Prostate Cancer Proton Beam Therapy

Cancers Treated With Proton Therapy

Proton therapy is useful for treating tumors that have not spread and are near important parts of the body. For instance, cancers near the brain and spinal cord. It is also used for treating children because it lessens the chance of harming healthy, growing tissue. Children may receive proton therapy for cancers of the brain and spinal cord. It is also used for cancer of the eye, such as retinoblastoma and orbital rhabdomyosarcoma.

Proton therapy also may be used to treat these cancers:

• Central nervous system cancers, including chordoma, chondrosarcoma, and malignant meningioma

• Eye cancer, including uveal melanoma or choroidal melanoma

• Head and neck cancers, including nasal cavity and paranasal sinus cancer and some nasopharyngeal cancers

• Spinal and pelvic sarcomas, which are cancers that occur in the soft-tissue and bone

• Noncancerous brain tumors

Cost & Coverage Options For Proton Therapy Cancer Treatment

Dealing with a cancer diagnosis is difficult enough. We have a dedicated team in place to help you with the paperwork, work with your insurance provider, make a case for your treatment and even assist you with appeals, easing the burden of dealing with cost and insurance coverage so that you can focus on becoming well.

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Whats The Procedure Like

Since delivering the protons to the cancer cells is the goal of therapy, a lot of time is spent on positioning your body and adjusting the equipment before each session.

Youll have to remain perfectly still while the proton beam is delivered, but it will only take about 1 to 3 minutes. Its noninvasive, and you wont feel anything. Youll be able to leave right away and continue your normal activities.

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What Do We Think

For men with localised prostate cancer, current evidence suggests that proton beam therapy does not produce better outcomes than existing radiotherapy techniques. There is also limited evidence to suggest that it results in fewer side effects than radiotherapy. Because standard radiotherapy works just as well as, or better than proton beam therapy, it isnt used to treat prostate cancer in the UK.

Radiotherapy is a highly effective treatment for localised prostate cancer, enabling 98% of men with localised prostate cancer who receive conventional radiotherapy survive for at least 10 years. Men with this stage of the disease can also choose from a series of other treatment options that include active surveillance, radical prostatectomy and brachytherapy.

Unless further clinical trials are carried out to show that proton beam therapy will benefit men with prostate cancer through increased overall survival or the reduction of side effects, Prostate Cancer UK does not actively encourage men to pay for this treatment or seek it abroad.

If you have any concerns about prostate cancer or the treatment options for localised prostate cancer, you can confidentially contact our Specialist Nurses on 0800 074 8383.

i NHS England : Clinical Commissioning Policy: Proton Beam Therapy for Cancer of the Prostate. July 2016.

Advantages Of Proton Therapy

The capability to precisely target the tumor cells is the primary advantage of proton treatment. According to studies, proton therapy exposes the tumor to a larger dose of radiation while exposing nearby healthy cells to much less radiation. Radiation-related adverse effects are less and the risk of secondary cancer is much lower when less healthy tissue is exposed to the radiation.

Proton therapy has additional advantages because of this precision targeting:

• Preserving critical brain processes like memory or speech when a tumor is present close to the regions that govern these processes
• Limiting radiation exposure to the heart and lungs when treating breast cancer or spine cancer
• Lowering the chances for cancer in children, who frequently experience long-term negative effects from harmful cancer therapies
• Helping to prevent more radiation from being applied to areas that have already received radiation in the event that a tumor returns there or nearby.

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Effect Of Dosage Schedules And Other Technological Factors On Patient Outcomes

Several clinical studies have examined whether dosage schedule , use of pencil beam modality, and total delivered dose influence outcomes. Hypofractionation has been examined in 2 small RCTs., The first RCT randomized 82 men to a moderate hypofractionated PBT dose schedule or an extreme hypofractionated schedule and compared long-term GI and GU toxicity and cancer control. The rates of GI and GU toxicity were slightly different between treatment arms, but these differences were not statistically significant. Cancer progression as measured by PSA levels was significantly higher in the extreme hypofractionation arm. The second RCT reported small and nonsignificant differences in GU and GI toxicity between patients on a hypofractionation schedule or conventional dosage schedule.

