CyberKnife Compared to Proton Beam & HIFU for Prostate Cancer

by | May 15, 2019 | Prostate Cancer

At CyberKnife Miami we are often asked what’s the difference between the CyberKnife, Proton Beam and HIFU when it comes to treating prostate cancer?

Let’s start with CyberKnife 

Both CyberKnife and Proton are forms of radiation therapy used to destroy tumors while preserving the surrounding tissue.

CyberKnife Radiosurgery is a highly focused radiotherapy also known as stereotactic body radio-surgery or (SBRT). 

Unlike conventional radiation techniques used to treat certain types of cancer, the CyberKnife’s robotic arm delivers the highest dose of radiation in the smallest number of treatments. It is a non-invasive, painless treatment that may be an alternative to open surgery in many cases.

The CyberKnife system also uses image-guided robotics to precisely destroy tumors with hundreds of beams of high-energy radiation hitting the tumor all at once from many different angles. 

Using missile-guided radiation technology to target tumors with pinpoint accuracy, CyberKnife delivers radiation directly to the tumor and is the only technology that follows and tracks the tumor even when a patient moves or breathes normally.

CyberKnife therapy requires only five, 45 minute treatments over a 10 day period which helps maintain your quality of life.  

CyberKnife Radiation Therapy is used to treat low-risk and intermediate-risk localized prostate cancer and is an alternative to surgery or other types of radiation therapy.

CyberKnife is fast becoming the treatment of choice for prostate cancer treatment.

There is no cutting, incision, blood, anesthesia, pain and requires no recovery time.

This revolutionary prostate cancer treatment has helped save many lives while maintaining patients’ quality of life.

CyberKnife Radiosurgery is FDA approved and covered by most insurance companies.

During treatment the patient reclines on the CyberKnife bed while the machine moves slowly around.

You will not feel anything and the CyberKnife does not touch you. 

The benefits of Radiosurgery with the CyberKnife far outweigh any potential risks, which are minimal. 

CyberKnife treatment is:

 Completely non-invasive- Despite its name, there is no knife or cutting involved
 Painless with few to no side effects – You can resume your normal activities immediately following treatment
 Catheter is not needed
 NO Anesthesia
 Quick – Each treatment typically lasts around 45 minutes
 Highly successful – The radiation delivered is so precise that the prostate cancer is destroyed
 Preservation of sexual function remained the same for most men after treatment
 Individuals who are not candidates for surgery or chemotherapy, or those who have been previously treated with radiation, may be a candidate for CyberKnife.
 Fewer treatments than standard radiation. Thanks to its remarkable clinical accuracy, the CyberKnife treats prostate cancer in 5 treatments over 2 weeks, unlike the low doses of conventional radiation therapy that require 40-45 treatments over the course of 2-3 months. 

10-year study outcomes show patients remain cancer free:

The disease-free survival (DFS) rate was 93.7 percent, indicating there were no signs or symptoms of the cancer during the evaluation period; 

The median prostate specific antigen (PSA) value was 0.1 ng/ml. A low PSA value is associated with a reduced risk of cancer recurrence or metastases; and 

Patient-reported bowel and urinary function scores showed initial declines which recovered to baseline where they remained throughout the remainder of the study period

What is Proton Beam Therapy

Proton Therapy is a type of particle therapy in which high-energy proton beams are delivered to tumors by a cyclotron. 

With Proton Therapy, doctors determine the precise point in a patient’s body where the proton releases the majority of its energy, maximizing exposure to cancer cells while minimizing exposure to normal tissue. 

Proton Therapy is usually delivered in 20 to 25 treatments with typical out-patient sessions lasting less than 5 minutes. Side effects such as fatigue are usually minor and temporary.

Proton beam therapy utilizes lower doses of radiation, so more treatments are required. These treatments use conventional fractionation with small doses given daily over a four to six week period.

It does not track the tumor as the patient breathes or moves so there’s more risk of damage to surrounding healthy tissue.

While FDA approved it is most often NOT covered by insurance so patients must pay out of pocket and it can cost as much as 100,000 dollars.

