1. The Role of Cyberknife Stereotactic Body Radiation Therapy in the Treatment of Localized Prostate Cancer David M. Spellberg M.D., FACS Naples Urology Associates, P.A. Naples, Florida

3. TREATMENT OPTIONS WATCHFUL WAITING SURGERY RADIATION THERAPY CRYOTHERAPY HIFU PROTON HORMONAL MANIPULATION CHEMOTHERAPY EXPERIMENTAL

4. COMPLICATIONS OF TREATMENT INCONTINENCE IMPOTENCE EJACULATION DYSFUNCTION BOWEL PROBLEMS WORSENING OF OVERALL HEALTH

5. Radiation Options ConvenienceInvasiveToxicityEfficacy IMRTLowNoModHigh LDR BrachyTx HighYes X 1ModHigh HDR BrachyTx ModerateYes X 2ModHigh CKHighNoVery LowTBD

7. PATIENT DRIVEN NON-INVASIVE MINIMAL SIDE EFFECTS MINIMAL DISRUPTION OF LIFE EFFICACY

8. Precise control limits dose to the rectal wall and urethra Prostate Radiosurgery Image courtesy of San Diego CyberKnife Center

9. Patient lies comfortably on the couch while the CyberKnife robot moves, images and treats. Treatments typically last 1 hour Most patients require no sedation allowing them to depart at the completion of their treatment CyberKnife Treatment Delivery

11. Precise control limits dose to the rectal wall and urethra Automatic correction for target motion during treatment Prostate Radiosurgery Footage courtesy of St. Anthony’s Hospital

12. Basic Demographics Ages 62 to 85 Stage cT1cNoMo to cT2bNoMo All patients treated between 12/07/2004 and 12/31/2007 Total number of Patients = 213

13. PSA Response to Cyberknife

14. IPSS Scores After Cyberknife SBRT

15. RAS and SHIM Scores after Cyberknife SBRT

16. Summary Cyberknife is a new and innovative treatment delivery technique for prostate cancer. Cyberknife monotherapy produces an early decline of PSA’s in low risk patients. The acute toxicity of Cyberknife monotherapy is very minimal compared to other radiation treatments. Cyberknife therapy is a noninvasive and convenient treatment option for patients with early stage prostate cancer. Prostate cancer patients treated with Cyberknife should continued to be enrolled and followed in research protocols, and the data collectively analyzed.