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Dr. Garber is a Urologist specializing in the following areas:

- Penile Implants / Impotence
- Prostate microwave treatment
- Prostate laser vaporization
- Cryo (freezing) prostate cancer
- CyberKnife® Treatment of Prostate Cancer
- Other Male Urologic Disorders
- Urology Expert Witness Services
- UROLIFT enlarged prostate treatment
- NEW: Penile Enlargement and Male Genital Cosmetic Procedures
- Urologic Instruments

CyberKnife® Treatment of Prostate Cancer

Prostate cancer can be treated in a variety of ways, including:

  1. Observation (no immediate treatment);
  2. Radical prostatectomy (complete surgical removal of the prostate and seminal vesicles, through an incision in the abdomen or under the scrotum, or using laparoscopy with or without a surgical robot);
  3. Hormone therapy (anti-androgen treatments designed to lower the male hormone level and/or block the effects of male hormones);
  4. Chemotherapy (usually reserved for patients with extensive cancer); and
  5. Radiation therapy.
Radiation therapy for prostate cancer has undergone tremendous evolution in the past two decades and has included techniques such as:
  1. Four-field external beam treatment;
  2. 3D conformal radiation;
  3. Intensity-modulated radiotherapy (IMRT);
  4. Brachytherapy (low dose rate radioactive seed implantation, and high dose rate brachytherapy);
  5. Tomotherapy;
  6. Image-guided radiotherapy (IGRT);
  7. Proton therapy; and, most recently:
  8. CyberKnife® stereotactic radiosurgery.

CyberKnife® is a robotic radio-surgery system, which is used to treat a variety of benign and malignant tumors. It is composed of a compact linear accelerator (a source of radiation), which is mounted on a computer-controlled arm. The CyberKnife® System uses real-time continuous image guidance during each treatment session. It delivers multiple beams of high-energy radiation to the tumor from many different directions, and constantly adjusts for any movement of the target organ. The net result is a high dose of radiation delivered to the cancer, in the most precise way currently possible. Radiation treatments are accurately delivered to the prostate and a small amount of tissue surrounding the prostate, minimizing the amount of radiation received by sensitive nearby structures (such as the bladder, rectum, and penis).

A typical patient would proceed as follows:
  1. Prostate cancer is suspected due to an abnormal prostate exam or an elevated prostate-specific antigen (PSA) level;
  2. Prostate cancer is diagnosed by a prostate biopsy;
  3. X-rays (a bone scan, MRI or CT scan) may be ordered to evaluate the extent of the cancer;
  4. Treatment options are discussed. If CyberKnife® is selected, the patient is referred to Philadelphia CyberKnife® Center in Havertown, PA (610-446-6850, www.phillycyberknife.com) for evaluation by a CyberKnife®-trained radiation oncologist. When the decision to proceed with CyberKnife® treatment has been made, the patient returns to Dr. Garber for placement of 4 tiny gold markers (fiducials) into the prostate. This is done in the office with local anesthesia, and only takes a few moments. These 4 gold markers are important; they are used to track the position and movement of the prostate during CyberKnife® treatments, and allow pinpoint accuracy of the CyberKnife® therapy.
  5. Approximately 1 week after placement of the gold markers, the patient is scheduled for a CT and/or MRI scan of the prostate. Once this data is available, Dr. Garber and the radiation oncologist carry out computer-based treatment planning, so that the CyberKnife® targets the prostate and avoids the surrounding tissues.
  6. Once the treatment planning is complete, the actual treatments are scheduled. All treatments are outpatient. They are painless, and take 1-2 hours each. Typically only 5 treatments are needed, and are done over the course of a week. No anesthesia is required.

To see video animation of the CyberKnife® system, click here.

Typical advantages of CyberKnife® stereotactic radiosurgery include the following:
  1. Treatments are painless and non-invasive
  2. No anesthesia is needed
  3. Only 5 treatments needed, unlike the 6-7 weeks of daily treatment needed for standard radiotherapy
  4. Quick return to normal activities
  5. Radiation is directed precisely at the prostate, with maximal sparing of the bladder, rectum, urethra and penis, thus minimizing radiation cystitis and proctitis
  6. No scalpel, no surgery, no blood loss, no risk of infection
  7. Proton therapy, widely touted in the news media, cannot compensate for prostate movement and cannot be targeted as precisely as CyberKnife®.
Dr. Garber has pioneered CyberKnife® treatment of organ-confined prostate cancer in the Philadelphia area, and is featured on the Philadelphia CyberKnife® website (www.phillycyberknife.com). To find out more about this treatment option, schedule a confidential consultation with our office: 610-613-9251. Please refer to the "Your Initial Visit" section of this website, so that you bring all of the necessary information with you.

CyberKnife Treatment of Prostate Cancer by Dr. Bruce Garber

Dr. Bruce B. Garber

Box 686
Bryn Mawr, PA 19010

610-613-9251 Phone

urologicsurgeons@comcast.net Email


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