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CyberKnife “robotic radiosurgery” for localized prostate cancer …

Posted Sep 28 2008 1:49pm

… Are we getting things out of proportion?

The CyberKnife® system  was initially developed as a method to treat tumors in places like the brain that were inaccessible to physical surgery, and was originally approved by the FDA in 1992. Now it is being touted as “the next thing” in “radiosurgery” for prostate cancer.

In 2003 an article was published by King et al. that reviewed the theoretical potential of the CyberKnife in treatment of prostate cancer. And a Phase II clinical trial has been initiated to explore whether CyberKnife surgery really does have potental in the treatment of prostate cancer. The trial hopes to enroll nearly 300 patients and won’t report outcomes until some time in 2014. This is the sort of thing that can happen when large number of people start to present with a treatable condition: the numbers and types of treatment start to expand, sometimes exponentially.

Of course, because the CyberKnife is already approved, there is nothing to stop CyberKnife users from carrying out such “radiosurgery” today. Ando some centers clearly are. If you want to get an idea of the marketing that is already in place, have a look at this link (just as an example). This morning in my mail I received an invitation to an “eSymposium” on CyberKnife use in the treatment of prostate cancer, in which one of the speakers is an employee of the manufacturer of the CyberKnife technology.

Here are some questions that need better answers than those offered below:

  • Is CyberKnife as effective and as safe as other forms of therapy for the treatment of localized prostate cancer? Answer: We don’t know.
  • What is the cost of CyberKnife treatment for localized prostate cancer? Answer:We don’t know, but the equipment alone costs around $4 million.
  • Is the average health insurance carrier reimbursing for CyberKnife treatment of prostate cancer? And what about Medicare? Answer: We don’t know, but it would surprise us if they are.
  • Would you have considered CyberKnife therapy for prostate cancer, if it had been available when you were treated? Please let us know by posting your comments below.

Please let us be completely clear. CyberKnife therapy may be an absolutely wonderful form of treatment for localized prostate cancer. But what we know at the moment is that:

  • Many men who get actively treated for localized disease may not need treatment at all (especially some of the older ones).
  • Most men who have treatment for early stage disease do well with available therapies.
  • The available data on the short-term (let alone the long-term) outcomes of CyberKnife therapy for prostate cancer are minimal at best.
  • There are only three papers on CyberKnife therapy for prostate cancer in the PubMed database (and not one of the three offers peer-reviewed clinical data).
  • Several centers are actively promoting this form of therapy, despite the limited outcomes data available.

Finally, so that we are not accused of being out of date curmudgeons (or similar), you may want to read one patient’s view of the situation. We offer the following link to Donn Rosenauer’s decision to go with CyberKnife therapy.

Filed under: Management, Treatment | Tagged: prostate, cancer, robotic, localized, CyberKnife, radiosurgery

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