Proton Treatment

neilm

I have been on this site previously. Been on AS for 3 years. Continuing growth in positive cores and appearance of 3+4 in two cores are moving me to treatment. I am committing to Proton believe the following

Cost is much higher than SBRT/IBRT

Curative power for PCA is equal to other radiation types and RP

Lower secondary cancers while anticipated lack proof side by side

Rectal burns were problematic early on but Spaceor has vastly improved that

Pencil Beam IBPT is the most current and desirable method

University Teaching / High volume center is best environment

GI evaluation needed prior to treatment to cover potential conflicts with therapy.

Appreciate any input on things I am missing / potential items I may regret taking this path. I am past focal therapy consideration but still contained in prostate. Any big misses in this plan?

Marlon

My first question would be does your insurance cover it.

neilm

Yes.

Wheel

What is your age?

neilm

69

Marlon

Please come back after you've had treatment and share the results and longer term progress. There's not much first hand experience around here to compare outcomes. I've had the surgery, but in case I have a recurrence, I'll want to know the pros and cons.

swl1956

I'm curious for what reason are you "past focal therapy consideration"?

Wheel

one thing to consider is the likely age for surgery cutoff would be in around 4 years, that is assuming a person is in good health. I am 70 and decided I wanted the surgery option now, as I know a person’s health can change rapidly and did not want to risk not having that option. I know people discuss that their is still the option for salvage surgery, but only by a limited group of experienced surgeons that will undertake that and I was also worried how Radiation might affect my overall health and side effects that might preclude the salvage surgery and you still have to be in that window for regular surgery. and in good health. As part of my consultation’s after meeting with a Radiation Oncologist I also went to meet with a Salvage Surgery Surgeon at a local leading cancer hospital.

neilm

https://csn.cancer.org/discussion/comment/1717779#Comment_1717779

My 3+4 ‘s are bilateral

Clevelandguy

https://csn.cancer.org/discussion/328449/proton-treatment

Hi,

I think Proton therapy is an excellent choice, is your doctor going to require the Spaceor gel even though the Proton beam stops at the designated target and does not go past?

Dave 3+4

neilm

Yes Spaceor is used and inserted along with fiducials. I think it adds additional margin for the procedure.

neilm

https://csn.cancer.org/discussion/comment/1717783#Comment_1717783

You have a very good strategy, thank you I had not viewed it this way

Old Salt

The following is 'stolen' from the Johns Hopkins site:

Current National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology note that proton therapy is an effective and acceptable form of external beam radiation. To date, most studies of proton therapy for prostate cancer have shown that photon and proton therapy are equally effective at eliminating prostate cancer. Two national trials comparing the toxicity profiles of IMRT and proton therapy are ongoing, including the COMPPARE (COMparative Study of Outcomes with Proton and Photon RAdiation in PRostate CancEr) study (www.comppare.org and ), which is available at the JH PTC.

https://clinicaltrials.gov/ct2/show/NCT03561220

Personally, I might have preferred SBRT because it is so much faster (typically five sessions) and hence, less expensive to the individual (and the system). Most important though is the expertise of the radiology group, whether proton or photon therapy is chosen.