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Proton Therapy, Gleason 7, 28 Treatments

jmadison
Posts: 5
Joined: Nov 2010

It has been recommended to me, that since one biopsy core has been evaluated at a Gleason 7, the other two being Gleason 6, (PSA 4.5) that a proton therapy course of treatment should be 28 treatments, rather than the normal 40 treatments, with the 28 treatments being accompanied by a higher proton radiation dose.

Does this make sense?

Has anyone else undergone this course of treatment? What has been your outcomes?

I presume that the risk of side effects rises?

Thanks for any input.

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

My father underwent Proton Treamtent at Loma Linda back in 1997. He is doing fine today with no cancer reccurance.
At time of treatment his was an overall Gleason 6. They gave him both Proton treatments and then some regular radiation treatments at Loma Linda. This was in the early days of proton and they were trying different methods to determine what worked best.

His sides effects at the time were urgent, frequent need to urinate. Mucus discharge from the bowell, tiredness and about 5 years post treatment the loss of erection ability. He will turn 80 this August.

Was it the proton center that made the reccomendation to you?

Larry
Davinci treatment for my Gleason 4+3 - 7

VascodaGama's picture
VascodaGama
Posts: 1594
Joined: Nov 2010

Madison

Your received recommendations make sense to me. I do not think that the risks from side effects would increase for the shorter protocol on treatment sections. In fact I believe in the contrary. The isodose curves (area of irradiation) will be the same and the dose volume histograms (DVH) will be higher.
There has been reported evidence that hypo-fractionation (the use of large dose-per-fraction such as in CyberKnife) increase the therapeutic benefits from the radiation.

A higher risk for side effects is related to precision in the delivery of the rays. This is avoided if the equipment in the treatment is of the IGRT type that verifies organ position and motion and does corrections in real-time in a higher accuracy, without compromising close tissues.

In my opinion, proton beams are the most accurate form of delivering radiation treatment in the present days. Just as much as photons (X-rays) the radiation passes through all body tissues to reach its target. From there the proton stops (Bragg peaks) whether photon doesn’t. It continues on its path with reflected radiation. In cases where precision is required protons can better ascertain a well done job, and that will reflect to lesser side effects. However, proton treatment is expensive and clinics choose who to treat. Newcomers should expect for a long waiting list before being scheduled.

Wishing you the best.
VGama

Trew
Posts: 892
Joined: Jan 2010

I think those working with proton therapy know what they are doing and do it well. I would trust them on this.

rnoyes
Posts: 2
Joined: Jul 2011

I am half way through a 28 treatment proton therapy plan at the University of Florida Proton Therapy Institute Center in Jacksonville. Initial PSA 5.5 Gleason 6 and T1c score. First let me say that Proton Therapy for my low grade prostate cancer was the best solution for me. I am relatively young, still play volleyball, swim and do other physical activities that could have been compromised with surgery, IMRT or radioactive pellets all of which damage sensitive nerves and tissues around the prostate more than Proton Therapy. I web researched Proton Therapy when I was making my decision and found some papers presented on it at the University of Penn. showing that this treatment protocol is the way that many Drs. in proton therapy are leaning. I have no more side effects (changes in urinary sensation and other minor changes)than my peers doing the 39 treatment proto. I am able to work normally through treatment and have not had any interruption in any of my normal physical activities and bodily functions. The protocol goal is to accomplish the same results as the longer course by using higher individual proton doses but reducing the overall total body dose of radiation. (a plus in my book) UFPTI says that they have had no change in reported side effects or overall effectiveness using this protocol. Contact them for more info. The advantage to me are having to undergo 11 less treatments and therefore reducing my treatment bill by +/-20%. My doctor at UFPTI said that the Institute is planning to make this protocol their primary treatment for prostate cancer within the next year or two. The advantage to the center is that this protocol allows them to treat 20% more patients! The biggest disadvantage of Proton Therapy is the low number of Proton Centers and the expense of living away from home during treatment. Outcomes are only a few years old so not instructive at this point. The overall outcomes of Proton Therapy going back 15 years at Loma Linda are far better than other therapies. Check with UFPTI about their success and side effect rates. The UFPTI website is http://www.floridaproton.org/

For more info on prostate cancer treatment by proton therapy, contact the Brotherhood of the Balloon blogs of proton prostate cancer recipients. http://www.protonbob.com/proton-treatment-homepage.asp Robert Markini is collecting the experiences of men who have gone through the short course for posting on the blogs there.

By the way, the Proton Center is doing treatment for lung, pancreatic, brain and spinal cord cancers. They are starting a protocol on breast cancer at UFPTI.

Silverstreak
Posts: 4
Joined: Jul 2011

Just Finished Proton Therapy ( 44 treaments ) two weeks ago ... I felt nothing during the entire process , was able to continue every day activities etc etc ... Have every bit of confidence that I selected the best "CURE" for cancer that is available ... psi level was 5.1 with gleason score of 6 ..

robert1
Posts: 82
Joined: Apr 2011

Dear jmadison:

I just completed several months of study and comparison for the variety of radiotherapy options. My choice is IGRT + Brachytherapy. The primary reason is the large amount of impressive cure rate data for my first choice and a lack of sufficient published data on Proton Beam Therapy. You will probably never meet a dissatisfied PBT survivor, and this would have been my #1 choice if not for 8 of 15 biopsy cores showing involvement up to 80%. Even with a 3+3=6 Gleason and PSA at 3.5, I cannot consider myself low risk. For true T1c and lower risk patients (low grade disease and low volume of disease), PBT looks to have mid to upper 90% cure rates with relatively few side effects.

For intermediate risk guys like me, the published 10 year cure rate numbers fall pretty fast and remain too much of a question mark. The republished 5 year cure rate for low risk patinets is 97.3% for those given a total of 79.2 GyE, and 87.4% for intermediate risk patients. Darn good! The original study reflected low risk patient 10 year cure rates of 92.9% but only 69.6% for intermediate risk patients. Not good enough.

The data I am referring to is in the Journal of Clinical Oncology volume 28, number 8, March 1, 2010. A correction from Dr. Anthony Zeitman from Mass General was published in an online JAMA article in 2008

Even without data sufficient for me, PBT therapy was still amazingly hard for me to say no to.

robert1

robert1
Posts: 82
Joined: Apr 2011

By the way jmadison, your Gleason 7 score automatically puts you into the intermediate risk catagory (according to Johns Hopkins), so you should certainly seek treatment options appropriate and proven for this risk category.

If you would like the proton study I mentioned previously, just send me your e-mail address and I will be happy to send it to you.

Best wishes, and God Bless You!

Robert1

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