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Prostate Proton Therapy Vs Surgery

Who Was In The Study

IMRT vs SBRT vs Protons vs Brachytherapy | Ask a Prostate Expert, Mark Scholz, MD

The study included 2,550 men from across the United States with localized prostate cancer. All the men started the study within six months of being diagnosed. Of these, 74 percent were white, and 26 percent were other races. The average patient age was 64, and all were younger than 80. Of the surgeries, 76 percent used a laparoscope, a small robotic instrument with a video camera that works through small cuts to the body. Among the men who chose radiation, 45 percent also took medicines to reduce male hormones.

Major Clinical Trial Pits Proton Versus Photon Radiotherapy In Prostate Cancer

The national 3000-patient COMPPARE trial, which is examining outcomes with proton versus photon radiotherapy in prostate cancer, continues its robust enrollment at more than 50 clinical sites.1

Both forms of therapy are considered standard of care in prostate cancer however, some data suggest that proton therapy may offer a safer alternative without sacrificing efficacy.2 The safety difference may arise because while photon therapy delivers X-rays that go through the tumor, potentially damaging nearby healthy tissue, proton therapy transmits proton particles that stop directly at the tumor, sparing healthy cells.

The open-label, nonrandomized, parallel assignment COMPPARE study is enrolling patients with adenocarcinoma of the prostate who have localized disease based on a composite of biopsy, PSA, clinical stage, Gleason score, and digital rectal exam.3 Prior treatment for prostate cancerother than androgen-deprivation therapy per NCCN guidelinesis not allowed. Patients are also not eligible if they have metastatic disease, very high-risk prostate cancer per NCCN guidelines and joint AUA/ASTRO/SUO guidelines, or any prior prostate surgical procedure.

The targeted enrollment for the trial is 3000 patients. At the latest study update in February 2021, it was reported that 1210 patients had enrolled. Data are accrued through patients answering brief surveys for 3 years or more.4 The estimated primary completion date is March 1, 2023.


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

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Prostate Cancer Treatment Radiation Vs Surgery

Being diagnosed with prostate cancer may be a cause of distress for the entire family. Many questions pop-up in a mans mind when being told that he is now a prostate cancer patient.

He may be asking:

  • How severe is my situation?
  • Will I be cured?
  • What type of treatment should I choose?
  • What would the side-effects be?
  • Will I recover fast?

When it comes to deciding which prostate cancer treatment option is the best, corresponding to the specific, situation, many doubts and worries may arise.

Dr. David B. Samadi has treated over 7.000 prostate cancer patients so far and explained in the following video which treatment option is considered to be most efficient for most patients.

Treatment And Analysis Of Data

Proton Therapy Case Study  Prostate Cancer

The value of the PSA at the time of failure was kept as the last PSA record for that patient, discarding subsequent PSA values, because they would be influenced by androgen deprivation.

The cases confirmed as loss in the follow-up were censored on the date referring to the last follow-up recorded in the medical record. Patients who died due to causes unrelated to prostate cancer or its treatment were censored at the date of death.

The cases were stratified according to risk classification proposed by DAmico,2121 DAmico AV. Combined-modality staging for localized adenocarcinoma of the prostate. Oncology . 2001 15:1049-59 discussion 1060-2,1064-5,1069-70,1073-5.considering: low risk as patients with PSA 10ng/mL, a Gleason score 6 and staging T2a intermediate risk as patients with staging of T2b or PSA between 10 and 20ng/mL, or Gleason score of 7 and high risk as patients with PSA > 20ng/mL or Gleason score 8 or staging T2c.1414 Comploj E, Pycha A. Experience with radical perineal prostatectomy in the treatment of localized prostate cancer. Ther Adv Urol. 2012 4:125-31.,2121 DAmico AV. Combined-modality staging for localized adenocarcinoma of the prostate. Oncology . 2001 15:1049-59 discussion 1060-2,1064-5,1069-70,1073-5.

We used the Epi Info 2000 program for input and descriptive analysis of the data and Stata version 9.0, for survival analysis and prognostic factors.

The study was authorized by the ethics committee of the Federal University of Juiz de Fora .

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Treatment Options For Prostate Cancer

Early-stage prostate cancer is often slow-growing. Here, it is hard to balance treatment benefits against its side effects. Therefore, delaying treatment until there is evidence of cancer progression is one way to avoid unnecessary side effects.

In some cases, a doctor may recommend watchful waiting or active surveillance to avoid unnecessary treatments.

Who Is A Good Candidate

In most cases, you will be a good candidate for proton therapy if you were initially offered radiotherapy as an option. Patients who receive radiotherapy usually have no problems being a candidate for proton treatment. They are usually patients in an early stage or those with localized prostate cancer. It is also useful to keep advanced cancer under control for as long as possible and treat recurrent prostate cancer cases.

