If you or a loved one is facing a prostate cancer diagnosis, you may be wondering about the best treatment options available. Join Dr. Sean P. Collins as he educates listeners on the groundbreaking CyberKnife technology he uses to treat his patients at Tampa General Hospital. Dr. Collins shares insights on the precision and convenience of this innovative treatment, allowing patients to complete their therapy in just five sessions instead of the traditional 25-40. He discusses who qualifies as an ideal candidate for CyberKnife therapy and what you can expect throughout the process.
CyberKnife: Revolutionizing Prostate Cancer Treatment
Featuring:
Sean P. Collins, M.D., Ph. D.
Dr. Sean P. Collins is a highly accomplished radiation oncologist, most recently serving as the director of the CyberKnife Prostate Program at MedStar Georgetown University Hospital in Washington, D.C. With board certification from the American Board of Radiology in Radiation Oncology, Dr. Collins has dedicated over two decades to advancing the treatment of prostate cancer. Specifically, he has treated over 2500 men with prostate cancer utilizing the CyberKnife. He has been at the forefront of innovative radiation therapies, earning him recognition as a Washingtonian Top Doctor since 2015.
In addition to his clinical expertise, Dr. Collins is a prolific researcher and educator, contributing to national and international efforts to improve cancer treatment outcomes. He has published over 300 peer reviewed articles and abstracts many of with evaluated patient reported outcomes (PRO) following prostate cancer treatment. He has obtained grant funding from the National Cancer Institute focusing on determinants of racial disparity in prostate cancer. Has served as an active member of the Alliance in Oncology Radiation Oncology and GU Committees since 2010. He currently serves on the steering committee for two trials assessing the potential benefits of rectal spacers with prostate radiotherapy. Most recently he was selected as incoming Chair of the Programmatic Panel for the Department of Defense (DOD) Prostate Cancer Research Program. Recognized for his leadership in prostate cancer care, Dr. Collins continues to push the boundaries of cancer treatment, while mentoring the next generation of radiation oncologists.
Transcription:
Amanda Wilde (Host): Prostate cancer treatment with CyberKnife has become an invaluable tool in the treatment of prostate cancer, but it's not necessarily widely available. We'll get into the details next.
This is Community Connect, presented by TGH. I'm Amanda Wilde. Joining me is Dr. Sean P. Collins, Professor and Vice Chair of Faculty Affairs at Tampa General Hospital. Welcome, Dr. Collins.
Dr. Sean Collins: Thank you for having me. This is an important message that I want people to hear.
Host: Well, let's talk about the CyberKnife. I know it's a robot. How is it different from conventional radiation therapy for prostate cancer?
Dr. Sean Collins: So, your prostate moves with bladder and rectal filling. And most other radiation modalities just add a larger margin around the prostate when they're treating so they don't miss it. With the CyberKnife, we actually put gold markers in the prostate, do continuous tracking where the prostate is, so we can treat with small treatment margins, which allows us to give large doses of radiation, which are more effective for prostate cancer over a shorter period of time.
So instead of going for like 25 or 40 treatments that you do with conventional radiation, you can get treated in just five sessions with the CyberKnife. You know, like men in their 60s and 70s are still working. They're really busy. They don't have time to go for 25 to 40 treatments of radiation. They have lives to live, jobs to do. They want to travel, they want to see the world. So, the CyberKnife allows them to complete their treatments in just five treatments over one to two weeks.
Host: So, CyberKnife is a more focused, more precise radiation.
Dr. Sean Collins: Yes.
Host: And the sessions you're talking about-- five versus, say, 25-- are they a different length of time than the traditional radiation?
Dr. Sean Collins: That is an excellent question. They're actually about the same length of time now. In the past, they used to be about an hour long. Now, with the new CyberKnife that we have at Tampa General Hospital, each treatment is roughly 20 minutes or similar to what a conventional radiation treatment would be.
Host: So, what is involved for the patient who's undergoing CyberKnife treatment? Can you kind of do a walkthrough of how it would be?
Dr. Sean Collins: Yes. So, what happens is first you meet a radiation oncologist like me, and we interact with you and we decide whether you're a candidate. If you're a candidate and you decide to proceed, then I usually put, or urologist puts gold markers in your prostate that the CyberKnife can track using x-rays. And sometimes we put gels between the prostate and the rectum too, to protect your rectum from the radiation. You come back roughly about a week later, and we get a treatment planning CT scan and MRI. And this helps us identify where your prostate is, where your urethra is, and also tells us what the relationship of your prostate is to the bladder and the rectum. And this why we can target the radiation to your prostate while minimizing the dose to your bladder and your rectum.
