What You Need To Know About The Prostate Pros And Cons Of Proton Therapy For Prostate Cancer
The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. During puberty, the body produces semen in a large number of cases, including enlarged prostate. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This is why the prostate is important to the body. It can be caused by many factors, including infection and inflammation.
A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.
Protons: A Different Mechanism
Protons can also be administered by two methods. The older method includes large beams of passively scattered protons that are shaped with the use of high-density blocks or apertures to shape the large beam as it exits the nozzle. Compensators are employed within the beam to alter the beam profile to better conform the SOBP to the actual tumor. A second, newer method employs a very narrow, pencil thin beam to paint the dose on the target, and no blocks or compensators are needed. The pencil beam is swept in a raster pattern back and forth across a target guided out of the nozzle by magnets . This allows the delivery of intensity-modulated proton beam therapy , with a greater ability to conform the dose to an irregularly shaped target. Although not widely available, many new facilities are being planned with pencil beam-only systems.
Pencil beam scanning. The pencil beam is swept in a raster pattern back and forth across a target. Reproduced with permission from Mayo Clinic News Network.
aAs determined by Phoenix criteria. bAs determined by American Society for Therapeutic Radiology Oncology criteria. c Determined by a rise in prostate-specific antigen to > 50% than the nadir and > 2 ng/mL.
2D, two-dimensional 3D, three-dimensional GI, gastrointestinal GU, genitourinary HD, high dose IMRT, intensity-modulated radiation therapy LD, low dose.
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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Proton Therapy Side Effects
After your session, you might feel tired. Proton therapy side effects are similar to those of other radiation treatment methods. Because the technique can mean less exposure to the radiation, side effects can be less than those of traditional radiation treatment.
Side effects can develop gradually after treatment, and might include:
- Sore, reddened skin around the treatment area that can look and feel like a sunburn
- Hair loss in the treatment area
- Tiredness or low energy
Additional side effects, depending on the area treated, can include headaches and problems with eating and digestion.
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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
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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.
Whos A Good Candidate For This Procedure
Anyone who can have radiation therapy can have proton therapy. Proton therapy can be used as primary treatment for early stage prostate cancer or as part of a total treatment plan for prostate cancer. Its also an effective treatment for people who require pelvic radiation therapy after undergoing previous therapies.
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Proton Therapy Vs Other Prostate Cancer Treatments
Is proton therapy superior to hormone therapy or chemotherapy? The answer might not be that simple because it depends on what you need.
Each treatment method has its pros and cons. They also have specific applications, and using them or not in a determined patient depends on comprehensive studies that evaluate what works better for most.
However, for educative purposes, lets make a brief comparison between proton therapy and other prostate cancer treatments:
Consensus Statement On Proton Therapy For Prostate Cancer
Corresponding Author:
Curtis M. Bryant, Randal H. Henderson, R. Charles Nichols, William M. Mendenhall, Bradford S. Hoppe, Carlos E. Vargas, Thomas B. Daniels, C. Richard Choo, Rahul R. Parikh, Huan Giap, Jerry D. Slater, Neha Vapiwala, William Barrett, Akash Nanda, Mark V. Mishra, Seungtaek Choi, Jay J. Liao, Nancy P. Mendenhall, the Genitourinary Subcommittee of the Particle Therapy Co-Operative Group Consensus Statement on Proton Therapy for Prostate Cancer. Int J Part Ther 1 September 2021 8 : 116. doi:
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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.
Entrance And Exit Dose Defined
Entrance dose: The dose of radiation that inadvertently makes contact with normal cells before it reaches the cancerous tissue.
Exit dose: Imagine the radiation hitting the tumor, but then continuing on beyond it, taking out normal cells in its path.
The primary difference between proton therapy and Cyberknife is that protons do not have an exit dose, says Dr. Cavanaugh. Both modalities deliver entrance and target dose.
Many insurers have been unimpressed with the differences in outcomes with proton therapy and have declined to pay.
For many patients I prefer HDR brachytherapy to both proton and Cyberknife therapy. HDR stands for high dose rate.
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Active Surveillance For Prostate Cancer
Also known as watchful waiting, active surveillance is a non-treatment option that involves continued monitoring of prostate cancer. More frequent checkups are often required to keep an eye on any changes through PSA blood tests, Digital Rectal Exams and ultrasounds. Biopsies may also be done to assess the aggressiveness of the cancer and its risk of growing and spreading. Studies have found that, after 15 years on active surveillance, less than 1% of men developed a metastatic disease. Additionally, over 30% of men have prostate cancers so slow-growing that non-treatment may be a better option.
