i believe that all of your questions are covered in my thread "Proton Radiation Therapy - My Journey With Prostate Cancer". However, I will give you the short version below, as requested.
"Okay Dave, I think you are one of the experts, so I'll ask you:
you flatter me, but i am not really an expert! i try to do a lot of research and gain as much knowledge as i can about PC.
In light of reports of pathology after surgery, posted here, in which so many have more cancer than shown by biopsy (B&B included), what assurance were you given that the proton radiation would eradicate all the PCa?
there is no doctor that can give any PC patient a guarantee that their treatment will eradicate or cure their cancer, including proton. there are no tests prior to treatment that can tell a patient with 100% accuracy what their stage of PC is. the tests, while imperfect, are the best available stats that a doctor has to work with. based on such stats, doctors can predict the probability of eradicating the cancer based on historical treatment data. the earlier the projected stage of cancer, the higher the probability of a cure. these are only estimates at best. because i am older and it is projected that i am in an earlier stage of PC, i felt i had as good a chance for a potential cure with proton radiation as with surgery with a much lower risk for negative side effects longer term.
the reason so many men decide to have surgery is that they want the cancer removed promptly and feel it is their best chance of a cure. we know, of course, that even with surgery the cancer could recur if it was in the margins and the surgeon couldn't identify all of it for removal. some believe that radiation might be better than surgery because an area beyond the prostate is radiated, hopefully killing any cancer that may have escaped the prostate into the surrounding margins. again, there are no guarantees that the cancer will not recur.
Is the proof in the PSA pudding after treatment?
the PSA after treatment, whether it be surgery or radiation, is the key test to identify recurring PC. after treatment, men will have to be monitored with periodic PSA tests for the rest of their life, not knowing if future tests will show a rise in their PSA indicating a good probability that their cancer has recurred.
In addition, what have you heard about continence and potency waning over time (5 yrs?) after radiation?
i have not heard of any continency problems with radiation. during radiation you can experience slower flow, more frequency and some mild burning sensation. after treatment, these symptoms usually go away. longer range continency and urination problems could well relate to an enlarged prostate.
there is no question that those treated with radiation (whether it be proton or photon (x-ray) may sooner or later reach total or some degree of impotence. however, in many of these cases, it appears that viagra and other similar drugs will overcome the impotence, which is not always true with surgery. many men can go years before they have to deal with impotence after radiation.
Why would anyone even have surgery if proton radiation is so minimally hurtful?
younger men (40's and 50's), in particular, often don't want to take what they perceive as a risk in being treated with radiation (i.e., they feel that surgery offers them a greater chance of eradicating their cancer). part of the problem is one of perception and fear of radiation. another problem is that, other than Loma Linda, there are not really definitive long-range studies of the success rates with proton radiation, especially relating to younger men who undergo this treatment.
proton radiation for treatment of PC and many other cancers has been around for several decades, but only on a very limited basis. with many new proton centers now opening up in the U.S., proton radiation will undoubtedly come to the forefront of cancer treatment, including PC. proton therapy has therefore been somewhat hidden and many PC patients are not led in that direction because only a minority of PC patients have been treated that way. also, most urologists talk their patients into surgery.
when i first started to read about proton therapy for PC i took notice and decided to explore its potential for my treatment in depth, including talking to those who have been treated with proton radiation. I became convinced early on that it was the right treatment for me. I know that many PC patients, even in their 50's have chosen proton radiation. it really boils down to becoming an educated consumer regarding the various type of treatment for PC and narrowing it down to what you believe is best for you.
Yes, I have read some threads, but its getting awfully "thready" in here...I am ready for your short version, if you would. Thank you,"
i guess i ended up giving you a long answer! all the best! dave
68, Biopsy 9/27/06, Stage T1c, PSA 7.1, Gleason 6 [less than 5% in two areas], Gleason 7 (3+4) [less than 20% in third area], negative DRE, bone scan and MRI. Starting proton radiation therapy 2/22/07.