Proton Therapy verses SBRT side effect differences

[Yearofthecow]

Are the side-effect profiles between Proton Therapy and SBRT essentially the same? The Proton Therapy advocates say the side effect profile from Proton Therapy is significantly less than SBRT or other External Beam types of radiation, but are there any side by side comparisions to show this?

Issues such as cystitis and proctitis are concerning. Also, I am wondering if SpaceOAR or other similar implementations, have been shown to actually protect the rectum from radiation?

[Tall_Allen]

Proton advocates are true believers. Ask for the comparative data. You will find there is none. All we have is data on different patient groups, and all we can conclude is the side effects are no better and no worse:

prostatecancer.news/2016/08...

You will also notice that the serious late term rectal side effects of SBRT occurred in 0%. That is what SpaceOAR claims to prevent. I call it "a cure in search of a disease." Here's an article about it:

prostatecancer.news/2017/01...

[Yearofthecow in reply to Tall_Allen]

Thanks Allen. I was looking for data and I couldn’t find it

[Justfor_]

There are no side by side comparisons. Sort of "political correctness" kind of thing. "All linacs are equal, etc". Luring potential patients, at least out in the open, is not kosher in medicine. All have to make a living.

One thing for certain. Newer gantries equipped with more degrees of motion freedom can disperse unwanted irradiation better, hence, are safer compared to their older counterparts.

This is true both for protons and photons.

[Yearofthecow in reply to Justfor_]

Thanks. Good point

[maley2711]

Here is a recent Blue Cross evidence determination re the coverage for SpaceOar injection......

fepblue.org/-/media/PDFs/Me...

[Yearofthecow in reply to maley2711]

Interesting maley. Blue Cross consider SpaceOar investigational and insufficient data, while National Institute for Health and Care Excellence say it is "adequate"

Thanks

[NYC_talker in reply to Yearofthecow]

United Healthcare, Ahthem, Aetna -- three largest insurers -- and many others do cover it.

[Currumpaw]

You may be interested in these links below.

From an acronym guv agency freshly posted February 13th of this year 2022.

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Proton Therapy for Prostate Cancer: Challenges and …

SECUREncbi.nlm.nih.gov/pmc/articl...

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From Johns Hopkins--again relatively recent--the last reference is dated 08/28/2020

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Proton Therapy FAQs for Prostate Cancer - Hopkins …

SECUREclinicalconnection.hopkinsmedicine.org/...

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I see that Tulsa focal therapy was recommended to you. Should that interest you I would suggest a conversation with Dr. Busch whose patients highly recommend him. I have never talked or corresponded with the doctor. Any decision will be your decision.

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Busch Center - TULSA Procedure

SECUREtulsaprocedure.com/busch-center

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Focal laser ablation might also interest you. Dr. Karamanian in Texas is highly recommended by his patients.

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Prostate Laser Center, PLLC – Offering minimally …

SECUREprostatelasercenter.com

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Proton therapy! I have, in past years, spoken or corresponded with Dr. Gary Larson of Integris Health. I found him to be knowledgeable and professional.

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Gary Larson | INTEGRIS Health

SECUREintegrisok.com/doctors/gary-larson

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I wish you the very best. You have some reading to do and a decision to make. Be thoughtful and do not allow anyone to pressure you.

Currumpaw

[Yearofthecow in reply to Currumpaw]

Thanks Currumpaw. Not all your links translate into proper hyperlinks. The NIH one does, and that has some interesting theories and speculations. Appreciate the information

TULSA or HIFU I believe are dependent on the MRI identifying the area. In 2019, An MRI found two areas rated as PiRAD 4 in the anterior TZ, and had a directed biopsy on them. On came back as 3+3, and the other as BPH. Fast forward to 2022, this time the MRI only identified one area in the anterior TZ rated as PiRAD 3. Had a Precision Point 15 Core biopsy. The anterior TZ now was graded at 3+4, with 10% pattern 4, and a very small area in the right apex 3+4, which the MRI failed to show up, though I believe that was an area where they thought the DRE indicated a slight "firmness"

My point being is the MRI will only pick up something if it is big enough, and of course subject to the interpretation of the pathologist, where it may or may not be obvious. That begs the question, if it is too small to be identified on the MRI, and it also wasn't identified on the PSMA scan in the right apex, even if it is a higher grade, that means there are limits to the technology. It has to be large enough to be flagged.

Under TULSA, that means they would not treat the small 3+4 in the right apex, because it doesn't show up on the MRI. An option would be to treat the whole gland with TULSA, which the urologist suggested, but the radiologist suggested leaving it alone, because whole gland treatment with TULSA would be more susceptible to side effects, than just focal treatment.

The point being, none of this is simple for any of us

Take care

John

[Currumpaw in reply to Yearofthecow]

If you copy the entire script between the lines it will take you to the sites. I should have mentioned that. My apologies.

Currumpaw

[Yearofthecow in reply to Currumpaw]

Thanks

[wilcoxsaw]

There are currently two trials comparing Photon beam to Proton beam being done, one in Florida and the other in Massachusetts. Neither has published any data yet. If you are looking purely for data and base all of your opinions purely on data and nothing else then as TA says there is no data to confirm the superiority of either type of radiation.

However, if you put any stock in speaking directly to patients that have undergone these treatments and can speak directly about their side effects and cure rates then there is a lot of this information available. There are large reference lists of proton patients having been treated at multiple centers that you can call on the telephone and speak to directly and ask pointed questions and get direct answers. There are those that will accuse those patients of confirmation bias. There are others that recognize that these patients are trying to help other patients and are out there to answer questions truthfully which they do when spoken to.

The difference in physics between protons and photons is undeniable. Take it for what it's worth, the proton particle can be stopped at the tumor site whereas Photon radiation passes through entire body. Draw your own conclusions as to which you feel might deposit less radiation on healthy tissues.

Unfortunately the two large studies are not yet to complete and the data that you seek is not yet available.

I have been treated by proton beam several times, Photon beam to treat two hotspots would have passed radiation through my left lung as well as my spleen and small intestine. Proton beam, because the particles could be stopped, did not pass any radiation through these critical structures. Once again an illustration of the difference in physics between a Charged particle and a beam of radiation.

I hope this helps with your inquiry.

Scott

[conbio]

I was debating about EBRT vs Proton. Talked to folks who had one or the other, and to a number of radiologists. My takeaway: Proton was developed for use on head/neck cancers for kids - and then there was a search for how else it could be used. Several radiation oncologists noted that over a decade they have seen minimal effects by EBRT because of its continual refinement. Two noted more rectal bleeding with Proton. ALL of them said there was no difference in effects/outcomes. I went with EBRT and Brachy

[sciaticaman]

I asked some 6 different experts about protons versus photons. They all said there was not any good data showing any differences for long term survival or side effects. I went with protons anyway, probably because my insurance paid everything. A year and a half later after radiation my only “complaints” have to do with the side effects of 6 months of Lupron. So far there is no fecal or urinal incontinence. At least not yet. I was given the SpaceOar to help prevent burning of the rectum as well as a ballon up my rectum to prevent any movement while being irradiated.