Virtual Reality Education Before CyberKnife Treatment for Prostate Cancer

Study subjects randomised in this arm will receive VR-assisted education.

VR-assisted education will be provided for study subjects randomised in this intervention group.

Stereotactic radiosurgery is a non-surgical radiation therapy that uses precisely focused beams of high-dose radiation to treat small tumors, lesions, or functional abnormalities

Study subjects randomised in this arm will receive standard education.

Stereotactic radiosurgery is a non-surgical radiation therapy that uses precisely focused beams of high-dose radiation to treat small tumors, lesions, or functional abnormalities

Standard education will be provided for study subjects randomised in this intervention group.

The primary outcome measure is to assess and compare patients' understanding of CyberKnife radiotherapy and preparation requirements between the VR-assisted education group and the standard education group. Understanding will be assessed using the five-item knowledge test in Part 2 of the study-specific questionnaire. Each correct answer will receive one point, yielding a total score from 0 to 5, with higher scores indicating better understanding. The questions cover the treatment schedule, bladder and rectal preparation, the importance of consistent anatomical conditions, the consequences of inadequate preparation, and cooperation during irradiation.

Patients' perceptions of the clarity of the information provided, their ability to anticipate the first irradiation, and their understanding of preparation requirements will be assessed using Part 1 of the questionnaire. Four items are rated on a five-point agreement scale, from 1 (strongly agree) to 5 (strongly disagree), with lower scores indicating more favourable responses. A separate three-category item assesses whether patients perceive their understanding to have improved following education. Responses will be compared between groups and analysed separately.

Current stress, concerns about the treatment room experience, and confidence in knowing what to expect during treatment will be assessed using the three separate numerical rating scales in Part 3 of the questionnaire. Each item is rated from 0 to 10. Higher scores indicate greater stress, greater concerns, and greater confidence, respectively. Each item will be analysed separately and compared between groups.

Part 4 of the questionnaire will assess the VR group's perceptions of how VR helped them visualise the treatment room, understand treatment and preparation requirements, and reduce concerns. Willingness to recommend VR education will also be assessed. These four items use a five-point agreement scale, from 1 (strongly agree) to 5 (strongly disagree). A separate categorical item records discomfort experienced during VR use, including nausea, dizziness, or other symptoms. Responses will be analysed descriptively within the VR group.

Patient preparation will be evaluated indirectly by assessing prostate position on pre-treatment X-ray images acquired before each CyberKnife treatment fraction. Prostate localisation will be based on implanted fiducial markers. Deviations from the planned reference position will be recorded and compared between the VR-assisted education group and the standard education group.