Pencil beam scanning is a newer technique that potentially can deliver more precise dosing in PBT, compared with conventional PBT. A multi-site registry study has enrolled patients receiving either PBS or conventional PBT and has reported data on toxicity rates for the 2 alternative modalities., Both acute and late GU toxicity were higher in the PBS group, while GI and sexual toxicity did not differ between the groups. The methods for controlling for confounding were limited in this study. Overall, the current evidence is insufficient to draw conclusions about the comparison of PBS to conventional PBT.

What Are The Pros And Cons Of Proton Therapy For Cancer

The pros of proton therapy for cancer include that it is more accurate than alternative treatments and less likely to cause damage to surrounding tissues. Proton therapy also can be precisely targeted to the exact depth of the tumor, minimizing damage to other parts of the body. The treatment can cause the same side effects as other forms of radiation treatment, however, and also is expensive.

One of the main advantages of proton therapy is that it has a lower chance of causing severe side effects than other forms of therapy. This is because protons are larger and heavier than the particles used in other types of radiation therapy. The larger mass means the protons dont scatter into other parts of the body as much, reducing collateral damage to surrounding tissue.

It also is easier to target protons to tissue of a certain depth. If other types of radiation are used, such as X-rays, it is difficult to get the radiation to stop at the precise depth of the cancer. This means the radiation continues on and can affect other parts of the body. The energy of protons, on the other hand, can be adjusted so most cant penetrate any farther than required.

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What Are The Best Proton Beam Centers In Europe

Proton beam therapy is a quite new treatment option, and is available not in every European medical center.

Among the most popular proton treatment centers in Europe are:

• Rinecker Proton Therapy Center . It is the 1st certified proton beam center in Europe, serves about 2,000 patients annually.
• Proton Therapy Center .

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Which Treatments Are Best In Keeping Men In Remission

Here is your opportunity to compare prostate cancer treatments. Over 129,000 patients underwent PSA monitoring after treatment to see which treatments were most effective at keeping the cancer in remission. The charts show which treatments are more likely to leave patients Prostate Cancer Free, for how many years. Share this data, talk with your Doctor, or multiple Doctors and make an informed decision. Select the treatment option, that is best for you.

Compare Prostate Cancer Treatments by gathering information about your own Prostate Cancer Diagnosis. Your Doctor will provide three elements that describe your prostate cancer. Your PSA, Stage and Gleason Score. These three elements help you determine your risk group. Find and select your Risk Group in the table below. This will take you to the comparing prostate cancer treatments page, where you can select different prostate cancer treatments on an interactive chart and graphically see their effectiveness over time.

The treatments included in this study are Prostate Surgery or Prostatectomy, , Brachytherapy or Seeds, High Dose Rate Radiation, HDR, External Beam Radiation Therapy or EBRT, Androgen Deprivation Therapy, ADT, or Hormone Treatment, Proton Therapy, High-Intensity Focused Ultrasound, HIFU, Cryotherapy, Cryo and Hypo-Fractionated External Beam Radiation Therapy. For more advanced prostate cancer, treatments are combined to increase effectiveness.

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Prostate Cancer Treatment Proton Beam Therapy

Overview by Dr Sarah HarrisProfile

In 2022 , the options for the active treatment of non metastatic prostate cancer are many .This provides men with many decisions to make , knowing that the chances of cure or control of localised prostate cancer are likely to be high but the side effects are different .

Within the non-surgical options are radiotherapy treatments which have also evolved significantly in the last 2 decades . This page concentrates on the use of proton beam therapy a less common form of external beam radiotherapy .

Why might Protons be good a Cancer treatment?

Radiation is a form of energy which causes changes to the chromosomes or genetic material of cells as is passes through the body tissues . This damage preferentially kills cancer cells allowing normal body tissues to recover from the damage .

