Finally, we have Level 1 evidence that proton vs. photon treatment of low-risk/intermediate-risk localized prostate cancer is no different in effectiveness or any quality of life domain (rectal, urinary, or sexual).
This prospective randomized trial, called the PARTIQoL trial, was an enormous undertaking, involving 450 patients from 30 recruiting centers, including 12 proton centers beginning in July 2012. Hormone therapy was not allowed. Patients were stratified on the following parameters:
It makes sense that any healthcare treatment facility that has not arranged it’s insurance reimbursement relationships so that it can operate competitively by pricing proton treatment and other forms of radiation treatment comparatively has made a business planning error. The UPenn Roberts Proton Treatment Center has established the pricing of it’s RT procedures comparatively. It’s financial underpinnings are sound and it’s use of proton beam treatments is outstanding.
thanks Alan saves me a trip to the proton center in Harlem. Please get us the follow up mirage trials from Dr. Kishan out of UCLA and MRI guided Meridian radiation.
A proton facility opened in a new purpose built facility at my local hospital. It will not bankrupt the larger institution. The longer I live the more I see medical experts adopting the attitude of patients rather than scientists. “It might work and insurance will pay. Why not.”
I shook my head 2 years ago when they announced it.
Good to know!! Thank you, TA. When I was at Mayo and said something about Proton the Kwon assistant said that was just for baby's brain cancers, and not needed for prostate cancer. So this apparently confirms that. $$$$$$$$$$
Not necessarily. But proton doctors would have to explain why results would be any different. With salvage radiation, urinary side effects are particularly risky, and we see that urinary side effects were not different in localized PCa.
Thanks - reinforces what my radiation oncologist was telling me when I made my decision regarding EBRT. I did ask "But are there less side effects with photon therapy". And his reply was that he saw more rectal bleeding with photon therapy. He also said the standard radiation regime now was so targeted there is much less concern of damaging adjacent tissue compared to the older methods - but of course, that risk is not eliminated. So all combined I went with the standard and less costly cost of treatment.
The photon center almost sold itself to me when I visited. Saw the director of the center (did an exam on me - loved what he found - something he could zap).. it was the followup marketing that combined with the PITA to get treated (close enough that it would be hard to justify staying in a motel nearby each weekday, but a miserable drive at any hour of the day..) that killed that idea.
The marketing was pretty relentless - sent me all the forms, all filled out, called daily to ask if there were any questions - when someone is trying that hard to sell me on something I always start to draw back.
I had a friend who was doing photon at the same time as I was about to do proton - and he became a salesman for it.. that's when I realized he'd bought the boat (as we used to say when sailing..) and was reassuring himself that he bought the right one.
We all tend to think the decision we made was the "best" decision for treatment, and perhaps it always is given the circumstances, but in this case, the promises made by the sellers of photons is unjustified. Shame on them.
What's interesting - is no study yet on high-risk patients. And I don't know if one is even being done.
I am so glad these results are now available. I have argued on other prostate cancer forums that proton therapy has never been proven superior to photon therapy, but my arguments have usually failed to be convincing. Folks always bring up the argument about lesser damage to tissues beyond the area irradiated. They don't seem to realize that the protons can damage tissue prior to hitting the target. From now on I can quote the ASTRO abstract and I hope, in due time, a 'real' referenced paper.
Not just "prior." Secondary neutrons are formed when protons stop, and they scatter and do a lot of tissue damage. Also protons are diffracted from the nozzle head.
Happy proton patient here, so I freely admit my bias. But it seems to me that the comment about proton facilities declaring bankruptcy assumes that prostate treatments are a major part of their revenue stream. I have no real idea, but in my treatments at Sibley I saw plenty of non-prostate patients -- kids, esophageal, etc. In any case, I remain a satisfied customer.
Another, larger-scale trial is being conducted now, about the relative merits of proton & photon treatment. As I understand, it does include high-risk patients (like me). It’s called COMPPARE, but I believe it won’t be completed for another year or two.
I’ve just started hormone therapy, and will be getting radiation, probably starting in January. My inclination is to get proton, but I have a question that you - and other good folks in this community - may be able to help answer. I live in Baltimore. There’s a proton center here, but I’d prefer to go to the one you went to: Hopkins’ Proton Center in DC at Sibley Hospital. That would be a commute of about an hour-and-a-half each way for about six weeks. I can drive, plus my wife is happy to help drive, and a couple of other family members can help if needed. But I’ve been told that during the final weeks of radiation treatment, it’s fairly likely that I’ll be feeling lousy, fatigued, and may be dealing with diarrhea and other issues. So my question is this. Do you think it’s realistic to plan on doing that commuting, while going through proton therapy?
I did my treatments at Sibley, and since we live in Delaware, we rented an apartment in Bethesda for the 9 weeks I was there. I drove myself to and from Sibley every day, and had no problem with fatigue or other issues. The hardest part was bowel and bladder management (they want empty rectum and full bladder every time). I did mine early in the morning, and got into a rhythm of when to drink and go accordingly. YMMV as they say!
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