I am Dr. Sean Collins. I am a radiation oncologist at MedStar Georgetown University Hospital. I love
my patients. I take care of men with prostate cancer. I learn more from my patients than they
learn from me. They're amazing. Most of them are retired. They're living their lives to the fullest.
They have hobbies. They're traveling. I get a lot more from patients than they get from me.
My philosophy is it's not a good enough to cure someone anymore. You have to cure them
and make sure that they don't have adverse side effects from the treatment. If I cure you and
you're leaking on yourself afterwards, that's not a good outcome. If I cure you and you have decreased
sexual function, that's not a good outcome. I always want to be communicating. I'm not going to just
treat you and then forget about you. We're going to treat you, and we're going to follow you for
the rest of your life and make sure that if any you know thing comes up that we take care of it.
I get to use amazing technology to cure people with life-threatening cancers. I actually enjoy
working with people. So the fact that I get to treat someone and interact with them for the
rest of their lives, I really like that aspect of it. When I started, radiation oncology didn't have a
lot of accuracy to it. Over the last 20 years, our treatments have become more accurate so that we
can actually treat people with fewer treatments. So instead of someone coming five days a week
for eight weeks for treatment, they just have to come five times over two weeks. So instead of
hanging out in my radiation oncology department, they can be living their lives, traveling, seeing
the world, taking care of their grandchildren, and not thinking about their prostate cancer.
I'm not just an M.D. I'm an M.D., Ph.D. So it's not acceptable to me to just do treatments
and keep the standard of care the way it is. I want to improve treatment outcomes.
The only way to improve treatment outcomes is to treat someone and then follow them
and see how they do afterwards. I'm not only helping the patients that I'm treating now,
I'm also helping future generations of prostate cancer patients. Prostate cancer is a team sport.
So we have the best urologists. We have the best medical oncologists. In the Radiation Oncology
Department, we've been treating prostate cancer with the CyberKnife for 14 years.
We've treated approximately 1,800 patients. We're one of the most experienced centers in the world.
We were one of the first centers to have a CyberKnife on the East Coast the United States.
We have the most experienced therapists. They love working here, so they stay with us. We have the most
experienced physicists. They stay here because they like working with us. We're just an amazing team.
So CyberKnife is a linear accelerator or a radiation generator on a robotic arm. The
reason why that's important is it can set up to your prostate very accurately, target motion,
and treat with very small margins. Why is that important? Your bladder, your rectum, and your
penis are right next to your prostate. The smaller the treatment margins, the less bladder, rectum, and
penis that we treat with the radiation. And what does that mean? That means that you'll
have less long-term side effects. What it also means is that we can give the radiation more quickly.
Radiation for prostate cancer works better if we give it more quickly. Five large doses of radiation
given accurately works better than 40 small fractions of radiation given with less accuracy.
So the important thing about the CyberKnife is your prostate actually moves, and the CyberKnife
actually tracks prostate motion and adjusts. So as your prostate's moving, the CyberKnife is tracking
it. So we put gold markers in your prostate, and the CyberKnife can set up to those goal markers
and watch them move and adjust as we go. The other nice thing about the CyberKnife is we
get a high resolution treatment planning MRI and CT scans. And these scans, because we have
such a good Radiology Department at MedStar Georgetown University Hospital, really let me
target where the problem is in the prostate and not overdose other areas. And so, we get those scans,
and we give you five large doses of radiation focusing on your prostate
and minimizing doses to other structures so that we can minimize late side effects.
I would argue that CyberKnife is a good treatment option for all prostate cancer patients. And the
reason why it's a good treatment option is because it's highly accurate, and it tracks your prostate
with motion so we hit your prostate without damaging it the surrounding structures. If you
do have cancer in your lymph nodes, we still give a high dose to your prostate with the CyberKnife and
then treat your lymph nodes with alternative forms of radiation. Now, the good thing, the really cool
thing that's happening now is that we're starting to use the CyberKnife to treat oligometastases. So
some people with prostate cancer, unfortunately, have a few metastases either in a lymph node or
a bone. In the past, we used to just do hormonal therapy for the rest of your life which has lots
of side effects. We are now using the CyberKnife to cure men with limited number of metastases.
Everybody with prostate cancer is eligible for CyberKnife treatment. There are some treatment
techniques in radiation oncology that you can't use on men who have large prostates. Radioactive
seeds is a good treatment for prostate cancer with men who have normal size prostates, but you can't
put enough seeds into a man with a large prostate. So those men who have large prostates now have
a treatment option with the CyberKnife that is convenient. So you can go for five treatments going
for the instead of going for the 40 treatments that are required with conventional radiation.
The CyberKnife is extremely accurate, and that accuracy allows for smaller treatment margins.
Smaller treatment margins mean less bladder, less rectum getting radiation
dose which basically means less long-term side effects from from the radiation.
So there are side effects we are radiating your prostate, and your prostate does swell a little bit.
So just like with conventionally fractionated radiation, you can have
acute urinary frequency and urgency, acute bowel frequency and urgency, and a little bit of fatigue.
What we've learned at Georgetown using the CyberKnife for the last 14 years is that
if patients exercise and live their lives normally, they have less side effects. So we commonly tell
patients that they should not change their lives to get CyberKnife treatment. They should live
their lives their normal way. Be active. Spend time with their family. There's no restrictions.
The goal of the CyberKnife is to not disrupt your life. It's to allow you to live your life.
We've treated many patients, so our group is really good at making the process really easy.
So gold markers are first placed in your prostate. That can be done by a radiation
oncologist or urologist. You come back about a week later, and you get treatment planning scans,
an MRI scan so we can tell the computers what to hit and what not to hit, and a CT scan for
dose calculations. Because we treat so many patients, it only takes about a week or two to
do the treatment planning, and they usually come back for five treatments over one to two weeks.
So we usually treat people on Monday, Wednesday, Friday the first week, Tuesday, Thursday the
second week. Each treatment's about 30 to 40 minutes. You lay down on the table and most
guys fall asleep. We put some music on for you. The machine rotates around you, radiates your prostate,
35 minutes later you get off the table. You don't feel anything. You don't see anything. You go hey did
you guys do anything, and your PSA starts dropping months to years later and most likely you're cured.
Well the thing is that if you give radiation with high doses very accurately, you have
a better chance of curing a patient. So patients love it when they watch their PSA
start at 10 and go down to 0.1. And I didn't misspeak. PSAs end up being about .1 5 years
after CyberKnife treatment. So men feel much better, and their chance of being cured is much higher
when they have lower PSAs after treatment. And CyberKnife gives a very low PSA after treatment.
The thing that I'm most excited about with the CyberKnife is that
in the past when men with prostate cancer had oligometastases or or just a few metastases,
we used to tell them there's nothing we can do. And they would go on hormonal therapy for
the rest of their lives, and hormonal therapy has a lot of significant side effects like
weight gain, decreased libido, muscle thinning, bone weakening. So now for men with limited number of
metastases, we can actually treat their prostate and also treat their prostate cancer metastases.
We're not curing all of them, but we will cure a small subset of them. And we'll probably improve
the outcomes of those that we don't cure. So it's the most exciting part of my job that I can extend
the amazing technology in the CyberKnife to help people in the most dire situations.
We have had a CyberKnife at Georgetown for 20 years. We're one of the most experienced
centers in the world for treating men with prostate cancer with radiation.
We not only treat them, i've been the doctor taking care of the patients for 20 years. We treat them,
and we follow them for the rest of their lives. For the last 20 years, we've been improving on
the protocol making it better every year. So you're benefiting from all of our experience with
patients that we have treated in the past, and I think that our program is the best in the world.