Prostate cancer treatment with CyberKnife®

During the examination the treating doctor detected enlarged prostate and that the level of prostate-specific antigen (PSA) has elevated from 5 to 11.

Doctor told that prostate biopsy is needed to specify the diagnosis. Some tumour cells were found in one of samples and it meant that I have prostate cancer in early stage. He explained to me and my wife the examination results, possible treatment options and potential complications. I was offered a prostate surgery. Unfortunately, due to possible side effects about which I read in stories of other patients, I decided to refuse from the offered treatment.

I waited for another six months and then attended the urologist repeatedly, because the PSA level was still elevated, and therefore the urologist recommended radiotherapy. Conventional radiotherapy lasts for six weeks, but due to my work schedule I could not take such treatment and the very disease, according to doctor, was in the early stage. The urologist informed me about possibility to try a new and progressive radiosurgery system, CyberKnife, which was suitable also for my case, and referred me to a consultation to the Radiosurgery Centre in Sigulda. After consultation in Sigulda I was scheduled for five radiotherapy sessions with the CyberKnife system instead of thirty conventional sessions. I attended the procedures three months ago, just as planned.

Treatment process was a real surprise. Both professionalism and technical competence and careful attitude and attention of the staff was very good. The procedures were scheduled in a time convenient for me, on the second half of the day, taking into consideration the busy work schedule that I had. I could completely adapt it to my routine day at work. And, to be honest, I did not feel any discomfort.

Of course, it is too early to say that the cancer has fully disappeared. Doctors told that it would take some time to see if the process is becoming stable. Besides, neither during the treatment nor now I have any of those severe side effects the urologist referred to. Everything seems to work fine and also the PSA level got slightly lower during the first control one month later. During the treatment and also afterwards I carefully comply with the recommendations given by the doctor from the Radiosurgery Centre; so each of us have done their part of the job.

I can recommend patients with urological problems and prostate cancer diagnosis similar to mine to take a consultation and treatment in Sigulda. Staff working in the Centre is competent and treatment with CyberKnife progressed as described in the consultation. I express gratitude to the medical staff for great care and comfortable, almost cosy atmosphere in the Radiosurgery Centre Sigulda. I am grateful to all of them and my only wish is that people suffering from problems similar to mine could afford coming to Sigulda and be treated with CyberKnife. They won’t be disappointed for making such a decision.”

In order to decide on further treatment tactics, the urologist recommended performing MRI examination for the prostate. Magnetic resonance imaging exam confirmed new lesion in the left lobe of prostate without extracapsular growth.

It was followed by a question—what to do? Considering all aspects—my age, PSA index, Gleason score 7 and finding from the MRI scan —the urologist offered radical treatment methods like prostatectomy or surgical removal of the prostate. The physician also informed me about possible complications after the surgery, including complete loss of potency and inconsistency of varied severity. Faced with seriousness of the situation and consequences of the surgical treatment, I started to look for tumour treatment alternatives. If I were 80 years old, I would not give a second thought, but if there are alternatives of treatment nowadays, I want to know them.

In spring 2017, in an internet portal I foundan information about robotic stereotactic radiosurgery treatment possibilities in Sigulda. I found out that robotic stereotactic radiosurgery technology CyberKnife treats tumours of various origin and localisation, including primary prostate tumour.

In order to find out more about possibilities to be treated with this method, I made an appointment with a radiation oncologist. According to recommendations of the radiation oncologist I had positron emission tomography (PET) performed with preparation 68Ga-PSMA, which is currently recognised as the most precise diagnostic method for prostate cancer in order to determine possible tumour cells outside the prostate. Thanks to God, the tumour was localised only in one lobe of the prostate and no cells had been spread outside it.

As I learned about radiosurgery treatment possibilities, their benefits and possible complications, I agreed to be treated with that method.Prior to the treatment I read feedback from patients who were treated in Sigulda as well as experience of patients who were treated abroad.

