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

2. Frameless Radiosurgery Robotics Image Guidance Advanced Treatment Planning CyberKnife Technology

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

4. 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

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

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

8. 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

9. Prostate PTV: gland expanded 5 mm in each direction except posteriorly where it is expanded 3 mm

10. Prostate comparison: axial & sagittal 40 and 25 mm colls40 mm coll

11. Prostate comparison: urethra 40 mm coll40 and 25 mm colls 18.7% vol at 90% dose 30.8% vol at 90% dose

12. Prostate comparison: bladder 12.2% vol at 60% dose 16.7% vol at 60% dose 40 mm coll 40 and 25 mm colls

13. Prostate comparison: rectum 40 mm coll40 and 25 mm colls 20.5% vol at 60% dose 11.2% vol at 60% dose

14. 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

15. PSA Response to Cyberknife

16. IPSS Scores After Cyberknife SBRT

17. RAS and SHIM Scores after Cyberknife SBRT

18. 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.