However, some patients may not benefit from proton therapy if they have one of these problems :

  • In patients with hip replacements, because proton beams often cant reach beyond the prosthesis. In some proton therapy centers, these patients can still get a session when a hip replacement is limited to one side. But bilateral replacement makes it impossible to treat the patient with proton beam therapy.
  • In patients with advanced prostate cancer in which treating the pelvic lymph nodes is fundamental. Since proton beam radiation is less likely to reach other tissues than the prostate, it is not applicable when treating surrounding lymph nodes.
  • In overweight patients, because the proton beam can only go through a determined depth. This depth depends on the beams energy, and some centers may have a higher energy device that solves the problem.

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Proton Beam Therapy Better For Prostate Cancer

Nov. 1, 2012 — A pricey new treatment for prostate cancer called proton beam therapy appears to cause slightly less diarrhea, bloating, and cramping than traditional radiation treatments. But the effect is short-lived, a new study suggests.

The findings come from a review of questionnaires filled out by men who underwent one of three forms of radiation therapy, so the results are far from conclusive.

But even though proton beam therapy’s effectiveness and safety has yet to be proven, more and more men are opting for the treatment. The number of treatments has climbed steadily in the last five years and is expected to double in the next three years, says researcher Phillip J. Gray, MD, a resident in the Harvard Radiation Oncology program in Boston.

“Patients say proton beam therapy sounds so much better, they want it no matter what the cost,” says Colleen Lawton, MD, a radiation oncologist at the Medical College of Wisconsin Clinical Cancer Center in Milwaukee.

“We don’t know if it is less toxic. We donât know if it is more effective. All we do know is that it is more costly.”

Lawton, who was not involved with the research, moderated a news briefing to discuss the findings here at the annual meeting of the American Society for Radiation Oncology .

Some Things To Consider When Choosing Among Treatments

Radiation vs. Surgery for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

Before deciding on treatment, here are some questions you may want to ask yourself:

  • Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects?
  • Would you be comfortable with watchful waiting or active surveillance, even if it means you might have more anxiety and need more frequent follow-up appointments in the future?
  • Do you need to know right away whether your doctor was able to get all of the cancer out ? Or are you comfortable with not knowing the results of treatment for a while if it means not having to have surgery?
  • Do you prefer to go with the newest technology , which might have some advantages? Or do you prefer to go with better proven treatments that doctors might have more experience with?
  • Which potential treatment side effects might be most distressing to you?
  • How important for you are issues like the amount of time spent in treatment or recovery?
  • If your initial treatment is not successful, what would your options be at that point?

Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the âwrongâ one. In many cases, there is no single best option, so itâs important to take your time and decide which option is right for you.

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Choosing A Prostate Cancer Treatment: Surgery Versus Radiation

Although many treatment options are available, patients with newly-diagnosed prostate cancer often narrow down the choices to two surgical removal of the prostate or radiation therapy. Since many factors influence this decision, choosing which treatment to use can be daunting.

The biggest advantage to radiation therapy is that it is easier to undergo than surgery. Even with robotic technology, its small incisions are not as small as the openings made by a couple of dozen needles inserted into the skin behind the scrotum when radiation seeds are implanted. General recovery from robotic prostatectomy is usually 2-3 weeks, whereas recovery from radioactive seed implantation is 1-2 days. Many patients who choose the radiation route will also undergo daily external beam treatments for 6-7 weeks.

The biggest advantage to surgical removal is the information learned that is not available through other treatment methods. Once the prostate is removed, it can be fully analyzed to determine the extent, location, and grade of the disease within the prostate and seminal vesicles . More important, the ability to monitor a patient for possible recurrence is dramatically enhanced. When the prostate is removed, the PSA blood test should become undetectable within six weeks if all the cancer cells have been successfully eliminated. Prostate cells are the only source of PSA, a protein made by these cells and partially released into the blood stream.

Different Types Of Focal Therapy

  • HIFU : HIFU focuses the energy of sound waves to create heat and destroy cancer cells. Just like a magnifying glass concentrating sun rays to burn a hole in the paper. During the procedure, an ultrasound probe is inserted into the patients rectum while the patient is asleep from anesthesia. Guided by MRI and ultrasound 3D-images, the physician finds the tumor, plus the area to be treated, and delivers the energy aimed at the diseased tissue in the prostate gland. HIFU is a noninvasive precision treatment that spares healthy tissue and lowers the chances of negative side effects associated with radical prostate surgery or radiation, such as impotence, incontinence and bowel function disturbance. UChicago Medicine is the first medical center in the Midwest to offer and perform this procedure with the newest Focal One advanced robotic HIFU technology. This fills a significant treatment void for men with localized prostate cancer who find themselves in between active surveillance and whole gland treatments such as radiation or surgery. The treatment has been used for years in both Europe and Asia.

