How Effective Is Proton Therapy For Prostate Cancer

Positioning For Proton Beam Treatment

Positioning the body is very important. It can take several minutes for the team to adjust both you and the instruments to make sure the proton beam will reach the exact spot of the tumor.

While the treatment is happening, you must be very still on the table. The team will work with you to help keep you in place. For example, a custom-fitted mask can help those who are getting treatment for brain tumors. The mask is made of mesh that allows patients to see and breathe.

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Cancers Types That Are Treated With Proton Beam Therapy

Proton beam therapy is usually used for localized tumors and is used infrequently for stage 4 tumors . It may be used alone or combined with other treatments such as surgery, chemotherapy, immunotherapy, or traditional radiation therapy. Some types of cancer in which proton beam therapy may be used include:

• Lung cancer: Proton therapy for lung cancer may be used for early-stage cancers that cannot be treated with surgery, or for a recurrence when conventional radiation therapy has already been given.
• Brain cancer: The precise area of delivery offered by proton beam therapy may be beneficial for brain tumors in which even small amounts of damage to nearby normal tissues could have significant side effects.
• Childhood cancers: Proton beam therapy, as discussed below, may do less damage to nearby normal tissues. Since DNA damage to normal cells may lead to secondary cancers, itâs thought that this therapy may be a better option at times for children.
• Head and neck cancers

Some noncancerous tumors, such as benign brain tumors may also be treated with proton therapy.

Proton Therapy Vs Traditional Radiation Therapy

So, what makes proton therapy so much more successful than other prostate cancer treatments? The answer lies in the protons themselves.

Unlike proton therapy, traditional radiation treatment uses photons, which deliver low levels of radiation to the cancer tissues. These lower levels of radiation, in addition to the lower mass of the beam in comparison to a proton treatment, mean the radiation will cause damage to both the cancerous tissue and the surrounding healthy tissue.

On the other hand, proton therapy uses positively charged subatomic particles called protons, which are located in the nucleus of an atom. Because the mass of the proton beam is higher than the photon beam, a clinician can control the proton radiation in the patients body. The electrons in the patients body slow down the protons delivered from the beam. This results in an energy release that can destroy cancerous tissue, but avoid unnecessary radiation to surrounding areas. Unlike traditional radiation therapy, the clinician can use the proton beam to target the cancer cells in the body specifically, allowing for a more successful and far less damaging procedure.

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How Proton Therapy Effectively Treats Prostate Cancer

Proton therapy treats prostate cancer with high doses of radiation that are more accurate, and potentially more effective, than traditional radiation. Our targeted proton beams focus most of their destructive energy at the tumor site, therefore causing less damage to healthy surrounding tissue as they enter the body. Because of this, proton therapy patients dont have to worry about many of the side effects and additional healthy tissue damage that is commonly associated with X-ray therapy.

an effective cancer treatment alternative

Questions To Ask Your Doctor Radiographer Or Nurse

• Will I have a planning session at a different time to the treatment, or immediately before?
• Will I have external beam radiotherapy or hormone therapy as well?
• What side effects might I get?
• How will we know if the treatment has worked?
• What should my PSA level be after treatment and how often will you test it?
• If my PSA continues to rise, what other treatments are available?

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What Types Of Radiotherapy Are There

There are two common types of external beam radiotherapy:

• intensity-modulated radiotherapy
• 3-dimensional conformal radiotherapy .

Intensity-modulated radiotherapy

This is the most common type of external beam radiotherapy in the UK. A computer uses the scans from your radiotherapy planning session to map the location, size and shape of your prostate. The radiotherapy machine gives beams of radiation that match the shape of the prostate as closely as possible. This helps to avoid damaging the healthy tissue around it, reducing the risk of side effects.

The strength of the radiation can be controlled so that different areas get a different dose. This means a higher dose of radiation can be given to the prostate without causing too much damage to surrounding tissue.

3D conformal radiotherapy

As with IMRT, the radiation beams are mapped to the size, shape and position of the prostate. But the strength of the radiation cant be controlled in 3D-CRT, so all areas are treated with the same dose.

IMRT is now the standard type of external beam radiotherapy for prostate cancer in most hospitals, but some still use 3D-CRT. They are both effective ways of treating prostate cancer. Ask your doctor or radiographer which type of radiotherapy youre being offered.