The treatment planning process takes about two weeks, and then you come back and you get five treatments over two weeks. At Tampa General, we usually do them Monday, Wednesday, Friday, the first week; and Tuesday, Thursday the second week. Each treatment is about 20 minutes long. You lay flat on a table, the machine rotates around you, tracks your prostate. And basically, you can't smell the radiation, you can't see the radiation, you don't feel it. And you get off the table the first day you're like, "Did you guys do anything? I don't feel anything."
Host: And is there anything patients feel later after CyberKnife treatment?
Dr. Sean Collins: So when we radiate your prostate, your prostate does swell a little bit, so just like conventional radiation, you can have urinary frequency and urgency for about three months, and bowel frequency urgency for about a month. Some patients have no symptoms, but some patients do have urinary frequency and urgency, and bowel frequency and urgency.
Host: So, those are temporary side effects?
Dr. Sean Collins: Usually, acute side effects are temporary and they go away with time.
Host: And are there other side effects?
Dr. Sean Collins: Well, unfortunately, your prostate is a sexual organ. And you can get sexual dysfunction that happens months to years after the radiation. The good news about radiation is that men with sexual dysfunction related to radiation usually respond to oral agents like Viagra, Cialis, and Levitra to regain erectile function.
Host: Well, I imagine the treatment for prostate cancer is somewhat dependent on the stage of the disease. Who is the ideal prostate cancer patient for CyberKnife treatment?
Dr. Sean Collins: Everybody with prostate cancer is potentially a candidate for CyberKnife treatment. Usually, for the low to intermediate risk prostate cancer patient, we usually do the CyberKnife alone with five doses of radiation over one to two weeks. For the unfavorable intermediate risk patients, we usually add some hormonal therapy to make the radiation work better. And for the high-risk prostate cancer, sometimes we combine the CyberKnife, with a short course of conventional pelvic radiation to make sure that we don't undertreat the pelvic lymph nodes. But that was a great question because everybody's a potential candidate for CyberKnife. That's why you need to be assessed by someone who is highly experienced treating patients with the CyberKnife.
I've been a practicing radiation oncologist for 20 years. I've treated over 2,500 patients with prostate cancer, with the CyberKnife. I am highly experienced. I have an amazing team of dosimetrists, therapists, physicists who have CyberKnife experience. I have a great nursing staff with a great nurse practitioner. We have lots of experience managing any potential side effects. And one of the main reasons for coming to Tampa General Hospital is because of our team.
Host: Well, I was going to ask you about Tampa General Hospital specifically. Why come to TGH for CyberKnife treatment?
Dr. Sean Collins: I was at Georgetown for 20 years, and the Tampa General recently got the most up-to-date version of the CyberKnife, which I think is a real advantage. I love living in Tampa and moving to Florida, but it's also nice having the best radiation machine in the world. And the great thing about the CyberKnife at Tampa General is it has a multileaf collimator that allows us to treat the patients more quickly, which is great because laying on a table for 20 minutes versus an hour, I rather lay on the table for 20 minutes.
The other great thing about the CyberKnife with the multileaf collimator is the radiation exposure to the normal tissues like the rectum, the bladder, and your penis are a lot less with the new CyberKnife. And I have yet to meet a guy who wasn't concerned about his radiation dose to his penis.
Host: Yeah, that's understandable. So with the advances in technology, we're seeing new iterations of the CyberKnife.
Dr. Sean Collins: the CyberKnife, I've been using it for 20 years, and it gets better all the time. It gets more convenient for patients with less dose to normal tissues. I'm lucky that I get to use it every day. It makes me a better doctor, the fact that I have good technology.
Host: And I think you touched on this a little earlier, how have you seen CyberKnife impact patient outcomes differently than other treatments?
Dr. Sean Collins: What we've learned over the last 20 years is if you can give the radiation accurately more quickly, it's actually more biologically effective. So when you use the CyberKnife, you're actually giving a higher dose of radiation than you do with conventional radiation. And that higher dose of radiation gives us a better chance of curing men with prostate cancer. The PSA nadir are lower when you give five large doses of radiation over giving 25 to 40 small doses of radiation, so not only is it more convenient, it's more effective.
Host: Well, Dr. Collins, thank you for the work that you do that gives patients the best possible treatment for prostate cancer.
Dr. Sean Collins: Well, I got to tell you, I love my job. I love hanging out with older guys. I wouldn't trade my job for any other one.
Host: That was Dr. Sean P. Collins, Professor and Vice Chair of Faculty Affairs at Tampa General Hospital. For more information, please visit tgh.org/cancer.
Host: If you enjoyed this episode, please be sure to like, subscribe and follow Community Connect, presented by TGH on your favorite podcast platform. I'm Amanda Wilde. And this is Community Connect, presented by TGH. Thanks for listening.