Gary Larson, Medical Director - Procure Proton Therapy Center - Oklahoma City - PI - PCG-OKC
quora.com/Where-in-your-opi...
In a perfect world, the lowest dose to normal tissue (bladder and rectum) can be achieved with Proton beam irradiation. Some would say that Pencil Beam Scanning can improve that ratio even more, but our recent analysis of acute GU toxicity from the Proton Collaborative Group Registry database showed lower rates using spot scanning or double scattering than with Pencil Beam Scanning.
Insurance is reluctant to pay for proton beam irradiation for prostate cancer, especially in the post-prostatectomy setting, but if financial resources are not an issue, I would suggest going to a proton beam treatment center. Loma Linda, Procure Oklahoma City, Procure New Jersey and the University of Florida all have strong Prostate cancer programs - others may as well, but I’m not familiar with them. These four should give you geographical diversity.
If protons are not a viable option, then any good IMRT center with prostate experience is the next best choice. They are numerous.
Seminal Vesicle Involvement (SVI) is a strong indication for post-operative radiation therapy in at least some form (a recent paper in JAMA Oncology analyzed predictors of recurrence following prostatectomy and SVI was near the top of the list).
