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My experience of CyberKnife radiotherapy

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User
Posted 06 Jun 2022 at 07:27

Hi everyone.

I am 60 years old and from the UK originally, but have lived for many years in Finland. Following sepsis in March 2021, I was diagnosed with localised prostate cancer - Gleason 4+3 with a PSA of 11. The default treatment option at my local hospital is surgery, which I rejected due to the side effects. Luckily, here in Finland we have the option (by Law) of choosing which hospital we want to be treated at. Obviously a patient cannot choose the treatment, but other hospitals do offer alternatives, and if the patient meets the criteria then the patient will be accepted for treatment there (funding is transferred from one health authority to the other). After some research, my wife discovered CyberKnife, and that they offer this treatment at Kuopio University Hospital - both in the public and private sector.

I had never heard of Cyberknife before, but after some further research (mainly YouTube) I asked to be considered for this treatment, primarily because the side effects were said to be minor and the course of treatment is short - 5 sessions of radiotherapy at 30 minutes each, as opposed to 37 to 40 sessions with conventional radiotherapy. Following 2 hormone injections in December 2021 and January 2022, I had the treatment in March 2022, and the purpose of this post is to share my positive experience. To be honest, it was incredible to see the robot moving around me, and the fact that it was such an easy course of treatment was a bonus. It did not disturb my daily life at all. The 5 sessions were over a 10-day period, I didn't have to take any time off work, and the side effects have been negligible (I am writing this in June 2022). For the first 2 weeks after the treatment I had to go to the toilet maybe 1 or 2 times per night, but that's it. When the swelling subsided, I went back to going through the whole night without having to go at all. No incontinence at any time, no bowel problems, and my sexual function has returned to normal as the hormone treatment has begun to wear off. Apparently, my testosterone levels will be back to normal by the end of 2022.

Obviously it is still early days in my case, but the studies done at Kuopio Hospital over the past 10 years show that CyberKnife offers equivalent results to surgery.

To be honest, I do not know why this machine is not available in more hospitals. Sure, the initial capital cost is probably a fair bit higher, but 5 hospital appointments as opposed to 40 must make it cheaper in the long run. But that's another debate.

If any fellow sufferers would like to know more about this treatment then please feel free to post. My message is consider your options carefully and decide what's right for you. Obviously choice is limited by availability, but if you have the chance to receive CyberKnife treatment then I would certainly recommend it. To be honest, I feel very lucky, and even if things don't work out in the long run, at least my decision regarding preferred treatment was respected.

Best regards, Philip

User
Posted 06 Jun 2022 at 10:18

Hello Philip,

It's similar here in England. Patients can ask to be referred to any NHS hospital which will accept them (although not many patients know that).

Cyberknife is a particular brand of machine which does SABR (or SBRT, same thing), although it has some advanced facilities too which are not normally needed for treating prostates (such as tracking a treatment area which is moving while you breath). While the centres of excellence will all have Cyberknife, some recent LINACs also do SABR (and can also cope with breathing, but do so by switching the beam on only while the target area is in the right place, although this is not necessary for prostates - more relevant for breasts). SABR is increasingly being offered by the main treatment centres, same protocol as yours, 5 treatments usually a couple of days apart. There's also a trial of 2 treatments.

This is part of an increasing trend towards hypofractionation - delivering treatment in fewer fractions of higher power, and is also made possible by better imaging and beam shaping capabilities of the newer machines. Prostate cancer turns out to treat better with higher power and need less total dose for same treatment effect. Some other areas that might be treated outside the prostate don't cope so well with hypofractionation though, so it's not used in all cases.

We also don't yet have good long term data on hypofractionation, and the Pelvic Radiation Disease Association did comment at their last annual conference that while it's too early to be sure yet, from early data it's looking like it might be that the incidence of Pelvic Radiation Disease is increased by hypofractionation. It is also known that this generates significantly more fibrosis around treated organs which does make salvage prostatectomies more difficult (although they're rare) and any other nearby abdominal surgery that might be needed in the future. On the other hand, it's more convenient for many patients to have fewer visits to the treatment centre, and we don't have enough therapeutic radiographers any more to treat everyone without using hypofractionation.

User
Posted 06 Jun 2022 at 11:13

Thank you Andy for your informative post.

I guess the deciding factor for me at the time I made my decision was quality of life. My rationale was 10 years of good quality life is much better than 20 years of compromised quality - during which time you might die of other causes anyway. But everyone has their own views and criteria. The oncologist who treated me said I made the right decision, which is good enough for me.

It does seem there is a difference of opinion between urologists and oncologists. The former seem to advocate surgery, because they are the ones who do it, whereas the latter prefer other less invasive approaches (if possible). At the end of the day, I made my informed decision and can only blame myself if things don't work out. For me, that is a good position to be in.

My choice was also influenced by the tales (of a woe) of a previous colleague who went down the surgery path. But I also understand the mindset of guys who just want to get rid of the problem via surgery. I never had this strong psychological reaction I must say.

Good to hear that the UK offers choices, and that advances are being made. 

Best Regards, Philip 

 
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