Is Proton Beam Therapy as good as many say it is?

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imtls
Regular Member


Date Joined Oct 2011
Total Posts : 25
   Posted 12/6/2011 8:03 PM (GMT -6)   
After 6 months of research, I am looking at 3 PC therapy options: (a) robotic surgery, (b) combination of brachytherapy (internal radiation) plus IMRT (external radiation) and (c) proton beam therapy. Right now I am leaning towards proton beam therapy.

I have talked to a urologist and a radiation oncologist about PBT and they both say PBT has shown no better long term benefits than other therapies. Dr. Peter Scardino says the same thing in his 2010 edition of his Prostate Book. They also all say PBT is very expensive. Are there any long term statistics for PBT and can I access them?

Online postings listing negatives of PBT include: expensive, insurance coverage issues and few US treatment sites (I believe the current number is 9). I have not looked very extensively but I do not find online PBT postings where ED or incontinence is listed as a major issue. I can’t say that about other PC therapies.

I like what I read about PBT online (I would welcome recommendations for the most active online sites discussing PC). In his book Dr. Scardino says PBT is “YET to show any real benefits of this expensive new technology”. I am wondering if the current state of PBT will show real improvement in long term benefits. MD Anderson Cancer Center touts an advance in proton therapy called “Pencil Beam Technology”. They describe the Pencil Beam as spraying a narrow 1 cm beam like an air brush versus the current proton technique employed at many treatment centers as using a can of spray paint (this seems a much wider spray area depending on how far the spray can is placed from the object you are spraying). For all you US non-metric experts, one centimeter is approximately the distance from the center of a US penny to the outside edge (i.e. the radius of a US penny).

I live near the Mayo Clinic and saw the Mayo Clinic was not listed in the 9 treatment centers in the USA currently providing PBT. A little online searching discovered the Mayo Clinic is building TWO proton beam facilities and plan to open them in late 2014 or early 2015 (the Mayo Clinic has 3 major clinics in the US and two of them are getting PBT facilities). The cost of these new facilities runs into the hundreds of millions of dollars. “We are enthusiastically moving forward with this program because we believe it offers additional, innovative options for cancer patients” says john Noseworthy, M.D., Mayo Clinic president and CEO. Does anyone think spending this amount of money on multiple facilities can be viewed as a positive endorsement of PBT?

One other reason why PBT is now on the top of my list is it does not remove my prostate. I also believe it is less invasive than other radiation therapies. I am hoping this means I am not eliminated as a candidate for future noninvasive PC therapies now in clinical trials if PC ever reappears in my body. I have read about problems with surgery following radiation but I will take that risk hoping my treatment options in the future will be superior to my salvage treatment options today. What are the current salvage treatment options following PBT if necessary?

One new approach for treating PC has arrived: Provenge: Provenge is the VERY FIRST immunotherapy approved by the FDA for treating advanced PC patients. From provenge.com: Provenge is designed to work “By stimulating the natural ability of your body’s immune cells to target and attack advanced prostate cancer”. Treating my blood to attack my cancer is an early stage PC treatment choice I would like to have today. Other immunotherapy treatments for PC are currently in clinical trials and hopefully they will provide improved PC therapy options for all of us.

Your comments and opinions are appreciated.

GLTA, Terry
Male, age 63, psa 4.34, biopsy 7/27/11 2 of 14 cores positive & 1 PIN
Gleason 3 + 3 = 6, T2
9/27/11 PCA3 score 14.0
9/28/11 biopsy 2 of 14 cores positive, Gleason 3+3 = 6
10/06/11 Mayo reviewed 9/28/11 biopsy & upgraded Gleason 3+4 = 7
11/28/11 PSA 3.43

