Proton therapy after prostatectomy.

Do you mean in general or as opposed to photon therapy? I've had IMRT after prostatectomy which is photon.

How was you experience with photon?

It was salvage radiation, 39 sessions 5 days a week. Oddly enough it went by pretty quickly. While taking the treatment there seemed to be a cumulative sort of fatigue that came on during the treatment period. It wasn’t terrible but just noticeably more tired by the end of the treatments. After treatment that went away rather quickly. I don't believe I've had any lasting effects from the radiation itself.

A friend had Salvage Treatment about 2 yrs ago in a clinical trial at Johns Hopkins using proton radiation.
I and a different friend had Salvage Treatment also at JH (different ROs) using IMRT radiation.
So far, all 3 of us have had substantially similar results: PSAs have been undetectable and side effects from radiation modest/moderate, which resolved a few weeks after treatment.
Best wishes for a successful treatment.

I don’t think they use proton therapy for salvage. Protons are very precise and are targeted to expend all of their energy at a given point - usually the prostate and a preset marginal area around it (Bragg Effect). The benefit is that the beam ends at that point and does not pass thru other structures.
Salvage radiation MUST pass thru in order to hit wayward cells that could be anywhere - behind the prostate bed or in front of the rectum. The beam, however, can be ‘shaped’ to avoid maximum effect to sensitive structures. Hope this helps.
Phil

While undergoing treatment this winter/spring, I was with several men who were receiving proton therapy for salvage each of whom reported excellent results after completion of treatment.

Hey Brian, As usual I am looking thru the narrow lens of my own experience with IMRT 5 yrs after surgery.
From what I understand ( and I could certainly be wrong) proton radiation is usually given as ‘adjuvant salvage’ radiation immediately after surgery when there are known metastases directly outside the prostate bed or in the pelvic nodes.
These areas can, of course, be targeted and proton therapy is very effective at treating them and causing minimal peripheral damage. However, in cases such as mine, with rising PSA 5 yrs post-op and NO visible activity on PSMA I do not believe proton therapy would be as effective; there are targets (bed and nodes) but the radiation beams produced by proton radiation vary in intensity from the center (strongest) to the periphery (weakest) and you may overtreat one part of the target and undertreat the other.
IMRT offers more consistency thru its arc - which ironically is both its strongest and weakest points: it will fry everything evenly, but do more damage to other organs on the way in - and out!
It would be interesting to know if the men you met were in the adjuvant salvage or late salvage stage. Thanks for the post!
Phil

Phil, first of all, I'm so glad you found a treatment option that worked for you. To answer your question, there was one gentleman getting proton 6 months after RP; the others were all getting proton salvage several years out from RP, including one gentleman who had been cancer free for a decade. As with everything related to PcA, treatment recommendations are all patient-specific, Center-specific, and individual provider-specific. In charting our own path, I just don't think one should arbitrarily rule out a specific plan of treatment without first having done the difficult work of consulting with the providers in whom we have the most trust and after considerable due diligence.

Yeah, most of the recommendations for treatment are very user biased - or center biased if they have a multimillion dollar machine that needs to be paid for, right?
Can’t wrap my head around how proton therapy would work in a late salvage case, but I’m not a physicist and when they get down in the weeds and start throwing around Greek letters, it’s pretty much past my level of comprehension😖😩