Prostate Cancer
Share this page:
Locally advanced or unfavorable disease
For patients who present with a prostate-specific antigen (PSA) level greater than 10 ng/ml, Gleason score > 7, palpably advanced tumor, or combinations of these factors, the prognosis may decrease dramatically compared with the “favorable” group, especially if multiple negative factors are present (29). As with early stage cases, there is a lack of consensus as to optimal therapeutic management. High dose external beam radiotherapy plus or minus androgen suppressive therapy is commonly applied in such cases, which are often considered too advanced for small margin treatment approaches such as radical prostatectomy or brachytherapy.
CyberKnife® prostate radiosurgery would qualify as a small margin approach, and therefore, not suitable for use against non-favorable cases as monotherapy. The combination of EBRT plus a CyberKnife® prostate boost may be a much more viable approach to these patients though, theoretically delivering identical efficacy compared with combined EBRT plus HDR brachytherapy, which has been published effective for non-favorable patients (14).
Combined with EBRT, CyberKnife® boosting represents less of a departure from well published standard integrated radiotherapeutic approaches, such as EBRT plus HDR, and as such, is reasonably delivered in routine clinical practice, whether or not the subject of a clinical trial. As with monotherapy, CyberKnife® radiosurgery delivers the benefit of recapitulating HDR dosimetry without the hospitalization and without the indwelling transperineal catheters.
Written by Donald B. Fuller, M.D. – Radiation Oncologist