Photon or Proton

[SherryKahn]

Deciding between proton with Dr. Gorovets at MSK or IGMRT Photon 26 sessions with Dr. Borys. Husband getting brachytherapy on Wednesday so we have a few weeks to make a decision for EBRT. I am concerned about SE and minimizing them. So any feedback would be appreciated.

[Tall_Allen]

There is no evidence of any difference in SEs.

[Infamous9597]

does he need to cover the whole pelvic?

[SherryKahn in reply to Infamous9597]

Yes and extra boost to the pelvic lymph nodes.

[Infamous9597 in reply to SherryKahn]

I am in the same boat as your husband. I will get brachytherapy at MSK next Wednesday, followed by 25 sessions of IMRT for the whole pelvis a month later. Lately, I've been thinking about proton therapy for its lower side effects.

I read somewhere that proton therapy does not cover the whole pelvis and only offers 5 sessions, but I could be wrong.

[Infamous9597 in reply to Infamous9597]

Just got a response from MSK's RN. She said they haven't had or heard of any patients who have received brachytherapy with proton therapy. Let me know what you find out on your end.

[SherryKahn in reply to Infamous9597]

My husband is. Getting Brachytherapy Wednesday and consult with proton dr next week. Our RO who is scheduled to do IGMRT suggested we meet with both drs and make our decision so they do it. Otherwise this would not have been offered to him.

[SherryKahn in reply to Infamous9597]

sorry brachytherapy is not with proton . The proton therapy will replace the IGMRT. Sorry for the confusion.

[Tommyj2 in reply to Infamous9597]

What kind of brachytherapy are you getting…..seeds or HDR with needles? Either way…best wishes to you.

[Infamous9597 in reply to Tommyj2]

Thank you. I will have HDR brachytherapy

[lowT163 in reply to Infamous9597]

Wrong I hope. They told me I had whole pelvic and was a bunch more than 5 of those balloons they eased into place.

[TylexGP]

I had HDR Brachytherapy with Dr. Gorovets and EBRT with Dr. Guttman. Three years out and my only SE is some increased bowel urgency which has not significantly impacted my QOL.

[Retireddoc]

In my discussions with several ROs at 3 different COEs over the past 3 years, there is no different in SEs and there is no study demonstrating improved survival of one modality vs the other.

Proton therapy is clearly superior in treating some cancers, such as Neuro axis tumors in children but has not shown superiority for treatment of prostate cancer. It is considerably more expensive than traditional photon EBRT.

[Pinetree]

I can’t speak for photon therapy. I’m sure a lot also depends on your age, stage and health at diagnosis. I’m now 67 and had 8 weeks of proton in Jacksonville FL in 2020 for intermediate stage 2, PSA 13, cancer in 13 of 16 cores mostly Gleason 6 with four Gleason 7 (two 3+4 and two 4+3). I continued to swim and run throughout treatment. It was like an 8 week vacation. No side effects during or after. Trace amount of blood in stool began 1 year after treatment. Happy with the results. I had a good friend who did the photon and he had lots of problems with rectal bleeding. I read outcomes were not much different between the two treatments. I’m only one case when considering side effects so if TA says they’re similar, they probably are. I know a lot more people who have had the surgery who suffer from side effects. Go with your gut, and wallet, if necessary. My insurance paid all but $1500 for proton.

[SportsFanx99 in reply to Pinetree]

My proton treatment occurred in Irving TX, also in 2020. My results are/were almost identical to yours! Anecdotally, a friend of mine that had just completed EBRT as I was to begin proton therapy said to me, "well, you will need to buy some depends, because you are going to need them". I did not take that advice. Now, almost 4 years later I still have not needed, nor have I ever purchased such products for my personal use.

[SportsFanx99 in reply to Pinetree]

Regarding cost, the key is whether or not your insurance will cover it. You did a lot better than me -- I was out of pocket $7500

But with that said, as we both found, many insurance companies did cover it in 2020, and I suspect that even more cover it now. This is what the Irving center currently accepts:

texascenterforprotontherapy... .

The bottom line is that your out of pocket maximum will be reached regardless of the therapy you choose, so your net out of pocket cost will be the same.

[SportsFanx99]

I did my research in mid 2020 and completed proton therapy a week before Christmas, 2020. I wish to point out an article published in April 2021:

ncbi.nlm.nih.gov/pmc/articl...

