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PC treatment: Prostatectomy or Proton Beam Therapy
Prostate Cancer | Last Active: Jan 22 11:40am | Replies (47)Comment receiving replies
@northoftheborder
I know I personally had a PSMA PET scan and it found a metastasis on my spine. I got it zapped three years ago, and I have been undetectable since.
I know so many people I can’t count how many that had PSMA PET scans that found metastasis that were zapped and most are doing just fine. Scholz believes strongly in Waiting for the PET scan to show metastasis and have them treated. He feels it is extending the lives of many people doing it that way instead of salvage radiation
I don’t think there’s any doubt that the PSMA PET scan has proved useful long-term for many people that have had metastasis found. Before that scan, there was no way to find them, though a CT scan was marginally helpful, It’s just not the same.
I know one guy had over 15 metastasis zapped and he’s still around at least a couple years after having it done. Normally, they do chemo for that, but he went for multiple SBRT sessions.
Proton radiation has been used for over 30 years. The guy that invented it had his prostate cancer treated decades ago with it. He lived to Over 100.. They’ve been doing that type of radiation on children for brain tumors.
I’m not so sure these particular techniques are unproven.
Replies to "@northoftheborder I know I personally had a PSMA PET scan and it found a metastasis on..."
@jeffmarc And likewise, the long-term benefits of proton over (considerably less expensive) photon-beam radiation for overall survival and quality of life are also yet to be proven, at least for prostate cancer.
That doesn't mean that proton-beam RT itself isn't as effective as photon-beam; just that the evidence doesn't exist yet to justify the huge extra cost (in most cases).
In the U.S., a proton-beam facility is often a business venture: it's justified as long as it produces enough revenue to cover the capital and operating cost and turn a reasonable profit, so once someone builds one, they market it hard and try to keep in in constant use.
Much of the rest of the world does medicine on a traige basis, so they want hard evidence that the enormous cost of a proton-beam facility (up to 30× that of an SBRT facility) actually makes a measurable difference in the long run, vs using the money to build more SBRT facilities in under-served areas. I think they're persuaded that it does for brain cancer, but not (yet) for most other types.
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@jeffmarc Benefits are "unproven" in the sense that researchers can't yet demonstrate improved overall survival for people getting PSMA-PET instead of alternate (less costly) scans.
Agreed that there are many personal stories like yours about PSMA-PET finding new metastases before CT, MRI, or bone scans could, but as far as I know, those haven't shown up in improved OS at the statistical level yet, at least not for the majority of patients getting routine scans.
In your case, with the BRCA mutations, the extra sensitivity of PSMA-PET likely outweighs the noise of false positives that the test also often produces, which can lead to unnecessary alarm and overtreatment for many patients (we've also seen personal stories about that here in the forum).
In a sense, it's like a smoke detector. If you make it more sensitive, it will give you earlier warning of a fire, but might also go off every time you fry an egg or make toast. It's all still up in the air whether PSMA-PET is like that oversensitive smoke detector, or whether it will actually save lives in the long run. The U.S. uses it a lot, so we should have more data soon.