Post Edited (imtls) : 12/6/2011 6:07:21 PM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3732
   Posted 12/6/2011 9:00 PM (GMT -6)   
Terry,
There are a couple of studies that compare Proton therapy with other treatment options.
The ICER 2009 is the most comprehensive and the Prostate Cancer Study Group Results also has some proton studies in their summary of 700 plus studies on treatment options.
The data I have seen gives no advantage to Proton over any of the other forms of radiation in either effectiveness or QOL.
Proton was the radiation treatment of choice in the 1990s as the other forms of radiation such as Brachy and IMRT were not yet developed to the extent they are today. Proton is also very useful and effective in small cancers that are in hard to reach places such as the brain and neck, but have not been that successful in treating large irregular objects such as the prostate.
There is little doubt that Proton will work well on low grade, low volume prostate cancer, but every other treatment also works very well on these types of cancers. Higher volume more agressive cancers require high doses, which are not available with Proton at this time; for these Proton is usually augmented with a boost from IMRT.
You can also go on The New Prostate Cancer Infolink and search Proton Treatments and there are several articles that are critical of the data that was compiled at Loma Linda, the longest running Proton center in the US.
Anacdotal information from proton patients is very favorable, sometimes bordering on a "cult" culture. This is understandable because most Proton patients travel to receive treatment and spend a lot of time with other proton patients in similar conditions receiving a lot of positive reinforcement about their treatments.
The bottem line is that patients love it, but the data does not support it being more effective than current forms of radiation. It is also 3 times more expensive than current treatments and this does not include travel expenses to visit a treatment center if not local.
JohnT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

SkeeterZX22v
Regular Member


Date Joined Apr 2011
Total Posts : 190
   Posted 12/7/2011 6:36 AM (GMT -6)   
Terry,

I am a proton beam therapy believer, having just recently completed treatment at IU Health @ Bloomington, Indiana. I had never heard of proton therapy when I was diagnosed, but after several months of intense research including interviewing several men who had undergone surgery, I ultimately decided on proton beam therapy. Without going into all the "pros" and "cons" of the various therapies, the bottom line as I understood it was that there was little difference between proton beam therapy and photon beam therapy as far as killing the cancer cells in the prostate was concerned. Both were forms of radiation and both were equally effective. The big difference I believed existed between the two forms of treatment was the likelihood of fewer "quality of life" issues from the proton beam treatment. Yes, a lot of the evidence is "anecdotal" but I also talked with several who had undergone conventional photon treatment, as well as several physicians not directly related to prostate treatment for their opinions. Although IMRT is good (and what I would have done if proton had not been available for me) there is still a higher likelihood of collateral damage to adjacent tissue, especially the rectum, than with proton beam therapy.

Proton Beam Therapy seems to trigger "attacks" from some people for whatever reason when it is discussed. I have never claimed nor believed that its effectiveness as a cure was "better" than IMRT. For me it was all about taking the least risk with respect to side effects. I do believe the science of proton beam therapy has a legitimate argument in that regard. The critics are right in that it is expensive, and not readily available nationwide, thus requiring travel and a lengthy stay at one of the treatment centers. But that does not mean it is not a valid form of treatment. And yes, the decision to build new proton centers to include the Mayo Clinic and other leading institutions does reinforce (at least in my mind) the legitimacy of this form of treatment.

Finally, as to the "cult" culture that John T mentioned, yes there is some positive reinforcement about receiving proton treatment because you do see the same people for an extended period and often make new friendships. But there is also some satisfaction in knowing that you did everything you possibly could to get treated and yet avoid the side effects that are so often discussed on this forum. Most who undergo proton beam therapy just feel incredibly lucky to have been approved by their insurance, and to have found out about the treatment option before making their final decision.

Options are nice to have. Proton Beam Therapy is certainly one of them. Ultimately it is your decision as to what to do.
Age 61, psa 4.6, 30 days cipro, psa 4.3, biopsy 4/28/11, 2 of 12 cores positive, Gleason 6
T1c
Central Ky
Approved (insurance) for Proton Therapy at IU @ Bloomington 7/14/2011
8/17/2011 Proton Therapy Treatment begins
10/19/2011 Proton Therapy Treatment Completed!
IU Health Proton Therapy Center: http://iuhealthprotontherapy.org/about/

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 1720
   Posted 12/7/2011 9:51 AM (GMT -6)   
Terry, you should also check into High Dose Rate brachytherapy. It is the form that does not leave the radioactive seeds in permanently and has less side effects than permanent seed brachytherapy. You may be a candidate for monotherapy and potentially could avoid the IMRT. The best information is at www.cetmc.com by Dr Jeffrey Demanes, the HDR pioneer that heads the radiation department at UCLA. I used HDR and had two excellent providers to choose from in Atlanta. You can check into it in your area. There is also a renowned specialist, Dr Alvaro Martinez, in the Detroit area.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13, 2010.
PSA <.1 and T 23 on 2-3-2011. PSA <.1 on 4-7-2011. Second Eligard shot on 4-7-2011. PSA <.1 and T <3 on 7-15-2011.