If only it was available a year earlier! When you research these topics, you owe it to yourself to seek out the must current information available.

This is a very lengthy and detailed article, co-written by 18 doctors and with 65 references.

Feel free to get as deeply into the weeds as you like. But keep the first sentence of the conclusion in your mind as you do that:

"As an established and effective treatment for patients with prostate cancer, proton therapy reduces the excess radiation delivered to healthy tissues surrounding the prostate when compared with photon-based radiation therapy."

The implications are clear.

[Tommyj2]

is Dr. Gorovets recommending hdr brachytherapy?….how far do you have to travel to get to MSK? 28 Sessions can get pretty wearing if you have to travel a long distance…..im trying to schedule sbrt proton salvage therapy with Dr. Gorovets even as we speak .

[SherryKahn in reply to Tommyj2]

We live two subway stops away from MSK so not to far to travel. My RO suggested HDR. Will meet Dr. Gorovets next week.

[j-o-h-n in reply to SherryKahn]

Don't forget the M66 bus which you can catch on 68th and Lex and runs west along 68 street (past the Kimmel Center across from St. Catherine's park at First Avenue). Last stop of bus on 68 and York avenue.

Good Luck, Good Health and Good Humor.

j-o-h-n

[SherryKahn in reply to j-o-h-n]

Wow great to know. Thanks John!

[khaiden]

Sherry,

My prostate cancer was high risk. Gleason 8, PSA 15. I did the following treatment at Emory in Atlanta February/March 2022:

- 18 months of ADT with Eligard

- 25 sessions of Proton radiation

- HDR

I am 56 now. I had hardly any side effects and continued my personal and professional life without any interruption or impairment

I had rare rectal bleeding when running during and 6 months after the procedure

I had slight fecal leakage when farting during running and walking. Pretty much gone by now

No incontinence issues. Never wore a pad. Did Kegel exercises

My sexual functions have finally recovered, with help of ED medication (Viagra). That took almost a year after coming off ADT.

Last PSA is 0.43 slowly climbing to a Nadir.

The insurance paid for proton radiation. Emory needed to apply 3 times to get approval. The total cost was $50k for proton radiation. The Emory Proton Center in Atlanta did an excellent job.

Proton radiation definitely worked for me.

[SherryKahn in reply to khaiden]

Thank you this is very helpful

[Oatmeal2]

Hi, my husband is a patient of Dr. Gorovets. He is a great doctor. We went to him originally because we were interested in proton therapy. Even though he specializes in it, he recommended the 26 treatments of IMRT. I got the impression from him that there was no real difference and with the new mri guided radiation they can really hit their target. My husband had minimal side effects and the team at MSK does a great job with delivering the treatments so it’s most effective. At first it may be a little difficult getting the drinking down but after a few sessions, he will get the hang of it.

[SherryKahn]

thank you very helpful. I know we are in great hands either way at MSK.

[kainasar]

Has any one considered SBRT to lesions and l nodes, and beginning ADT?

[SherryKahn in reply to kainasar]

For my husband the dr said they don’t do it for advanced prostate cancer so he wasn’t a good candidate for that. Not even an option for us.

[chaplainj in reply to SherryKahn]

Sherry, I meant to include where I had my SBRT treatment for my advanced prostate cancer… Florida Proton Center in Jacksonville Florida. Greatest RO I’ve ever met (Dr. Roi Dagan) he treated me last month with the newest treatment known as Pencil Beam Proton.

[chaplainj in reply to kainasar]

I’ve had several spots treated with SBRT over the last 5-7 years that were very successful. Just this past month I had 2 spots treated not wiih SBRT but the newest proton treatment called Pencil Beam. Absolutely no side effects.

[T911]

Went to Miami Cancer Institute for consult regarding Proton vs Photon because they offer both and thought they would not be pushing the only one they offered. Ended up doing my HDR Brachy there followed by Proton. Doctor said it was a toss up between the Proton and Photon for both efficiency and side effects. Very happy with facility and my treatment team. Fatigue during treatments along with very manageable urinary and fecal urgency. After treatment ended very fast recovery and feel decades younger. Only dealing with adt side effects now. Insurance did a quick approval.