Proton Therapy Treatment For Prostate Cancer Patients
Proton therapy is a form of radiation treatment for cancer patients. Also called proton beam therapy, proton therapy involves focusing proton particles into a beam, which is then delivered to the cancer cells in a non-surgical procedure. The positively charged particles can be controlled to stop at the tumor site, enabling the cancerous tissues to be destroyed with high levels of radiation without causing damage to nearby healthy tissue and vital organs. Proton therapy is considered more precise than other types of radiation therapy. It is also non-surgical, non-invasive, and has minimal side effects. Proton therapy treatment requires little to no recovery time, and the radiation has very little impact on a patients energy level compared to other cancer treatment options.
Proton therapy exhibits higher success rates in prostate cancer patients.
According to a study published by the University of Florida, prostate cancer patients who received proton therapy treatment were found to be free of cancer progression for five years after their treatment. Patients with low to medium risk prostate cancer experienced a success rate of 99%, while those with high risk prostate cancer experienced a success rate of 76%.
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What Are The Side Effects Of Proton Therapy
Proton therapy limits the radiation to the healthy tissue, but it can be affected causing side effects. Side effects can start during or after treatment, and might include:
- Tumors in the base of the skull.
The list of cancers being treated by protons continues to grow as we learn more about this type of treatment.
What Are The Disadvantages Of Proton Beam Therapy
Proton therapy is not the right choice for everyone. Some negatives of proton therapy include:
- Availability: There is a small number of proton therapy centers in the U.S., which means you may need to travel for treatment that may last several weeks.
- Longer planning time: Your radiation oncologist will need a few weeks to plan proton therapy. They may recommend traditional radiation if you need treatment sooner.
- Insurance coverage/cost: Proton therapy costs more than photon radiation therapy because the machines and equipment for proton therapy are very complex, and they are expensive to make and operate. Some insurance providers may not approve proton therapy if there is no definitive evidence that it is a better treatment option. It is important to check with your insurance provider about coverage. Many proton therapy centers, including the center at Johns Hopkins, have insurance authorization specialists who can assist you in obtaining treatment authorization.
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Possible Side Effects Of Proton Beam Therapy
Like most cancer treatments, proton beam therapy can cause side effects and complications. Even though proton beam therapy is delivered to a precise area, damage to normal cells near the tumor may occur. Many of the side effects are similar to the side effects of conventional radiation therapy, but due to the precise focus of damage, may be less severe. The most common side effects include:
Possible Risks And Side Effects Of Brachytherapy
Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.
There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.
These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.
Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.
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Pencil Beam Scanning: Highly Advanced Proton Therapy For Prostate Cancer
At the New York Proton Center, patients with prostate and other genitourinary cancers receive Pencil Beam Scanning. Its the most sophisticated and precise type of proton therapy.
Pencil Beam Scanning allows clinicians to create a highly customized treatment field based on the unique shape, size and location of the prostate cancer tumorsimilar to traditional proton therapy, only with even greater precision.
As the name implies, Pencil Beam Scanning uses an extremely narrow beamjust a few millimeters wideto dot protons onto the cancer. The process is repeated, layer by layer, like paint applied by the tip of an incredibly fine brush. The treatment is ultra-precise, capable of closely regulating the radiation dose according to the volume of the tumor.
Cancers Treated With Proton Therapy
Proton therapy is useful for treating tumors that have not spread and are near important parts of the body. For instance, cancers near the brain and spinal cord. It is also used for treating children because it lessens the chance of harming healthy, growing tissue. Children may receive proton therapy for cancers of the brain and spinal cord. It is also used for cancer of the eye, such as retinoblastoma and orbital rhabdomyosarcoma.
Proton therapy also may be used to treat these cancers:
Central nervous system cancers, including chordoma, chondrosarcoma, and malignant meningioma
Eye cancer, including uveal melanoma or choroidal melanoma
Head and neck cancers, including nasal cavity and paranasal sinus cancer and some nasopharyngeal cancers
Spinal and pelvic sarcomas, which are cancers that occur in the soft-tissue and bone
Noncancerous brain tumors
Diarrhea Flatulence Or Painful Defecation
These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.
Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.
Ideas For Future Studies Of Proton Therapy
Despite the studys limitations, these intriguing findings raise questions that should inform future prospective phase 3 trials, Dr. Buchsbaum said, although there are barriers to large studies of proton therapy.
For instance, it is particularly encouraging that proton therapy appeared to be safer in a group of older and sicker patients who typically experience more side effects, Dr. Baumann noted.
Dr. Buchsbaum agreed that proton therapy may be especially helpful for older and sicker patients, but he noted that ongoing phase 3 trials were not designed to analyze this group of patients.
And because proton therapy may cause fewer side effects, future trials could also explore whether combining proton therapy with chemotherapy might be more tolerable for patients, the authors wrote.
For example, both chemotherapy and traditional radiation for lung cancer can irritate the esophagus, making it painful and difficult for patients to eat. But proton therapy might limit damage to the esophagus, making it easier for a patient to tolerate the combination, Dr. Baumann explained.
Future studies could also explore whether combining proton therapy with higher doses of chemotherapy might increase cures without causing more side effects, he added.
Dr. Buchsbaum agreed, saying that it would be worthwhile to explore this possibility. Just asking the question: Is more effective? might not be giving it a fair opportunity to demonstrate its benefit to society, he said.
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Does Msk Offer Proton Therapy For Prostate Cancer
Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.
External Beam Radiation Therapy
In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.
You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment takes longer.
Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.
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Proton Therapy Vs Other Prostate Cancer Treatments
Is proton therapy superior to hormone therapy or chemotherapy? The answer might not be that simple because it depends on what you need.
Each treatment method has its pros and cons. They also have specific applications, and using them or not in a determined patient depends on comprehensive studies that evaluate what works better for most.
However, for educative purposes, lets make a brief comparison between proton therapy and other prostate cancer treatments:
Entrance And Exit Dose Defined
Entrance dose: The dose of radiation that inadvertently makes contact with normal cells before it reaches the cancerous tissue.
Exit dose: Imagine the radiation hitting the tumor, but then continuing on beyond it, taking out normal cells in its path.
The primary difference between proton therapy and Cyberknife is that protons do not have an exit dose, says Dr. Cavanaugh. Both modalities deliver entrance and target dose.
Many insurers have been unimpressed with the differences in outcomes with proton therapy and have declined to pay.
For many patients I prefer HDR brachytherapy to both proton and Cyberknife therapy. HDR stands for high dose rate.
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What To Expect With Proton Therapy
The first step in your care is a consultation. During consultation, we review your medical history, perform a physical exam, decide if any additional tests are needed, discuss all radiation options that may be appropriate for your treatment plan, make recommendations, and answer questions.
Patients with prostate cancer typically undergo a minor procedure to place three small markers in the prostate, called fiducial markers. These markers allow the treatment team to accurately align the treatment each day to the location of the prostate. Your doctor will also determine if you are also eligible for placement of a special hydrogel between the prostate and rectum , which creates additional space between the prostate and the rectum to further reduce radiation exposure to the rectum and dissolves after a few months.
After placement of the markers , most patients return another day for a simulation or planning session. During this visit our radiation therapists will help position you the way you will be treated each day. A CT scan will be done to create a picture of you in the treatment position to design your radiation plan. Some patients also undergo an MRI during this visit to help identify the target for treatment. It normally takes 10 days for the team to design the proton treatment plan and perform the quality assurance checks before treatment begins.
Differences Between Normal Radiation Therapy And Proton Therapy
Proton therapy and conventional radiation therapy are both prescribed by radiation oncologists. One of the most obvious differences is the locality of treatment. Proton therapy accurately targets very specific locations, which may result in less damage to surrounding tissues. Conventional radiation therapy is less targeted, and more “normal” cells in the region of a tumor may be damaged.
