Starting Proton tomorrow Post RP

Going to Scripps starting tomorrow 4 2/3 years after my RP (11/2010) . I just had my MRI and CT and they were clear but it helps in Dr. Rossi (director of proton therapy at Scripps) design my program. I will need 28 visits. A 120 mile r/t drive but just have to do it!

My PSA crept up to .23 last month so here I go!

Wish me luck!

Scott

Good luck, good wishes, and the whole nine yards. And you will do just fine.

Thanks for the kind words.

My understanding from working with the Director's of Cedars Sinai and Scripps that Proton Therapy is a very good tool for SRT. It is used at the Mayo Clinic, Loma Linda and Kettering etc. There are only about 16 locations in the country as I understand.

The advantage is that is is NOT "scattered" radiation but a very close designed pin point process. Your other organs are sparred. There is a small chance your bladder or rectum could get a little dose but minor as I understand it.

So here I go

Good Luck, Scott.

Regards,
Kris

Thanks everyone. I'm on treatment # 3 today. It is totally painless and very quick. Kind of like a star wars atmosphere. All white rounded treatment area with whirling machines and table. When it happens it is about a minute but the whole process is about 7 minutes. Just amazing, splitting an atom just for you :)

I am wondering about who is paying for this too.....Perhaps the proton treatment providers have made some price adjustments so this type of treatment is now competitive with photon...

Good luck. I too, was surprised, never heard of Proton therapy being used for SRT. Apparently it's becoming a more widely accepted protocol.

What can they see from a CT on day 5? Am I completely missing something here? Did not think .23 would show up.

Post Edited (Octorobo) : 8/9/2015 12:56:13 PM (GMT-6)

I have a question for knowledgeable participants in this tread. If someone can give a good technical explanation, I will need to change my thoughts/comments.


I clearly understand the proposition for using proton beam radiation therapy (PBRT) for first-line treatment of prostate cancer in cases when spread beyond the prostate is highly unlikely.

However, I would NEVER have thought of proton beam therapy as useful for salvage treatment for men who have recurrent cancer. In fact, my comment would have been that use of PBRT for salvage radiation therapy (SRT) would be LESS beneficial than external beam/photon treatment because of the very nature of PBRT, as I will describe here.

The success of SRT depends on three factors: dose, treatment volume and (the key point here) localization of all clonogenic cells to be within the radiation treatment field. So, PBRT is uniquely beneficial for certain types of cancers because it delivers a “pencil-thin” beam of radiation. But in PC SRT procedures, where do you aim? In fact, in the more standard photon treatment for SRT (or even with HIFU), it is desirable to cover a wider field for this very reason—the precise location of the residual PC cells within the prostate fossa is not only indeterminate, it is also un-determinable.

I have searched and found no peer-reviewed medical literature where PBRT has been investigated as salvage therapy for recurrent prostate cancer. (Heck, it’s hard enough to find decent peer-reviewed literature on PBRT for first-line PC treatment.)

So how is it, or why is it, that PBRT has emerged as a candidate for PC SRT? Can anyone give a technical explanation, or is it merely an economic explanation (more utilization by the facility operators of the expensive assets)?

I understand the proton beam can be intentionally broadened by placing "leaves" in the beam that serve to open up the pattern. Unfortunately, in early efforts to do this, this technique resulted in the generation of high-energy neutrons which radiated everything in the treatment room, including the patient...Hopefully this problem has been resolved..

The latest photon LINACS do MUCH better at sparing healthy tissue and organs than machines that were in use only a few years ago...The Varien RapidArc and its newer brothers have greatly improved outcomes while reducing healthy tissue damage to a much more manageable extent than was possible just a few years ago...

We still don't know what the treatment (proton) costs..We just know Scripps accepted whatever Medicare was willing to pay..

"I've been using PBT to treat post-op for 15+ years, when I first started doing this I had same skeptical conversation with (name omitted for privacy) from Harvard but when I explained my reasoning he understood."

The above paragraph seems to indicate you are a practicing doctor, possibly a radiation oncologist..Am I correct?

Ok, thanks themacs for sending my question off to your radiation oncologist. I understand the response. There is a "radiation treatment plan" for each and every radiation patient to cover a specific 3-dimensional volume (whether there is a prostate there, or not (as in your case for SRT). Without having a specific organ, or the prostate, to target (your case), the plan is to blast a pre-defined, albeit broad, area in the prostate fossa where cancer cells may have attached.

Delivery in such cases can be with a "pencil-beam" or something a little wider. If it's pencil-beam, the plan would require (let me dumb it down and say) "moving it around more," or as Fairwind describes, "leafing" it which would essentially make it more IMRT-like.

So basically, it is an economic motivation. We have this big expensive asset sitting around, let's find another way (SRT) to use it...which is back to the roots of how PBRT was first introduced to prostate cancer patients: It was a big expensive solution (and a great tool for a few rare cancers needing the "pencil-beam" capabilities for the brain or eye) looking for a problem to solve. The emergence of the mass-PSA screening era provided a steady flow of cash flow.

Huh?

I agree…good luck to Scott/themacs on salvage treatment. And thanks, again, to themacs for not only responding to my question in his tread, but also for taking the additional time and effort to send it off to his radiation oncologist. I really appreciate it! And, now I understand the big-picture context and can explain it robustly to others. Apparently, it’s such a reasonable question, themacs’ oncologist’s colleague at Harvard asked him essentially the same thing…he called it “the same skeptical conversation.” So I additionally appreciated themacs adding this part of the oncologist’s response which I interpreted to be a powerful validation of the apparent quality and appropriateness of my question!

I had not ever previously heard of PBRT for SRT (and I checked with Pubmed) and would not have thought of PBRT for SRT, nor had several others who made the same comment earlier in the thread, and it’s now very clear that many others hadn’t either. The posts had nothing about agreeing or not agreeing, or even the merits of PBRT…it was a technical question about how/why PBRT works (perhaps counter-intuitively) for SRT. Question explained, asked, and answered.

No offense intended, themacs. And thanks for educating me, and others who will read our comments in the future. (If you enter "proton srt" into the HW search engine, you will find others in the past have also had essentially the same question, but this is the first time it was answered.) Continued good luck!

I just belatedly looked at this thread and I do hope themacs does let us know how things are going. I was also surprised about using proton for SRT, but it's clearly an accepted technology and I'd like to know more about it and how he's doing.

Most important--Good Luck to You Themacs!