Proton Therapy

hunter22

I had my prostate removed in March 2016 after finding 11 of 12 biopsy hits cancerous. My PSA was 17. Gleason score was an 8. Cancer was found in one lymph node. I had no radiation and was placed on Lupron injections. My PSA stayed at 0.02 for 6 months and then increased to 0.04 in February. Cat scans were negative but bone scan showed a microscopic sized spot on my left hip. Biopsy confirmed it was prostate cancer. Doctor said he had never seen prostate cancer metastasize at this low PSA level. PSA reult for May was 0.16. I still have not had any radiation treatments and wonder if Proton Therapy could possible kill the cancer cells in my hip? I will finish my Provenge treatments in early June. I have called MD Anderson for an appointment after I finish the Provenge. I have only seen a urologist and not an oncologist. My urologist tells me that he is doing the same thing an oncologist would be doing. Your thoughts?  

hunter22

I might add that I am in no

I might add that I am in no pain and would not know anything was wrong if I had not had the bone scan/biopsy. I just got back from a Colorado hunting trip where I climbed mountains at 8500ft elevation. I walk/run about three miles a day.

FinishingGrace

Don't know...

I don't know the answer to your question about the proton therapy. However, it seems from the research I've done and some of what I have read here, urologists and oncologists often differ in their treatment approach to prostate cancer. I would definitly get the opinion of an oncologist before making a decision about treatment if it were me. Of course, a second opinion is always the wisest approach in my opinion.

VascodaGama

Proton may or may not be the best choice

Hunter22,

I concur with Grace regarding the second opinions. You should consult a radiologist for the proton treatment and an oncologist for target medication (hormonal treatment). In any case, you can find these specialists (many of the best) at MD Anderson.

Proton is very effective to treat PCa but just like any other form of RT (radiation) you need targets to direct the treatment. Your first step should be in identifying the location of the metastases using sophisticated image studies. The bone scan has some limitations which could mean that some other spots may exist, and apart from the affected bone (confirmed by the biopsy) soft tissues may also be infested, and not yet located.

Radiation treatment is by far superior to any other option to treat metastatic PCa, if the cancer is well identified and located at convenient places. The field of attack should be planned to cover all targets and be done once. To such extent, proton may or may not be the best RT modality. IMRT is the traditional choice but one may give preferences with two modalities combined (ex: Proton to the prostate and IMRT to the spots, etc).

PET scan (in combination with CT or MRI) using specific agents (PSMA or choline based) is at present the best image exam. You should discuss with the team at MDA on this matter. Another critical aspect you may consider is the consequences that Provenge may have caused. Your immune system should have returned to normalcy before engaging in any shots (infusions of substances). The radiation will also require you to be healthy fit not just physically. Get all parameters checked (lipids, heart, bone, etc) before any decision.

We would like to hear about your experience with Provenge. Can you share with us your history (why, what and the results).

Best wishes.

VGama

Clevelandguy

Proton

Hi,

From what I know about Proton radiation is that it has a fixed focal length beam.  It goes right to the tumor and not past it.  Might be some colateral damage going in but the beam does not go through your body past the tumor and hit other organs or tissue.

Dave 3+4

Swingshiftworker

Why Just Proton Beam Therapy?

OP: Why have you only mentioned proton beam therapy (PBT) vs other forms of radiation treatment? 

IMRT would typically be used following a failed prostate cancer surgery.  Cyberknife is also a possibility.  Both are widely available and suitable for treatment of all kinds of cancer.

Also not sure why you say that the biopsy of the "spot" on your hip was diagnosed as prostate cancer -- it's apparently bone cancer in your hip.  If there's no latent cancer in the area of the prostate, why do you think that the "spot" originated from the cancer in your prostate that was removed?

Isn't it possible that you just developed bone cancer in you hip independent of your earlier prostate cancer? 

Go with PBT if you prefer but the availability of PBT treatment sites is very limited and you may find that using IMRT or CK may be more convenient and equally effective.  Good luck!

 

 

Old Salt

CyberKnife vs SBRT

Stereotactic body radiation therapy (SBRT) is sometimes used to kill bone metastases. The pros and cons tend to generate a lot of discussion, but we need not go there right now. Judgment is best left to either a rad oncologist and/or a medical oncologist. 

