Recommended for radiation--considering proton therapy

Hi AKoldtimer,

It's too bad about the extra positive cores, but on most Active Surveillance programs nowadays, that would not kick you out of the program. The current thinking (from Dr. Klotz who started AS) is that it is safe to stick with AS until they detect a predominant Gleason pattern 4 on a biopsy.

If you're uncomfortable sticking with AS, there are many kinds of radiation (protons are a kind of radiation) that will likely do a great job of getting rid of the cancer while minimizing side effects of treatment. The new proton machines are doing a great job, much better than the older ones, although they are probably no better than IMRT and insurance may not cover it. Other kinds of radiation that may be worth looking into (and you have PLENTY of time to do research) include LDR brachy (permanent seeds), HDR brachy (temporary seeds), and SBRT (5 total treatments).

AKoldtimer, sorry about your recent test result. Have you considered getting 2nd opinion from Johns Hopkins? If you decide to get proton therapy, most likely any facility you go to will want 2nd opinion, and Hopkins is widely recognized as the best.
University Florida Proton Institute (UFPTI) is where I plan to go if I proceed with proton therapy. I called them and expressed an interest in their program and they sent me a package overnight with 2 books and forms to complete and return. Also enclosed was a spreadsheet of graduates of their program with contact information. I have talked with about 15 so far and they were all very willing to discuss their diagnosis, what led them to have proton therapy, and how they have done since, including side effects of treatment.

Data on Proton has been around since the 1990s and has never shown any significant improvement over standard IMRT or IGRT. The newer pencil beam Proton has shown excellent cancer control, but disturbing ED results. Proton is three times more expensive than IMRT and may involve travel and related out of pocket expenses that are hard to justify. Insurance companies may not pay for a treatment that costs three times normal treatments with no data to support any increased effectiveness in either cancer control or side effects.
There is a thread on the PCAF site that you may be interested in.
http://advancedpcatalk.freeforums.net/thread/155/proton-therapy-astro-lancet-far

Dr Brian Lawenda, a Harvard trained radiologist, stated that Proton's costs can't be justified in this age of rising medical costs given it's results for prostate Cancer.
For now it is an expensive technology that is looking for both justification and patients to support the new $300 million dollar Proton centers.