What is HIFU for Prostate Cancer 

HIFU is NOT FDA Approved in U.S. to Treat Prostate Cancer  

It is ONLY FDA Approved for Prostate Tissue Ablation  

· Touted as Non-invasive, however it is Minimally Invasive

· Requires Anesthesia

· It is NOT Covered by Most Insurance Companies

· There Are No Long Term Studies to Determine Safety and Effectiveness

The Center for Devices and Radiological Health at the FDA reports that HIFU was approved recently for prostate tissue ablation (to destroy tissue cells of the prostate), it has never been approved in the U.S. to treat prostate cancer. 

How the HIFU Procedure Works 

HIFU is considered a minimally invasive procedure for the treatment of low-risk, localized prostate cancer and for prostate cancer recurrence in the prostate gland. 

HIFU is an option for men who are not candidates for open surgery (prostatectomy) or don’t want to undergo surgery or radiation therapy.

HIFU uses high-intensity sound waves to heat and destroy cancer cells. 

It is not indicated for cancer that has spread (metastasized) beyond the prostate.  

Here’s what happens: At the start of the HIFU procedure, a catheter is inserted through the penis into the bladder to catch urine during the procedure and remains in place for 1 to 3 weeks after surgery. 

Then during the procedure an ultrasound probe is inserted into the rectum and directs heated sound waves through the walls of the rectum to destroy cancer cells. 

With the use of MRI or ultrasound imaging, the sound waves are aimed toward the cancer cells, heating up to temperatures as high as 90 degrees to ablate the targeted cells. 

HIFU is a 3 hour procedure performed under anesthesia with an additional 3 hours in recovery. 

Pain medication and antibiotics are prescribed after surgery and up to 1 week of downtime is required after the procedure.
Potential Side Effects of HIFU Affect Each Man Differently & Include:

Erectile dysfunction – Occurs in nearly all cases immediately after surgery. 

In extreme circumstances, ED can last 18 to 24 months or longer

Urinary incontinence – Most men may experience some urine leakage for several weeks following surgery, but the condition typically resolves itself within a few months

Ejaculatory dysfunction – Occurs in all men

Retrograde ejaculation – Develops in 40 to 90 percent of men

Orgasmic issues – Occurs in about 50% of cases

Penis shrinkage – Frequent occurrence that can worsen over time

Nocturnal and morning erections – Men typically lose these erections immediately following surgery, although they do return over time 

Blood or tissue in urine – It is typical to see some blood in your urine while the catheter is in place. 

You may also see some small pieces of prostate tissue in your urine for at least six to eight weeks following the procedure 

Symptoms include:

· Urinary frequency and burning
· Rectal wall injury from probe
· Rectal incontinence, burning, and bleeding
· Prostate infection

Rectal fistula – Very rarely, HIFU can cause a hole between the rectum and the urethra (the urinary tract). Signs of a possible rectal fistula include:

  • Urine coming out of your rectum
  • Pain in your pelvis or rectum
  • Bowel contents in your urine
  • Air bubbles in your urine

You’re more likely to get side effects if you have had more than one HIFU treatment or if you’ve had other types of prostate cancer treatments prior to HIFU. HIFU risks are increased each time the procedure is performed.

If you have an enlarged prostate you are not a candidate for this procedure.

HIFU is Often NOT Covered by Insurance 

Medicare covers the actual operational costs of an approved facility where the procedure takes place however the patient is still responsible for the following:
· The time of the physician who performs the HIFU procedure (and the time of any and all associated clinical support staff)
· The time of the anesthesiologist who administers anesthesia 
· Any and all follow-up patient care and support services post-treatment 

FDA’s Report on the Effectiveness and Safety of HIFU Concluded:

• There are “no HIFU effectiveness data relevant to clinical decision-making such as overall survival or prostate-cancer-specific survival in the US.”
• Long-term effectiveness data from outside the US are sparse and outcomes are variable.
• There are “no patient preference data on HIFU treatment in men with prostate cancer.”

When considering HIFU as a treatment strategy for prostate cancer you should seek out a qualified professional who has performed a significant number of the procedures.

To learn more about all of these treatment options and determine which is best for you talk to your doctors. Ask a lot of questions and get a 2nd or 3rd opinion if you are unsure. You can also contact our Prostate Cancer Experts at CyberKnife Miami and they will walk you thru the options to see which one is best for your wants and needs – here’s the number 305-279-2900 and visit our website to learn more