Re: Proton Beam Therapy and Sexual Side-effects ?

April 20, 2011

Can't speak to 10 Year data just 1 year data from someone who has personally gone through it.

No Urinary issues

Minor ED Issues which is more due to my low Testosterone than anything from the treatment.

In Short NO Detectable cancer and feel 100% healthy... No Question my treatment was correct for me.

Please note: You may view my story on Yana Tomas Bergman

April 20, 2011

C:

There are no independent long term data

that support that claim. To be fair there are very few long term studies that

support any claims made about the diagnosis, treatment choice or outcome of prostate

cancer. The lack of such empirical evidence is often very difficult for some to

accept, but them’s the facts. We all have to make our decisions on

imperfect information.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of C

Sent: Wednesday, 20 April 2011

11:06 PM

To: ProstateCancerSupport

Subject:

Proton Beam Therapy and Sexual Side-effects ?

I'm looking into proton beam therapy for a friend. The

" Ten-Year Study " that's referenced on the " Proton Bob "

website talks about urinary side-effects of proton beam therapy, but not sexual

side-effects.

The Loma website makes this claim:

.. . . " This means a much lower chance of side effects

.. . . such as incontinence or impotence in prostate cancer patients. "

Can anyone point me to _data_ that supports that claim (as regards impotence) ?

Thanks --

PS -- I'm looking for something statistical, not something anecdotal. I'll be

checking YANA next . . .

April 21, 2011

As an interesting side note, Varian is building newer proton therapy systems

with the planned roll out of one unit per state over the next few years. The

Varian system with teh accompanying containment and support systems costs nearly

a quarter BILLION to install in its entirety. Simultaneously, Still River

Systems has developed and is prototyping a system that would be installable in

existing radiation departments at about one tenth the cost. The Still River

Systems approach is targeting FDA approval by mid-2012 with a current prototype

operating, I think, in St Louis. The latter system should reduce the cost and

improve the accessibility of proton beam radiation in the relatively near future

provided users do not take the savings as increased earnings.

Proton, although there is little comparative published data on side effects as

is so true of many prostate treatments, technically has a significant claim to

reduced side effects just be the very nature of proton beam attenuation with

distance.

For those who may have been recently diagnosed, especially with limited positive

cores present in their biopsy and who can feel comfortable with surveillance,

there is promise of alternatives soon to be available.

Incidentally, I have absolutely no connection with either approach other than

being a male who has posted before and has had my fair share of biopsies.

Rich L

Green Bay, WI

>

> I'm looking into proton beam therapy for a friend. The " Ten-Year Study "

that's referenced on the " Proton Bob " website talks about urinary side-effects

of proton beam therapy, but not sexual side-effects.

>

> The Loma website makes this claim:

>

> . . . " This means a much lower chance of side effects

> . . . such as incontinence or impotence in prostate cancer patients. "

>

> Can anyone point me to _data_ that supports that claim (as regards impotence)

?

>

> Thanks --

>

> PS -- I'm looking for something statistical, not something anecdotal. I'll be

checking YANA next . . .

>

April 21, 2011

You might find this Oct 2009 ASTRO report useful:

http://www.astro.org/Research/CommentForm/documents/ProtonReport2010.pdf

Keep in mind proton seem to be (slowly) moving to IMPT and photon IG-IMRT is

(quickly) moving to Arc Therapy (Tomo, RapidArc, SmartArc).

Sexual side-effects seem to be a toss-up. I don't think proton's lateral beams

can currently treat at much less than ~1cm margins due to inherent beam energy

inconsistencies.

Although photon (Arc) IMRT can effectively spread a very low entry/exit dose

across normal tissue at some point those thousands of photon beamlets must

converge near/at/in the prostate to generate a hi dose theraputic field which

seemly would also generate a nerve and vessel damaging margin.

>

> I'm looking into proton beam therapy for a friend. The " Ten-Year Study "

that's referenced on the " Proton Bob " website talks about urinary side-effects

of proton beam therapy, but not sexual side-effects.

>

> The Loma website makes this claim:

>

> . . . " This means a much lower chance of side effects

> . . . such as incontinence or impotence in prostate cancer patients. "

>

> Can anyone point me to _data_ that supports that claim (as regards impotence)

?

April 21, 2011

blk-shr wrote:

....

>Sexual side-effects seem to be a toss-up. I don't think proton's lateral beams

can currently treat at much less than ~1cm margins due to inherent beam energy

inconsistencies

....

Searching the article for the word " impotence " I found a few references on page

50. The one study that looked at it reported that 60-62% of men in the study

population became impotent as a result of proton beam therapy, but noted that

" impotence " was not defined in the study.

Without a clear definition of impotence, it's hard to draw conclusions. However

if it means the usual thing, no erection stiff enough for penetration, then I

suspect the numbers for x-radiation are similar.

Alan

April 21, 2011

THANK YOU !!!

Page 50 has a finding from the Mass General study (which was very early):

>>>

Impotence rates were also reported however impotence

was not defined. There were 78 potent men prior to treatment of which 24 (60%)

in the high dose group and 24 (62%) in the low dose group became impotent.