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 12/7/2011 11:53 AM (GMT -6)   
Terry,
 
I live in an area where PBT is available. It is heavily marketed in this area and I hear a lot about it. John T summed it up nicely in his post above. While most men who have had it seem very pleased, there is not much long term evidence that it is any better than other treatment options as far as cure rates and QOL issues when treating the prostate. I elected to go with BT/IGRT and have had minimal SE's. Hopefully you will get some response from someone who is several years out from PBT for some longer range results. Either way, in my opinion, (and it is an opinion only based on what I have read on this site) you will reduce the chances of unwanted SE's.  
Age 69 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA as of 8/4/11 - 0.1

imtls
Regular Member


Date Joined Oct 2011
Total Posts : 25
   Posted 12/10/2011 8:53 PM (GMT -6)   
I would like to thank all of you who responded to my original post. You have been very helpful.

I am creating a new post for this forum with a request for PC therapy options to investigate.

GLTA, Terry
Male, age 63, psa 4.34, biopsy 7/27/11 2 of 14 cores positive & 1 PIN
Gleason 3 + 3 = 6, T2
9/27/11 PCA3 score 14.0
9/28/11 biopsy 2 of 14 cores positive, Gleason 3+3 = 6
10/06/11 Mayo reviewed 9/28/11 biopsy & upgraded Gleason 3+4 = 7
11/28/11 PSA 3.43

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 2350
   Posted 12/11/2011 1:02 AM (GMT -6)   
Protons weak link is a technical one..It's how the proton beam is focused on its target. I am not an expert on this, but I remember reading how Loma Linda had problems positioning PC patients and controlling the beam to provide effective treatment..Normally, a proton beam is very small, the "pencil beam" analogy..When used for treating PC, the beam must be spread out a little. This can be very tricky and the masks or petals placed in the beam to accomplish this generate a lot of neutrons that scatter around the treatment room and bombard the patient..Hopefully, the newer machines have overcome these limitations and more advanced methods of controlling the beam have been developed.. The treatment room the patient sees is only a small part of the proton treatment device. The machine extends for 2 stories above and below the patient...That's why they cost so much and take so long to build. Each machine is custom-built on site...My description may not be 100% accurate, but if I was going to spend the time and money to be treated on one, I would certainly investigate the points I have raised...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA <0.1 10/'11, <0.1

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2086
   Posted 12/11/2011 3:36 AM (GMT -6)   
I thought PBT was still too new for it to be possible to have any studies available about the long-term affects, benefits, side effects etc.

My understanding about why PBT might be better was that due to the way the protons' energy has a peak it does not do have as much effect on the healthy tissue as it passes through the body on its way to the target or on its way out. I've also read about it being good with tumours when surgery was impossible (eg brain).

I'd assumed however, that the side effects from irradiating the prostate were likely to be the same regardless of what type of beam was used.

I'd also reckon that it stands to reason that all beams will spread/scatter the wrong way if the plates are not shaped correctly in the head.

And with all beam therapy the most important aspect is actually ensuring that the docs can work out exactly where the target area is and what the dose needs to be to do just enough damage but not too much.

