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Thread: Proton Radiation vs Photon Radiation?

  1. #1
    Regular User
    Join Date
    Oct 2016

    Proton Radiation vs Photon Radiation?

    Does anyone have any experience with the proton radiation or any experience info they could share.

    Found out today that my father (diagnosed last week Gleason 9, PSA 2.4) was recommended to do radiation with hormone therapy. A family member has had the proton therapy and I'm wondering if there is anyone else who chose this over traditional radiation?


  2. #2
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    I think that proton is still not established as a traditional treatment. I could be wrong, but the proton delivery is designed to hit only specific areas of the prostate, whereas traditional EBR bathes the entire prostate.

    The proton delivery is designed to hit just where tumors are known to sit.

    The thing that bothers me is that other tumors -- which may not be known about at the time of the proton treatment -- would go untreated. With EBR, the whole prostate -- along with any other tumors that might be in the prostate -- is treated.

    Did I read it correctly when you noted it was a Gleason 9 with only a PSA of 2.4? This is certainly not impossible, but a G9 would usually be associated with a much higher PSA number.

    If it is Gleason 9, and just a PSA of 2.4, it "could" bode well for his chances of a cure because it is probably still confined to the prostate.

    Wishing the best of luck to your dad!
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Eight annual post-op exams 2012 through 2019: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  3. #3
    Regular User
    Join Date
    Oct 2016
    Thank you so much! This is all so overwhelming!

    Yes, you read correctly- Gleason 9 and PSA 2.4. Evidently somewhat rare and aggressive. Surgery was ruled out today because there is bladder neck involvement. However, the bone scan was clear so we are thankful!

    Based on what I'm reading, it sounds like tradional radiation may be the best way to go.

    Thanks again! So thankful to have found this forum!

  4. #4
    Proton treatment does have a place treating very small cancers in places that photon radiation has trouble with. When used for treating prostate cancer, no advantage has been demonstrated either in the success rate or the side-effect risk. One thing for certain, it costs MUCH more than traditional photon (X-ray) treatment which is expensive enough already. Most insurance companies will deny proton treatment for prostate cancer because equally effective but much cheaper photon treatment is available...

    One thing to investigate, it has been demonstrated that the usual 40 fraction treatments can safely be reduced to 25 or so greatly reducing the cost and the stress endured by the patient..If you do your homework you can find the studies and clinical trials that support having fewer treatments...As you might expect, many Radiation Oncologists will resist this change...
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5. 10/14 PSA 0.6, T-11. 1/2015 PSA 0.106. 4/15. 0.4, 9/15 1.4, 3/16 Zytiga, 0.04, 5/17 1.4 may switch to Xtandi. 3/1/2018. PSA now 54, chemo will begin next month. 7/19, PSA 2000 starting Lu-177 tomorrow..77 years old now..

  5. #5
    I had salvage radiation, for what it's worth a friend was considering proton radiation but ultimately decided on EBR as it had longer proven track record . Make sure you and your dad ask a lot of questions before committing to proton, it may be great but if so why aren't more men choosing it.

  6. #6
    Regular User
    Join Date
    Dec 2015
    I had the proton radiation therapy 5 months ago. Not one side effect after treatment. During treatment I went on flomax to help urinate but a month after completing radiation urination is as good as it once was. Only problem that I incurred was with Blue Cross insurance. This past December 2015 I was given the ok to start treatment at UF Health Proton Institute which I finally started in February. Three quarters thru the treatment I was informed that my health insurance would not cover the treatments. BC/BS federal in 2016 is not approving my proton treatments, after the fact.

    Very happy with my choice to use UF Health PI, they were great.
    Age: 60 - 11/14/55
    11/12/15 - PSA: 5.28 - Happy Birthday!
    12/10/15 - Biopsy - 3 out of 13 cores positive - Gleason: 3+3=6
    1/20/16 - Selected to use Proton Therapy at UF Health Jacksonville FL
    2/18/16 - PSA: 4.3 Free PSA: 1.1 %Free: 26
    2/22/16 - MRI showed small tumor deposits in the right and left mid peripheral zones
    2/23/16 - SpaceOAR Gel inserted
    Proton Therapy scheduled 2nd week in March 8 weeks of treatment.
    3/10/16 - Start of Prpton treatment
    5/4/16 - My last Proton treatment
    5/5/16 - PSA: 1.9
    11/3/16 - PSA: 0.6

  7. #7
    Hey Bad:

    Sorry to hear about your insurance problems with proton therapy. We've heard similar stories on this thread regarding difficulties trying to get insurance companies to pay for that particular treatment.

    May I ask if the denial was based on whether BC/BS considers the treatment to still be "experimental" or whether there is a belief in the insurance industry that it is just too expensive relative to other available proven choices?

    Age: 71 -- 12/2013 - Cat Scan sees new irregular 1.8 cm nodule in right middle lobe.
    3/13/14 - PET Cat Scan confirms presence of same nodule -- same size. Nodule lights up indicating likelihood of lung cancer -- Location not conducive to biopsy.
    3/17/14 - Three top doctors say it MUST come out via a wedge re-section. If cancerous, the entire right middle lobe must be surgically removed.
    6/13/14 - Nodule shrank by 1/3. Not cancer. Surgery cancelled. Next scan 9/14. Nodule "resolved" - gone.

    Age: 67 -- 2/2010 - PSA: 4.05
    8/2010 - PSA: 4.95
    9/2010 - Biopsy - 2 out of 12 cores positive - Gleason: 3+4=7
    11/8/2010 - DaVinci RALP - small positive margin - was told it was meaningless.
    2/11 - PSA: 0.02; 8/11 - PSA: 0.04; 2/12 - PSA: 0.06; 8/12 - PSA: 0.08; 2/13 - PSA: 0.11; 5/13 - PSA: 0.16 - referred to oncology radiologist.
    9/2013: 40 sessions of IMRT salvage radiation completed.
    1/14, 4/14, 7/14, 10/14, 1/15, 8/15, 3/16, 8/16, 3/17 - All PSA: 0.00


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