Over 233,000 men will be diagnosed with prostate cancer this year. Most men along with their families are faced with a vast amount of treatment options. With a quick Google search, one can dive deep into any one treatment and a number of comparisons from various experts. The problem is language. Radio surgery, robotic surgery, radiation, robots, systems, targeted fusion -- no wonder most patients are confused. Following diagnosis, patients are presented with a lot of information, in order to make sense of the different treatment options. This can make even the most educated patient uncertain. While the internet contains many valuable resources, advertisements are often cloaked as educational tools, and patients should be cautious. While it is important to be educated regarding your disease, going to a search engine is not always the best first step. Talking with your physician and asking for recommended resources is a safer way to start your education.
Robotics is one such technology that has been quickly embraced and adapted to medical therapy. Two treatment options often confuse patients -- Cyberknife and robotic surgery for prostate cancer.
Traditionally, patients had two main treatment options: surgery or radiation. Based on a patient's goals, disease state, and health, an appropriate treatment plan would be made. However, over the past decade the marketplace has become flooded with new technologies for cancer treatment. Furthermore, patients are relying less on their physician to make the decision for them and are taking an active role. As newer therapies are introduced, patients are not always equipped to entangle marketing from medical facts.
First let's clearly define each treatment option.
Robotic surgery for prostate cancer is also known as da Vinci Robotic Prostatectomy or Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP) or removal of the prostate gland. Da Vinci Robotic Prostatectomy is a surgical procedure performed by a surgeon (and his/her team) with the aid of computer-enhanced robotic system. This state-of-the-art technology and tools are 100 percent in the control of the surgeon, which allows him or her to see a magnified, high-resolution view of the operating field to safely and efficiently remove the cancerous prostate.
In the case of robotic prostate surgery, the robot builds on concrete oncologic principals. Early on it was shown that removal of the cancerous tissue, in this case the prostate, results in improved survival. Robotic surgery increases the magnification and visualization of the surgical field while allowing for precise and intentional movements. As a result, in the hands of a skilled surgeon, the prostate can be removed with greater attention resulting in improved functional outcomes, decreased blood loss, and a shorter recovery.
Robotic prostate surgery is recommended for men healthy enough for surgery and men with prostate cancer that has been isolated the prostate.
Pros vs. Cons of Robotic Surgery:
- high rates of curing cancer
- accurate staging of the cancer
- minimal blood loss
- less pain
- shorter recovery times
- shorter hospital stays (1 to 2 days)
- extreme accuracy and precision of necessary surgical instruments
- high definition magnified visibility of the prostate and surrounding tissues and organs
- high rate of normal sexual function after surgery when performed by a skilled and experienced robotic surgeon, and the prostate cancer is completely removed resulting in higher cancer cure rates when performed by a skilled and experienced robotic surgeon
- possible erectile and urinary side effects after surgery when the procedure is performed by a less-skilled and inexperienced surgeon.
The Cyberknife Robotic Radiosurgery System as its formerly known is a completely different adaptation of robotic technology. First the name radio surgery is misleading as this is not actually surgery but rather radiation therapy. In this treatment modality, a computer programed robot is employed to reposition the radiation beam in order to deliver targeted therapy. Originally the technology was developed for dynamic tissues, like the lung which are in constant movement. While radiation therapy has been employed by oncologists for decades, the Cyberknife utilizes a dramatically different dosing regimen called hypofractionation. Traditionally, external radiation is given over approximately 40 treatments but with hypofractionation, patients receive less than half the traditional radiation dose in a significantly shorter period of time. Overall, radiation therapy for prostate cancer does not improve disease failure rates and causes significantly more urinary function problems in most patients.
CyberKnife is most often used for patients with early stage prostate cancer confined to the prostate or in combination with another therapy, such as external beam radiation for patients with cancer that is present beyond the prostate. Your doctor will recommend a treatment plan depending on the stage of the patient's prostate cancer.
Pros vs. Cons of Cyberknife:
- no hospitalization
- low levels of toxicity produced
- less pain compared to other procedures
- fatigue
- erectile dysfunction (20 to 30 percent of patients develop erectile dysfunction)
- there is no doctor or surgeon controlling the device
- lack of high definition internal visuals to accurately diagnose and treat prostate cancer
- it can be difficult to accurately stage the cancer
- it requires multiple trips to the hospital for treatments
- it is a fairly new surgery which means there is limited clinical history to determine the true long-term effectiveness.
Watch the video on Surgery vs. Radiation.
Each treatment for prostate cancer can have various outcomes. Experts have long debated surgery versus radiation, especially when it comes to treating prostate cancer. Surgeons of course push surgery and radiation oncologists push radiation. But the truth is surgery is the only option that gives an accurate staging of the cancer.
Surgery remains your best chance for a cure.
Many patients are naturally attracted to a new technology such as Cyberknife but the important thing to remember is technological innovations in medicine are not equal. A robotic prostatectomy compared to a Cyberknife procedure couldn't be more different from a clinical perspective.
Another important thing to note is radiation therapy in general distorts the shape and form of the prostate gland to the point where surgery in most cases cannot be performed, should radiation not work. But having surgery first does leave the option for radiation if the cancer recurs.
Prostate cancer is the second most common malignancy, second only to skin cancer, in men. Being diagnosed with cancer usually sets off a cascade of emotions, making patients feel confused, anxious, and at times, even hopeless. All too often this is compounded by the challenges of determining a plan of action to treat ones disease.
Patients diagnosed with prostate cancer must weigh their treatment options with their personal treatment goals. Regardless of therapy, strongly consider physician experience. Choose wisely: It is with the robot that a surgeon completes the surgery, not the robot itself. The experience of the surgeon is one of the most important factors to consider.
Quality of life after prostate cancer matters most. Of course, every patient wants to be cured from this cancer but what about urinary control and sexual function? With radiation, the outcomes are far too varied. With robotic surgery, where the essential nerves are spared by a skilled surgeon, patients can get back to their regular day-to-day life.
So take the time to speak with your physician about the options that will most benefit you in the long run. As prostate cancer is often referred to as "The Silent Killer" the critical action men must make is an effort to get screened, to catch this disease early because in the end "the silent killer" doesn't always have to kill.