Radiation & Recurrence Treatment (Inside & Outside Prostate)

@clevelandguy
You say it’s been used for many years, but the people I constantly hear from don’t seem to Corroborate that. Like I say, I have never heard of it being used, And I am seeing and hearing from people constantly, that are talking about their treatments. Do a search for it in this forum. I don’t think you will hear of one case, if it’s so much used, then you sure should hear about it.

It would take many years of evaluation before they know what the real long-term side effects are of doing radiation over what was referred to as maximum lifetime dose of IMRT or SBRT.

Do you personally know people that have had this treatment?

@clevelandguy
You say it’s been used for many years, but the people I constantly hear from don’t seem to Corroborate that. Like I say, I have never heard of it being used, And I am seeing and hearing from people constantly, that are talking about their treatments. Do a search for it in this forum. I don’t think you will hear of one case, if it’s so much used, then you sure should hear about it.

It would take many years of evaluation before they know what the real long-term side effects are of doing radiation over what was referred to as maximum lifetime dose of IMRT or SBRT.

Do you personally know people that have had this treatment?

@jeffmarc Proton beam radiation for prostate cancer treatments have been used for a few decades.

When I was researching this back in 2020, the earliest reference to proton beams being used for prostate cancer treatments that I could find was a 1979 JAMA paper titled “Proton radiation as boost therapy for localized prostatic carcinoma”
https://pubmed.ncbi.nlm.nih.gov/107338/
I was on active surveillance for 9 years (2012-2021) and only did a little looking into this early-on before I started getting serious about the possibility of me needing treatment and needing to dig further for the best treatment for me.

I read about this topic all the time from those who should’ve (and those who wouldn’t have) known better that “…,it’s new, it’s experimental, there’s no data, nothing’s ever been published on it, etc.”

Well, after digging around for a couple of years, I came across that 1979 JAMA article. That is said to be the first paper in the medical literature about treating prostate cancer with protons. Not exactly new….never been done….there isn’t any data on it. It’s been done for a long time, and there’s lots of data on it since then, if one knows where and how to research.

So thankfully, it’s one of the many ways to treat prostate cancer (and the one that I used).

More info:
> the first mention of prostate cancer in medical literature (that I could find) was this 1853 paper in Lancet.

> the first evidence of what they think was prostate cancer was in this mummy from the BC era.

Lots of fascinating information.

@jeffmarc
Yes on the other forums that I participate in several folks have used Proton radiation for Prostate cancer. Both the Cleveland Clinic and University Hospital in Cleveland have Proton machines(very well known teaching hospitals) it is widely used around the US as a tool to kill cancer. Using Proton as a mop up has been around for a while. What you don’t seem to understand is that it is a completely different technology that uses Proton’s instead of x-ray’s that use photons. Since its a different technology it does not add more x-ray load to a certain area. It kills cancer that were left behind by the x-ray based machine. Different technology but it still kills cancer just like x-rays. Just because you do not know anyone that has used it does not mean it is not a well used technology. It’s just another tool that people can used after an area has been maxed out with other forms of radiation. Don’t discourage people that want to look into this just because you have not heard of it. You should be open to different treatments based on established technology, we are all hear on this forum to learn and discover.

@clevelandguy
I have posted this before maybe you missed it. I have watched Dr. Carl Rossi’s presentation on the use of proton radiation.

If you watch the 2023 PCRI Video and see Dr. Carl Rossi talking about radiation you find some interesting things. For one he’s been doing Proton radiation treatments since 1994 when they built a building for the machine in San Diego. The first patient was the person that invented it, He lived to over 100. He has done Proton radiation on over 13,000 prostate cancer patients.
That video link is Starting at 3:38:45

Dr. Rossi did start using proton radiation in 1991, Before that machine was built.

I am also aware of these technical aspects of proton

Protons deposit most of their energy at the end of their path, a phenomenon called the Bragg peak, before stopping completely. This allows radiation oncologists to deliver a high dose of radiation directly to the tumor and then have the radiation cease, avoiding unnecessary exposure to healthy tissues.

Proton beams can be precisely shaped to conform to the exact contours of the prostate tumor, which is crucial for accurate cancer control and protecting nearby organs.

Using proton radiation after someone has had their lifetime amount of radiation involves a few things, and is not possible to do for everybody.

Location of Recurrence: If the cancer is strictly confined to the prostate, it is easier to treat. If it has spread to surrounding tissues that were also fully irradiated, it is more complex.