High energy Xrays deliver their highest dose of energy just under the skin and then fall away as they are absorbed passing deeper into the tissues . Protons are charged particles and deliver their majority of their energy at one depth the Bragg peak and then stop beyond this point. The energy or strength of the proton beam is selected to have this peak where the tumour is to be treated .

Why might Protons be good for treating Prostate Cancer ?

Sadly , there is no level 1 evidence comparing proton and X-ray treatment for early prostate cancer yet and clinical trials are now underway to answer this question .

How many treatments do I need?

Summary

Data Sources And Searches

To identify articles relevant to the key questions, a research librarian searched Ovid MEDLINE, Ovid CENTRAL, and ClinicalTrials.gov, as well as the AHRQ and Cochrane Databases of Systematic Reviews through February 2022 using terms for proton beam and prostate cancer . Formal Requests for Scientific Information were sent to manufacturers of proton therapy systems . Additional citations were identified from hand-searching reference lists and consultation with content experts. We limited the search to published and indexed articles involving human subjects available in the English language. Study selection was based on the eligibility criteria described above. Titles, abstracts, and full-text articles were reviewed by 1 investigator and checked by another. All disagreements were resolved by consensus or discussion with a third reviewer.

and are comparative effectiveness questions, so all studies judged to be potentially relevant compared outcomes in 2 or more patient groups . Studies with comparative data were included in the review if patients in the comparison condition received IMRT or brachytherapy and patients in all conditions were treated for similar durations. Studies comparing PBT to older modalities for delivery of external beam proton therapy were excluded. Studies that examined only PBT and stratified patients into subgroups defined by patient characteristics or difference in the dosage, schedule, or delivery method of PBT were considered eligible to address .

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Secondary Treatment Following Relapse

Hormone therapy may also be used as a secondary or salvage treatment when PSA levels rise following initial prostate cancer treatment, indicating the cancer has returned. This situation is known as biochemical recurrence. The salient points to keep in mind are that hormone therapy is most often used as a salvage treatment when PSA doubling time is less than six months, indicating that the cancer is aggressive or may have already metastasized.

Positioning For Proton Beam Treatment

Positioning the body is very important. It can take several minutes for the team to adjust both you and the instruments to make sure the proton beam will reach the exact spot of the tumor.

While the treatment is happening, you must be very still on the table. The team will work with you to help keep you in place. For example, a custom-fitted mask can help those who are getting treatment for brain tumors. The mask is made of mesh that allows patients to see and breathe.

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Recovering From Prostate Cancer Treatment

If youve been through first-line treatment but still have cancer, your doctor will adjust your treatment accordingly.

After surgery, radiation, or chemotherapy, you may be cancer-free. However, youll still require monitoring for any signs of cancer recurrence. If youve been taking hormone therapy, you may also need to continue to do so.

Periodic prostate-specific antigen testing can help figure out the effectiveness of hormone therapy. The pattern of PSA levels can also help monitor for recurrence.

The process of recovery is different for everyone. Much of recovery depends on the stage of diagnosis and the extent of treatment. Your age and general health also play a role. Your doctor will take all these factors into consideration to give you an idea of what to expect, including:

• the schedule for follow-up exams and tests
• how to deal with short- and long-term side effects
• diet and other lifestyle recommendations
• signs and symptoms of recurrence

Evidence Brief: Proton Beam Therapy For Treatment Of Localized Prostate Cancer

David H. Hickam, MD, MPH, Methodology, Supervision, Investigation, Data curation, Writing original draft, Writing review & editing, Johanna K. Anderson, MPH, Project administration, Methodology, Supervision, Investigation, Data curation, Writing review & editing, Basmah Rahman, MPH, Investigation, Data curation, Visualization, Rachel M. Ward, BA, Investigation, Data curation, Visualization, and Nicholas J. Parr, PhD, MPH, Conceptualization, Methodology, Investigation, Data curation, Formal analysis, Visualization, Writing original draft, Writing review & editing, Project administration.

