CyberKnife vs. Robotic Prostatectomy – What to choose?

Dr. David Samadi, the Director of Men’s Health at St. Francis Hospital, has performed over 7,000+ robotic prostatectomy procedures in the past years. Robotics is among the latest buzzwords across a wide range of medical specialties. With regard to prostate cancer treatment, the options are vast and the names can often be confusing.

For example, robotic prostatectomy surgery has very little in common with robotic radiosurgery, despite the similarities in name. Let’s see Dr. David Samadi’s take on two prostate cancer treatments: CyberKnife vs. Robotic prostatectomy.

What is CyberKnife treatment?

Robotic radiosurgery, also branded as CyberKnife Robotic Radiosurgery, is not actually a type of robotic surgery. Developed by Accuray, a radiation oncology company, FDA-approved CyberKnife involves no cutting at all, but rather is radiation for the treatment of cancer. 

Through a series of 1-5 procedures on different days, the patient receives targeted radiation to the cancerous area. This is a minimally invasive procedure believed to limit the radiation exposure to the surrounding non-cancerous tissue through its precise ability to hone in on the cancerous prostate. 

A recent multi-center study of low-risk prostate cancer patients showed a 93% non-recurrence rate after 5 years. On the other hand, the procedure is relatively new and data is limited. 

Can the CyberKnife procedure treat prostate cancer?

In Dr. Samadi’s opinion, this type of radiosurgery has two significant limitations. First, it relies on pre-surgery CT scan data to determine the size, shape, and location of the tumor. 

“We just don’t learn enough from those pre-surgery scans,” stressed Dr. Samadi. “What we think is low-risk, very localized prostate cancer could be more invasive, and could therefore be missed by this type of treatment.” Further, Dr. Samadi clarifies, this is radiation and though the hope is that the cancer will never return, treatment options may be limited if it does. “It’s considerably more challenging to perform robotic prostatectomy surgery after radiation, so if the cancer comes back treatment options can be more limited.”

Why use CyberKnife for prostate cancer?

CyberKnife is the first treatment that leverages the true meaning of robotic precision in order to track down, detect, and correct according to tumor motion in real-time. All this technology is in place to guide radiation precisely towards cancer cells while limiting damage to healthy tissue. Nonetheless, CyberKnife remains a viable option for early-stage prostate cancer. In these cases, the treatment is usually combined with other therapies such as hormone therapy in order to address the cancer cells that reached nearby tissues. Doctors may also recommend CyberKnife to individuals with advanced cancer with the purpose of slowing down progression.

Unique benefits of CyberKnife radiosurgery system

• Speed – while traditional radiation therapy requires weeks in order to deliver results, prostate cancer patients finish their CyberKnife treatment in days;
• Precision – CyberKnife has the advantage of extreme accuracy in killing cancer cells while sparing healthy tissue;
• Comfort – even though it has the word “knife” in its name, this treatment actually requires no incision and it’s a non-invasive procedure;
• Flexibility – CyberKnife can be adapted to numerous tumors and lesions;
• Synchronization – CyberKnife differentiates itself from other treatments through the ability of tracking, adapting, and synchronizing with the movement of the prostate gland in real-time which ensures the delivery of radiation to the right target – cancer cells.

Possible side effects of CyberKnife treatment

Side effects of CyberKnife treatment are usually mild and temporary. They can include:

• Blood in stool;
• Constipation;
• Hemorrhoid;
• Rectal bleeding;
• Urinary bleeding;
• Erectile dysfunction.

Recovery after CyberKnife robotic surgery

CyberKnife robotic surgery is a non-invasive, non-surgical procedure. It is painless and the patient can go back to their normal routine right after the treatment. In other words, there is little to no recovery time.

The patient doesn’t need to be sedated during the procedure, and that’s because the body receives no incision whatsoever. Therefore, the patient feels no pain, and there’s a significantly reduced incidence of sexual, urinary, and bowel function side effects. All in all, the patient can conduct normal activity during the CyberKnife treatment.

What is robotic radical prostatectomy?

During a robotic radical prostatectomy procedure, the surgeon uses finely controlled robotic tools consisting of high-resolution cameras and micro-surgical instruments to remove the cancerous prostate. Though minimally invasive, the surgeon is still able to clearly see the entire surgical field. 

Benefits of robotic prostate surgery

Blood loss is minimal, vision is 3D and enhanced 10x, and the dexterity of the instruments allows an experienced surgeon to guide it in all directions with full rotation. For Dr. Samadi, robotics is the perfect blend of old and new. “I see robotic surgery as a great marriage of the benefits of traditional, open surgery and state-of-the-art technology,” said Dr. Samadi whose patients have a 97% cure rate. “Essentially, I can see and do everything I used to see with traditional surgery without risking the same traumas to the patient.”

And seeing is everything, according to Dr. Samadi. “The reality is that cancer staging tests provide limited information. Often, it’s not until I’m in the midst of surgery that I can fully see the extent of cancer. And there’s a high incidence of post-surgical tests that stage a patient’s cancer at a more advanced level than pre-surgery biopsies were able to.” 

For this reason, Dr. Samadi believes prostate cancer staging is useful but should not be depended on too heavily.

Last, the peace of mind that follows robotic radical prostatectomy is a major advantage, according to Dr. Samadi. “After robotic prostate surgery, a man’s PSA level typically remains at zero. For someone recovering from a prostate cancer diagnosis, that zero is like a golden egg. After radiation, PSA levels can continue to fluctuate. This can be mentally and physically taxing with ongoing prostate cancer tests and treatments.”

How long does robotic prostate surgery take?

Robotic prostate surgery is a minimally invasive procedure that can be performed in an outpatient setting. It is a surgical treatment for prostate cancer.

The surgery takes about 2 hours, but the patient needs to stay in the hospital for 1-2 days after the surgery.

Risk and side effects of robotic prostatectomy

Robotic surgery has been found to be more effective than traditional open surgery because it reduces blood loss and post-operative pain. The risks and side effects of this surgery are minimal. The most common side effect is urinary incontinence, which can be treated with medication or physical therapy. Here are other possible complications:

• Infection;
• Blood clotting;
• Bleeding;
• Heart attack;
• Hernias;
• Permanent urinary incontinence;
• Impotence;
• Strictures.

Schedule an appointment with Dr. Samadi, one of the best robotic surgeons in NYC, for the best treatment advice!