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Prostatectomy vs Photon radiation vs Proton Beam Therapy
Prostate Cancer | Last Active: Nov 15, 2025 | Replies (32)Comment receiving replies
I was considering protons. I'm 75, Gleason 4+3, cT3b by virtue of seminal vesicle invasion. I was surprised when discussing treatment options at my recent appointments at an NCI designated cancer center. This center has a proton facility. Management is heavily promoting it for prostate cancer therapy. I can't listen to local sportscasts without hearing advertising about this fantastic game changing therapy.
The urologist I saw there to talk over RP didn't think surgery was the best given my particular case. So this is a surgeon recommending radiation therapy. When I said I liked what I had read about the theoretical characteristics of protons, he was very negative. The senior radiation oncologist he referred me to, this is at the same NCI facility that is heavily promoting protons for my type of case, was also negative. One of his comments was they should stop aiming all these ads at prostate cancer patients. His proposed treatment plan was photons.
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@climateguy
This may help explain things:
So why would a radiation oncologist recommend IMRT (photons) over protons?
Because treating the seminal vesicles requires wider, deeper radiation fields.
And in that situation:
IMRT often provides better coverage and fewer risks than protons.
Specifically:
Seminal vesicles are long, thin structures that extend upward and outward.
They are harder to target precisely.
IMRT handles complex shapes better.
It can “wrap” dose around anatomy more smoothly.
Proton beams can be more sensitive to motion and tissue changes (like bowel gas or bladder filling).
For deep or irregular targets like seminal vesicles, this can reduce accuracy.
Several major cancer centers prefer IMRT for prostate cancer with extracapsular extension or seminal vesicle invasion (SVI) for these.
I summary: For prostate cancer that has spread into the seminal vesicles, IMRT is often the safer, more reliable option to cover all cancer areas fully while protecting organs as much as possible.