Proton therapy?

What are your thoughts/experiences with proton therapy?

A high risk diagnosis is worthy of exploring all the treatment choices. Surgery as a monotherapy offers approximately 50% chance for a cure. If you’re in the 50% category that requires follow-up treatments radiation and ADT are likely. Although some guys do well with surgery side effects others have issues with ED, and urinary issues.

Although I have no experience with proton therapy I would certainly include it as a treatment option. Given your location and challenging diagnosis I would be consulting with MD Anderson. They are world class and have experience with proton beam. Possibly you could consult with a virtual visit. All of my followup with Cleveland Clinic post treatment has been virtual. If a visit to MD Anderson happens be sure to take your biopsy slides with you or have them mailed. Keep posting since a number of us are following this thread with interest. Terry

I once read a paper on this which i did not save unfortunately but bbn it was informative
First you do need to explore all viable option
2nd not all ins will fully cover
3rd with RT the skill of the radiolo ghb ist is most important
Having said that what i remember from this paper is
There are not any large studies to prove effectiveness and side effects lot of bbbj info is theoretical ad based on small studies
So it is widely beleveived that proton is equally effective as photon cause effectiveness is about delivering a certain amount of energy to the target
Side effects in theory should be less but in the prostate bed there are a lot of tissues close together so limiting exposure is still about accuracy in targeting. The accuracy and new techniques with photon make it less damaging and reduce any potential advantage of photon. Photon is most effective in situation with large tumors in areas with no as many criticle tissues close and require high energy

So those are the main point that come to mind

Both Proton and Photon are forms of external beam radiation that employ ionizing radiation and have the same DNA damaging action on the PCa cells. Neither hold an advantage of cancer control, they are equal.

Photon radiation goes through the target (prostate) and body so it radiates the unintended outside areas of the body. That is why a rotating gantry is used to change the entry-exit points of the beam. By doing so, Typically the prostate receives about 90% of the radiation and unintended non-cancerous areas get the other 10%. This is where the negative side effects result.

With Proton the beam starts strong and then diminishes in a physical distance. This is called the Bragg Peak. This means the radiation can be programmed to stop just at the far side of the prostate and thus not go through the body, a theoretical advantage over Photon. However, it is much stronger entering the body. Thus, it uses a rotating gantry to spread the radiation and not concentrate in one area. It, too, tries to get to the similar 90-10 ratio of Photon.

A significant disadvantage of Proton is radiation dispersal or scatter. A little physics explains. Photons are light waves and are not physical matter. They either go through certain types of matter, or are absorbed by certain types of matter and this limits dispersal. Proton radiation is physical matter and when it comes into contact with other forms of matter some will stop and some will bounce off and go in unintended directions away from the target. The combination of the strong entry radiation and more dispersal to unintended area is basically why no study has yet to indicate that Proton causes less negative treatment side effects than Photon for PCa.

Proton does have advantages for certain cancers, just not for PCa. That is why most all third party reimbursement plans either deny reimbursement for Proton, or limit the reimbursement to the amount allowed for Photon leaving the patient responsible for the significant cost difference.

BWeaver, where are you located? Is there a particular Proton Center you are in contact with? Have you met with different radiation oncologists regarding different forms of brachytherapy and external beam radiation? For high risk like you and I, the best cancer control and lowest negative side effects utilize a combination of IMRT external beam radiation and High Dose Rate Brachytherapy. This combination has served many men on this board very well. I, and others have 10 or more years of complete cancer control and minimal treatment side effects using IMRT and HDR-BT.

Pleased to see a thorough dismantling of any advantages proton beam therapy might have for the treatment of prostate cancer. I will have a cup of coffee rather than repeat what has been said before.

It also bears repeating what Duck2 has stated: you need to look into a double or triple approach if you decide not to use surgery. Depending on your situation, this approach could include brachytherapy (there are two kinds), IMRT, and SBRT with an 'overlay' of hormone therapy (ADT).
Yes, I realize that this is a lot to cover but it will be worth your time.

Another excellent suggestion that was made is to consult with a top-notch institution early on.

Looks like you now have two Proton Centers in OKC. Best wishes on the assessments and decision making process. You have our prayers.

I'll join Skeeter as a member who had Proton Therapy. Six years ago I had choices just like most and after careful consideration I decided to go with Proton at UFPTI. I do believe surgery and several forms of radiation are equally effective. For me it came down to side effects. My urologist is a fine surgeon and told me that my chances of permanent ED with surgery would be 50%. With Proton the stats showed about 30%. I'm glad to report that I did not have ED or any notable side effects from the Proton treatment. As to successful treatment, I cannot say as my PSA has not fallen to a level that gives me confidence.

With your digagnosis you will likely need hormone therapy before and after whatever radiation you choose. I have friends who chose Proton, Photon, and HDR brachytherapy. All are doing well. I am the only one still with relatively high PSA.

No doubt that there are many with excellent outcomes after proton therapy. Great!
But as several have argued above, there is little or no evidence that proton therapy is better than photon therapy. Whereas none of us are MDs, let me emphasize that the American Urological Association has the following guideline:
Clinicians should inform localized prostate cancer patients who are considering proton beam therapy that it offers no clinical advantage over other forms of definitive treatment. (Moderate Recommendation; Evidence Level: Grade C){/B]

Post Edited (Sr Sailor) : 3/26/2021 3:09:19 PM (GMT-6)