I'm sorry I haven't responded in some time...been very busy. (I probably shouldn't even start a thread, if I'm won't be around to reply or respond).
Anyways, John regarding the ICER review of it, I gathered that the conclusion was proton beam wasn't worth the added costs. I don't know if by costs, they mean to the patient, the organization or both. What I also don't understand is there is a statement that says the long term effectiveness of proton beam is still unknown. I find that difficult to take in, as proton beam has been available for a fairly long time. In addition, the early attempts at photon radiation were more like a shot gun approach, or a "spray and pray", if you will. I agree that photon radiation has much advanced in the past decade, with IMRT, RapidARC, IGRT etc. But that doesn't mean proton is sitting still either. Mayo Clinic is installing "Pencil Beam" proton therapy, I believe that is similar to image modulating photon.
When reviewing the Yana site, it just seems to me that the proton group has the least side effects. And if the outcome is similar to photon radiation, then perhaps proton isn't getting enough credit. My dad had some fairly rough side effects to deal with from 3dCRT. He did not survive prostate cancer, but than again, got treated late, and had an aggressive tumor, a double whammy.
MSK prostate calculator unfortunately doesn't calculate the % of being progression free for proton, but (again just a observation here) it seems that the spread between photon and surgery is narrowing on the short and long term duration.