Experts Debate CyberKnife for Prostate Cancer

"There are places in Florida you can't go a mile without seeing a billboard for a CyberKnife," said Paul E. Wallner, a radiation oncologist who co-chairs ASTRO's emerging technology committee.

Wallner and others said patients and many doctors tend to assume that just because something is new, it is better.

Despite the reservations, Medicare and private insurers in many parts of the country are paying for the treatment, which costs about the same as more traditional radiation therapy -- about $20,000 to $30,000. Some insurers, however, have decided against covering the treatment until more evidence is available, and Medicare, concerned that it was inadvertently creating a financial incentive to use the CyberKnife, next year will make doctors justify being reimbursed for referrals.

Some experts also worry that the CyberKnife may exacerbate concerns that patients who could avoid treatment or have surgery instead are being steered toward standard radiation therapy by urologists who have a financial interest in the machines used for that.

"It's the dark side of medicine," Zietman said. "Self-referral is already a big issue. CyberKnife could have a similar problem."

Proponents, however, suggest that the criticism of the CyberKnife is driven by doctors who are wedded to existing treatment, resistant to change and fearful they will lose patients to a superior alternative.

"There's big money in this field, so people are bound to be interested in preserving their turf," said Robert Meier, co-founder of the CyberKnife Center at the Swedish Cancer Institute in Seattle.

Dawood says the company encourages doctors to offer the treatment as just one option, to tell patents about the limitations of existing research and to collect detailed data to validate the long-term safety and effectiveness of the device.

In the meantime, proponents say, it would be wrong to deny patients the care.

"To me, waiting 20 years to prove it's as good as our old way of doing it doesn't make sense. You are withholding it from many people who might benefit from it," Collins said.

Blythe, meanwhile, remains happy with his choice.

"I'm glad I did it," he said. "It was efficient and fast, and from everything I've read, it doesn't sound like people are having problems with it. I'm not worried."