The majority of prostate cancer patients in the U.S. receive surgery to remove the gland and Intuitive Surgical’s (NSDQ:ISRG) da Vinci surgical robot has a corner on the market, but Accuray (NSDQ:ARAY) president & CEO Euan Thomson thinks that trend may be partially driven by misconception and marketing.
In launching a head-to-head clinical trial comparing Accuray’s CyberKnife radiosurgery system to Intuitive’s da Vinci surgical robot, Thomson aims to clear away some of the inherent clamor accompanying the word "robot."
"I think [da Vinci] is a great tool and I don’t want to criticize it, but there are certain things about it that I think people need to be realistic about," Thomson told MassDevice.com in an exclusive interview. "There really is a difference between a robot and something which is under a sort of manual control."
It’s a distinction that Thomson feels very strongly about, and one that he hopes to highlight in the upcoming trial.
Accuray’s CyberKnife system uses precisely targeted, massive doses of X-ray radiation to non-invasively destroy tumors. A physician initiates the treatment and designates anatomical structures to target and avoid, and CyberKnife does the rest, even automatically adjusting the radiation target to account for organ movement.
Because CyberKnife requires minimal physician involvement beyond the initial treatment planning and supervision, Thomson views it as the true robotic system.
"A car is a machine, but it’s not a robot," he told MassDevice.com. "If you wanted to make a robotic car you’d make one without a driver."
"The reality is that the da Vinci is a mechanical system and it’s driven by a surgeon," he added. "Just like with a a car, a really good driver will get really good results and a really good operator of the da Vinci robot will get really good outcomes – but it doesn’t mean everybody behind the wheel of a car is a great driver."
"There is nothing about the system that will automatically make the surgery a better surgery," he said.
Ultimately, that means that treatment results with the da Vinci system are still operator-dependent and outcomes aren’t necessarily consistent among treatment centers.
"In contrast with da Vinci, when a patient lies on the CyberKnife couch, the CyberKnife is directing the treatment," Thomson said. "As a result you can assume that a CyberKnife treatment is a CyberKnife treatment wherever it is delivered and whoever is delivering it. It’s a true robotic system: it’s self-guiding and self-delivering and quality is inherently guided by the system itself."
"It’s a distinct difference between the 2 approaches. It’s something I think for the medical profession to realize and I think it’s something for patients to realize as well," he added.
Patients are a big focus of the upcoming clinical studies comparing CyberKnife and da Vinci. Thomson aims to ensure that patients have all the details before making a decision that may be overly influenced by business rationale. Surgeons have adopted the da Vinci system in droves, he says, partially because reimbursement and revenue models are clear and lucrative. That’s something else he hopes the trial might have an influence on.
"We recognize that physicians have to make a living and if you’ve got a treatment there than they can deliver and get paid for and one which they may not get paid for it’s very tough for them to find a balanced approach," he said. "We all feel very strongly that we somehow need to overcome business elements that we feel are starting to hold the medical practice back. We really want to use this study as a method for doing that."
Accuray plans to enroll more than 250 early-stage prostate cancer patients in its Prostate Advances in Comparative Evidence study, a 1st-of-its-kind 10-year follow-up clinical trial comparing randomized treatment with CyberKnife radiosurgery, da Vinci prostatectomy and conventional radiation therapy.
The therapies in questions have never been subject to a direct comparative study prior to the PACE trial, but there is meta-data comparing outcomes with the da Vinci system against those of CyberKnife.
Both treatments both a 93% effectiveness rate in treating prostate cancer, but CyberKnife evokes fewer risks from bleeding, infection or pulmonary complications because there’s no surgery involved. Patients don’t require urinary catheterization or anesthesia and the treatment is done on an outpatient basis.
The da Vinci system, on the other hand, boasts lower rates of urinary side effects and rectal injury, according to an Accuray comparative chart.
Rather boldly, the chart poses the question of each treatment: "Is treatment performed by a robot?"
For the CyberKnife system, the chart reads: "Yes (The CyberKnife Robot automatically delivers a pre-planned treatment under expert supervision)."
For da Vinci: "No (da Vinci cannot act on its own and treatment is performed by a surgeon)."