Welcome to today's Schaufenster Spezial. As you can tell, today we are at the Großhadern Clinic which is right next to the European CyberKnife Center. And this is where genuine innovations in cancer treatment are taking place.

I am about to meet with Professor Alexander Muacevic and Dr. Alfred Haidenberger, who will tell us some more about what the CyberKnife is capable of and why it is such a groundbreaking technology.

Professor Muacevic, we are at the European CyberKnife Center in Munich. Please tell our viewers what you do around here and what you specialize in.

15 years ago, we started the project in cooperation with the Großhadern Clinic and the AOK Bayern. All in all, we are part of an integrated care concept and we carry out highly specialized, local tumor treatments.

With CyberKnife, we can treat a range of tumors. But we must always assess each individual case – based on the findings and imaging – to determine whether we can treat the tumor at hand. The tumors we treat are fairly small and clearly demarcated. And in many cases, we need to cooperate with colleagues to tackle them – e.g., from the Großhadern Clinic.

Which indications lend themselves to CyberKnife treatment?

Initially, our work focused on brain tumors, where we collaborated intensely with the neurosurgical clinic. Since then, the range of treatments has expanded to spinal tumors, as well as tumors in the lungs, liver, kidneys and more. Prostate cancer, a major medical issue, has joined the list of treatments we offer more recently.

Essentially, there are two medical professions that treat prostate cancer patients: urologists and radiation oncologists. CyberKnife therapy is now emerging as a further option which is newer, but it has in fact been used on a large scale in the United States for years. Over 30,000 patients with prostate cancer have received CyberKnife therapy in the United States.

Talking about prostate diseases: How widespread are they? Is it fair to say that they have become a mass disease? In other words, did the numbers not dramatically increase in recent years?

Well, prostate cancer is the most common tumor in men. In fact, if we all live long enough, we will develop prostate cancer at some point in our lives.

Modern imaging plays a crucial role in the diagnosis of prostate cancer. What we need is a high-resolution MRI scan, and a biopsy of the carcinoma. After all, not every carcinoma requires treatment and we can only determine the next steps if we have all the findings.

With regard to CyberKnife treatment itself, what exactly does the procedure involve?

The main advantage of treating prostate cancer with CyberKnife is the short time it takes: Patients only face five sessions, whereas conventional radiotherapy requires up to 40 sessions. That is, one week of therapy versus eight weeks. Moreover, we have recently upgraded the CyberKnife system to the latest generation of software. It reduces each of those five sessions to only 15 minutes. 15 minutes times five sessions makes for a swift and comfortable therapy.

The therapy is not entirely free of side effects – no therapy is. However, patients do not notice the therapy itself. After two to three weeks, most of them experience notice some changes to their urination – i.e., usually, a more frequent urge to use the toilet, also at night. Overall, CyberKnife therapy has few side effects though.

My urologist wanted the operation to take place as early as March 8. We had a conversation about it, and right at the end he asked me, "How do we want to proceed?" So, I told him: "I'm not going to rush this decision." I wanted to make up my mind before this went any further. Then I heard about CyberKnife.

We also use CyberKnife treatment for recurring tumors in the prostate or prostate gland; i.e., when tumor recurs after conventional surgery or radiotherapy. Thanks to CyberKnife radiosurgery, we can treat these tumors in isolation and with high precision. To achieve this high accuracy, we carry out a PET-CT and an MRI scan in advance. Afterwards, our colleagues from the Department of Urology implant a small gold marker in the tumor so that we can track it and compensate for its movement.

What is the best way to help a patient overcome their fear? How do you approach them?

The beauty of CyberKnife is that it adapts to the patient. It differs from conventional methods because it adjusts to the movement of the prostate. But in general, I would like to point out once again that there are many options for treating prostate cancer. And in most cases, these options range from a complete removal to "Let’s just see how it develops".

On the one hand, it is nice for patients to have this range of options. On the other hand, however, it is also challenging because I have to make a decision: What is the best way for me? Therefore, it is important for patients to gather comprehensive information and to talk to various specialists in advance. I always tell my patients that they should also talk to a surgical specialist such as Professor Stief, here in Großhadern, who is renown around the world for his expertise in prostate surgery. He is certainly a valuable resource for patients.

