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Proton versus Davinci

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Prostate Cancer
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Posted 11/4/2011 8:43 PM (GMT 0)
smhair  

  Just came from urologist's office and the time of "Watchful waiting" has ended after two biopsies in past year.  My husband is trying to decide between the davinci prostrate removal or the Proton therapy.  He is 69, health is good except over weight,255, and taking cholesterol meds.  Cancer cells in 3 lobes, 6.8 PSA.

davinci surgeon's office just called and we have a consultation Monday morning.  We need some input from those with experience.

Posted 11/4/2011 8:54 PM (GMT 0)
welcome aboard,

it would help to know what his Gleason Score is from the biopsies, and if you have the info, how much cancer was found in each of the positive cores.

david
Posted 11/4/2011 9:26 PM (GMT 0)
 

  Thanks,

  

my Gleeson score was 6.  Cancer has been detected in 3 of 4 lobes of the prostate but early stage. However increase in PSA from 5.7 to 6.8 in thelast 6 months since my last biopsi.

ACC

 

Posted 11/4/2011 9:46 PM (GMT 0)
I had Proton.

The pros:
Treatments are a "breeze"
Side effects are minimal or non-existent.

The cons:
Very Expensive, supportive insurance is a necessity.
Few treatment centers (unless you're in a city with a proton center you'll probably have to send 8 weeks in Loma Linda CA, Jacksonville FL, Bloomington IN, Houston TX, Philadelphia or a handful of other places.

Much more info here: www.protonbob.com

Others can comment on da Vinci.

...Jerry
Posted 11/4/2011 10:54 PM (GMT 0)
Any treatment your husband has is likely to have the same end result, about a 90% or better chance of curing his PC. Even in the small percentage chance that treatment fails he will most likely live for a minimum of 10 years and most likely 15 or 20 years or longer which exceeds normal life expentancy of a man his age.
Proton has the advantage of lower side effects than surgery, but brachytherapy and standard IMRT also have about the same side effects as Proton and are far less expensive and more widely available.
You have plenty of choices that have a high degree of success.
JT
Posted 11/5/2011 12:55 AM (GMT 0)
I had brachytherapy with Gleason 6 in June. I had practically no side effect. Currently, I don't have to get up at night to go to the bathroom. Unlike proton therapy it is an one time treatment.

So you should seriously think about it.

Posted 11/5/2011 1:13 AM (GMT 0)
Proton is going to cost SOMEBODY a lot of money...Be sure to get per-approval from your insurance. If he is on Medicare, be sure the treatment center you are considering accepts Medicare patients..In the end, proton has never been able to demonstrate it works any better than photon treatment when treating prostate cancer..

Todays modern photon equipment has greatly reduced the side-effects endured by patients being treated on these newer machines..
Posted 11/5/2011 2:28 AM (GMT 0)
 

Thanks to all!  ACC patient speaking now!

I am in Oklahoma City and we have a proton therapy center.  I understand that they will accept medicare.

But what I really want is info on the two major side affects: continence & impotence.  Please helpon these!

Thanks,

ACC

 

Posted 11/5/2011 3:36 AM (GMT 0)
52 yo, gleason 3+3, had Davinci prostatectomy Oct. 3rd, foley out 10/12. Still with significant incontinence. PSA max was 4.8 prior to surgery. Cancer found throughout prostate, but clean margins. Some question of nerve involvement. Nerves spared on lt side. No pain issues. Back to work ( despite incontinence) three weeks post-op. Hard to focus on anything but the incontinence right now, but glad I had the surgery.
Posted 11/5/2011 3:43 AM (GMT 0)
Radiation generally has fewer and less severe side effects than surgery. If your husband is as low risk as he appears from the information you have provided, then he should pursue the treatment that has the least side effects.

As John T says the treatments all have comparable effectiveness in managing the cancer and resulting in similar life spans, but they can have marketedly different amounts of side effects. Of the radiation therapies, proton and HDR brachythrapy have the lower levels of side effects when compared with photon IMRT and permanent seeds. Proton will cost 3-4 times what HDR brachytherapy will cost and will probably result in similar side effects and cancer management effectiveness.

You should visit with several radiation oncologists that specialize in the different forms of radiation before deciding. There is no magic in proton therapy and it is no more curative than other forms of radiation. The best surgeons won't operate on people age 70 and over. With his weight, unless he is 6'6" or so, he could be approaching the point where surgery presents risks that don't need to be taken whether it is robotic or open.

Go for the lowest side effects and least risky procedure and maintain a higher quality of life.
Posted 11/5/2011 9:44 AM (GMT 0)
ACC,

Generally speaking, incontinence is a non-issue with proton beam therapy. Impotence is possible, but from what I have read, (and was told at IU Health) the percentage of patients becoming impotent from proton therapy is less than surgery (around 30-35%). Also, radiation impotency generally occurs over a period of time rather than immediately after treatment.

Other forms of radiation treatment also have fewer immediate side effects than surgery, as others have written about in this discussion. IF incontinence and impotence are your primary concerns, then some form of radiation treatment is probably your first choice. I chose proton beam therapy at IU Health at Bloomington, Indiana, and am now 3 weeks past completion of my treatment. AS of now, I have virtually no side effects (the temporary side effects of urinary frequency and burning have rapidly subsided).

Yes, proton therapy is expensive. Without insurance coverage I could not have afforded it. Yes, you have to travel to one of the 9 centers in the USA where it is offered and stay for 8-9 weeks. But for me I believed it offered the best chance for effective treatment with fewest side effects. In defense of IMRT, I will say that had my insurance battle been unsuccessful, I was already scheduled to undergo IMRT at the Brown Cancer CEnter in Louisville as my second choice.

But, your original question was proton or surgery. For me, that was an easy decision. I chose proton.

Steve
Posted 11/5/2011 11:17 AM (GMT 0)
I had davinci and you can see from my history the cancer seems to handled BUT I now have a artificial urinary sphincter and a penile implant so, yes, I had side effects and nearly everyone does to some extent. Two cousins of mine had proton and they had none, or that's what they tell me, maybe this is anecdotal but from what others have said, maybe not. I elected RRP mainly because I didn't want to travel 450 miles and live there for 2+ months to get the proton. Since you have a proton center where you live, that would certainly make me give that option more consideration. Either way good luck with his treatment, since it has been watched for awhile, hopefuly it is not an aggressive type and he gets a good outcome.

Ron

Posted 11/5/2011 6:26 PM (GMT 0)
I did a lot of proton research in my decision making and ran into a no go with my BCBS of AL insurance. What I found was there are fewer short term side effects from PBT than other radiation treatments, however due to the short time PBT has been around long term studies are not available yet for SE and recurrence, but at your age I would definitely look for into it if you  are a good candidate. My URO who did my Davinci surgery has a bother who had PBT at Loma Linda in Calif 10 years ago and he told me his brother has had no recurrence and only some mild urinary issues about 4 years after the surgery that were more frequency related than continence.

Terry

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