I understand that both treatments are comparable in terms of toxicity and cure rate, but a radiation oncologist mentioned that proton therapy may carry a lower risk of secondary cancers 30-40 years down the line, making it a more logical option for me.
Assuming both treatments are equally covered by insurance, are there any DOWNSIDES to choosing proton therapy?
The RO is probably referring to this paper:
"Second Cancer Risk After Primary Cancer Treatment with Three-Dimensional Conformal, Intensity-Modulated, or Proton Beam Radiation Therapy".
acsjournals.onlinelibrary.w...
"... The crude absolute incidence of second cancer per 100 patient-years was 1.55 overall (95% CI, 1.53-1.57), 1.60 after 3DCRT (95% CI, 1.57-1.62), 1.55 after IMRT (95% CI, 1.53-1.57), and 0.44 after PBRT (95%CI, 0.37-0.52). ..."
thank you for the information
I had IMRT and in 3 years was dx with myelodysplastic syndrome, a form of blood cancer.
I'm really sorry to hear about your diagnosis. Wishing you strength and support through this.
As I tell everyone, I'm past my expiration date. Into a day at a time thing. Works well for mè.
I had a very good experience at Caifornia Proton.Not perfect after the tx but compared to what i understand happens after any radiation tx very good.Minimal after effects.I did alot of research before tx and was very wary of side effects so i waited 11 years before tx for slow growing cancer and becoming medicare eligible which paid for tx while kaiser would not pay.Tricky thing about radiation is having delayed effects as read about but again mine is very minimal with slow urine flow and a little leaking if not patient which is about it.Im very satisfied when i compare myself with others.Now if i could only reverse the aging process.
Thank you for sharing your experience. It’s encouraging to hear that you had minimal side effects after your proton treatment
It is less important whether one is treated with photons or protons than the skill and experience of the team doing the planning/simulation. I am also assuming that since you are being offered radiation, your PCa is metastatic. In which case secondary cancers are something to be dealt with if/when they happen. With advanced PCa, living another 20-30 years is a mega-lottery win. You can up your odds of doing that a lot more by exercising the right way vs merely picking proton therapy.
That is not actually known so I would be suspicious of that opinion. Does this RO work in a Proton facility? They are famous for their biases because proton facilities are so expensive of an investment.
In the pelvis protons loose their advantage because the Bragg Peak phenomenon is not so predictable and therefore not so precise. I’d go with IMRT for prostate and whole pelvic application.
Other possible points about photon vs proton. The intensity of the former allows for SBRT vs IMRT, reducing the number of RT sessions, and (I guess) SBRT is sometimes superior. Also, sometimes brachytherapy is used in combination with RT, in which case it may matter a lot if the half-life of the brachy is incompatible with the session duration of protons or the combination simply has no track record to speak of. Finally, there is the possible future use of RT again to the same area. My sense is that photon RT'ed tissue is tricky to re-radiate. Has anything comparable been done with proton RT'ed tissue?
The APCa Hydra only offers bad-worse decisions and thrives on fear.
Thank you Derf4223. You brought up a good point about the compatibility of brachytherapy and proton therapy, and there may not be a lot of track records for it. I’ll make sure to bring it up at MSK on Wednesday
thank you for the advice Mateo.
My radiation oncologist is Dr. Gorovets from MSK. I specifically brought up whole pelvic treatment during our conversation, and he didn’t express much concern. He mentioned that proton therapy is a viable option for the whole pelvic area, but I’m not sure if I should follow his advice.
I forgot to mention, I will be having HDR brachytherapy in two days, and I will decide between proton or photon therapy for whole pelvic treatment.
One advantage I can think of for photon therapy is that many more patients are treated with it each year compared to proton therapy (thousands vs. hundreds), meaning radiation oncologists typically have more experience with photon treatments.
Other than that, if all things are equal, I think I may choose proton therapy, as in theory, it offers a small hope of fewer side effects.
update
WHAT ARE THE CURRENT EFFECTIVE SALVAGE TREATMENTS IN CASE OF A REOCCURRENCE IF YOU HAVE HAD SBRT,IMRT, WITH PLACEMENT OF GOLD BARS? 
PC History
