Prostate cancer

Treatment of localized prostate cancer

The usual treatment options include surgical removal of the prostate and possibly the lymph nodes (radical prostatectomy), external beam radiotherapy, brachytherapy (seed implantation), high-frequency ultrasound therapy (HIFU), hormone deprivation therapy or active surveillance, depending on clinical stage, symptoms and age.

As an alternative to these methods, a new form of therapy, CyberKnife radiosurgery can be offered in selected cases. In Munich, patients with Gleason Score 6 or 7, PSA < 15 ng/ml and age > 60 years can be treated (Hypostat). The highly precise and cutting edge Cyberknife technique presents a gentle way for treating prostate cancer.

Radiosurgery is a method in which a very high dose of radiation with a maximum protection of healthy tissue is placed in the prostate. Radiosurgery is performed in most cases in 4 and 5 therapy sessions to perform the most effective and gentle treatment.

The Cyberknife confirmed long-term data increased. Meanwhile scientific data of thousands of prostate cancer patients are existing, with follow-up of up to 10 years. 

Nearly 15.000 Prostate cancer patients were treated with the cyberknife system. (Accuray 2015)

For safe and precise treatment in advance the contribution of small gold markers in the prostate is required. These serve to ensure that the exact position of the prostate is recognized by the CyberKnife system and only reached the emitted radiation as possible the prostate.

For this purpose a small intervention is required, which is an outpatient procedure shortly before the actual radiosurgery under local anesthesia during treatment planning. This procedure is similar to the sampling of the prostate and complications. In rare cases, it can lead to bleeding or infection. Therefore, a short-term antibiotic treatment is carried out for prophylaxis.

Radiosurgical irradiation can cause side effects, despite careful planning and execution. In most cases, you can treat the symptoms and regress or thereby improve significantly.

After the treatment, it may result in increased stool and urination. Also urination symptoms may be associated with (frequent urination, burning, weak urinary stream). It can rarely flatulence (usually nutritionally dependent), and very rarely diarrhea may occur. Rarely, after therapy to mucus and blood disposals during bowel movements, involuntary loss of urine and bloody urine. Most of the complaints will form usually after a few days (or weeks) back. In a small percentage of patients (less than 5%) remain the symptoms persist longer. As late effects may occasionally the above changes in bowel and bladder persist. 

The most significant late side effect is the rare event of a narrowing of the urethra (about 2-3%), but as a rule by bougienage (expansion) can be successfully treated in otherwise healthy patients. Very rarely have serious side effects such as fistula formation between the bowel and bladder on the basis of chronic ulcers in the lining of the rectum or bladder. Adhesions and strictures of intestinal loops protrude almost never.

Should you pass a normal erectile function before therapy, there is a risk of about 20% to deteriorate this over the course of 12-18 months. In these erectile dysfunction drugs may allow a largely normal sexual activity. We do not have a long-term monitoring over 10 years of patients after CyberKnife treatment available, so it cannot be excluded that some of these side effects are more common long term.

Standard treatments for your condition are surgical removal of the prostate and seminal vesicles, the radioiodine seedtherapy or standard radiotherapy of 8 weeks duration. Active surveillance (active surveillance) without treatment is not a cure, but may be considered.

Based on the experience of the last few years, there is the scientifically-based impression that an equally effective therapy such as with the previous standard method is made possible by a robot-guided radiosurgery, but the side effects appear after the data available to date significantly lower for better patient comfort. Based on current knowledge of medicine it cannot yet be said in conclusion, which therapy for the individual patient is the best. The American Society for Radiation Oncology (ASTRO) does now suggest Cyberknife for low and intermediate risk cases.

It is expected that the effects of CyberKnife radiosurgery are set after a few weeks. To ensure that a safe therapy is done, should be the first PSA control after 6 weeks and then be carried out on a quarterly basis.

A correct interpretation of the value can only be done by your urologist and / or radiosurgeon. In addition to the usual follow-up examinations, such as prostate examination by your urologist (with the fingers and / or ultrasound), possibly also PET-CT controls or CT / MRI of the pelvis possible.

Prof. Dr. med. Alexander Muacevic
Radiosurgeon - Neurosurgeon

Dr. med. Alfred Haidenberger
Radio Oncology Specialist

Dr. med. Markus Kufeld
Radiosurgeon - Neurosurgeon

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