Summation Of Current Dataadult Cancers
PBT CE data in non-small cell lung cancer is limited. Whereas stereotactic body radiotherapy is most cost-effective for early-stage stage I NSCLC , Markov analysis of advanced NSCLC requiring concurrent chemoradiotherapy showed that PBT increases QALYs by 0.549 and 0.452 compared to 3DCRT and IMRT, respectively . Though data are limited, they suggest that advanced-stage lung cancers may be more cost-effectively treated with PBT as compared to early-stage cancers, but whether PBT is the most cost-effective option requires additional research. A national clinical trial of PBT for locally advanced NSCLC is underway and will address the CE question as a secondary analysis.
As discussed earlier, PBT has been used to treat uveal melanomas since the late 1960s . A recently published CE study showed similar costs for PBT, enucleation, and plaque brachytherapy with nearly identical QALYs. A criticism of the analysis was that tumors were not stratified for size. Moreover, the study did not use high-fidelity quality-of-life data, because enucleation is known to be associated with poorer quality of life, and the also study failed to take into account recent phase III trials showing improved outcomes with PBT versus brachytherapy . Overall, this highlights the great dependence of CE analyses on available prospective trials, and necessitates additional analyses in the future as additional data emerge.
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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.
Proton Therapy: The Successful Treatment For Prostate Cancer You Should Be Getting
Prostate cancer is the second most common cancer in American men, behind only skin cancer. As of 2022, about one out of every eight men will be diagnosed with prostate cancer at some point during his lifetime. However, its rare for those who are younger than 40 to develop prostate cancer. Nearly six out of 10 prostate cancer patients are over the age of 65. In this article, well explain why proton therapy is an ideal treatment option for many prostate cancer patients.
TREATMENT LOCATIONS:
The prostate surrounds the urethra and is located beneath the bladder. The gland secretes prostate fluid as one of the components for seminal fluid. Cancer begins to develop in the prostate when the cells of the gland begin to grow uncontrollably and form a malignant tumor. If left untreated, prostate cancer can spread to other parts of the body such as the bladder, rectum, bones, and lymph nodes, where it can become life-threatening.
Fortunately, modern medicine has made the survival rates of prostate cancer fairly high. The American Cancer Society reported in 2022 that more than 3.1 million Americans previously diagnosed with prostate cancer are still alive and well today.
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Protons: A Different Mechanism
Protons can also be administered by two methods. The older method includes large beams of passively scattered protons that are shaped with the use of high-density blocks or apertures to shape the large beam as it exits the nozzle. Compensators are employed within the beam to alter the beam profile to better conform the SOBP to the actual tumor. A second, newer method employs a very narrow, pencil thin beam to paint the dose on the target, and no blocks or compensators are needed. The pencil beam is swept in a raster pattern back and forth across a target guided out of the nozzle by magnets . This allows the delivery of intensity-modulated proton beam therapy , with a greater ability to conform the dose to an irregularly shaped target. Although not widely available, many new facilities are being planned with pencil beam-only systems.
Pencil beam scanning. The pencil beam is swept in a raster pattern back and forth across a target. Reproduced with permission from Mayo Clinic News Network.
aAs determined by Phoenix criteria. bAs determined by American Society for Therapeutic Radiology Oncology criteria. c Determined by a rise in prostate-specific antigen to > 50% than the nadir and > 2 ng/mL.
2D, two-dimensional 3D, three-dimensional GI, gastrointestinal GU, genitourinary HD, high dose IMRT, intensity-modulated radiation therapy LD, low dose.
Proton Therapy Advantages And Disadvantages
Proton radiation may represent an incremental improvement over IMRT due to the reduced exposure of surrounding normal body tissues to radiation. Therefore, in the situations outlined above where IMRT would normally be considered, men may prefer to choose proton radiation over IMRT. The purported advantages of proton radiation over IMRT remain theoretical and clinically unproven. No head to head studies comparing the IMRT and proton radiation exist.
Disadvantages associated with proton radiation are related to its high cost and the fact that not all insurance programs cover proton radiation. In addition, there are relatively few centers doing proton radiation, so geographic inconvenience can be a major factor considering that numerous visits are required over a 5 to 9-week period.