<<<

That's in the range I've seen for surgery and brachytherapy. No magic, here. I

was hoping for something better.

> >

> > I'm looking into proton beam therapy for a friend. The " Ten-Year Study "

that's referenced on the " Proton Bob " website talks about urinary side-effects

of proton beam therapy, but not sexual side-effects.

> >

> > The Loma website makes this claim:

> >

> > . . . " This means a much lower chance of side effects

> > . . . such as incontinence or impotence in prostate cancer patients. "

> >

> > Can anyone point me to _data_ that supports that claim (as regards

impotence) ?

>

April 22, 2011

The enthusiasm of adherents aside, there is no particular 'magic' in the use of

proton radiation for treating prostate cancer. The theoretical advantage is the

concept that the so-called " Brag peak " , where the particle energy is released to

the ionizing radiation that damages the cancer DNA, results in much less

radiation proceeding beyond the target compared to conventional " photon " or

x-ray radiation. This theoretical advantage in reducing radiation exposure to

normal tissue beyond the target is somewhat offset by the higher precision in

focusing narrow x-ray beams in modern IGRT or stereo-tactic (CyberKnife, etc.)

radiation.

In terms of cancer control, radiation is radiation, irrespective of how it is

generated.

In terms of sexual side effects, the only possible improvement in reducing ED is

to reduce the radiation exposure to the nuerovascular bundles and fine blood

vessels leading to the penis. However, since treatment by radiation does not

offer the ability to examine a removed prostate to see if there was any escape

of cancer beyond the prostate, almost all radiation treatments include targeting

an area next to, but outside, the prostate wall. Last I heard from a consult at

Loma , that margin was about a half inch. The more precise IGRT or

CyberKnife may include a smaller margin, depending upon the estimate from the

diagnostic information of the probability of cancer being outside the prostate.

However, the nuerovascular bundles are at least partially embedded in the

surface of the prostate gland. This is what challenges the surgeon's skill to

remove the prostate without damaging these nerves and blood vessels. This also

means that ANY radiation that includes all of the prostate walls will also

affect those nerves and small blood vessels.

So, with respect to ED, there is no advantage of proton radiation over any other

external radiation source. As Dr. Mullhall has published in his excellent

book on prostate cancer treatments (Saving Your Sex Life: A Guide for Men With

Prostate Cancer), the ultimate probability of ED (not being able to have normal

intercourse without drugs or other aids) two to three years after treatment is

essentially the same for any form of surgery or radiation-- about 60%. Surgical

ED is immediate, and then may lessen over time. Immediate radiation ED is less,

but increases over time. Ultimately most men end up in very similar ED

situations within 5 years of treatment.

Interestingly, all this was explained to me originally by Dr. Jabola at Loma

in 2006 during a consult when I was considering proton treatment. One of

the factors that led me to Active Surveillance for the time being.

The Best to You and Yours!

Jon in Nevada

>

> THANK YOU !!!

>

> Page 50 has a finding from the Mass General study (which was very early):

>

> >>>

> Impotence rates were also reported however impotence

> was not defined. There were 78 potent men prior to treatment of which 24

(60%) in the high dose group and 24 (62%) in the low dose group became impotent.

> <<<

>

> That's in the range I've seen for surgery and brachytherapy. No magic, here.

I was hoping for something better.

>

April 22, 2011

It might be helpful to understand that Photon Radiotherapy uses multiple

beamlets that individually are sparsely ionizing, and don't have enough energy

to effective induce fatal cell damage.

It is when the multiple beamlets converge at/in/near the prostate that they

collectively become densely ionizing and fatal. After they cross and exit they

are again sparsely ionizing.

A single Proton beam carries enough energy to becomes densely ionizing at its

Bragg Peak then dissipates.

Tissues can generally repair damage and handle repeated exposure over time to

sparsely ionizing radiation, although sparsely may be a somewhat subjective

term.

Also Dr. Mulhall's ED rates are based on older 3D-CRT EBRT and he states in

chapter 5 (pg 80) ...(when IMRT) is used dose delivered to the penis is reduced

by 40% .... likely that we will see in the future that IMRT results in lower ED

rates than 3D-CRT.

Several current studies have indicated that IMRT seems to have a ED nadir at

about two years. ED studies are poor at best and vary a lot.

>

> The enthusiasm of adherents aside, there is no particular 'magic' in the use

of proton radiation for treating prostate cancer. The theoretical advantage is

the concept that the so-called " Brag peak " , where the particle energy is

released to the ionizing radiation that damages the cancer DNA, results in much

less radiation proceeding beyond the target compared to conventional " photon " or

x-ray radiation. This theoretical advantage in reducing radiation exposure to

normal tissue beyond the target is somewhat offset by the higher precision in

focusing narrow x-ray beams in modern IGRT or stereo-tactic (CyberKnife, etc.)

radiation.

>

> In terms of cancer control, radiation is radiation, irrespective of how it is

generated.

>

> In terms of sexual side effects, the only possible improvement in reducing ED

is to reduce the radiation exposure to the nuerovascular bundles and fine blood