There were several factors to the advantage of my choice: high-precision technology that delivers radiation exactly to a tumour thus saving the surrounding tissues as much as possible, low complication risk, no direct surgical invasion, painless procedure after which one can go home, short five days’ course of treatment that is adjusted to patient’s routine as well as deep understanding by the radiation oncologist and convincing perspective on my situation andsolutions.

I started treatment in March 2012. Sigulda Hospital is very up-to-date and patient-friendly establishment. In my case I headed for the procedure for five successive days with my car. Each session lasted for approximately one hour and during it I was lying peacefully, thinking over my life and felt no pain. After the session I went home by myself. Even though I had taken a vacation due to the treatment course, I think it would not be problematic to keep working during the treatment.

On a week following the treatment I had slight complaints about which I was already warned. Initially due to oedema I had difficult and more frequent urination, and more frequent elimination due to irritation, because the prostate is located very close to colon. As I observed the recommendations given by the specialists the side effects diminished within few weeks. Three months after the radiosurgery treatment course PSA indexes were back to norm—3.01 ng/ml and two more months later PSA stood at 1.47 ng/ml. At present moment I feel good. Potency is retained, there are no routine complaints about urination, perhaps only more frequent elimination is an issue but I call it nonsense. In dynamics I continue controlling PSA and observe situation on an out-patient’s basis at the urologist. I continue communication also with the Radiosurgery Centre’s specialists regarding the efficiency of my therapy.

I am grateful to Sigulda Hospital Radiosurgery Centre collective and especially Dr. Maris Mezecklis for being responsive,comprehensive and professional.”

We think the problem we noticed is that behind every great doctor in the UK, there is a very highly organised medical secretary, worth their weight in gold, who is highly skilled and deals with all the planning issues to ensure everything runs like clockwork and smoothly and in a timely manner. This part of the equation seems to be sadly lacking in Sigulda this time. We just perceived that you do not seem to get enough support and are left to deal with stuff that you shouldn’t be dealing with as a doctor. We contact you as we know you will respond and deal with everything accordingly but you should have a right hand person, who is as equally efficient and dedicated to take some of the pressure of you.

You mentioned that the Director was looking to expand and find new customers and to do that your support system needs to be much stronger to cope with increasing customer numbers. The other issue is the CT scan and planning for treatment is now done in Sigulda, which frees up more time for you as a doctor, instead of going back and forth to Riga but the MRI still needs to be done in Riga, which seems wrong. We know these machines are very costly but it would make sense to have a top of the range MRI in Sigulda too, so all could be done on site. 

As we mentioned the main problem is people in the UK don’t know about CyberKnife. It is not available on the NHS, so NHS oncologists do not tell people about it, as there is nothing worse than being told there is a treatment available but it is out of reach financially to most people in the Uk. The only reason we knew about CyberKnife and the psma test is Peter’s surgeon told him about it and only because he was based at Birmingham University Hospital, which is one of the few NHS hospitals that have a CyberKnife machine. The problem came in that they withdrew CyberKnife treatment at the end of December for state patients, unless used for areas such as brain cancer and now is only available for people with medical health insurance, so Peter missed treatment by a couple of weeks. The issue with prostate cancer is it tends to be diagnosed in men over retirement age and most give up their private medical health insurance when they retire to cut costs, so can’t access CyberKnife now in the UK. 

Clearly once we knew about CyberKnife and then found we could no longer get it on the NHS and could not afford to pay for it privately in the UK, we researched countries where we could afford it, hence our trip to Latvia but we were the exception.  If you go to the oncologist now, they will not tell you about a treatment they cannot offer, as that will only upset people. There Is a big problem that each country has CyberKnife but the majority of people of that country cannot afford to access it. We are not sure what the solution is but it seems very wrong, as I am sure the cost of treatment in Latvia is doable for us but not for the majority of people of Latvia.

Thank you again for the treatment and we hope that all teething problems are ironed out, as we would highly recommend you to anyone thinking of having treatment. We hope you have a great holiday and a well deserved rest.
Kind regards

Peter and Marry”