Dose Received Previously: The doctor will analyze the original radiation plan (\(doses\) and \(fractions\)).

Patient Health: The ability to tolerate further treatment, considering age and other factors.

@jeffmarc Proton beam radiation for prostate cancer treatments have been used for a few decades.

When I was researching this back in 2020, the earliest reference to proton beams being used for prostate cancer treatments that I could find was a 1979 JAMA paper titled “Proton radiation as boost therapy for localized prostatic carcinoma”
https://pubmed.ncbi.nlm.nih.gov/107338/
I was on active surveillance for 9 years (2012-2021) and only did a little looking into this early-on before I started getting serious about the possibility of me needing treatment and needing to dig further for the best treatment for me.

I read about this topic all the time from those who should’ve (and those who wouldn’t have) known better that “…,it’s new, it’s experimental, there’s no data, nothing’s ever been published on it, etc.”

Well, after digging around for a couple of years, I came across that 1979 JAMA article. That is said to be the first paper in the medical literature about treating prostate cancer with protons. Not exactly new….never been done….there isn’t any data on it. It’s been done for a long time, and there’s lots of data on it since then, if one knows where and how to research.

So thankfully, it’s one of the many ways to treat prostate cancer (and the one that I used).

More info:
> the first mention of prostate cancer in medical literature (that I could find) was this 1853 paper in Lancet.

> the first evidence of what they think was prostate cancer was in this mummy from the BC era.

Lots of fascinating information.

@brianjarvis Yes, Proton has been around a long time, but the debate is not whether it can be used to treat PCa, but if it can be used AFTER the lifetime dose of photon radiation therapy has been administered.
It would seem to me that the main advantage of proton therapy is in its Bragg Peak effect and how it does not pass thru to other tissues.
However, it still delivers a powerful dose of radiation to whatever it is targeting; so a prostate previously irradiated by photons (fried) is now going to AGAIN be irradiated (refried!) by protons…?
And this is supposed to cause no harm? I just don’t see it, internet searches and AI notwithstanding.
Would be incredible if true.
Best
Phil

@heavyphil Yes, they can give photon after photon (or proton after proton) – re-radiation can be done. But, there are concerns, (I’m not sure that the prostate being “fried” is a correct representation.)

Dr. Rossi goes over all of this —>

The concern with re-radiation – and this gets to the unknowns — is that even though that normal prostate tissue may not have been clinically damaged the first time it was treated, there may be some microscopic injury that may or may not be repaired (or reparable). They’re still learning more about how much of that actually is repaired as time goes by.

Historically, the primary concern is that if you re-radiate, you're going to place patients at a high risk for complications impacting nearby tissues and organs: for instance the rectum – because rectal tissue does not tolerate radiation well. But, these days you have rectal spacers that can create big margins, that way you avoid re-treating the rectum. (SpaceOAR reduces radiation to the rectum by 70%.)

If (for example) you gave me 70 Grays of radiation the first time and it didn't work, giving me another 30 – 40 more Grays doesn't make any sense; we not only risk exceeding the prostate’s radiation tolerance, but also causing complications of the colon/bowel. It’s gotten to be much better these days because of better delivery and excluding the rectum away.

So, the biggest concern is what happens to the rectum, bladder, urethra, and other surrounding tissues that might accumulate permanent radiation injury. Once these tissues reach their tolerance dose, additional full-dose radiation becomes unsafe.

Again, re-radiation is generally not the preferable salvage route. If there is a recurrence after primary radiation there are different ways to address that – and re-radiation is just one of them. What’s preferable and probably the safest way to do it is focal cryo surgery – freeze the area where the recurrence is because it's more controllable than doing re-radiation; also HDR brachytherapy is an excellent way to do it because you have more control over where the dose goes.

I personally know 2 guys who had their recurrence re-treated with SBRT, because the recurrent lesions were localized, small and well-defined. In those two cases using advanced techniques, administering a tightly focused and administered photon dose was done. And, it’s worked out well for them.

@brianjarvis Yes, a friend who underwent SBRT was told by his radiologist at Sloan that ‘seeds’ could be done if there was a recurrence.
Don’t know if he was using the word ‘seeds’ to mean HDR or LDR and my friend didn’t ask.
But I guess any modality is on the table; as you say, it all comes down to size and the precision of treatment. Best,
Phil