tissues (the rectum, bladder and nerves that control the ability to have erections). CyberKnife delivers an effective treatment in just five visits rather than 30-45 treatments using common radiation equipment. Less time in the clinic means less interruption of your life.

Over the past six years, I’ve treated hundreds of prostate patients with CyberKnife, and they would likely tell you the biopsy caused more side effects than the treatment did. For those with early low-risk tumors, there has not been a single failure to control their cancer. These results, along with those from 44 other CyberKnife centers throughout the United States, are published in the January 2015 paper titled “Multi-Institutional Registry for Prostate Cancer Radiosurgery,” a prospective observational clinical trial written by me, as well as Drs. Freemen and Perman, that presents data on 1,750 men treated with the CyberKnife for prostate cancer.

Anova Cancer CareAnova is recognized as an international leader in the treatment of prostate cancer and I am seeing patients with prostate cancer from other cities, states and countries who take advantage of my expertise. If you or someone you care about has prostate cancer, you deserve the same opportunity.  I encourage any man who is diagnosed with prostate cancer to contact Anova to learn more about treatment options. Our professional and friendly clinical team will provide you with exceptional care.

Treatment of your prostate cancer with CyberKnife SBRT can make it possible for you to be able to enjoy the rest of your life after prostate cancer.

Treating Brain Cancer Anova Cancer Care

The standard for treating brain metastases back in 1954 was whole brain radiation therapy. The intent of whole brain radiation therapy is to help deal with cancer that spread to the brains by treating the whole brain, all of it, with radiation.

When I trained in the ’80s, whole brain radiation remained the standard of care for brain metastases. I observed that the effects of the treatment were often worse than the disease itself with respect to the patient’s quality of life. Patients always had moderate to severe problems with brain function after treatment.

How bad was it? Let’s say if they could balance their checkbook prior to treatment, they weren’t likely to be able to after. Other negative effects included memory problems, being able to understand, and other changes in how they were able to think and do things prior to treatment.

The benefit of the treatment was that the patients could live a few months longer…but I always thought, and still think, that the downside was very significant.


Learn about Brain Cancer treatment options 


Fifty years later the standard for treating brain metastases is still whole brain radiation. What? How can this be true with all the advances in medical science over the last 50 years? How can this be true when treating brain metastases, using radiosurgical techniques with CyberKnife and other machines, is readily available?

According to the Wall Street Journal article, “Cancer Radiation Questioned,” 200,000 patients with brain metastases are subjected to whole-brain radiation therapy for brain metastases each year. Doctors at MD Anderson have recently investigated the outcomes after using whole brain radiation and…. surprise! They found a negative impact on brain function that was “more than they expected!”

This is not the first group of doctors who studied problem and found whole brain radiation an unsatisfactory treatment option for patients with brain metastases who were doing well otherwise — responding to other treatments, and would live for months or years if not for the brain metastases.

What alternatives are there? As I have said, treating brain metastases with radiosurgical techniques, such as with CyberKnife and other machines, is readily available and is not associated with the consequences of whole brain radiation.

I have helped hundreds of patients enjoy control of their brain metastases and excellent quality of life with respect to brain function for years while working with their team of physicians and keeping the cancer in other parts of their body in check.

However, to be fair, there are some patients for whom whole brain radiation could be the right treatment, and I do recommend it for those few patients that I consider it to be the best treatment option.

The treatment of brain metastases is another one of the many areas where radiosurgical treatment with the CyberKnife excels, and if you’re reading this, know that the procedure is available today for patients who have brain metastases.

Make it your mission to not let someone you love or know become one of the 200,000 casualties of over-treatment with whole brain radiation every year.

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About the Author: Lee K. McNeely, MD

card imageDr. McNeely has an extensive background in the treatment of cancer tumors with radiation oncology to include IMRT, IGRT, brachytherapy and radiosurgery. He has treated patients on the CyberKnife since 2003 when he brought the first system to Colorado. It was only the seventh CyberKnife installed in the United States and Dr. McNeely’s clinical expertise aided in the testing and development of some of the innovative technological advances now integral to treatment of early stage lung cancer, brain and spine tumors, as well as some of the earliest prostate cancer cases. Subsequently, Dr. McNeely was on staff at Colorado CyberKnife in Lafayette and the University of Colorado Hospital Gamma Knife. Then in 2013, he was instrumental in helping St. Vincent Healthcare in Billings grow its cancer program with the addition of a CyberKnife stereotactic radiation facility. His clinical expertise includes the treatment of prostate cancer, lung cancer, and brain and spine tumors. In his personal time, Dr. McNeely loves spending his time hiking, skiing and climbing in the mountains and traveling.