Men considering treatment for prostate cancer need to do their homework. Side effects from radiation can be irreversible. The selection of optimal radiation varies with patient circumstances. Many factors need to be considered when radiation is contemplated.
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Comparative Studies Of Proton Therapy Versus Photon
Hoppe et al compared prospectively collected patient-reported QOL data for patients treated with proton therapy or photon radiation therapy for localized prostate cancer. The investigators analyzed prospective patient-reported QOL data from men with prostate cancer who received high-dose photon-based therapy through the PROST-QA study. Those patients were treated with IMRT and received doses between 75.6 and 79.2 Gy delivered at 1.8 to 2 Gy per fraction. Patients treated with proton therapy were from a single institution , and patient-reported outcomes were measured prospectively as well as after radiation therapy of 78 to 82 GyRBE delivered at 1.8 to 2 GyRBE per fraction. At 2 years of follow-up, there were no differences in EPIC bowel, urinary irritative/obstructive, or sexual summary scores between the 2 groups. On multivariate analysis, the patients treated with IMRT had significantly more moderate or big problems with rectal urgency and bowel frequency than did those treated with proton therapy.
Which Treatments Are Best In Keeping Men In Remission
Here is your opportunity to compare prostate cancer treatments. Over 129,000 patients underwent PSA monitoring after treatment to see which treatments were most effective at keeping the cancer in remission. The charts show which treatments are more likely to leave patients Prostate Cancer Free, for how many years. Share this data, talk with your Doctor, or multiple Doctors and make an informed decision. Select the treatment option, that is best for you.
Compare Prostate Cancer Treatments by gathering information about your own Prostate Cancer Diagnosis. Your Doctor will provide three elements that describe your prostate cancer. Your PSA, Stage and Gleason Score. These three elements help you determine your risk group. Find and select your Risk Group in the table below. This will take you to the comparing prostate cancer treatments page, where you can select different prostate cancer treatments on an interactive chart and graphically see their effectiveness over time.
The treatments included in this study are Prostate Surgery or Prostatectomy, , Brachytherapy or Seeds, High Dose Rate Radiation, HDR, External Beam Radiation Therapy or EBRT, Androgen Deprivation Therapy, ADT, or Hormone Treatment, Proton Therapy, High-Intensity Focused Ultrasound, HIFU, Cryotherapy, Cryo and Hypo-Fractionated External Beam Radiation Therapy. For more advanced prostate cancer, treatments are combined to increase effectiveness.
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Developing The Uk Proton Beam Therapy Service
The government committed £250 million capital investment for both NHS proton beam therapy centres. This includes the buildings and PBT cyclotron and gantries, providing 6 NHS treatment rooms .
Both Trusts have more information about the new proton beam therapy centres on their websites. This includes information on the clinical facilities, their location and, for UCLH, progress on construction.
Stereotactic Body Radiation Therapy
This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.
SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife, X-Knife, CyberKnife, and Clinac.
The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.
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Treatment Options For Men With Urinary Symptoms After Radiation For Prostate Cancer
Many men benefit from medical treatment to help them with urinary symptoms during IMRT, CyberKnife, proton beam, or brachytherapy. These medications include alpha-blockers such as Flomax, alpha-reductase inhibitors such as finasteride or Proscar, and anticholinergic medications such as Detrol, or Vesicare.
When medical treatment does not provide sufficient benefit or of the symptoms persist, other treatment options offered at New York Urology Specialists include Urolift procedure, Rezum procedure, iTind for prostate, Greenlight laser of the prostate, Botox injections in the bladder, and TURP.
It should be noted that men with urinary symptoms after radiation therapy for prostate cancer should have a cystoscopy at a minimum to exclude urethral stricture disease and bladder tumors. Some men may also benefit from a urodynamic evaluation.
Did you know?Dr. Shteynshlyuger has performed over 1,000 surgeries and procedures for enlarged prostate, including Rezum, Urolift, prostate enucleation, laser ablation of the prostate, and TURP. He performs over 100 prostate procedures a year.
