Proton Therapy after Robotics and PSA

[9791asil]

Radiologist advised against proton radiation therapy because his last PSA was <.1. His oncologist thinks radiation is indicated unless <.05. What lab has PSA testing that is this precise? He was Stage 3 Prostate Cancer.

[Tall_Allen]

Recent trials show that he can wait until PSA reaches 0.1 or 3 consecutive increases.

prostatecancer.news/2017/06...

Not sure why you want protons, but during the pandemic, it may be wise to go for a hypofractionated protocol.

[tango65]

He can wait until PSA is 0.1 to 0.3 different studies used these values of PSA or 2 consecutive increases to start early salvation RT treatment.

ro-journal.biomedcentral.co...

jamanetwork.com/journals/ja...

Why are they going to treat him with proton therapy.? Proton therapy for PC is not asociated with better outcomes than photon therapy.

pubmed.ncbi.nlm.nih.gov/309...

hopkinsmedicine.org/news/ar...

[Justfor_ in reply to tango65]

"A total of 693 proton therapy patients were matched to 3,465 IMRT patients. Proton therapy patients had a lower risk of composite urinary toxicity (33% v 42% at 2 years; P < .001) and erectile dysfunction (21% v 28% at 2 years; P < .001), but a higher risk of bowel toxicity (20% v 15% at 2 years; P = .02). "

pubmed.ncbi.nlm.nih.gov/295...

[tango65 in reply to Justfor_]

It is not a RCT, it is a retrospective study using 2 different patient databases. This type of studies could have selection bias.

The study I mentioned is a meta analysis including many of the studies done about proton therapy and IMRT therapy.

To my knowledge there are not RCT about proton therapy vs IMRT. We do not have a definitive answer if one is better than the other. I am not trying to say that proton therapy is less effective than IMRT. It is not clear to me that proton therapy has advantages over IMRT.

I do not want to start a contest of cherry picking studies, but to give you an idea of the problem , this is the results of other retrospective study:

" In a propensity score-matched comparison between IMRT and proton therapy (n = 1368), IMRT patients had a lower rate of gastrointestinal morbidity (absolute risk, 12.2 vs 17.8 per 100 person-years; RR, 0.66; 95% CI, 0.55-0.79). There were no significant differences in rates of other morbidities or additional therapies between IMRT and proton therapy.

Conclusions: Among patients with nonmetastatic prostate cancer, the use of IMRT compared with conformal radiation therapy was associated with less gastrointestinal morbidity and fewer hip fractures but more erectile dysfunction; IMRT compared with proton therapy was associated with less gastrointestinal morbidity."

pubmed.ncbi.nlm.nih.gov/225...

TAllen has nice review of this subject:

prostatecancer.news/search?...

Best of luck on your journey.

[Justfor_ in reply to tango65]

There is a randomized one currently recruiting in the UK.

Selection bias surely there is, because most papers that I have read issue the value for money element which is suspicious at least.

[j-o-h-n]

Could you give us more info about "HE".... Age?, Location? Scores psa/gleason? treatment(s) to date? Treatment locations? Doctor's name(s)? Meds? Thank you!!!

All info is voluntary but it helps us help "HE" and helps us too. Just add the bio to your home page.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 09/21/2020 6:54 PM DST

[9791asil in reply to j-o-h-n]

I forwarded the link and your informative replies to him for follow up. Thank you so much.