In August 2017, Dennis Gingras of Marshall became the first patient in western North Carolina to be treated with Mission’s Cyberknife system for prostate cancer. After only five short treatments, his prostate-specific antigen (PSA) returned to normal range. Now, he’s feeling like his old self again.
What Is Cyberknife?
Cyberknife is a technology that delivers external radiation. “Unlike the traditional linear accelerator, the Cyberknife is an accelerator at the end of a robotic arm,” said Eric Kuehn, MD, a radiation oncologist with Mission Cancer Care. “So rather than treatment delivery restricted to one plane, the robotic arm allows the team to choose almost any angle to deliver the beam. When multiple beam angles are utilized, the radiation is given to a tightly focused area.”
Mission Health has been using its Cyberknife system for the treatment of certain brain and lung cancers since 2005, and has treated well over 1,500 patients since then. In fact, Mission was the first hospital in the Carolinas to introduce the technology. But it wasn’t until published data was available on the use of Cyberknife in prostate cancer treatment that the hospital started offering the treatment to that particular patient population.
“There were a few academic centers that were using Cyberknife to treat prostate cancer for several years with good results,” said Dr. Kuehn. “The problem was that no one had ever published their data. We would get calls from patients all the time asking about Cyberknife, but we were never comfortable offering it until we could see the data on outcomes and toxicity.”
“Fortunately, over the past couple of years that information has been published in medical literature,” continued Dr. Kuehn. “After seeing that the technology works quite well and that the toxicity wasn’t much different than any other forms of radiation, we were eager to start offering it to prostate cancer patients.”
As part of the preparation to begin prostate cancer treatments, Mission replaced their original machine with the newest version of the technology to allow delivery of the radiation even more efficiently than before.
Shortening Treatment Times
In terms of outcomes, the Cyberknife doesn’t necessarily deliver better results than other prostate cancer treatments. That’s because, when caught early, prostate cancer is generally a highly treatable cancer. “The results in treating early prostate cancer are pretty good no matter which method the patient chooses,” said Dr. Kuehn. “It’s hard to improve on the outcomes we already get.”
Therefore, the biggest selling point of Cyberknife is that it drastically shortens a patient’s treatment period from 40 treatments over the course of 8 weeks to five treatments within a week and a half. Dr. Kuehn said this patient-friendly feature is particularly important in western North Carolina, where patients sometimes drive long distances to receive treatment.
“Mission covers a wide geographic area, and we see lots of patients who live a long way from Asheville and have to drive an hour to an hour and a half or longer to get here,” said Dr. Kuehn. “In the past, radiation for prostate cancer required huge time and travel commitments from them. It’s a big win for those patients that they now have something as good as the traditional treatment, but with more convenience.”
The shorter course of therapy was ultimately what convinced Gingras to choose Cyberknife. When he met with Dr. Kuehn prior to his treatment, Dr. Kuehn discussed all treatment options with Gingras, including Cyberknife.
“It’s a big decision, but in the end I chose Cyberknife because there would be fewer treatments,” said Gingras. “I also liked that it was a highly targeted and accurate treatment.”
Gingras said the treatments were a breeze for him. “It was so easy and simple – just like getting an X-ray,” he said. “You don’t have any pain while it’s happening, and it’s just incredible to watch the machine work. So you just lie there listening to music and looking at the stars on the ceiling while this amazing robot works, and then in 15 minutes or so it’s over. I did that every other day for 10 days, and that was it.”
Gingras also saw immediate results from his treatments. Before he started, his prostate-specific antigen (PSA) number was 8.7. After his five Cyberknife treatments, it was already down to a 1.7.
The Ideal Patient
One of the reasons Cyberknife was such a good treatment option for Gingras – and why Dr. Kuehn recommended it to him in the first place – is that he was the type of patient who would benefit well from the therapy.
According to Dr. Kuehn, Cyberknife is recommended for men with relatively early prostate cancer. “The more advanced prostate cancers, would not be appropriate to treat with this technology,” he said. “Not only do we not have published outcomes of treatment in those patient populations, but we know that Cyberknife is ideal for targeting smaller areas with finite edges. With more advanced prostate cancer, we’re dealing with much larger areas at risk, possibly including the lymph nodes and the tissues around the prostate.”
Dr. Kuehn said the treatment is also not usually recommended for men with large prostates. “One of the side effects of the treatment is that it can temporarily cause difficulty emptying the bladder, and that can be worse for those who already have trouble emptying their bladders due to a big prostate,” he said.
The side effect Dr. Kuehn mentions is one Gingras experienced. Prostate swelling due to the treatment caused him difficulty in emptying his bladder. But through a combination of medications and self-cathetering, his symptoms have slowly tapered off. Dr. Kuehn said this side effect can last two to three months following surgery.
Special Care Every Step of the Way
While Cyberknife is a fairly straightforward treatment, Dr. Kuehn and the rest of the cancer care team take special precautions to improve outcomes, as well as patient experiences. Gingras said the follow-up care he received was also top notch.
“Dr. Kuehn would call me every week just to check on how I was doing,” he said. “But, really, everyone I interacted with throughout this process has been so nice – from Victoria Urological Associates to Dr. Kuehn’s team. They’re your doctors and nurses, but you come to think of them as friends too.”
Eric Kuehn, MD, is a radiation oncologist with Mission Cancer Care.