 Prostate cancer is one of the more common diseases that we treat at Winthrop, and one of the more common diseases in oncology in general. It affects more than 200,000 men yearly in the United States, and one in seven men over the course of their lifetime will develop this disease. Now some of you may have heard some controversies associated with PSA, but we strongly believe that PSA is the single most effective way to screen for this disease period. If you are diagnosed with prostate cancer or you have an elevated PSA, oftentimes the first step is to be referred to a urologist. Will they work you up with certain tests and possibly a biopsy? If the biopsy does show prostate cancer, oftentimes you're going to have many different options, and I encourage all patients to go to a place that has a multidisciplinary approach to prostate cancer where patients are seen not only by a radiation oncologist, but also by a urologist where we can tailor the treatment to the individual's best needs. Also what we do is we have a multidisciplinary tumor conference that meets monthly where we present some of the more complicated cases where we have radiation oncologists, urologists, medical oncologists, pathologists, radiologists, but 30 doctors in a room where we discuss each case individually to come up with a tailored plan. So what is CyberKnife? This fantastic technology consists of a regular linear accelerator, a radiation machine has been miniaturized and placed on a robotic arm. So the advantage of it is it's intelligent, and in contrast to our other radiation machines, we're on something called a gantry, which means it moves in a circle like a record player. This technology has a shoulder, an elbow, a wrist, and fingers, so we're able in real time to aim the radiation beam at hundreds of different angles while giving a higher dose of radiation to the cancer or the prostate in this situation, and much lower doses of radiation to the normal anatomy. We're able to avoid the rectum, we're able to avoid the bladder, things that we can't do with the older forms of technology. So the benefits are pretty minimal, there's some urinary frequency, maybe a little bit of rectal urgency, there's no pain, there's no cutting, and you get back to your lives in a week or less. And that's the advantage, I think, compared to some of the other forms of treatment. So unfortunately, some physicians in this area are giving misleading information to their patients about the different treatments for prostate cancer. Some will say that surgery is the only option for prostate cancer. Surgery is an option, but we don't believe it's the only option, and we don't believe it's the best option. I think many options are equivalent for patients. Any doctor that tells you that there's a one best therapy for you, run away from. As I told you earlier, we believe that patients should be seen by several different physicians, and some will tell you that, well, if you have radiation or cybernive, you can never have surgery. So while it's true that it's difficult, but not impossible to have surgery, but it is a more difficult surgery, what they won't tell you is that you actually have more options in the unlikely event that radiation doesn't work, comparative surgery doesn't work. So if surgery doesn't work, your only real option prior to going on hormones is to have regular radiation. You can't have cybernive because your prostate's out somewhere. Regular radiation will look about half the time, and if that doesn't work, then you go on hormones. If it comes back after cybernive or any radiation for that matter, it's difficult but not impossible to do surgery. However, you can have cryotherapy, which is freezing the prostate. That will cure about two-thirds of patients that fail radiation. You can have repeat cryo if that doesn't work, which is even less likely. You can have high-frequency ultrasound and only then do you go on hormones. So I actually make the argument with my patients that you have more options after a radiation failure than you do after a surgical failure. Not that either one of us is planning on failing. Some people would say, well, we do this because it's a moneymaker. No offense, I find that offensive. Again, you have doctors that are making millions and millions of dollars a year that are saying that, well, these other treatments don't work. We don't believe that at all. We think you have many options. And I would challenge you if a doctor says you have to have surgery, ask that doctor, well, do you also present my case or let me see a radiation oncologist? If they say no, run away from them. If I see a patient for cybernive, I'm going to refer a patient to our urologist so that we all are on the same page and we agree with one consistent plan for that patient, be it cybernive, be it surgery, be it cryotherapy, or no active therapy at all. To say that there's a one-best therapy and that's the only therapy I think is absolutely wrong and frivolous and irresponsible. If you're a candidate for surgery, you're a candidate for cybernive. Patients that have early-stage disease that's confined to the prostate that hasn't spread are perfect candidates for cybernive, just like the perfect candidates for surgery. And if you look at our results, which we published, and one of the things I do encourage my patients is to go to a center where you can have a center that publishes and tracks their own outcomes. You're looking at a 90 to 95% cure rate in patients with early-stage prostate cancer that are treated by us at Winthrop University Hospital. Any doctor that tells you that surgery is the only option is not doing you a service. And surgery is a real procedure. It's in the operating room. You're in the operating for several hours. It's an open procedure. Even if it's done robotically, there's cutting involved. You're in the hospital for several days and you're recovering at home for several weeks. Cybernive is completely outpatient. It's five days, again, with no cutting, no incisions. And I think it's equivalent to surgery without having the side effects associated with surgery. There's no incontinence. There's less impedance compared to other forms of radiation. And