Wall Street Journal article on Proton Therapy

Today's WSJ has an article on proton treatments for anyone that's interested. http://online.wsj.com/article/SB10001424127887324296604578177802556030578.html

The article cites two recent studies, Harvard and M.D Anderson which showed no difference in the results of Proton vs IMRT. There was a slight difference in short term side effects with Proton that disappeared within 1 year. Bascially the two treatments are equal in regards to efffectivness and SE's with the major difference being that Proton costs Medicare $32,000 and IMRT $19,000..

"The findings put the ball back into the Proton advocates to demonstrate that the benefit is there"

Post Edited (John T) : 12/14/2012 11:49:48 AM (GMT-7)

Dr Anthony Zeitman, who is ASTRO chair (ASTRO is the organization of radiation oncologists, overseeing all types of radiation treatments) wrote an interesting editorial in the Journal of Clinical Oncology titled “ The Titanic and the Iceberg: Prostate Proton Therapy and Health Care Economics. ” Using his Titanic/Iceberg metaphor, he wrote (bold added by me): Sailing forward, powered by the winds of advocacy, of market forces, and of high-stakes investment, is proton therapy: the proud vanguard of modern technology. Elsewhere, waiting patiently in the darkness, are the hard, cold, and unyielding laws of economics. The collision is yet to come , but, with many new proton centers breaking ground, it cannot be far away. Konski et al 1 have made an illuminating and timely contribution to this debate by assessing the potential costs and benefits of proton therapy in contemporary prostate cancer treatment. I say timely because the business model employed by the emerging US proton therapy centers is prostate cancer, and it is on this disease that they will either sink or sail (Note: The author treats prostate cancer with both IMRT and proton beam and the Massachusetts General Hospital and the Francis H. Burr Proton Therapy Center, Boston, MA.).   In another article, proton beam therapy (PBT) was described as a solution looking for a problem ...when it found prostate cancer.   PBT can be extremely and uniquely effective against a number of very rare types of cancer which occur in unusual places in the body.   The issue is that there are nowhere near enough cases of those rare cancers to justify the very high cost of the PBT treatment centers…so they need to pull in some additional revenue into their business model.   With the growing prevalence of PSA screening over the last decade, more and more men are being diagnosed at younger and younger ages with less and less severe cases of PC… bingo!   PBT "works" just as effectively as IMRT, but there is nothing novel with the results for PC treatment.   Interesting economics.

Proton is not a new technology; it was 20 years ago and compared to the ERBT machines of that era it was a superior treatment. It is still a superior treatment for small tumors of the brain and neck, but does not have any advantage in treating wide irregular areas such as a prostate.
If costs were equal we would not be having this discussion, but paying double the costs for the same results doesn't make a lot of sense.

However, proton continues to evolve too, with the newer "pencil" beam centers. The article did mention that side effects were less compared to IMRT.

It's the cost that Medicare pays to its contractors. As an individual you would pay much more..

So, it sounds to me like Proton Therapy is being pushed as the "Latest & Greatest" as a marketing strategy, since the results aren't any better than IMRT. But the new Proton Centers might have patients flocking to them while the number of Proton Centers remains low.

Where can WE get a piece of this action ? And how do patients determine what is the optimal treatment for themselves ? Who is the patient's advocate ? Is this how the free-market system is suppose to operate ? Should medicine operate on a free-market principle ? Or should the Docs be forced to follow strict protocols ?

I get the uneasy feeling that many patients are being "thrown to the wolves", especially CaP patients. But maybe I'm just cynical .......

If you decide on radiation therapy, would you rather have a form of radiation (x-ray/IMRT) that delivers a beam of radiation where the highest point of energy release is at the skin and the energy delivery slopes down from there and continues out the other side of your body? or a form of radiation (proton/pencil beam) where 95% of the energy release can be directed to occur within <1mm? Fortunately for me, I work for a company with great health care benefits and cold make the choice and went with proton beam therapy. I was greatly concerned with excess radiation exposure to my bowels, bladder and all of the surrounding tissues. I chose MD Anderson precisely because they were the only facility offering pencil-beam proton delivery which can shape the delivery more accurately that other center that employ a scattered proton beam and use a polycarbonate template/stencil to create a pattern and field of depth.

Unfortunately, this article uses generalized comparisons to discuss the results and does not tell you any specifics of the statistical analysis. Do G6-7 patients have statistically significant different outcomes? G9-10s? Are they analyzed by age? By pre-existing urinary/ED conditions? When I was at MDA, the majority of men I met there (I only met one other patient in 3 mons) had already been on hormone/Lupron injections; are those patients populations separately analyzed for ED SEs from patients without? Like most of these "trials" it is virtually impossible to ferret out which treatment is "better" with SEs, since there is such a large variation in disease progression, patient age, pre-existing patient conditions (urinary issues, ED issues, bowel issues, etc). I do clinical trials for a large medical device company and know that when outcomes (mortality, occurrence, SEs) are very low for current therapies that it takes an enormous sample size to show statistical significance. My point is, to research how and where the radiation is delivered and where it is released and determine for yourself what is better for you.

The cost of treatment with today's rising health care costs is obviously a source of concern and PTB therapy CAN cost up to $180K (retail price), I myself have been confronted by other PC patients with comments like "it's people like you who are driving up the cost of health care for all of us". Like all evolving technologies PBT has gotten cheaper and will continue in the future, During trestment in Houston I spoke with the Hitachi engineers there and they are currently working on room sized particle accelerators (compared to the football sized ones that most facilities currently run off of) that will significantly reduce the cost of the facilities.

Off the PBT soapbox with that and Merry Christmas all!!