Why so few proton treatments on HW

The main reason is costs and insurance companies not paying for Proton treatments. Proton costs three times what IMRT costs and there is no evidence that Proton is more effective in either cure rate or SEs than IMRT.
Why would an insurance company pay more for a treatment that has shown no advantage over one that is three times less expensive?
JT

I went to the Proton Center at MD Anderson for a 2nd opinion and possible treatment earlier this year. I am trying to get Cyberknife treatment for the following reasons:
1. CK doesnt generally require hormone treatment and although Proton therapy and hormone are 2 different things the Proton center at MD Anderson was very insistent that I have it done first.
2. The number of treatments is minimally 3 times more than CK
3. ASTRO policy makers have not been supportive suggesting it be used only in a clinical trial not as routine care. How this works with MD Anderson I dont know since they offered it to me as front line treatment.
4. This will have an adverse impact on insurance coverage. I am covered under commercial insurance and I need to know what my obligation will be prior to the treatment.
I am not saying that CK is the way to go. I just knew that I didnt want to go surgical unless I had to

dennis h said...
I went to the Proton Center at MD Anderson for a 2nd opinion and possible treatment earlier this year. I am trying to get Cyberknife treatment for the following reasons:
1. CK doesnt generally require hormone treatment and although Proton therapy and hormone are 2 different things the Proton center at MD Anderson was very insistent that I have it done first.

Did MDA say why they require HT? With your 1 positive and GS 3+4 you're a low intermediate risk. Unless your prostate is very large I don't understand why they would require it.

Things I believe about Proton Therapy:
1. it is just as effective as surgery or other forms of radiation, jury is still out as to being more effective
2. yes, it costs more. the technology and infrastructure is more expensive and insurance companies are tight
3. side effects are minimal, this to me was a big selling point.
4. you see less participation in boards like this, because there are less complications for proton patients.
I don't expect everyone to agree with what I believe.
Bottom line, if you are seeking treatment, do your own research and decide what is best for you and never look back. Don't take any one specialist's knowledge to be all inclusive. If they are dismissive of a treatment method, be very suspicious. Remember, they are selling their services.

Regards to all,
Kris

I think Kris is right that most proton patients have their treatment and move on. Also, I think that there are other venues (e.g. protonbob) that provide more focused support and info for proton patients than we can at HW. Finally, I'm not sure HW has been as welcoming to proton treatment as to other options -- including by we men who have chosen other radiation options.

When I was making my treatment decision I seriously considered PBT. I got all of the paperwork and had extensive conversations with the folks in Jacksonville. At the end of the day I made the choice to have LDR brachytherapy because:
1. There were no long term studies showing either the efficacy of PBT for cure or the low level of claimed side effects. While PBT seemed logical to me, much of the evidence was anecdotal and I wanted more data driven information.
2. The treatment plan was much longer and more inconvenient than brachytherapy. Without evidence that it was "better" in either cure or SE's, it just didn't make sense to me to select a more difficult option.

I admit have not kept up with current PBT studies but would love it if someone could provide some good non-anecdotal evidence re cure and SE's to our HW forum members. This has been done by other members for HDR brachy and SBRT. If I was making a choice of treatment today, I would search for the same level of evidence for PBT and, if it was not there, I would be choosing between LDR brachy, HDR brachy and SBRT for the reasons mentioned above. Surgery would still be low on my list of options because the cure rate is no better than the radiation options but the chances of SE's is much higher.

Jim

Has anyone read that Medicare is even considering stopping coverage for proton therapy? I see that some large insurers are rethinking their coverage and some have stopped. My Google searches have turned up some proposed reduction in payments for 2015, but no discontinuance. I also have BCBSNC Medicare supplement plan F which has to pay whatever Medicare doesn't, as long as it's a Medicare approved procedure.

I read that University Hospitals in Cleveland is getting a compact proton unit that costs 30 million. A couple of companies are creating cheaper proton devices.

"UH signed an agreement in 2011 with Mevion Medical Systems (formerly Still River Systems) to purchase the MEVION S250 Proton Therapy System, the next generation of proton therapy technology. While the first generation of proton beam systems require massive equipment, large facilities and cost up to $150 million to implement, scientific breakthroughs by Mevion have led to the development of this first-of-its-kind more compact and less costly model. The MEVION S250 received FDA approval in August 2012."

ProNova is another company.
IBA Proteus One is another new compact system.

Post Edited (robertC) : 7/23/2014 1:54:15 PM (GMT-6)

I seriously considered all options.

MD Anderson was willing to do Proton, but offered some fairly low percentages of success in similar cases to mine. My insurance refused Proton as being experimental. I would have also had to go on disability to be away from my work (at 60% pay and a lot of other issues), and would have had no reimbursement for travel costs.

I didn't have to decide, as I did not have the funds to pay myself, nor evidence that spending that money would have a resoundingly better result