again, you're back to your life very, very quickly. Mind you, we don't discourage surgery. Quite the opposite. We feel strongly that every patient should seek multiple opinions. And one of the things that we feel incredibly strongly about at Winthrop is that you have a multidisciplinary approach to your care. Every patient that I see is also seen by our surgeons and our general urologists. If a patient wants to have surgery, that's a great treatment if it's indicated. If they want to have cryotherapy, that may be a great treatment. Sometimes we recommend no active treatment and we have a very robust active holistic surveillance program. So again, don't go to a center where they're forcing you into one therapy. Go to a center where we're kind of all inclusive to want you to have a variety of choices so that we can help you tailor the best choice for you with you as an equal part of the treatment team. So if you decide on radiation, there's several different ways to deliver radiation. Cybernive is a five-day radiation treatment. Some of the other treatments are something called conventional radiation or IMRT. That's a nine-week course of therapy. There's another form of radiation called protons, which is also a nine-week course of therapy or prostate seed implant, which requires that you go to the operating room where we put radioactive seeds and you'll be radioactive for several months. Vantage of Cybernive is that you're able to fractionate the treatment but you don't have to prolong the treatment. So this is a model of the prostate. And when we do the nine weeks of radiation, the IMRT, that machine's not intelligent. It can't compensate for the movement of the prostate in real time. So in order to compensate for that uncertainty of movement, we have to treat a much larger margin of normal tissue around the prostate when we do the radiation so that as the prostate moves, which it will, it doesn't move out of the radiation beam so we don't miss. So we're radiating more of the bladder, which is here, more of the rectum, which is where my finger is, and we have to do the radiation much slower. We do it over nine weeks. Protons, which try to take advantage of something called the Bragg peak, which means theoretically all the radiation is given over a very narrow period of space, the problem with protons is as I just showed you the prostate moves. So since protons can't compensate for that movement either, they have to do something to keep the prostate still. What they do is they put a balloon into the rectum for all two months of treatment. They inflate the balloon and the balloon pushes the prostate up against the pubic synthesis. That's that hard bone in the front of your pelvis. The problem with doing that is that you're pushing the rectum into the dose, which is what you don't want to do. So there's an excellent paper that was published in the Journal of the American Medical Association several years ago, where they looked at the different types of radiation treatment for prostate cancer. And not surprisingly, they found that protons had the highest risk of GI complications. You can predict that because by pushing the rectum into the balloon or the balloon into the rectum, you're doing exactly what you don't want to do. You're pushing the rectum into the dose. Prostate seed implant, which is convenient that it's a one-day treatment, is disadvantageous because by putting the radioactive seeds into the patient, the patient's going to be radioactive for several months so they can't be around any pregnant women or any children under 18. I personally think that of the radiation treatment, and I'm skilled and knowledgeable in all of them, CyberKnife has the greatest advantage to the patient in that it's more accurate, it's less invasive, it gets the patient done in five days. And most importantly, you're radiating less of the normal anatomy and giving a better dose of radiation to the prostate itself. So instead of putting a big 20 millimeter margin around the prostate, we do a three to five millimeter margin. So radiating less of the bladder, less of the rectum, and again, we're able to do the radiation much faster. That's why quite simply, I think it's a much better treatment. Why come to Winthrop? We are among the largest sites in the world and the largest site in the country for treating prostate cancer with CyberKnife. We've treated thousands of men over the past 10 years. We lecture, we publish, we're what's called a reference site. So when doctors from around the world want to come to learn CyberKnife, they're sent to us for training. We publish our data, we lecture. I think it's important to go to a center that has a lot of experience that publishes their outcome and trains other doctors how to do CyberKnife. We're the only center, both in Manhattan and Long Island with this technology. And we think it's a fantastic place to come because you're gonna come to the doctors that teach others, that publish. In addition, we're also gonna encourage you to meet with our specialists for the different other types of treatments for prostate cancer, as we talked about. Surgery, cryotherapy, active holistic surveillance. You're not gonna come and be forced into one treatment quite the opposite, we wanna open your eyes so you see all kinds of treatment for prostate cancer and feel that you explored all your options before you make a decision. I also wanna point out that this technology is not only for prostate cancer, it's for brain tumors, for lung tumors, for pancreatic tumors. We also opened up and treated over 50 patients now with breast cancer, with CyberKnife. We published a paper looking at these patients and rather than treating over six long weeks, we were able to accelerate the radiation down to five days. So patients were again able to get back to the life of breast cancer. I think that the technology is fantastic. I think with our experience and the fact that we use it for many different diseases, if you come to us, we treat it with their hospital, you're gonna be in the best hands. So if you'd like more information about CyberKnife, you can dial 1-866-Winthrop to speak with us directly or you can visit us online at winthrop.org.