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Patient movement during proton therapy more problematic than photon?

Prostate Cancer | Last Active: Aug 11 10:40am | Replies (16)
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@gently

hi, Carter,
my treatment was seven years ago at CAProton. Original Medicare patients were automatic. Medicare Advantage waited the longest. Private insurers responded on appeal. CAProton was good at persisting and prevailing. I can recommend Carl Rossi (I'm probably not the only one who has to be careful not to call him Carlo). https://www.californiaprotons.com/team-member/carl-rossi-md/ You might not want to travel to a beautiful beach town, la jolla, and be stuck there for a month or so. He wasn't my physician, though.
The viewrays are hard to find partly because of the expense and partly because of a bankruptcy. Repairs were impossible until a wealthy Indian american intervened. The viewrays needing repair were immobilized. Meanwhile other companies filled the gap. The margins for the old viewray was 2mm, better than the 3-5mm for the other machines. A change in software for the viewray or improvements in other MRI guided machines may have changed the Viewray advantage. Which is to say in an extended fashion, you might ask about the the ROs about the margins. There are several Viewrays in CA and I know of one in NY. When I last spoke with Mayo there were none operative there.
No one recommended proton for me. Doctors were sidling up to whisper that I was making a big mistake. Who is your RO?

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Replies to "hi, Carter, my treatment was seven years ago at CAProton. Original Medicare patients were automatic. Medicare..."
carter777 | @carter777 | Aug 9 9:33am

Hi @gently ,
Thanks for the info on CAProton. Dr. Rossi's experience is very impressive! I will definitely try to learn more about them and consider treatment there. (I love San Diego. Have friends there and was stationed there MANY years ago while in the US Navy, when San Diego was a far smaller place. Love La Jolla, great beach memories.)

After reading the article, "Consensus Statement on Proton Therapy for Prostate Cancer" from 2021, I have a much better understanding of the movement issues during therapy. I had been thinking of the whole patient moving, but it is more the prostate moving due to things like the bladder filling, peristalsis, gas in the rectum, and the rectum filling with stool.
See the section "Technical Delivery of Proton Therapy". I don't have permission to post the link as a new member of this forum. It was published in "International Journal of Particle Therapy" and can be found through sciencedirect.com and nih.gov.

Kudos to you for pursuing your choice of proton therapy when doctors were advising against it. That takes strength and determination! Along those lines, I received an interesting
response to my initial post from @5galloncan who indicated that in conversation with many fellow patients undergoing proton therapy at UFHPTI they all indicated "no urologists or doctors outside the proton community recommended or mentioned proton treatment to them".

My RO at Mayo Rochester is Dr. Ryan M. Phillips, MD, PhD. His PhD is in pharmacology. Nowhere near the experience of Dr. Rossi I would say, by the way. He's been at Mayo for about 3 years, I estimate, after being chief resident at Johns Hopkins School of Medicine.

Good luck to you, and thanks again for sharing your experience and knowledge!

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