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Proton Beam and Bilateral hip replacement

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Posted 10/26/2015 6:40 PM (GMT 0)
I have bilateral hip replacement. I had plans of considering Proton Beam Therapy and then I found this statement online.

"After they perform a total hip replacement or metallic hip implant, their patients cannot have proton therapy for prostate cancer because the protons must pass exclusively through the hips and are blocked by metal"

First – Is this statement 100% true?
Second – I am open for alternative radiation suggests. My urologist highly recommended radiation treatment and is aware of my hip replacements.


turn

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House_rocker
Age 65
PSA numbers and some history`:
06/1992 – psa 1.8
01/1993 – Left hip total replacement
06/1993 – psa 0.9
11/2001 -- psa 1.9
05/2003 - Right hip total replacement
02/2004 - psa 2.0
06/2005 - psa 1.8
02/2009 - psa 3.6
10/2009 - psa 2.4
11/2010 - psa 4.4
06/2011 - psa 3.9
12/2011 - psa 5.4
01/2012 - psa 4.2
03/2012 – psa 4.4
03/2012 – psa Free 0.54, 12.3%Free psa (24% probability)
08/2012 – psa 4.8
02/2013 – psa 4.2
07/2013 – psa 5.0
02/2013 – psa 5.7
03/2014 – 3.0 Tesla mpMRI (two areas of interest)
08/2014 – psa 6.1
03/2015 – 1.5 Tesla mpMRI (PIRADS 3/5 and 4/5)
07/2015 – psa 6.4
07/2015 – PHI 50.10
10/2015 Biopsy G7(3+4)

Post Edited (House_rocker) : 11/1/2015 4:09:05 PM (GMT-7)

Posted 10/26/2015 6:52 PM (GMT 0)
I've heard about some experiments to alter doses and try to deliver RT basically working around the prosthesis (depending on material), but yeah, this is my basic understanding: radiation beams bounce off, and cannot penetrate through, the metal hip implants which are in very close proximity to the prostate bed. RT for uterine or cervical cancer is also a problem following hip replacements.
Posted 10/26/2015 7:16 PM (GMT 0)
Rocker, I have no idea about PBT and hip replacements but the statement makes sense. Beyond that, there are multiple excellent radiation alternatives including LDR Brachy, HDR Brachy and SBRT. What are your stats, i.e. age, PSA, Gleason scores, number of cores cancerous and % of each core and has your biopsy pathology been read by an expert such as Epstein or Bostwick?

Jim
Posted 10/26/2015 7:39 PM (GMT 0)
A man in my PC support group had very successful SBRT with one hip prosthesis. There are several issues - with PBRT and IMRT, the gantries are in fixed positions and the beams may hit the metal. However, there are other kinds of radiation delivery devices where the beam nozzle moves - Tomotherapy, CyberKnife, VMAT (e.g., Rapidarc) and can avoid the metal. But another issue is imaging - both for planning and during treatment. The metal causes artifacts that may interfere with accurate CT imaging. An MRI can get around this for planning purposes, but the daily motion detection is usually done using cone beam CT (and stereoscopic X-rays too in my case.) I'd guess that with the right machine and an experienced RO, this can be done. Imaging may be a problem as well for brachytherapy.

Since you're in MD, I suggest you talk to Sean Collins at Georgetown - if he can't do it, he might be able to refer you to someone who can.
Posted 10/27/2015 3:22 PM (GMT 0)
House.

I have a hip prosthesis and my RO was able to administer IGRT/IMRT for my initial therapy. They had a little trouble with imaging artifacts, but worked around it. Expert RO and the newer machines can still deliver proper doses in the right places.

Good Luck

Carl
Posted 10/27/2015 11:08 PM (GMT 0)
House_rocker,
Contact a Proton facility, I am sure they will be able to tell you if you are a candidate. I read something on line that said I was not a good candidate for Proton, but was told otherwise when I contacted them. Just remember, take everything you read on line with a grain of salt, as it is not always the opinion of an expert. I would be very surprised if your hip replacement would disqualify your treatment with protons.
Good luck with which ever treatment you go with,
Kris
Posted 11/1/2015 11:06 PM (GMT 0)
I thank everyone for the comments. . . . it is helpful.

I did contact 3 proton facilities. The basic answer was NO. University of Texas Medical Branch said NO. Seattle Cancer Care Alliance Proton Therapy Center said NO. Hampton Virginia Proton Facility said they have done seven (to me that is a NO).

Tall Allen

You were right on target with your reply. Thanks for the detail explanation as to why PT will not work for me. Dr Sean Collins was already on my list of doctors to visit. My best friend used him about 2 years ago for prostate cancer. My consultation with Sean will be on 11/03/2015.

On another note. TA . . . I know Cryablation is not high on your list of proven alternatives, but I am considering it. I heard the success rate is only about 85%. Two physicians that have been recommended are Dr. Woodrum (Mayo Clinic Rochester) and Dr. Walser (University of Texas Medical Branch). Your comments are welcomed.

turn
Posted 11/2/2015 6:03 PM (GMT 0)
I did it in the opposite order, I had the cancer first (I opted for surgery) and just this past January I had both hips resurfaced. I now have a nice symmetrical set of three vertical scars. tongue

So I've got no advice, but I will say that getting teh new hips was the best thing I've ever done for improved quality of life. I played squash for 2 hours yesterday with my son, where a year ago I was having trouble tying my shoes.
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