Proton beam therapy is not one single type of treatment, but rather there are different types and methods. Newer types of proton beam therapy such as pencil beam scanning are thought to make this therapy even more tolerable.
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What Is Proton Therapy Used For
While proton therapy is most often used to treat cancer, it can also be used to treat noncancerous tumors in children and adults. Proton beams can be used to treat tumors composed of different types of cells and located in different parts of the body some examples include:
- Eye cancer, such as ocular melanoma
Researchers are studying the potential benefits of proton beam therapy on different kinds of cancers.
Advantages Of Proton Therapy For Prostate Cancer
Proton therapy has proven to show remarkable promise and advantages over conventional therapy-especially in the treatment of prostate cancer. Proton radiation therapys accuracy and the control it gives physicians in terms of adapting treatment make it a non-invasive and low-risk option for prostate cancer treatment.
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A Gel To Prevent Rectal Burns
A lifelong rectal burn is rare, but it can be very debilitating, resulting in pain, bleeding, and loss of rectal control. A revolutionary technology called SpaceOAR greatly reduces the risk of a serious burn to the rectum. SpaceOAR hydrogel is injected between the prostate gland and rectal wall and remains in place throughout the period of radiation. The hydrogel moves the rectal wall away from the prostate gland and out of the radiation field. Thus, the risk of a radiation burn to the rectum is almost eliminated.
Proton Therapy Success Stories
Its one thing to hear about the success rate of proton therapy treatment for prostate cancer. Its another thing to hear the success stories straight from the mouths of survivors.
Wally, an Army pilot, biker, and all around adventurer, was diagnosed with prostate cancer only six weeks after being prescribed testosterone for his anemia.
There are unending volumes in thousands of books that attempt to describe the kaleidoscope of feelings and emotions that follow a diagnosis of metastatic cancer, said Wally in his journal entitled the Proton Chronicles. Im sure that like many, I attempted to rationalize or even justify the situation, but when faced with real mortality, your life and that of your family is forever altered.
After considering surgery and consulting multiple online forums, Wally finally decided on proton therapy to treat his cancer. Over the course of 20 hypofractionated treatments, Knight continued to bike on his favorite trails and play hockey in the local ice rink.
Its really kind of difficult to get your head around the whole situation, said Knight about his proton treatment. This is happening at the cellular level and its absolutely painless.
Earl, a mission pilot and pastor, also received proton therapy after being diagnosed with prostate cancer. Having lived in Alaska for nearly two decades with his wife, Lynn, he chose to seek medical care in other states after receiving his diagnosis.
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Benefits Of Proton Prostate Cancer Treatment
Proton therapy improves the quality of life for prostate cancer patients and survivors by offering a number of compelling benefits:
- It is non-invasive and therefore painless
- It is more accurate than other kinds of radiation
- Full or higher doses of radiation can be used for treatment without damaging healthy tissues and organs
- Treatment is provided in an outpatient setting
- Proton radiation therapy does not require recovery time
- The treatment has little to no impact on a patients energy level
- Proton therapy poses minimal risk of impotency
- The treatment has lower risk of side effects compared with conventional treatment.
Who Is Liable Photon Therapy Treatment
Any patient that is fit for radiotherapy as a treatment method can also benefit from photon therapy. Photon therapy is a remarkable treatment option for patients that have been diagnosed while the cancer is in its early stages. It can also serve as a long-term treatment method for the disease if it has already advanced through its late stages.
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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
Additional Information And Declarations
Conflicts of Interest: Nancy P. Mendenhall, MD, and William M. Mendenhall, MD, are Editor-in-Chief and Operating Editor, respectively, of the International Journal of Particle Therapy . Bradford S. Hoppe, MD, MPH, and Neha Vapiwala, MD, are IJPT Associate Editors. The authors have no additional conflicts of interest to disclose.
Funding: The authors have no funding to disclose.
Ethical Approval: This review did not involve human subjects or participants and was exempt from institutional review board approval.
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