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Why so few Proton Therapy discussions?

Prostate Cancer | Last Active: Jul 14 12:04pm | Replies (24)

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Sick Kids and Princess Margaret Hospitals in Toronto announced in 2022 that they're collaborating on a future proton-radiation therapy site in downtown Toronto, with a capacity of 1,500 patients annually. I doubt it would be available to prostate-cancer patients, though. Priority would likely go to pediatric cases and/or those with cancers where pin-point accuracy is critical (like brain cancer).

It's going slowly because

a) PBT facilities are mind-bogglingly expensive, even compared to SBRT machines (which aren't cheap): proton machines are so big that they require specially-constructed buildings with at least a 3-story-high ceiling (!!!), while SBRT machines at least fit into some larger existing hospital wards.

b) There's been no demonstrated overall-survival benefit from proton vs photon, as @jeffmarc mentioned.

c) For those where long-term side-effects are especially concerning (e.g. children with brain cancer, who might live 80+ more years for side-effects to develop), it's a lot cheaper for provincial health ministries just to fly them and a family member to another country (e.g. the U.S. or UK) and pay for their proton therapy there.

d) There's no profit motive: in the States, setting up a proton machine can bringing in huge revenue, with one round of radiation generating US $60–200K in income, so it's a good private-sector business venture (whether it's always strictly necessary or not).

e) Sometimes we don't even want radiation to be pin-point accurate. One of radiation's benefits over surgery (and also one of its disadvantages) is that it keeps spreading outside the prostate for a couple of weeks after treatment, so it can deactivate cancer cells not just in the prostate but undetected ones in the surrounding area as well (the downside is that it can also cause side-effects in those surrounding area, so 🤷).

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Replies to "Sick Kids and Princess Margaret Hospitals in Toronto announced in 2022 that they're collaborating on a..."

I admit that I am concerned that using PT for prostate cancer when so many pediatric patients need it’s benefits for brain cancers, concerns me. My assumption is that if they are offering it to PC patients, they are not doing it instead of real need. But I don’t know that, really. The cost quoted to me is not so high, in the 10K-20k range because Medicare covers it.
I am not entirely convinced of it’s pinpoint accuracy in the prostate. As you point out, you want to irradiate more than just the identified lesion.
The lack of evidence for better outcomes doesn’t concern me as much. My PC is localized, not large, not cribiform, clean PSMA scan, and I partly don’t trust doctors that want to go beyond what’s there. That could be a mistake I know. I am concerned about incontenence and rectal problems more than anything else.
Finally, I have always lived life as fully as I can. I have stopped drinking wine or weed and fully hope to die with it than from it :0. My granddaughters need me now. I only want to last until their into late high school.
I really shouldn’t post after champagne by the ocean in Portugal on my 49th anniversary 🙂