Alf
Age dx 48
04/09 PSA 8.6, DRE neg. Biop 2/12 pos. G=3+3
07/09 RALP at AVL Amsterdam
Cath out at 1wk Dry at night
PostOp G=3+4 Bladder neck & Left SVI -T3b. No PNI No vasc.inv. Clear margins
09/09 No pads
11/09 PSA 0.1
03/10 PSA 0.4 04/10 CT.
Summer/10 66Gy SRT
09/10 PSA<0.1
01/11 PSA<0.1
04/11 PSA<0.1
07/11 PSA<0.1
10/11 PSA<0.1
No real ED

golfnooch
Regular Member


Date Joined Sep 2011
Total Posts : 352
   Posted 12/11/2011 8:45 AM (GMT -6)   
I did not get proton, i went robotic instead, but I spoke to the top Radiation Oncologist at UPenn, one of the proton sites, prior to making my decision.

In his opinion, the benefit of proton vs. regular radiation was simply the targeted approach, lowering the chances of damage to the surrounding organs and tissues. Evidently, in normal radiation, the beam would pass all the way through and at times cause rectum or other issues with patients. According to him, the proton has a significantly lower risk of that. If I had gone the radiation route, I would have chosen proton if available and no insurance issues.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3732
   Posted 12/11/2011 1:37 PM (GMT -6)   
The following is a technical critique of Proton written by Dattoli. Dattoli is one of the most experienced radiaologists in the US, but has a vested interest in BT/IMRT. Understanding that this article may contain a bias, it is a good start for someone looking at the technical aspects of Proton Treatment.

http://www.paactusa.org/uploads/Sept2009_2371.pdf

PAACT Newsletter Sept 2009
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 2350
   Posted 12/11/2011 7:05 PM (GMT -6)   
Lets face it, this is BIG business and these guys must be salesmen if they want to survive in the marketplace, the Cancer Bazaar...But if just half of what Dattoli says is true, it should give everyone pause before they go seeking the latest, greatest and most expensive forms of treatment...The Dark Side is NEVER mentioned in the sales brochure...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA <0.1 10/'11, <0.1

Jimmie640
New Member


Date Joined Dec 2011
Total Posts : 2
   Posted 12/11/2011 8:16 PM (GMT -6)   
Terry,
I don’t know why PBR stimulates so much hostility on these fora
on the part of those who didn’t select it for treating their prostate cancer. It is simply another treatment modality which, with 20 years of treatment history, has demonstrated very low effects on quality of life while being as effective as other major modalities. I haven’t seen any place where it has been touted as more effective. In fact a little digging will show that surgery and all forms of mature radiation treatment have about the same effectiveness after 5 years (somewhere around 90%) when differences in acceptance for treatment are taken into account (surgery is normally performed only on patients whose disease is wholly contained in the gland and usually shows a small percentage more effectiveness over radiation which is often used on patients whose disease has spread outside the prostate and, thus, is less likely to be effective – as in my case). A very small percentage of PBT patients have ED after treatment – the reason has not been determined but could simply be in the normal course of events at the advanced age most PC patients are treated. Also a few patients have some bleeding into the urine. I don’t know if this is true of other radiation modes.

The reason for the difference in side effects of photon vs proton treatment that affect the quality of life is simply the difference in damage to healthy tissue vs cancerous tissue of the two modes. X-rays expend most of the energy of the beam along the path to the target (cancer), and beyond, in healthy tissue. Sophisticated beam concentration and variations in path to target techniques (IMRT) have greatly reduced the damage to healthy tissue while putting more energy on target. As particles protons produce a ‘Bragg Peak’ as they come to rest that causes most of the energy to be expended at that point. A beam of protons can be spread and shaped in cross section to the shape of the cancerous tissue to be treated, such as the prostate. The velocity of a beam of protons is also modulated so that protons come to rest throughout the tissue being radiated. A small amount of energy (as compared to x-rays) is lost by the protons on the way to the target but none beyond. The patient’s position relative to the proton beam is critical and pains are taken to ensure that the patient can be repeatedly positioned properly. The same necessity for careful positioning is also true for IMRT for the same reason. The following sites have good explanations that are understandable without the mathametics:

http://en.wikipedia.org/wiki/Bragg_peak

http://en.wikibooks.org/wiki/Radiation_Oncology/Physics/Radiation_Interactions

http://scholar.google.com/scholar?q=patient+positioning+IMRT&hl=en&as_sdt=0&as_vis=1&oi=scholart

The therapeutic effects of radiation of any kind on cancer is the damage done to the DNA that cancer cells cannot repair as well as healthy cells. IMRT and protons both do this very well with proton radiation having some advantage in accuracy and energy on target vs expended enroute. The disadvantage of proton beam radiation, as pointed out by others here, is the cost. Obviously if you ‘follow the money’ proton beam radiation has a enough advantages, across all uses (not necessarily just prostate cancer) to warrant the investment of the huge sums necessary to build the required facilities.

