@bjroc Medicine is a business in the USA. Several studies have shown that IMRT/SBRT is as effective as the like proton treatment for prostate cancer. Since photon is cheaper only classic Medicare routinely pays for proton PCa treatment. Medicare payments are much lower than other insurance. Not much incentive for a proton site to bother with a noncash pay PCa patient. One provider said they got about 50% approval provide company was self-insured and they did not use a benefits consultant (mine did). That ended this possibility since they said it would be a waste of their and my time. At one time MD Anderson treated PCa with proton and many on this board have been treated at Mayo, UCLA / UCSF, SK, etc. so it is (or was) possible to get Proton for PaC.