Affiliations

The Evidence Synthesis Program Coordinating Center is responding to a request from the VHA National Radiation Oncology Program for an Evidence Brief updating a 2015 ESP evidence review on the benefits and harms of proton beam therapy for localized prostate cancer. Findings from this report will be used to inform NROP policies on the provision of PBT for the treatment of prostate cancer.

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How Much Does Proton Therapy Cancer Treatment Cost In 2021

The cost of proton therapy treatment varies by your insurance provider, condition, medical history and other factors such as the number of treatments. Keep in mind the cost per daily proton dose may be slightly more expensive than traditional radiation, but the long-term cost can be much less as patients tend to experience fewer side effects that require treatment or medication. In fact, recent studies have shown that the cost of proton therapy is lower than other cancer treatment options.

What Is Proton Therapy

Proton therapy is a type of radiation therapy treatment that uses protons, equivalent to positively charged hydrogen nuclei, to target a tumor in a very precise way. Unlike conventional x-ray therapy, proton beams have the unique property of stopping at a certain depth in tissue. This special property of proton beams can be put to use and controlled to focus on a specific area of target in the treatment of cancer patients. Proton therapy is the latest addition to the wide variety of comprehensive radiotherapy services that are available to patients at the Robert Wood Johnson University Hospital and Rutgers Cancer Institute of New Jersey.

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Recovery From Proton Therapy

After being treated with the proton beam, most people can go home and resume their activities. For certain tumors, your doctor might order tests to see how the treatment is affecting the tumor, and adjust your treatment if necessary.

The Johns Hopkins Proton Therapy Center

Located at Sibley Memorial Hospital in Washington, D.C., our center combines advanced proton therapy technology, the latest research and caring specialists who provide tailored treatments for a variety of adult and pediatric cancers.

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Limitations Of The Studys Design

The study leaders and other experts noted several limitations to the studys design.

For instance, this observational study cant establish a cause-and-effect relationship between proton therapy and fewer side effects. In addition, all of the study participants were treated at a single institution, which can make it difficult to generalize the findings to a larger population.

Those are very significant limitations that shouldnt be understated, Dr. Buchsbaum emphasized.

Although single-institution studies have inherent limitations, Dr. Baumann noted, all patients in this study received high-quality treatment at a large academic medical center, regardless of whether it was proton or traditional radiation therapy, which suggests that the benefit of proton therapy that we saw is meaningful.

Also, because patients were not randomly assigned to treatment groups, there were differences between patients who got proton and traditional radiation, and that may have skewed the results.

For instance, patients who received proton therapy were, on average, older and had more health issues.

The proton therapy group may also have included more patients from privileged backgrounds, Drs. Park and Yu noted. Socioeconomic status and social support can affect treatment outcomes, they wrote.

In addition, fewer people with head and neck cancerwho are more likely to suffer from radiation-associated side effectswere included in the proton therapy group, the editorialists added.

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More About Radiotherapy Treatment

Every year in the UK over 30,000 people with breast cancer receive radiotherapy following surgery as part of their treatment.

Standard breast cancer radiotherapy uses high energy x-rays to kill cancer cells. As well as lowering the risk of cancer coming back, radiotherapy can increase survival rates.

Standard breast cancer radiotherapy is very effective for the vast majority of people and the benefits far outweigh small side effects.

However, there can be a very small risk of radiotherapy leading to heart problems much later in life .

This is usually because their breast tissue and the lymph nodes which require radiotherapy treatment are located close to the heart, and/or because they have an increased underlying risk of developing heart problems later in life.

The average radiotherapy dose that the heart is likely to receive from the radiotherapy planning scan can be estimated and together with age and other medical history, this information is used to predict the potential small lifetime risk of heart problems.

People allocated to receive proton beam therapy on the PARABLE trial will be treated at either The Christie NHS Foundation Trust in Manchester, or University College London Hospitals NHS Foundation Trust.

People in the trial will also record their experiences using questionnaires so that researchers can assess side-effects including skin reactions, breast pain and swelling, and other symptoms which are particularly important for patients.