Is SBRT with proton beam now a gold standard for prostate cancer?

Watch this video:

@frank 1956

Many thanks. Everybody should watch this video.

As an "amusing" comment I had a urologist tell me last year that proton therapy was experimental.

I looked at two specific types of radiation treatment. Proton was one of them and the narrow margin real time Mri, Mridian linac photon machine, was the other, which is similar to the Elekta machine. There are pros and cons to specific linac photon and proton type machines (ask me why, if you want my reasons). Many patients swear by their decision on these complex and emotionally difficult issues. I picked the MRIdian machine over Proton with five hypo fractional treatments.

One of the biggest issue for me was always how do I protect the healthy tissue, whatever radiation choice I make, because that will impact my side effects and quality of life, for whatever time period.

Different statements are made by different doctors but some doctors are better geared to informing the patient more broadly and specifically, than others, and I never assumed, one way or another, that doctors were infallible, just genuinely dedicated. The doctor in the video, as one example, talked about hypo fraction issues but nccn.org, an organization that most doctors use as a guideline, seems to be interpreting hypo fractional treatments, a little bit differently.

I like the video and it is good to hear his professional opinion on the subject and just as we get more than one opinion about our Prostate Cancer and it’s treatment, I like to hear from multiple drs talking about hypo fraction radiation, whatever kind that is, and as most of you know is complex enough to warrant hearing different opinions from other sources. I am glad frank1956 put the conference video up so that we can compare opinions from experts … without having to pay for them.

In a statement made in urology today magazine they had an interview with doctors about radiation clinical practices as they interpreted nccn.org guidelines and below is one comment regarding hypo fractional treatment, with the link to the article below, in case you’re interested.

“A number of Phase III studies have been initiated to compare SBRT to conventional regimes. And preliminary results show comparable GU and GI toxicity. The HYPO-RT-PC trial showed non-inferior, failure-free survival in intermediate high-risk disease patients for patients that receive 42.7 Gy in seven fractions, versus 78 Gy in 39 fractions. “
https://www.urotoday.com/video-lectures/nccn-prostate-cancer-guidelines-review/video/2402-nccn-clinical-practice-guidelines-in-prostate-cancer-radiation-therapy-external-beam-radiation-therapy-christopher-wallis-and-zachary-klaassen.html

I had photon SBRT with a focal boost the the dominant lesion and urethral steering to ensure my urethra did not receive more than the whole gland dose. I also am starting my 4th month (of 6) on Orgovyx. I am 68, fit, one 4+3, one 3+3, Decipher .84, PSA 7.6, PSMA PET showed confined to prostate. I had a Barrigel rectal spacer placed. I was treated on a Varian Edge linac.
For me this was the best treatment. I did not see proton therapy having enough of an advantage in my case to warrant my pursuing it.

I did the five proton treatments at Mayo Phoenix. I had only two episodes of urinary bleeding on day 282 and 286 after radiation. Up till day 225 I was peeing like a teenager, then started to feel a little different when going but nothing alarming at all till the bleeding. Had a cystoscopy that showed red area on the posterior bladder wall but nothing that was bleeding. I am now at day 335 with no other problems but I do take Flomax as I did before radiation for my huge prostate.

@rick137
Wow one of your urologists said proton therapy was experimental. Medicare pays for proton radiation treatments for prostrate.

UFPTI has been using proton radiation for prostrate cancer since 2006. Mayo Rochester and Mayo Phoenix have a very robust proton radiation treatments for prostrate cancer. Hopefully you have chosen a different urologist.

Many research studies show almost identical cure rates for both photon and proton. Some pros and cons with both but bottom line with proton is that is stops where oncologist/radiologist programs it to and does NOT proceed out through body like Photon.

Excellent that it’s worked out extremely well for you.

After being on active surveillance for 9 years, at 65y, I had 28 proton radiation treatments during April-May 2021 (with SpaceOAR Vue + 6 months of Eligard) for my 7(4+3) with PSA of 7.976. PSMA PET was not available back then, so we relied on MRI/bone/CT scans to confirm the disease was localized.

When I was evaluating treatment options (during 2017-2020 - compared to today, dated information), I considered photon SBRT. But, the 2 ROs I spoke to back then (one used Cyberknife, the other TruBeam), though they explained very well the accuracy of the technology, they could not explain to my satisfaction how they would avoid radiation scatter, that being a characteristic of photons (X-rays).

So, I wound up choosing proton, with its inherent Bragg-Peak characteristics. Of all the considerations and comparisons (including the fact that there was a proton center just a 40 minute drive away and that Medicare would pay fully for it), that Bragg-Peak characteristic was the major factor in my decision.

For me this was the best treatment. So far, it’s gone exactly as planned, hoped, and expected.