Proton beam vs IMRT for intraductal carcinoma of the prostate

@1hockeyjeff, Ductal carcinoma of the prostate is a rare variant of prostate cancer. Knowing that you have this variant helps your team develop the most effective treatment plan for this type.

From Mayo Clinic
"Intensity-modulated radiation therapy (IMRT) is an advanced type of radiation therapy used to treat cancer. IMRT uses advanced technology to manipulate photon and proton beams of radiation to conform to the shape of a tumor.

Proton beam therapy (PBT) is precise like IMRT, but it uses proton beams instead of x-ray beams. IMRT and PBT aim to deliver most of the radiation to the prostate cancer while sparing surrounding tissues. Both IMRT and PBT have been used in the treatment of prostate cancer and are thought to be equally effective treatments."

Fellow members @spryguy @biih and @zj69 have also mentioned that they have intraductal carcinoma of the prostate. Perhaps they have some insight.

Jeff, like you, I'd be interested in a more detailed explanation from your radiologist about why IMRT is used but proton beam therapy is not. When do you see your radio-oncologist again?

Thank you hiw do i contact them..see partial email

You can contact your Mayo Clinic doctors through the patient portal: https://sharedfiles.mayoclinic.org/patientonline.html

Usually it is because the proton beam costs more, is not covered by health insurance, or it is not available as protons require huge cyclotrons to split the atoms used to create the protons.

hmmm - i am about to start proton therapy for my Prostate Cancer that includes IDC-P. REALLY want to know why your doc didnt recommend it before i start down this road.

The only thing that makes sense to me is that protons expend all of their energy at a given predetermined matrix: ie - the prostate gland and the 3-5 mms around it. That is its main advantage, in that the protons don’t go past the target and affect healthy tissue,
Photons, however DO pass through the target, other tissues, and the radiation table until stopped by the lead shield. It is possible, based on other factors( possible spread outside the target area? Lymphatic activity on PSMA?) that your team is using photonic IMRT to blanket the entire prostate bed and pelvic area which I don’t think you can do with protons.
If you think in 3D, where do you tell your protons to ‘explode’ and release their energy ( Bragg Effect)? Ten mms past the gland? Thirteen? How far above or below if you suspect PCa cells?
I am not a nuclear physicist, nor an RO. I love the idea of using such a precise, tissue sparing tool. But even protons have limitations in what they can accomplish. Others on this forum have had Proton beam therapy so perhaps they can correct my errors in thinking.
You should ask your RO why you are not getting SBRT ( 5 sessions) or HD BRACHY + SBRT - those modalities are more often used today in cases of aggressive cells such as yours. That may give you your answer.
Phil

Why is HIFU or TULSA PRO rarely mentioned TULSA PRO is not even mentioned in Walsh’s book!!

Just wanted to add that IDC-P is different for "ductal" adenocarcinoma in PC - they are 2 different things . This patient had IDC-P, not ductal carcinoma.