Often Recommended for:
Possible Side Effects of Active Surveillance:
- No treatment-related side effects
Pros & Cons of Active Surveillance for Prostate Cancer
Pros:
- No surgery or hospital stays
- New technologies continue to improve imaging and testing
Cons:
- Frequent checkups for testing and biopsies
- May face a greater risk of prostate cancer growing and spreading
- Stage of your prostate cancer may advance
- May limit future treatment options and chances of curing the cancer
- Diagnosis can create stress and anxiety
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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Literature Search Results And Characteristics
Our searches of four databases yielded 6,378 articles. After 413 duplication records were removed, titles and abstracts of these records were screened for inclusion. Full texts of 46 records were read, and 33 studies met the inclusion criteria .
Figure 1 Flow diagram of the literature screening process and results.
Twenty PBT-related studies involved 48,765 patients with a median mean age of 66 years old. Median follow-up across all studies was 43.4 months . The included studies were published from 2010 to 2020. Most of the studies were from the USA , five from Japan , and one from Korea . For the trials from the USA, most of the studies set irradiation dose at 7082 GyE delivered in 544 fractions. For the five trials from Japan, the irradiation dose was usually set at 6380 GyE delivered in 2039 fractions. For one trial from Korea, they set irradiation dose at 3560 GyE delivered in 520 fractions. The basic characteristics of the included studies are shown in Table 1.
Table 1 Basic characteristics of included studies.
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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How Do You Determine Whats Right For You
Whether youve recently been diagnosed with prostate cancer or youre dealing with recurrent or metastatic cancer, you may be facing difficult decisions about your treatment. Its normal to be unsure about what steps to take, and most patients have more than one choice.
Start by talking to your oncologist about the specifics of your case and your options. The American Society of Clinical Oncology has a helpful list of questions to ask your doctor about prostate cancer you may want to reference.
If possible, see a multi-specialty cancer care team to get a bigger picture of your case and your options. This is also important because, sometimes, factors outside of your cancer stage may impact your treatment options. For example, you may have an obstruction in your urinary tract that makes surgery a more appropriate choice than radiation. Or maybe you have another health condition that makes surgery more risky for you. In that case, radiation may be a better choice. You want these doctors to talk to one another about your case each has expertise that makes an important contribution to the decision-making process. To facilitate this coordination, you may have to set up appointments to see multiple doctors and ask them to discuss your case.
If youre interested in getting a second opinion for prostate cancer, or if youd just like to talk with someone at CTCA about your cancer care, or chat online with a member of our team.
Is Proton Therapy Safer Than Traditional Radiation
Traditional radiation therapy delivers radiation to the tumor and to healthy tissues around the tumor. With proton therapy , the majority of the radiation is delivered to the tumor.
A type of radiation treatment called proton beam radiation therapy may be safer and just as effective as traditional radiation therapy for adults with advanced cancer. That finding comes from a study that used existing patient data to compare the two types of radiation.
Traditional radiation delivers x-rays, or beams of photons, to the tumor and beyond it. This can damage nearby healthy tissues and can cause significant side effects.
Plus, proton therapy is more expensive than traditional radiation, and not all insurance companies cover the cost of the treatment, given the limited evidence of its benefits. Nevertheless, 31 hospitals across the country have spent millions of dollars building proton therapy centers, and many advertise the potential, but unproven, advantages of the treatment.
In the new study, patients treated with proton therapy were much less likely to experience severe side effects than patients treated with traditional radiation therapy. There was no difference in how long the patients lived, however. The results were published December 26 in JAMA Oncology.
These results support the whole rationale for proton therapy, said the studys lead investigator, Brian Baumann, M.D., of the Washington University School of Medicine in St. Louis and the University of Pennsylvania.
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Open Radical Prostatectomy For Prostate Cancer
During a radicalretropubic prostatectomy, an incision is made in the lower abdomen to remove the entire prostate gland, some tissues and/or seminal vesicles. If there is a reasonable chance the cancer has spread outside of the prostate, your surgeon may perform a lymph node biopsy to test the area before continuing with the surgery as its unlikely it can be cured with surgery alone and the removal of the prostate could lead to other serious side effects. In a radical perineal prostatectomy operation, your surgeon will make an incision between the anus and scrotum to access the prostate. While this operation is shorter, may result in less pain and is an easier recovery, its more likely to lead to erection problems.
Often Recommended for:
- Stage 1 or stage 2 prostate cancer
Possible Side Effects of Open Radical Prostatectomy:
- Erectile dysfunction or sexual impotence
- Urinary incontinence
- Changes in orgasm
- Loss of fertility
- Lymphedema
- Changes in penis length
Pros & Cons of Open Radical Prostatectomy for Prostate Cancer
Pros:
- Can be a curative option
- Nerve-saving approach may help prevent impotence
- Removed tissue helps accurately stage cancer
Cons:
- Cancer in nearby lymph nodes most likely cant be removed
- Prostate gland may not be removed if cancer has spread
- Surgical risks
- Longer recovery times and activity restrictions
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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