Understanding the role of robotics in prostate cancer treatment: radiosurgery versus robotic prostatectomy; Dr. David Samadi explains.
NEW YORK, March 29, 2012
As it turns out, new-to-the-market CyberKnife® Robotic Radiosurgery by Accuray is not robotic surgery at all. Rather, in the treatment of prostate cancer, CyberKnife® uses targeted high-dose radiation to attack prostate cancer cells. As Vice Chairman of the Department of Urology and Chief of Robotics and Minimally Invasive Surgery at Mount Sinai Medical Center, Dr. David Samadi worries that CyberKnife® branding may mislead patients in its attempt to capitalize on the robotics craze.
“Prostate cancer radiosurgery is radiation, plain and simple,” Dr. Samadi clarifies, “While there are some very effective roles for radiation in the treatment of prostate cancer, patients do not benefit from clouded messaging and confusing branding.”
CyberKnife® radiosurgery does employ robotic technology for imaging and radiation administration; however, there is no surgical component. High-dose radiation over a series of 1-5 procedures targets prostate cancer cells in low to moderate risk prostate cancer patients. Dr. Samadi supports the use of radiation in the treatment of prostate cancer, particularly for high-risk patients in need of ongoing follow-up treatment. But, he stresses that prostate cancer treatments like CyberKnife® must be accurately categorized under radiation, inclusive of the same benefits and concerns.
CyberKnife® Robotic Radiosurgery realities:
Limited Treatment Planning – CyberKnife® radiation is administered based on a “best guess” plan guided by pre-treatment biopsy and CT scan imaging to evaluate tumor location, shape, and size. While imaging tools are also used during the procedure, Dr. Samadi knows the dangers of relying on limited pre-surgery diagnostics for prostate cancer staging and treatment planning. First-hand surgical assessment and post-surgery tumor testing is vital to success; this knowledge is simply unavailable with radiation. In fact, post-surgery tumor analysis changes prostate cancer staging in as many as 40 percent of patients, and it is not until that point that a significant amount of information is established regarding exactly what type of cancer is present, how much is there, and the status of the seminal vesicles and lymph nodes.
Lifetime PSA and Tumor Monitoring – CyberKnife® technology may or may not eliminate a prostate cancer tumor. The tumor may disappear over months or years following treatment, or it may remain in the body with stunted growth. Further, after radiation a man’s PSA level will continue to fluctuate. While robotic prostatectomy surgery does require post-treatment monitoring, the lifetime of testing and worry that accompany radiation can be physically and emotionally taxing.
Restricted Options for Recurrence – While CyberKnife® is an effective prostate cancer option for some men, recurrence of the disease after radiation has severe treatment limitations. Men who choose radiation as a first defense risk eliminating prostatectomy surgery as a secondary treatment. If the results of prostate cancer radiation are not as expected, or if the cancer returns, radiation can be repeated but surgery after radiation is very challenging and could be impossible.
Radiation Risks – As with all types of radiation treatment for prostate cancer, CyberKnife® patients may experience urinary issues involving urgency, frequency, and burning; sexual impotence or erectile dysfunction for up to two years after treatment; rectal irritation, rectal bleeding, and stool irregularities; sperm count and fertility issues; and fatigue and nausea. While the treatment cycle is short-term, the potential side effects may not be so. Radiation can also increase long-term risk of bladder cancer and colon cancer by 5 percent.
Dr. Samadi’s patients receive his full support in all post-surgery needs and recovery. The benefits of his unique robotic prostatectomy technique, SMART surgery (Samadi Modified Robotic Technique) are twofold – the prostate cancer is removed and quality of life is preserved. In most cases, 96 percent of Dr. Samadi’s patients regain urinary control within 2-6 months after a SMART surgery and 85 percent regain sexual potency in 12-24 months. Dr. Samadi follows up with every patient after a SMART procedure to ensure optimal post operative outcomes.
According to CyberKnife® patient data only 59 percent of men chose CyberKnife® technology because they believed it to be the most likely to eliminate their prostate cancer. “When I discuss robotic prostatectomy surgery with patients for the first time,” says Dr. Samadi, “I’m able to give them the assurance of the nearly 4,000 successful procedures I’ve performed myself from start-to-finish.” With compliance to post-operative care, Dr. Samadi’s patients have the cancer-free assurance of a zero PSA just six weeks after surgery – in contrast to the uncertainty of PSA fluctuations following CyberKnife® treatment.