What is Cyberknife treatment like for prostate cancer? – Harry Williams*

Harry Williams* was one of the first men in the UK to be treated outside of London with the CyberKnife procedure for prostate cancer. Mr Williams, aged 77, outlines his experience, explains why he chose CyberKnife and how he got on with the treatment.

“After a quite rewarding career in banking and finance I truly was enjoying retirement. By way of medical background, I gave up cigarettes some forty-five years ago; had only ever been on the mildest form of medication simply for seasonal ailments; and was still fit enough to cope with a fairly large garden – in-between holidays. The only blot on my health was that my good cholesterol apparently was not as good as it should have been – as identified in a routine age-related blood test provided under the NHS.

“After some six months of close supervision to my diet by my wife I (or was it she) requested a further blood test. By accident and not design the Laboratory Medicine Services Request Form included a request to measure my Prostrate Specific Antigen – the blood test which measures the protein produced by the prostate. The result, at 6.2 ng/ml (nanograms per milliliter of blood) was slightly above that which is regarded as normal for my age group. I have read some doctors have nicknamed the PSA as the “Promotes Stress and Anxiety test” – and I now know why. From that moment it felt as though the Sword of Damocles was dangling over me!

“My GP recommended a rectal examination at the local hospital whereon roughness was detected on one side of my prostate. A further blood test was taken which showed a rise in the PSA. A biopsy was recommended. At this stage I contacted my medical insurers who agreed to finance any additional tests at The Birmingham Prostate Clinic under Consultant Urological Surgeon, Mr Alan Doherty. He undertook a further rectal examination and a rectal ultrasound. He sent away a urine sample for a laboratory PCA3 Genes test, and arranged a MRI Scan. The results confirmed the need for a prostate biopsy which in turn confirmed there was an element of cancer in eleven out of the twelve needle samples taken. Another blood test showed a further increase in my PSA. An Isotope Bone Scan taken as a precaution was effectively clear – thankfully suggesting the cancer had not become aggressive and had not spread outside the prostate.

“Reportedly, one person dies from prostate cancer every hour and this prompted me into immediate action – namely making sure my Will and relevant papers were in a prominent place for ready access. This was not being flippant. It was something constructive I could do to make things easier for my wife and family should matters take a turn for the worst. I also searched the Web to obtain some background for prostate cancer. As well as contributions from the UK, web-sites in USA, Australia and Germany gave me a broad view and valuable understanding.

“Mr Doherty outlined various procedures and in particular surgery which is his area of expertise. I had confidence that, should I elect this route, I would be in very safe hands with him. He also directed me to Dr Ahmed El-Modir, Consultant Oncologist, who confirmed I was no longer an ideal candidate for active surveillance but radiotherapy was an option to surgery. The cure rate between the procedures is equal – and radiotherapy clearly is not as invasive for the patient. If I decided on radiotherapy there were three options: Brachytherapy, for which I was not the best of candidates because of abnormalities on my prostate; IMRT (intensity modulated radiotherapy) which would be administered in thirty seven sessions over a period of seven and a half weeks; and CyberKnife which is a robotically-controlled radiation delivery machine which allows large amounts of radiation to be delivered with precision to a very small area thereby reducing the number of sessions required to five. However, Cyberknife is not available under the NHS nor is it supported under some private medical insurance. The way forward was my decision.

“In my lifetime I had only once been under a surgeon’s knife. At age 25 I was rushed by ambulance for an emergency and truly life saving appendectomy. After three days in hospital (customary in those days) I was discharged but there were complications with draining of residual fluid. The outcome was a return to hospital and an uncomfortable eleven weeks off work – initially with an open wound which could not be sutured. I have since carried a three inch scar to remind me. So the odds were stacked against surgery and when my insurers agreed to CyberKnife (albeit with certain provisos) I was eager to follow that procedure before my cancer had more time to become aggressive.

“There are only four CyberKnife machines in the UK. One is located at Queen Elizabeth Hospital, Birmingham in a dedicated and highly reinforced room because of the intense radiation. The machine is mounted on a robot arm so that the radiotherapy can be given very accurately to the prostate. As with operations in every-day life, detailed preparation for this procedure is of prime importance and Dr El-Modir expertly commanded a coordinated team effort throughout. For guidance of the CyberKnife machine (think SatNav for comparison) preparation included implanting fiducials (three gold markers, the size of a grain of rice) into my prostate. This was done under general anesthetic. Tablets were prescribed for possible swelling. Further MRI and CT scans were later taken and superimposed on each other which I understand was to give the precise location of the fiducials in the prostate together with images of nearby muscle and bone. – there is literally nothing to it.

“That is the end of my attempt at explaining technicalities. Correspondence and precise detail of the procedure are available on the Internet. My contribution then was to administer an enema at home; attend the hospital at the prescribed time on five alternate days; lie on a quite comfortable bed; and keep as still as possible whilst listening to some very choice music. In an adjacent room Dr El-Modir’s excellent team were supervising the programmed CyberKnife machine, the robotic arm of which maneuvered over me for some 40-50 minutes each session delivering the prescribed doses of radiation and taking X-rays.

“My wife always accompanied me to the hospital, but I drove the car both ways and truly would have been fit for work – if I was not retired. The only noticeable after affect on me was a few seconds burning sensation initially when I passed water. This lasted over a period of about four weeks. It had been anticipated and tablets were prescribed to lessen the effect. I have been fortunate in always having complete muscle control for bladder and bowel purposes and this was in no way affected. I still have eight hours (minimum) undisturbed sleep each night!

“I believe CyberKnife was the right procedure for my particular circumstances and I made the right choice. In was not intrusive and I could not have asked for better treatment throughout from Dr El-Modir and his team. I am conscious, however, of that favourite saying in the good old Western films “The show’s not over until the fat lady sings”. I am happy to say that she may be in rehearsals as my PSA reading taken three months after the procedure had dropped substantially. My schedule is for check-ups after a further six months and, all being well, four more at yearly intervals – after which I will do the singing myself.

“I have volunteered this summary experience anonymously because prostate cancer was identified in my genes. This is a male related disease and, in addition to my wife, I felt that only our children and my brothers should be aware of my situation. Whether they tell their respective wives, sons and grandsons is at their discretion. Checking PSAs after, say, age 50 would be prudent for them but the measure could indeed Promote Stress & Anxiety. However it also gives the opportunity for Preparation Strategy & Action which could be life-saving. Not the most comfortable decision to be obliged to take but I wish you all well.”

*The patient wishes to remain anonymous so his name has been changed.