Proton, Photon, or Cryotherapy?

Medicare paid 80% of the cost of my proton radiation treatments (my supplement plan covered the 20% that Medicare didn’t).

Technically, Proton with its Bragg-Peak characteristic (“…proton does not proceed past the target area and out through body.”), should provide fewer QOL side-effects than standard IMRT/photon. (That is ultimately why I chose Proton.)

There are two clinical trials looking into this; COMPPARE and PARTIQoL.
> The PARTIQoL trial’s interim results indicate that both therapies achieved similar tumor control rates and patient-reported quality of life outcomes. Specifically, there was no significant difference in progression-free survival or patient-reported outcomes like urinary, bowel, and sexual function. (These results are interesting. If proton performs better than photon for brain, liver, and other cancer tumors, are the rad oncs not doing the complicated calculations correctly for prostate, or are other factors at play? Hopefully, the laws of physics still apply to prostate cancer……?)

> The COMPPARE trial is another large-scale study also comparing proton therapy and IMRT, but with a different focus on patient-reported outcomes. The COMPPARE trial is still ongoing.

See the attached Bragg-Peak characteristics graphic.

As for secondary cancers, those occur when radiation overshoots the prostate and hits otherwise healthy organs and tissues. So, the better the radiation accurately and precisely hits only the prostate, the lower the risk of secondary cancers. (I did use SpaceOAR Vue, just in case…..). . Just as important, not only the accurate/precise radiation, but also the dosimetrist (who calculates the correct biological effective dose), the physicist (who designs and shapes the beam, ensuring the tumor is targeted while minimizing exposure to surrounding healthy tissue), the radiation technicians (who are truly hands-on the radiation system), and of course the radiation oncologist (who I liken to a team manager). If they all do their jobs right, we come out with no side/after-effects!

With my proton treatments, they gave me three options:
> 20 sessions at 3.0 Grays per session,
> 28 sessions at 2.5 Grays per session, or
> 39 sessions at 2.0 Grays per session.
(As is typical for me, I picked Door #2.)

Finally, with all the research that I did, I overlooked one thing —> I was caught by surprise on the last day as I was leaving the proton radiation treatment facility. The entire radiation team was gathered around with a Certificate of (proton radiation treatment) Completion that they had all signed, as well as a bell for me to ring. Somehow, In all my studying up on various treatments, I missed that protocol for completion of radiation treatment. Still, that day was as much for them (as a team) as it was for me, so I completed that final task just before I left.

@brianjarvis
I had my proton radiation done at UFHPTI. They have been doing proton radiation since 2006.

UFHPTI was given a 25 million dollar grant to study the long term treatments and outcomes of radiation treatments. There were 2500 patients recruited. I am one of the patients in the study.

As I mentioned before when I was at UFHPT I saw so many children there is was sad. The UFHPTI facility is ultra modern. The entire length of the 5 gatries seemed to me about the length of a football field. Along the other side of the 5 different gantries and treatment rooms were special rooms for children before and after their treatments.

Patients come from all over the U.S. to UFHPTI and many countries also. I think because they have been doing proton radiation since 2006. My R/O has done thousands of radiation treatments. As you mentioned they have a physics department that decides the dosage, type beams, etc.

When I finished my treatments the entire team (you have the same team each time and are identified by colors (My blue team). The entire blue team accompanied me out into lounge area (a huge lounge area with a piano, refreshments, etc.) and a huge 6 foot like long cylintrical chimes. There is a rope and you swing a device that rings the chimes. I did that with my picture and team taken. Everyone in the lounge got up and applauded. I made sure every day I was there to make sure I did the same for others when their turn came to ring the chimes.

I am still going back there now every year for follow ups. And I fill out a questionaire every 3 months for the research study. When I have my follow ups they are twice as long as I am part of the research study and they go over every question on the survey along with the DRE.

I had my proton treatments at the University of Cincinnati that shares gantries with a Childrens Hospital. I was reminded of this when I went in for scans. (See attached photo.) The children’s side was kept separate from the adult side, but some things were shared. (See attached photo - Childrens Hospital on the left; Proton Center that I went to on the right.)

I chose to have my proton radiation treatment results submitted into a registry (https://clinicaltrials.gov/study/NCT02040467). Hopefully, it will help someone make a decision one day.

Interestingly, it turned out that one of the radiation technicians remembered me from a visit I had made to our local high school eleven years earlier when I was vice mayor of my city (later to become mayor). I had been invited to their AP Government class to talk about local government. The radiation technician remembered me from his senior class that I spoke at. (It pays to be nice to people. You never know who might be pointing a radiation beam at you one day!!!)

I haven’t been back to the proton center since my treatments ended. I selected a medical oncologist at a cancer center just a few miles from where I live. She coordinated my ADT injections and now my regular bloodwork.

So far, those visits have been uneventful.

If you watch the 2023 PCRI Video and see Dr. Carl Rossi talking about radiation you find some interesting things. For one he’s been doing Proton radiation treatments since 1994 when they built a building for the machine in San Diego. The first patient was the person that invented it, He lived to over 100. He has done Proton radiation on over 13,000 prostate cancer patients.

That video link is in the @brianjarvis message a few messages above this one.

Proton therapy definitely causes less secondary cancers than other radiation therapies. They prefer to use it in children to avoid secondary cancer risk over their lifetime. Proton therapy machines have been extremely expensive to build or treat patients, which is why it is so much more expensive and less used. They have finally been able to get a proton machine built in one and two rooms, which will greatly reduce the expense. Eventually, it seems proton, will probably be equal in priced to other techniques and will be used much more often.

Some information about secondary cancer risk

Stanford Edu
In a study of about 145,000 men with prostate cancer, the team found that the rate of developing a later cancer is 0.5% higher for those who received radiation treatment than for those who did not. Among men who received radiation, 3% developed another cancer, while among those who were treated without radiation, 2.5% developed another cancer.

Here is a link to the full study from Stanford

Prostate radiation only slightly increases the risk of developing another cancer, Stanford researchers find
https://med.stanford.edu/news/all-news/2022/070/prostate-radiation-slightly-increases-the-risk-of-developing-ano.html
The question with proton therapy is how long will you live? For somebody in their 60s desiring to live Another 20-40 years, it’s nice not to worry about secondary cancers. For somebody who is 75 the risk of a secondary cancer is very low so the lesser expensive therapies make more sense, or do they.

While we’re talking about it, here’s some info about the secondary Cancer risk of different types of radiation.

Studies suggest that SBRT may be associated with a lower risk of developing a second malignancy compared to other radiation modalities like conventionally fractionated intensity-modulated radiotherapy (CF-IMRT) and brachytherapy (BT), according to ScienceDirect.com. Another study found that SBRT's probability of causing secondary cancers was similar to that of radical prostatectomy (surgery), according to ScienceDirect.com.

I had salvage radiation at 67 and 10 years later no secondary cancers.

And lastly, here is a map of where the proton centers are located, it doesn’t show the exact location. Mayo in Scottsdale has one apparently. Surprising how most of them are on the eastern side of the USA.

Did you have Photon or Proton salvage radiation? Thanks.

I had photon, IMRT for 7 weeks. 12 years ago they really didn’t offer proton Where I was being traded, it also was not widely known about. I probably could’ve had it if I knew about the difference. Groups like this didn’t exist either, Not easy to get a Prostate cancer education back then.