Prostate

Eligibility

  • Histologically proven adenocarcinoma
  • Low risk disease (T1–T2a, Gleason score of ≤6 and PSA <10ng/ml)
  • Intermediate disease (T2b–T2c or Gleason score of 7 or PSA 10–20 ng/ml)
  • AUA symptom score of ≤20/35
  • Prostate volum <100ml
  • Patient condition satisfies simulation and treatment requirements for reproducibility
  • 18 years of age or older

Exclusions

  • Prostate volume ≥100ml
  • Implanted hardware or other material that would prohibit appropriate planning or treatment delivery
  • Prior radiotherapy to the prostate or lower pelvis, cryotherapy to the prostate, or HIFU to the prostate
  • T3–T4 disease
  • Gleason score ≥8
  • PSA >20
  • T1–T2a and Gleason score 7 and PSA >10
  • T2b–T2c and Gleason score 7 or PSA >10

Protocols

  • Fiducial marker placement must follow Accuray guidelines for size and placement
  • Diet and bowel prep:
    • Patient to use Beano routinely during course of planning and treatments
    • Minimal fiber and residue–restricted diet for:
      • 48 hrs prior to planning MRI and CT scans
      • 48 hrs prior to and during CyberKnife treatments
    • Fleet enema 1–2 hrs prior to MRI and CT scans and all treatments
    • Empty bladder 1/2 hour before MRI and CT scans, and immediately before each CyberKnife treatment
    • If treated in the morning, patient does not eat breakfast
    • If treated in the afternoon, patient may eat a light breakfast
  • Treatment planning simulation
    • Approximately 5–7 days after fiducial placement
    • Patient lies on thin table pad, small pad under knees, pillow for head, immobilization device for legs
  • Imaging studies
    • Primary planning CT (no cathether)
      • Supine, head first, with treatment pads
      • Start minimal residue diet 48 hrrs prior, Fleet 1–2 hrs prior, void 1/2 hour prior
      • No catheter, no contrast
      • 300–400 slices
      • Centered around prostate (pubic symphysis)
    • Secondary CT with catheter recommended, 16 French foley
      • Required if planning to prescribe PTV at <75% isodose line
      • MRI
    • Dose: 36.25Gy in 5 fractions of 7.25 Gy per fraction, every other day
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