In the fall of 1994 I selected proton beam at Loma Linda and have had no side effects. I was kept on hormone ablation for several years unnecessarily by timid ‘cookbook’ oncologists with substantial and debilitating side effects (probably including a heart attack) until Dr. Charles (Snuffy) Myers stopped it 6 years ago – no problems since. I highly recommend PBR if it is available to you.

Age when diagnosed in 1994 - 62
PSA when diagnosed – 101.6
Gleason Score – 3+3 – 6
PSA now – 0.19
ED - no

Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 12/11/2011 8:22 PM (GMT -6)   
SkeeterZX22V - I see those trigger "attacks" are coming.  Happens every time someone asks for info on proton and where these people come up with some of the "facts" they expouse baffles me.  As I stated in a previous post months ago, it is one reason I no longer post.
 
Imtls - I'm a member of that proton "cult" -I had proton 10 yr ago, no problems. 
Dutch 
 
 

Post Edited (Dutch) : 12/11/2011 6:41:05 PM (GMT-7)


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5904
   Posted 12/11/2011 8:50 PM (GMT -6)   
 
Back to the subject - my uro (and later surgeon) suggested that PBR was very valid (for many of the reasons already mentioned), but based on the biopsy, felt any form of RT was not sufficient treatment. I consulted with MD Anderson, and they believed I was likely not a valid candidate. My insurance would not cover any part of the cost (they consider PBR as equivalent to IGRT, which is available in my area), and I did not have sufficient time off or financial resources to cover the move to another city for such a lengthy time. So, I have no experience to offer, other than having strongly considered the treatment.
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Post Edited (142) : 12/11/2011 9:09:41 PM (GMT-7)


Water Guy
Veteran Member


Date Joined Jul 2011
Total Posts : 2403
   Posted 12/12/2011 9:07 AM (GMT -6)   
From one Terry to another, I also spent a lot of time looking into PBRT as an option after I was diagnosed last April. At first even my URO thought I could be a candidate as his brother had successful PBT at Loma Linda 10 years ago. I ran into some of the same problems as found stated here. My insurance BCBS of Alabama still considers PGT as "experimental" and will not pay for any of the cost and I would have had to travel over 300 miles to Jacksonville Florida for over 8 weeks. I own my own business and there was no way I could have gone that far for that long. What I did find out is that some amazing things are being done with proton RT for many different cancers around the country which is spurring more treatment centers being built.
 
I also looked into seeds RT and ran into the problem again with my insurance company as one of the best seeds RT clinics in the South is in Atlanta which BCBS considered out of network for me. I ended up having surgery by my URO which so far has been successful. My post pathology most likely would have excluded me from PBT consideration as the large size of my tumor and prostate did not show up in any of my original diagnosis but would have been found after I had done scans and MRI's for the PBRT.
 
Goiod luck in your journey,
 
Terry The Water Guy
AGE 61 with fam hist of PC
PSA
1.5 5/09
2.5 6/10
3.5 12/10 ref URO
5.25 2/11 all DRE Neg
BX 4/13/11 2 of 12 cores diag both sides 15% & 20% GS7(3+4)
RALP nerve-sparing 6/8/11 path G7 pT2C, Marg-Lymph-Sem-Vas NEG, organ confined 60% tumor involved 69grms 4.3X4X3 cm 100% dry 7/1/11
post PSA 8/30/11 <0.07
TRIMIX therapy for ED seeing improvement
Zero club member in good standing

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 7665
   Posted 12/12/2011 12:40 PM (GMT -6)   
Terry,
I was one of those guys that was on the other side of this argument and I was against proton beam therapy. I still might be but it's for other reasons than I have stated in the past I was wrong about those points. PBT is very effective in treating prostate cancer and those that had the therapy are proponents for the treatment. And for good reason. In the early 90's it was simply superior in avoiding side effects. But back then we didn't have accurate ways to deliver photon based therapies like we do today. Photon based IMRT or using guided technology such as beacons or markers with CT imaging have greatly improved photon therapies and I see an equal number of men doing well with small incursion of side effects.