PS: CyberKnife is just one instrument to administer SBRT. There is at least one other instrument (made by Varian) that is capable of doing that.

hunter22

I am trying to get an appt at

I am trying to get an appt at MD Anderson to see an oncologist. The only doctor I have dealt with is my urologist. He removed my prostate in March 2016. After the surgery my PSA was 0.16. Cancer was found in one of my lymph nodes that was removed. I was started on Lupron but had no radiation treatments. My PSA dropped to 0.02 and stayed there for 6 months. In Feb my PSA went to 0.08 and in May it went to 0.16. The doc told me it was prostate cancer in my hip. He suggested I start the Provenge treatment. But he now seems to have the attitude that I am a dead man walking and I am not ready for that. He has no urgency in his approach.  I appear perfectly healthy for a 67 year old and walk 2.5 miles/6 days a week. I am planning an elk hunt to Colorado this fall. 

Swingshiftworker

hunter22 said:

I am trying to get an appt at

I am trying to get an appt at MD Anderson to see an oncologist. The only doctor I have dealt with is my urologist. He removed my prostate in March 2016. After the surgery my PSA was 0.16. Cancer was found in one of my lymph nodes that was removed. I was started on Lupron but had no radiation treatments. My PSA dropped to 0.02 and stayed there for 6 months. In Feb my PSA went to 0.08 and in May it went to 0.16. The doc told me it was prostate cancer in my hip. He suggested I start the Provenge treatment. But he now seems to have the attitude that I am a dead man walking and I am not ready for that. He has no urgency in his approach.  I appear perfectly healthy for a 67 year old and walk 2.5 miles/6 days a week. I am planning an elk hunt to Colorado this fall. 

See that Oncologist ASAP!

How could the urologist conclude that the bone cancer in your hip was derived from the prostate cancer without further testing? 

That's a conclusion that doesn't necessarily follow but it doesn't really matter where it came from.  If it's cancer, it needs to be treated and if it's in your hip, your urologist is of no use to you for that purpose. 

On the other hand, the rise in your PSA suggests a recurrence of the prostate cancer and a failure of the surgery.  So, some form of supplemental chemical or radiation treatment may be needed to treated that as well. 

The question is whether the prostate cancer has actually mestastisized or not and only an spectrogrpahic MRI or CAT scan of the prostate bed and surrounding areas can tell you that.  

So, only an oncologist specializing in prostate and bone cancer can be of any help to you now and you need to see the one at MD Anderson ASAP!

S/he can also tell you whether provenge (which is still considered experimental and is very expensive treatment for metastasizing prostate cancer following hormone therapy) will be of any help to you or whether chemotherapy or any other form of treatment (including PBT or another form of radiation for the bone cancer) would be advisable. 

Good luck!

 

 

lakehouse123

Proton Therapy

My dad just completed 33 treatments of Proton therapy for metastatic prostate cancer into lymph nodes.(prostate removed about 14 yrs ago) Was being maintained with hormone injection, that worked for years. However, scans showed lymph node involvement and he decided to try proton therapy to stop disease from progressing.  He visited doctor today for three month follow up after completion of the 3 treatments. We were sad to hear the nodes had not changed size, however the PSA had gone from 5.5 to 0.06. Very encouraging. He is also being treated with  a different chemo type treatment, which he attributes to decreaes in PSA, rather than the radiation? -because size of nodes remains unchanged.? He will return in 3 months for another scan, Dr feels maybe nodes just still enlarged post treatment due to irritaition and inflammation post treatments. Has anyone else had this occur?

SPT

Get a second opinion at a newer facility

The proton machine at MD Anderson is over 10 years old.

Dr. AK Lee was the first RO to use pencil beam scanning in proton therapy.  He was at MD Anderson.

Now he is at Texas Center for Proton Therapy. There's a video of Dr. Lee on the page. 

He's a nice guy, something I find all too rare in oncologists and urologists.  The machine is state of the art, although the field is evolving so rapidly it won't be for long.

It's much more modern and capable than the one at MD Anderson. I'm not knocking the doctors there, but a workman is only as good as his tools.

Always get a second and maybe third opinion.  Take your time and consider the possible positive and negative outcomes carefully.  Prostate cancer is never an emergency.