Other types of radiotherapy

Stereotactic radiotherapy

Proton beam therapy

Read more about clinical trials. Or to find out about taking part in a clinical trial, ask your doctor or nurse, or speak to our Specialist Nurses.

Proton Therapy For Pediatric Cancers

Proton therapy is particularly beneficial for treating children and adolescents with cancerous and noncancerous tumors. Children are at a significantly higher risk of late effects from cancer treatments compared to adults. Two-thirds of children who survive a cancer diagnosis face at least one chronic health condition. One-fourth of pediatric cancer survivors face a severe or life-threatening side effect from treatment that occurs later in life. These include heart damage, lung damage, infertility, cognitive impairment, growth deficits, hearing loss, vision loss, secondary cancers and more.

Thanks to treatment advances, including radiation, pediatric cancer survival rates have dramatically increased to nearly 85% today from 10% only decades ago. One of these advancements, proton therapy, reduces a childs risk of experiencing harmful long-term side effects. Proton therapy limits and reduces radiation doses to healthy tissues and organs while delivering curative doses to the cancer.

We treat a number of childhood cancers with proton therapy. In certain situations, the cancer center will coordinate with Childrens Mercy specialists to develop a care plan suited to the childs individual treatment requirements. Childhood cancers we treat with proton therapy include:

• Atypical teratoid rhabdoid tumor
• Rhabdomyosarcoma

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Pencil Beam Scanning Proton Therapy

Pencil beam scanning is one of the most common ways to deliver proton therapy for prostate cancer. Another common method is double-scattered beam therapy.

With pencil beam scanning proton therapy, medical professionals are able to manipulate and focus the proton beams to a greater extent. This results in a more precise dose of radiation than double-scattered therapy, sparing surrounding tissue even more.

However, the difference in outcomes is minimal, according to

Side effects may include fatigue and skin redness or soreness where you had treatment. You may also have issues with incontinence or gastrointestinal side effects. Erectile dysfunction is another risk of radiation treatment.

Communicate With Your Doctor

The most critical recommendation to reduce your risk is to keep in communication with your doctor. Your case is different from any other, and you deserve personalized treatment. These recommendations should adapt to your case, too. Thus, talk to your doctor and follow recommendations. If your doctor considers it appropriate to screen with PSA testing, talk about the pros and cons with him. And if you need treatment, discuss the benefits and drawbacks of your treatment options. Ask questions and inform yourself about prostate cancer and what to do about it.

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What Should Patients Know About Msks Approach To Treating Prostate Cancer

At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.

Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.

The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.

We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.

Pacemakers And Implantable Cardiac Devices

Proton beam therapy may cause fewer side effects than standard radiotherapy. This is because normal cells are exposed to less radiation. The possible side effects will depend on:

• the area of your body being treated and what structures are close by
• the amount of proton beam therapy you have
• other treatments you are having, such as chemotherapy.

Below are some of the side effects of proton beam therapy. They will not affect everyone who has this treatment. Your cancer doctor, specialist nurse or radiographer will explain any possible side effects to you before you start treatment. It is important to tell them about any side effects you get.

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My Father Underwent Proton

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

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Proton Therapy Achieves High Efficacy With A Shorter Course Of Treatment

Typically, proton therapy for prostate cancer is given over an eight-week period with 39 treatments. There is new evidence from the UF Health Proton Therapy Institute that a six-week, 28-treatment course of proton therapy is highly effective and achieves excellent prostate cancer patient outcomes.

The article, Five- and seven-year outcomes for image-guided moderately accelerated hypofractionated proton therapy for prostate cancer published in Acta Oncologica, details outcomes of the first 582 men treated between 2008 and 2015 on a prospective outcomes tracking trial at the UF Health Proton Therapy Institute for either low-risk or intermediate-risk prostate cancer. The study was led by principal investigator Randal Henderson, MD, MBA, Associate Medical Director of the UF Health Proton Therapy Institute and Professor of Radiation Oncology, University of Florida College of Medicine.

Notably, at five years after treatment, the rate of freedom from biochemical progression overall was 96.8%. At seven years after treatment, the rate was 95.2%. FFBP is measured by the level of prostate-specific antigen in the blood a persistently low PSA following treatment with no worrisome rise indicates there is no evidence of active prostate cancer at that time.