I have a friend that was an RO at Harvard and he utilized Proton, Photon, and Cyberknife technologies. He likes the latter best as it requires less patient interaction. Therapy is done quicker basically.

My one concern about PBT is the costs. Rightly so. There is no data to support that it is any more effective than IGRT or IMRT but it costs up to three times more for treatment. That stated my friend believes that PBT will continue to drop in price as more centers come on line.

If you chose PBT you will likely do well. That's all we can ask for. And if it's the therapy you feel best about, then you should do what is best for you.

Tony
Advanced Prostate Cancer at age 44 (I am 49 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3732
   Posted 12/12/2011 1:00 PM (GMT -6)   
No one is knocking Proton Treatments, just putting out there the data that exists so a patient can make up his own mind. Unfortunately most of the Proton data we have been receiving is anacdotal. When long term data is presented in the few studies that have been done it does not support any advantage over other forms of radiation. As soon as favorable data is available that too will be published and that data will also be made available to patients. At this time you can either accept the scientific data available or accept the anacdotal stories.
Patients come to this site looking for answers and all sides of an issue must be presented whether we agree or disagree with them. As to the quote " I don't know where people come up with these facts":
All the published studies on Proton are readiable available if you do a search on the New Prostate Cancer Infolink or on Pub med. These are available to anyone curious about results involving lots of patients over many years and compliled by researchers and confirmed by peer review. This is the normal way treatments are evaluated. Of course when this data does not agree with a preconcieved view then there is a conspiracy somewhere.
As soon as data is presented that shows Proton is more effective in both cure and QOL than other forms of treatments then there will be a lot of converts and insurance companies will have to pay for the treatments. It's really pretty simple and there is no conspiracy involved as we all would love to have a treatment that is effective with very few QOL issues.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 222
   Posted 12/12/2011 1:51 PM (GMT -6)   
IMHO, from a pure radiation physics perspective, brachytherapy (permanent or HDR) provides the least side effect and collateral damage because the radiation comes from within the prostate and does not have to pass through any outside tissues. The strength of the radiation can also be designed to stop short and minimizes getting out into the surrounding tissues.

Proton has the Bragg Peak so it minimizes damage to the tissues beyond the prostate but from the entry point to the prostate, there are still some significant absorptions of the radiation to cause potential damage.

External beam photon (X-ray) can be designed to have the absorption peak at the prostate location (that is why the "MeV"-energy, is important as absorption peak depends on amount of tissues in front of the prostate and the energy of the X-ray) but the absorption peak is shallow, not as peaky as proton. It also has more potential problem of scattering from body tissues and the equipment/surrounding. That is why there is a whole industry studying beam design, equipment design and surrounding design/set-up.

From a radiation engineering perspective, I can envision all of them would be very effective if the cancer is local and well within the prostate. If the cancer is near the edge, I imagine proton would be less effective/more collateral damage to the adjacent tissues because the radiation is more "damaging" if directed at the wrong area. And being "pencil sharp" would be a disadvantage as no matter what, the location of the prostate cannot be precisely determined, like looking through a badly focus picture. In that regard, external/brachy would be more effective and a better choice.

In term of side effect, looking at the absorption curves, I can believe proton would give less side effect both because the absorption before the Bragg Peak is less than those from X-ray. Also, if the cancer is well within the prostate, a sharp beam is much better.

The good news for us is that all radiation treatments have made such tremendous progress that data showed SPC (secondary primary cancer) and other side effects are minimal and some studies indicating long term survival is as good as (perhaps in some cases better) surgery. So, I now believe both surgery and radiation are good choices and it is a matter of personal preference.

This is just my opinion as a non healthcare professional.

Post Edited (Newporter) : 12/12/2011 12:09:14 PM (GMT-7)

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