Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Prostate Cancer
3 items
Treatment Modalities3 items
iQuestions: Cyberknife Procedure for Prostate Cancer
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What is the CyberKnife procedure? How long does it take? Dr. Lee Ponsky, a urologist at University Hospitals, answers these questions and more for ShareWIK.com.
video3:34 · Jul 2026
Cuts Like a Cyberknife: New Surgical Technique for Prostate Cancer
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The future is now for prostate cancer treatment. University Hospitals' Dr. Lee Ponsky explains the latest technology for the treatment of prostate cancer using a new non-invasive surgery procedure.
video3:27 · Jul 2026
Prostate Cancer
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Dr. Lee Ponsky, Director Urology Institute Division of Oncology, discusses the multidisciplinary approach to treating prostate cancer at UH Seidman Cancer Center.
video1:58 · Jul 2026
Kidney Cancer
1 item
Surgical Techniques1 item
ponsky urologybook laparoscopic radical nephrectomy
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http://www.urologybook.com presents a case of laparoscopic right side radical nephrectomy performed by Dr. Lee Ponsky MD at University Hospital, Case Western Medical University, Department of Urology. For more step by step urology surgical
video · Jul 2026
More resources
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Update Course Rewind: 2024 Top Ten Key Takeaways
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Join us for a highlight reel of the Top 10 Key Takeaways from the 12th Annual Update Course in Pediatric Surgery. This session covers the latest advances, pract
podcast · Jul 2026
Update Course Rewind: Pectus Excavatum 2021
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Did you miss our 9th Annual Update Course last year? Don
podcast11:55 · Jul 2026
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CyberKnife stereotactic body radiotherapy delivers tumoricidal doses to the prostate via hundreds of low-dose beams converging at the target, with robotic tracking compensating for organ motion.[e13661-c3, e13662-c4, e13662-c5] Current eligibility criteria restrict use to low- and intermediate-risk disease (PSA <10, Gleason ≤3+4). The treatment compresses standard external beam schedules from 45 fractions over 6–9 weeks to just 5 treatments, with emerging data suggesting every-other-day scheduling may reduce toxicity compared to consecutive daily delivery.[e13661-c8, e13661-c9, e13662-c6, e13662-c7] Early institutional experience demonstrates PSA decline consistent with oncologic control, with urinary incontinence and erectile dysfunction rates reported as "very minimal" in most patients; transient urinary and rectal symptoms typically resolve by 3–4 weeks.[e13662-c8, e13662-c9, e13661-c12, e13661-c13, e13661-c15] Treatment planning fuses MRI and CT imaging to contour the prostate and dose-limit adjacent rectum, bladder, and neurovascular bundles.[e13662-c2, e13662-c3] Cost is modestly lower than protracted regimens due to the abbreviated course, and most insurers provide coverage.[e13662-c10, e13662-c11] No prostate cancer modality eliminates side-effect risk entirely.
- CyberKnife condenses prostate radiotherapy to 5 treatments via robotic delivery of hundreds of converging low-dose beams, tracking organ motion in real time.[e13661-c3, e13661-c9, e13662-c4]
- Current eligibility: low- to intermediate-risk disease (PSA <10, Gleason ≤3+4); every-other-day fractionation may reduce toxicity versus consecutive daily treatment.[e13661-c7, e13662-c7]
- Early PSA kinetics suggest oncologic efficacy; urinary incontinence and erectile dysfunction rates reported as minimal in institutional cohorts.[e13662-c8, e13662-c9, e13661-c15]
- Transient urinary and rectal symptoms peak at 2–3 weeks and typically resolve by 3–4 weeks post-treatment.[e13661-c12, e13661-c13]
- Treatment cost is modestly lower than protracted schedules; most insurers cover the technology, though pre-authorization is standard practice.[e13662-c10, e13662-c11, e13662-c12]
For patients & families
Doctors at University Hospitals are using a newer technology called CyberKnife to treat certain prostate cancers without surgery [e13661-c1, e13661-c2]. This approach uses a robotic arm that moves around the patient, sending hundreds of very low-dose radiation beams from different angles [e13662-c4, e13662-c5]. Each beam by itself causes minimal harm to healthy tissue, but where they all meet at the prostate, they work together to destroy the cancer . The treatment is currently offered to men with low or intermediate risk prostate cancer—typically those with a PSA under 10 and a Gleason score of 3+4 or less [e13661-c6, e13661-c7]. Instead of coming in five days a week for six to nine weeks like traditional radiation, CyberKnife patients receive just five treatments, each lasting about an hour [e13661-c8, e13661-c9, e13661-c10]. Most patients experience either no side effects or very mild urinary or bowel symptoms for two to three weeks, with most issues resolving by three to four weeks [e13661-c12, e13661-c13]. Early results show PSA levels dropping nicely over time, suggesting the cancer is being controlled, and serious side effects like incontinence and erectile problems have been minimal so far [e13662-c8, e13662-c9, e13661-c15].