At first, I had to get used to the situation. Before the treatment started, the assistant asked me: "What kind of music do you like?" So I said: "Birdsong!" I am a bit of a birdwatcher in my free time, so that’s what I asked for. Other than that, I just let the whole thing take its course and thought to myself: "Oh well, at least they won't have to cut me open, there'll be no blood, and no injections." Since my initial consultation had gone so well, I had complete confidence in the procedure.

The robot is the patient's friend – it offers an excellent alternative to conventional surgery. With CyberKnife, the patient needs neither anesthesia, nor invasive surgery. Patients treated with CyberKnife do not need to be hospitalized and, in many cases, do not even require rehabilitation.

As mentioned, we treat primary prostate cancer in five days – one session per day, 20 minutes per session. For recurrent tumors, i.e. tumors that have come back after previous treatment, we only need a single session.

We have already heard from Mr. Hörstmann, who underwent CyberKnife treatment for prostate cancer. Can you tell us a little bit about the specifics of this treatment? What exactly happens?

The treatment is really straightforward. When I talk to patients afterwards, most of them say: “If I had known what it was like, I wouldn't have lost any sleep over it.” In other words, they all say it was much less serious than they had expected – because, after all, they don't need anesthesia, there are no incisions and they simply lie down in their everyday clothes. And after 15 to 20 minutes they can go home and resume their day-to-day activities – be it playing tennis or going to work. Of course, you don’t have to do it during your lunch break, but there are some excpetionally keen people who want to do just that.

Before we can start, we need to make some preparations. We need good imaging; first and foremost a good MRI scan which should always be evaluated by someone who specializes in MRI imaging for the prostate. After all, this is a scientific field in itself. It is quite complicated, but we have experts on site who carry out these evaluations.

Based on the imaging, our team of physicists plans the treatment. Once we all come to the agreement that the proposed plan is the best we can achieve with this technology, the treatment itself can begin.

The patient goes downstairs to the treatment room, our assistants help them find a comfortable position on the treatment table and we start the treatment. The patient barely notices the actual treatment as the robot simply moves around them, directing the rays to the tumor with pinpoint accuracy. In fact, patients can eve listen to their favorite music, they can take a brake, they can go to the bathroom – they could even call a friend. All in all, it is a very relaxed procedure.

You have been offering CyberKnife treatment for the apst 15 years here in Munich. What has your experience been like?

We currently treat about 700 patients per year here at the CyberKnife Center. We also contribute regularly to the scientific community – with more than 100 published papers in recent years. Right now, we are working on a major study on over 1,000 cases of skull base tumors.

Hence, wo do not just treat patients, but also contribute to the academic discourse. This is especially important when dealing with new technology: In order to determine what we can achieve with this type of treatment, we need to document our results and substantiate them with scientific data.

Two things were important to me: Are there any side effects and what happens afterwards? None of the usual things you hear about cancer treatment – chemo, lengthy periods of rehab – were on the table. Those I feared the most. But CyberKnife does away with all of that, which gave me a great peace of mind.

Aftercare is another important part of treatment: How do you provide it to your patients?

Even if the treatment tself is very short and patients do not spend a lot of time here, we stay intouch with them for a long time. Once the patient’s treatment is done, depending on whether it was a benign or malignant tumor, we will see them again after three to six months. And we closely monitor how they are doing for many years after.

What about insurance coverage for CyberKnife treatment? Will insurance companies take care of the costs?

It depends: Due to our cooperation with AOK Bayern, coverage is guaranteed for all members of AOK. There are many other health insurances companies which also take care of the costs, such as the BKKs or the Barmer Ersatzkasse. So there are a number of health insurance companies that provide coverage for these treatments.

However, this does not apply to all German insurance companies. Unfortunately, there are also some insurance companies where you have to apply for coverage and then they will decide on a case-by-case basis whether they will cover the costs. If you have private health insurance though, you are very likely to have your costs covered.

That's it for today's Schaufenster Spezial. Thank you for joining us. It's been a pleasure and I'm sure we've been able to provide you with an exciting insight into the latest medical innovations. As always, you can access further information online at www.cyber-knife.net. See you next time. Stay healthy.