Proton vs Photon

@cecelia19 Questions to ask regarding prostate cancer external radiation treatments

You will want to weigh the risks, benefits, preferences, and outcomes of various treatment options; these can help guide your decision and help you start an open and candid conversation with your oncologist.

> What are the different external radiation treatment options (IMRT, SBRT, Proton) for my condition?
> Which kinds of external radiation therapy would treat my cancer best (IMRT, SBRT, or Proton)?
> Which are available at this facility?
> How many have you done?
> What are the procedures (When/Where/How) for each type of radiation treatment?
> What are the expected side and after-effects and risk factors with (the specific form of) radiation treatment?
> Will I require hormone therapy (Eligard, Lupron, Orgovyx) as part of my treatments?
> What side-effects should I expect from the hormone therapy?
> Is there a way to minimize the side-effects from the hormone therapy?
> What are the chances that I will suffer from complications during or after treatment (from either the radiation or the hormone therapy)?
> What are the chances that I will have GU, GI, ED, incontinence, bowel, rectal, problems during or shortly after, treatment?
> Should I be worried about side effects years after treatment has ended?
> What advanced technologies do you offer at this facility that can help reduce the risk of side effects?
> For (the specific form of) radiation, will I use a rectal spacer? If so, what type (SpaceOAR or Barrigel)?
> Is there a chance the cancer will come back after treatment?
> What will the preparation for each treatment look like?
> What will the duration of each treatment be?
> Can you describe the entire treatment plan?
> Will there be an impact on my daily routine?
> Will I be able to continue to work?
> What activities will I still be able to do?
> What activities are not recommended during each type of treatment?
> How soon must a decision on treatment be reached?
> Is there anything that I didn’t ask that I should know?

Hope that helps!
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@heavyphil A great question regarding entry doses. I never got to ask those questions because I had already decided on the Adaptive Photon Approach. I'm not sure if technology is still the same, but I read a lot about Protons leaving "tan" marks on the sides of your hips where the entry dose enters. I asked about this with my Adaptive IMRT and was told that there would be no tanning or other skin irritations because the gantry moves around you and there is not any one particular spot subjected to damaging levels of radiation (except the target area in and around the prostate). I'm not sure of the mechanics of how protons is beamed into your body or whether newer gantry technology has corrected the higher entry dose issue (my perception & words only), I didn't get that far.

To me, any irritation or tanning indicates exposure to healthy cells: the opposite of my personal treatment goals. Similar to diarrhea from photon radiation, which to me indicates unwanted exposure to the rectum. To better protect my rectum I chose to use a Bioprotect spacer rather than SpaceOar or other gel. Recently approved, Bioprotect is a saline filled balloon that provides an additional 2-3 mm space over and above SpaceOar. I am now 18 days into my 28 day IMRT and have had zero rectal side effects. None.

Also relatively newly approved and studied, Adaptive Photon Therapy constantly monitors my prostate position as the treatment is being given. Most days the Linac stops as sudden internal gas might appear and until it dissipates, a few seconds. Or it stops so the rad techs can re-position me a millimeter or two as my bladder continues to fill while laying on the table during treatment and shifts the target field slightly. This gives me comfort that the treatment dose is going where it needs to be with minimal unnecessary exposure to normal cells.

For me, I am super pleased that my research and treatment goals have led me to the right treatment for me.

I was treated with chemotherapy and radiation 40 years ago for Hodgkin’s lymphoma. This included 64 radiation treatments, 20 of which were to my pelvis. Now I have been diagnosed with prostate cancer. I asked my Urologist if radiation was an option for my prostate cancer and he was not sure. Does anyone have any insight on this topic?

My prayers and support to you at this difficult time. I been advised and after an excessive amount of search the proton therapy has an advantage over the photon. As the proton therapy has the characteristics to stop at a precise point so the other organs can be spared from being affected. Proton therapy is more expensive. Due to this advantage.

Your husband and you are not walking into that treatment room alone tomorrow. God goes before you, stands beside you, and surrounds you with His peace. What feels frightening to you is already in His hands.

Remember that fear speaks loudly, but faith speaks truth. And the truth is that you are stronger than you feel right now. The same God who carried you through yesterday will carry you through tomorrow.

Let every beam of treatment be guided by His healing hand. May His presence calm your heart, steady your mind, and fill that room with peace.

Tonight, rest knowing this:“The Lord is my light and my salvation—whom shall I fear?”
He is God Almighty.
You are covered in prayer, surrounded by love, and held safely in God’s care. Tomorrow is not a day of fear — it is a day of courage, hope, and healing. 🙏

@fitzhealthacct2025
Speak to a radiation oncologist. Urologists are not trained to be radiation oncologists.

SBRT radiation that is isolated to the prostate probably can do this. If they have to radiate the lymph nodes, that’s a problem. IMRT radiation does a much wider area and may not be possible. An RO can tell you much more.