Urologists Ariel Shalhav, MD, and Scott Eggener, MD, answer questions about new treatment options for prostate cancer, including focal therapy and HIFU, as well as specialized care programs for men diagnosed with advanced prostate cancer or at high risk for the disease.

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Surgery For Prostate Cancer

A radical prostatectomy is the surgical removal of the prostate. This procedure may be performed through traditional open surgery, which involves one large incision in the abdomen. Laparoscopic surgery using the robotic daVinci® Surgical System is a minimally invasive alternative. Robotic surgery only requires a few small incisions in the abdomen, which may result in reduced pain, lower risk of infection and a shorter hospital stay after surgery.

The technology associated with the robotic surgical system is designed to give the surgeon greater precision and control, which may help spare healthy tissue and one or two of the nerve bundles on the sides of the prostate. This often allows the patient to have better erectile functionin both the short term and long term.

How To Compare Radiation Vs Surgery For Prostate Cancer

Proton Therapy Case Study  Prostate Cancer

Research from the ProtecT trial shows us that radiation and surgery are good options, with the caveat that the specifics of your personal health condition could make one more advisable than the other. If thats not the case, rest assured that youre not at risk of making a terrible decision: Radiation and surgery are both solid options.

How to evaluate radiation vs. surgery comes down to understanding the disease and the research on treatment outcomes, getting a thorough understanding of your specific situation and then deciding which pathway you feel is right for you.

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Da Vinci Robotic Prostatectomy/robotic

The surgery is performed by a trained and skilled surgeon through the use of a computer-enhanced robotic surgical system. Instead of the large incision used in open surgery, da Vinci surgeons make just a few small incisions similar to traditional laparoscopy. The da Vinci System also features a magnified 3D high-definition vision system and special wristed instruments which precisely translates the hand movements of the surgeon.


  • Catheter removed in just 5-7 days
  • More maneuverability and precision for the robotic surgeon
  • More visibility of prostate and surrounding tissue/organs
  • Prostate cancer is removed with a higher cancer cure rate when performed by a skilled robotic surgeon


  • Possible erectile and urinary side effects post surgery when procedure is performed by a less-skilled and inexperienced surgeon

To Cut Or Not To Cut: Radiation Vs Surgery For Prostate Cancer

Ishaan Sangwan Nov 16, 2021 5 hits

Since prostate cancer is a slow growing disease, the value of treatment is often questionable. While many patients can be managed with active surveillance, those who do require treatment often have radiation and surgery presented as their two options. This article discusses the risks and benefits of these two treatments, with unique insights from Dr. Jeff Caddedu on the BackTable Urology Podcast. Weve provided the highlight reel in this article, but you can listen to the full podcast below.

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Treatment Protocols And Treatment Systems

Proton therapy was delivered at a total dose of 7080 GyE in 3540 fractions or 6366 GyE in 2122 fractions . All irradiation doses were calculated at the center of the target volume. The accelerator complex consisted of a synchrotron or a cyclotron . Patients were treated with 210235 MeV proton beams. Beam ranges were adjusted by a fine degrader. The spreadout Bragg peaks of the proton were produced using barridge filters. Patient setup was performed daily by subtraction of the two sets of orthogonal digital radiographs or inroom CT before each treatment. The translation and rotation of the patient detected by the positioning system were compensated for by adjustments to the treatment couch. The setup was continued until the bony landmarks and/or fiducial markers on digitally reconstructed radiographs agreed within 2 mm. Relative biological effectiveness values for PT were set as 1.1. As all tissues are assumed to have almost the same RBE for PT, doses expressed in GyE were directly comparable to photon doses.

Watchful Waiting And Active Surveillance

Dr. Henderson on Proton Therapy Versus IMRT in Prostate Cancer

Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities., Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery. For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.

Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression., This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.

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Pencil Beam Scanning Proton Therapy

Pencil beam scanning is one of the most common ways to deliver proton therapy for prostate cancer. Another common method is double-scattered beam therapy.

With pencil beam scanning proton therapy, medical professionals are able to manipulate and focus the proton beams to a greater extent. This results in a more precise dose of radiation than double-scattered therapy, sparing surrounding tissue even more.

However, the difference in outcomes is minimal, according to

Side effects may include fatigue and skin redness or soreness where you had treatment. You may also have issues with incontinence or gastrointestinal side effects. Erectile dysfunction is another risk of radiation treatment.


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