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How Proton Beam Therapy Works
Proton therapy is an advanced form of radiation treatment that uses protons instead of X-rays.
In regular radiation therapy, the beam of energy goes into the body, through the tumor, and out the other side. This exit dose of radiation might affect healthy tissue beyond the tumor. Protons, in contrast, are larger particles than those used in regular radiation. They release more of their energy within the tumor itself. This burst of energy can appear on a graph as what is called the Bragg peak.
After delivering the energy to the tumor, the protons stop: They do not exit the tumor and go into healthy tissue on the other side.
In this way, proton therapy reduces radiation exposure and potential damage to healthy tissue, especially in sensitive areas such as the brain, eyes, spinal cord, heart, major blood vessels and nerves.
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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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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:
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What Are The Best Proton Treatment Centers In Asia
There are few proton therapy centers in Asia. Among them is Apollo Proton Cancer Center . It is the first proton therapy facility in Southeast Asia. Apollo offers one of the most affordable prices for treatment without quality loss in the world.
Submit a request to undergo treatment at Apollo Proton Therapy Center.
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When Is Brachytherapy Alone The Right Choice
For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.
This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.
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Active Surveillance For Prostate Cancer
Also known as watchful waiting, active surveillance is a non-treatment option that involves continued monitoring of prostate cancer. More frequent checkups are often required to keep an eye on any changes through PSA blood tests, Digital Rectal Exams and ultrasounds. Biopsies may also be done to assess the aggressiveness of the cancer and its risk of growing and spreading. Studies have found that, after 15 years on active surveillance, less than 1% of men developed a metastatic disease. Additionally, over 30% of men have prostate cancers so slow-growing that non-treatment may be a better option.
Often Recommended for:
Possible Side Effects of Active Surveillance:
- No treatment-related side effects
Pros & Cons of Active Surveillance for Prostate Cancer
Pros:
- No surgery or hospital stays
- New technologies continue to improve imaging and testing
Cons:
- Frequent checkups for testing and biopsies
- May face a greater risk of prostate cancer growing and spreading
- Stage of your prostate cancer may advance
- May limit future treatment options and chances of curing the cancer
- Diagnosis can create stress and anxiety
Pioneers Of Proton Therapy
Working with the Harvard Cyclotron Laboratory , Mass General physicians became the first in the world to discover how to harness the extraordinary physical characteristics of high energy protons for medical care. By using protons rather than conventional x-rays , physicians could increasingly concentrate radiation energy in tumors and intended targets, reducing radiation dose and damage to nearby healthy tissue.
As part of the largest hospital-based research program in the country, we have led, and continue to lead, many studies to define the best use of proton therapy for clinical care. Learn more about our groundbreaking proton therapy research.
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Technical Delivery Of Proton Therapy
A minimum standard of treatment delivery must be followed to ensure the accuracy and effectiveness of proton therapy for prostate cancer. The goals of delivery should be to overcome 3 fundamental radiation therapy challenges: to minimize uncertainty regarding the precise location of the target during beam exposure, to maximize target coverage, and to minimize radiation exposure to organs at risk.
Although intrafraction and interfraction variability must be accounted for with both proton- and photon-based treatment planning, there is a proton-specific uncertainty called range uncertainty, which refers to the effect on the proton beam range that the slight variations in prostate position may have on the composition of tissues in the beam path. Range uncertainty is based on modeling studies and includes the addition of a margin to the proximal and distal edge of the target.
What Should I Expect From Proton Therapy
A specialized doctor will plan your proton therapy. Your treatment may involve daily proton beam therapy sessions for several weeks. The length of treatment depends on the type and location of the tumor.
Before your treatment begins, you will have a simulation with a computed tomography scan. Using the scan results, a radiation oncologist identifies the tumors exact size and dimensions. The CT scan guides your healthcare teams decisions about the most effective techniques to deliver proton beam therapy.
For each treatment, a radiation therapist helps you enter and position yourself within the treatment vault. An immobilizing device may help keep your body in a still position for treatment. Generally, proton therapy sessions only last a few minutes.
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