Doctors at University Hospitals are using a newer technology called CyberKnife to treat certain prostate cancers without surgery [e13661-c1, e13661-c2]. This approach uses a robotic arm that moves around the patient, sending hundreds of very low-dose radiation beams from different angles [e13662-c4, e13662-c5]. Each beam by itself causes minimal harm to healthy tissue, but where they all meet at the prostate, they work together to destroy the cancer . The treatment is currently offered to men with low or intermediate risk prostate cancer—typically those with a PSA under 10 and a Gleason score of 3+4 or less [e13661-c6, e13661-c7]. Instead of coming in five days a week for six to nine weeks like traditional radiation, CyberKnife patients receive just five treatments, each lasting about an hour [e13661-c8, e13661-c9, e13661-c10]. Most patients experience either no side effects or very mild urinary or bowel symptoms for two to three weeks, with most issues resolving by three to four weeks [e13661-c12, e13661-c13]. Early results show PSA levels dropping nicely over time, suggesting the cancer is being controlled, and serious side effects like incontinence and erectile problems have been minimal so far [e13662-c8, e13662-c9, e13661-c15].
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Update Course Rewind: Pectus Excavatum 2021
Dr. St. Peter's hospital completed a randomized trial of 110 patients comparing epidural and PCA, and epidurals did not show superior results
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position1:02 ↗
After implementing cryoanalgesia, the first patient went home on post-operative day one, leading Dr. St. Peter to discontinue enrollment in the epidural/PCA comparison trial
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position1:21 ↗
Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position1:56 ↗
The cryoanalgesia technique involves freezing ribs 4 through 7 for two minutes per rib
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position2:09 ↗
Cryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position2:09 ↗
With cryoanalgesia, length of stay decreased from four days (baseline) to one day
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position2:33 ↗
Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position2:43 ↗
Dr. Garcia expressed concern that there are no long-term studies of cryoanalgesia and potential for chronic neuropathic pain
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position2:52 ↗
Medical devices and implants are not required to undergo clinical trials before introduction to market, unlike medications which require FDA clinical trials with long-term results
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position3:14 ↗
Dr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position3:50 ↗
With erector spinae catheters, hospital stay is two days, catheters remain in place for five days total (three days at home on automated pump), and families remove catheters at home on day five
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position4:08 ↗
Erector spinae catheters reduced opioid requirements both in hospital and outside the hospital, achieving two-day length of stay compared to four or five days with epidurals
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position4:30 ↗
Dr. Rothenberg initially had concerns about cryoanalgesia including added operative time and risk of neuralgia, but after four cases observed that patients not only went home earlier but felt significantly better at discharge
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position4:52 ↗
Multimodal pain control components include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine to avoid opioids, and support from child life specialists, mindfulness resources, and physical therapists
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position5:34 ↗
Dr. Ponsky's multimodal regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position5:34 ↗
At Nebraska where Dr. Rayner practices, length of stay is under two days and patients are off opioids by one week using multimodal pain control
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position6:15 ↗
Bar flippage typically occurs early and is caused by the bar sitting in an incorrect intercostal space, poor positioning, inadequate wrapping, or insufficient securing
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position6:26 ↗
Bar flippage is a surgical technique issue; the bar must sit in a comfortable position before securing or it will not remain stable
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position6:26 ↗
Computational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, potentially increasing stability
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position7:35 ↗
Bar length selection is not standardized, though there is a trend toward shorter bars based on computational stress modeling
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position7:49 ↗
Dr. Wolkine uses sternal elevator in about 10% of cases, primarily in younger patients where thoracoscopy provides adequate visualization
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position8:01 ↗
Sternal elevation in deep, stiff pectus cases allows less tissue damage and better repair
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position8:01 ↗
Dr. St. Peter uses sternal elevator in every case because it eliminates guesswork and facilitates entering and exiting at the same intercostal space
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position8:01 ↗
Techniques to avoid cardiac injury during introducer passage include thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision
Host summaryCecilia Gigena summarizing a resource — not the host's own clinical position8:58 ↗
Some surgeons pass the bar from left chest to right chest because passing right to left directs the introducer toward the ventricle
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position9:20 ↗
Bar passage direction (left-to-right versus right-to-left) is surgeon preference; as long as the sub-sternal space is well dissected and visualization is clear, direction likely does not make a significant difference
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position9:20 ↗
iQuestions: Cyberknife Procedure for Prostate Cancer
CyberKnife is a newer technology that allows noninvasive treatment of prostate cancer
clinicalLee Ponsky0:30 ↗
University Hospital's Case Medical Center is one of the initial institutions offering CyberKnife technology
clinicalLee Ponsky0:36 ↗
CyberKnife delivers highly focused radiation directly at the prostate and tracks the movement as the prostate moves
clinicalLee Ponsky0:46 ↗
CyberKnife allows very precise treatment of the prostate while minimizing injury or side effects from surrounding organs
clinicalLee Ponsky0:53 ↗
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