For low-risk prostate cancer patients, the FFBP rates at five- and seven-years were both 98.8%. For intermediate-risk prostate cancer patients, the FFBP rates at five- and seven-years were, respectively, 95.0% and 91.9%.

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Potential Advantages And Disadvantages Of Pt

The potential advantages and disadvantages of PT result from its dosimetric features. Protons travel only a finite distance, proportional to their speed, which can be controlled during the acceleration process they deposit most of their energy at the end of their range in an area called the âBragg peakâ and, unlike photon-based radiation, there is no exit dose beyond the target. Additionally, the entrance dose is relatively low when compared to external-beam photon radiation. For many target locations, these features reduce the excess radiation dose delivered to surrounding organs and the number of beams needed to treat a target when compared to photon radiation . Multiple dosimetric comparisons have been performed evaluating the extent of the dosimetric improvements that PT offers for prostate cancer and, in general, they have shown that PT reduces the dose of excess radiation provided to OARs in the low-to-moderate range .

Figure 1

Nichols et al. retrospectively reviewed the medical records of 171 men treated with PT for localized prostate cancer and found that PT does not affect serum testosterone levels. PT provides less excess radiation dose to the testes when compared to photon-based radiation. Consequently, while photon-based radiation lowers testosterone by 9% to 27% on average, patients treated with PT can expect no changes in testosterone, which may reduce the risk for fatigue or sexual dysfunction after treatment .

New Study Compares Long

• By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Prostate cancer therapies are improving over time. But how do the long-term side effects from the various options available today compare? Results from a newly published study are providing some valuable insights.

Investigators at Vanderbilt University and the University of Texas MD Anderson Cancer Center spent five years tracking the sexual, bowel, urinary, and hormonal status of nearly 2,000 men after they had been treated for prostate cancer, or monitored with active surveillance . Cancers in all the men were still confined to the prostate when diagnosed.

Dr. Karen Hoffman, a radiation oncologist at MD Anderson and the studys first author, said the intent was to provide information that could help men choose from among the various therapeutic options. Surgical and radiation techniques have changed significantly in the last few decades, and at the same time, active surveillance has become an increasingly acceptable strategy, she said. We wanted to understand the adverse events associated with contemporary approaches from the patients perspective.

Roughly two-thirds of the men enrolled in the study had favorable risk cancer, which is nonaggressive and slow-growing. A quarter of these men chose active surveillance, and the rest were treated with one of three different methods:

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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.

An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.

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An Alternative To Traditional Prostate Cancer Treatment

Proton radiation for prostate cancer delivers precise doses of radiation with a lower risk of side effects. The difference is in the protons themselves. Since physicians have greater control over the distribution of the proton radiation dose, higher, more effective doses can be used.

And since proton therapy lacks an exit dose, and has a lower entrance dose than conventional X-rays, damage to critical tissue near the prostate is reduced, potentially lessening the likelihood of prostate cancer side effects like impotence, incontinence and gastrointestinal disorders. The figure to the right demonstrates the difference in radiation dose distribution between a conventional IMRT plan on the bottom and a proton plan on the top.

As apparent, much less of the pelvis is exposed to radiation with the proton plan, likely leading to a lower risk of secondary cancers in prostate cancer survivors. Also apparent is a lower dose of radiation to the rectum, which may lead to a lower risk of rectal injury with proton therapy.

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Prostate Cancer Stages& Treatment

The stage of prostate cancer is one of the most important factors in selecting treatment. Depending on the stage, combined treatments of surgery, radial prostatectomy, brachytherapy, hormone therapy, chemotherapy and radiation therapy may be needed for some prostate tumors. Treatment options also are affected by the type of prostate cancer, age, overall health and personal preferences.

When Will Proton Beam Therapy Be Available To Nhs Patients In The Uk

Proton beam therapy has been available to UK patients since 2008 through the NHS-funded overseas programme, and The Clatterbridge Cancer Centre has treated patients with rare eye cancers with low-energy protons for many years.

The Christie is the first NHS high-energy PBT centre in the UK as part of a £250m programme for a national PBT service. A second PBT centre is also currently being built at University College London Hospitals NHS Foundation Trust. The new facility is due to open in 2020 with the PBT service ramping up in 2021.

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