Jonathan Hill never had serious health issues until after he turned 69 six years ago. That’s when his PSA slowly crept up and a subsequent biopsy detected cancer.
A doctor at the Mayo Clinic in Jacksonville, Fla., suggested surgery to remove his prostate, scheduling the procedure for six weeks later.
“I wanted the surgery the sooner the better. If they had offered to do it that afternoon, I would have because having cancer scared me to death,” said Hill, who wrestled with his emotions while researching information and options on the Internet.
That’s when he found a prostate cancer discussion forum, survivor Allen Edel and other forum members. They became a wealth of information for Hill. They told him about their treatments from surgery to standard radiation, which could have entailed up to 42 treatments.
Edel had undergone something called CyberKnife treatment at UCLA six years prior. CyberKnife, a tool that delivers stereotactic body radiation therapy (SBRT), specifically focuses radiation on a clearly defined target in a more dose-concentrated way and in a shorter period of time than with traditional radiation methods.
Although the name contains the word “knife,” CyberKnife treatment involves no cutting or surgery. It is the first fully robotic radiotherapy device.
Hill was interested and set up a meeting with radiation oncologist Dr. Deborah Freeman in Tampa, Fla.
“The other doctors I met with really didn’t emphasize to me the importance of entertaining the idea of other forms of treatment,” Hill said.
“But once I did, my initial thought was that I almost made what could have been the biggest mistake of my life. Not that the surgery would have been inappropriate. It just would have not have been the best option for me.”
Receptive and Empathetic
Hill said Freeman was receptive and empathetic. She took the time to discuss the implications of having prostate cancer today, tomorrow, in six months, a year, five years, and what the implications would be pertaining to his family and his life over an extended period of time, he explained.
He cancelled the surgery and made the appointment at CyberKnife Centers of Tampa.
“I did not have any bad side effects. I had family in Orlando at the time, and we visited the theme parks in Orlando, every day, after treatment,” he said.
August marked six years since Hill’s treatment.
“Unlike with the surgery, I still have a functioning prostate, so I still have to watch my PSA,” he said. “There is never a 100% guarantee that it will not reoccur.”
If it happens, he said he would face it with a lot more confidence than he did the first time. He said that if he had to do it all over again, he would still choose the CyberKnife.
The “S” In SRBT
Stereotaxis, the “s” in SRBT, is the science and practice of precisely locating a tumor within 3D space. CyberKnife, developed by Accuray, is the only fully robotic radiation delivery system that can deliver radiation directly to that tumor from virtually thousands of beam angles with precision and accuracy to a sub-millimeter.
The CyberKnife is a non-invasive treatment for cancerous and non-cancerous tumors and other conditions where radiation therapy is indicated.
CyberKnife treatments are typically performed in 1 to 5 sessions. The CyberKnife System has more than two decades of clinical proof and has helped thousands of cancer patients.
Freeman said the system differs from other forms of radiosurgery in two ways.
“It is unique in its ability to deliver radiosurgery using not only robotic movement during radiation delivery, but also has freedom of robotic movement, meaning the ability to aim the beam from a multitude of different directions around a patient or a stationary target,” she said.
If the patient moves for a cough or even slight breath, she added, the system’s onboard image guidance corrects for that movement. Non-robotic radiosurgery treatments deliver multiple radiation beams simultaneously to the target area or tumor location but cannot deviate from the pre-designed path.
The extreme focus of the radiation keeps other normal organs from being affected.
“During treatment of a tumor in the pituitary gland, which is right between and behind the eyes, we can avoid the eyes altogether, or we can treat a cancer near the ear and avoid the hearing apparatus, or treat near the brainstem and avoid the brainstem, or even target the prostate but not the other organs next to the prostate,” Freeman explained.
Originally Designed for Brain Tumors
Freeman said the technology quickly gained popularity for its ability to treat targets or tumors outside of the head, including lung, prostate, spine, pancreas, some kidney or renal cell cancers, and metastatic cancers that may have spread from an original origin to lymph node or to bone.
Most recently, radiosurgery with CyberKnife is being investigated in a clinical trial in the United States for women who have had a lumpectomy for breast cancer.
This type of treatment is called adjuvant therapy, or additional treatment given after the first treatment to lower the risk of the cancer returning.
“After lumpectomy, instead of irradiating the whole breast as a precautionary measure, we are exploring three to four weeks using just a targeted area within the breast where the cancer was removed using more focused radio-surgical treatment,” Freeman explained.
When the breast is a radiation target, with conventional radiation, some of the underlying rib and lung and even the heart, if the surgery was on the left side, will be exposed to radiation. Even with very low doses.
“Our goal with radio-surgical trials is to try to keep the dose off of those targets and limit the radiation to just the breast itself or even just a portion of the breast,” Freeman said.
Some insurance companies currently do not recognize radiosurgery as an option after lumpectomy. Freeman noted that besides the clinical data, information also will ultimately help demonstrate to insurance carriers that this is a reasonable option that should be covered.
The trial is called Accelerated Partial Breast Irradiation (APBI) Using Stereotactic Body Radiation Therapy (SBRT) and can be found at: https://clinicaltrials.gov/ct2/show/NCT04985032.
The trial will study 200 patients who will be treated to a certain dose over the course of 5 small doses called fractions. These subjects will then have a follow up time of 5 years.
“The clinical trial is significant because breast cancer affects so many women, and to be able to shorten that course of radiation after lumpectomy for appropriate patients is, I think, a win-win for both the patient in terms of their convenience and savings and health care dollars too,” said Freeman, who added that radiosurgery is not effective for all types of cancer.
“In certain situations, the cancer may be too large,” she said. “For example, if a person had cancer of the tonsil and that cancer had spread to a lymph node in the person’s neck, the radiation treatment may need to cover a broader area. So the field of radiation to appropriately treat certain types of cancer would be notably larger than would be desirable with radiosurgery.”
Jonathan Believes He Made the Right Decision
As for Hill, he concludes that when you’re facing life-threatening circumstances, each patient has to be his or her own best advocate.
“Research your options because you can put yourself in a situation where you may have some serious regrets down the road,” he said.
“In fact, I know quite a number of people who’ve had prostate cancer. They go to their family doctor, they get referred to a urologist, they get either traditional radiation or surgery, and they never question anything and just do what is suggested to them first. I’m not that kind of person. From joining the forum, to meeting Allen, and then meeting Dr. Freeman, so I’m very thankful for all of that. For me, it worked out super.”
Photo courtesy of CyberKnife
