Re: Proton therapy - Was Re: Cryoablation-- a good, if not solid, bet?

[Guest guest]

So happy you are not having issues. I'm half done..and handling them...! And I can assure you they could be much worse. No pads...no bags...etc.!> I am in the middle of Proton Therapy and so far no issues.> This was on just the other night regarding other uses for> proton where they state they need more data I believe they are> speaking to the data on brain tumors not prostate as it is well> into its second decade of use.> Great video though and I can personally attest to its ease of> being treated with hope that when its all said and done I am> cancer free.> http://www.cbsnews.com/video/watch/?id=6522160nThat was an interesting video.As I understood the article citations posted here earlier, thebiggest controversy over proton

therapy involves prostate cancer,not pediatric cancers. The controversy is not over whether it'ssafe and effective, but whether it is any safer or more effectivethan x-ray radiation.Proton therapy does seem safe and effective for prostate cancer,but it costs more than x-rays, perhaps twice or even three timesas much. What do you get for the extra cost?The idea behind proton therapy is that a very high percentage ofthe radiation energy is deposited in the target region, whereaswith x-ray beams, a lot is deposited in healthy tissue in frontof and behind the prostate target.All of that is true, but x-ray techniques are much better thanthey were 20 years ago. Brachytherapy puts radioactive seedsright in the target area and relatively little gets out of it. 3dimensional conformal radiation and it's many variants (e.g.,IMRT, IGRT, Cyberknife) use many different angles and

intensitiesin order to be sure that the prostate gets much more radiationthan any particular tissues outside it. Furthermore, for somepatients, radiation is directed outside the prostate on purposein order to treat the area around the prostate and the seminalvesicles - something that is done with x-rays even when protonsare the main treatment modality for the prostate itself.Finally, some of the key side effects of radiation have nothingto do with damage to tissue outside the prostate, but with damageto the prostate itself. Impotence and urinary restrictions areboth due to prostate radiation and, even in theory, protonradiation offers no advantages over x-radiation in that area.Both saturate the prostate with high energy radiation. Both killof tissue inside the prostate and cause inflammation and damage.If they didn't, they wouldn't be effective.Prostate cancer is the bread and butter

of proton radiationclinics. The number of prostate cancers is far greater than thenumber of other types of tumor for which proton radiation isessential - such as pediatric brain tumors and eye tumors. Acouple of 150 million dollar proton centers would presumably beenough to treat all such tumors in the U.S. Spending another 1-2billion to build centers for treatment of prostate cancer may notbe warranted if x-radiation clinics can be built for 10% or lessof the cost. But now that we have so many proton centers, withmore under construction, the hospitals and clinics are undergreat financial pressure to pay off the loans and pay operatingexpenses. The only way they can do that is by convincingprostate cancer patients to be treated with protons.As a patient, choosing proton therapy is a perfectly fine choice- if you have money or insurance to pay for it. If you don't,and you prefer radiation

over surgery, then there are many x-raymodalities that should be equally fine choices. You can pick agood one from a good clinic and not be concerned that your chanceof success or your side effects will be measurably worse.For the insurance companies and for Medicare however thesituation is more complicated. Should they pay $100,000 fortreatment when there is evidence that a $40,000 treatment willwork just as well and be just as safe? Should premiums be raisedon all patients to cover it? Is this an example of why costs ofmedical care are skyrocketing while results are not improvingcommensurately?A lot of insurance companies have doubts about the costeffectiveness of proton therapy for prostate cancer, but theyhaven't wanted to go through the battles to fight it. However asthe number of PCa patients demanding proton therapy increases,the insurance company incentives to fight go up

too.That is my understanding of the controversy.Alan

[Guest guest]

gamlingman wrote:

> Alan Brought up some good points, but all I can attest to is my

> experience. First knowing 3 persons personally who went

> through IMRT and 1 who went through Calypso - All 4 stated that

> Fatigue played a major role during treatmet with increaded

> problems voiding. Post they had no real issues though the ones

> who were on Lupron certainly felt the affects.

I had a mix of HDR brachytherapy, 3DCRT external beam radiation,

and Lupron.

I did have some significant side effects, the worst of which were

due to radiation to the prostate itself - namely urinary

difficulty and, longer term, reduced potency. In *theory*, I

would expect those to be similar with proton radiation. I also

had some effects outside the prostate - some skin burns (minor,

cleared up quickly), some rectal scarring (permanent), and some

Peyronie's disease (permanent). In theory, I would expect those

to have been significantly reduced with proton radiation - though

in my particular case, the proton doctors might have used x-rays

anyway for the treatment around the prostate that I had. So I

might still have had the side effects.

My energy level also declined, though I attributed that to the

Lupron. But maybe it did have something to do with the

radiation.

Would I have done better on proton therapy? Maybe. I'll never

know. I'm thankfull that the treatment seems to have worked and,

at this point, I don't worry about the side effects.

What we really need is some well conducted clinical trials that

compare the two, randomizing some men to the best x-ray

treatments (though we don't know what those are: brachy? IMRT?

IGRT? Cyberknife?) and some to the best proton treatments. Then

we'll have a better answer than what we've got now. It is my

understanding that the comparisons we have now indicate fairly

comparable outcomes, but they are studies by different centers

using different study techniques on different patient

populations. Such studies may be underway now.

If the studies show that the safety and efficacy are the same, I

imagine that insurance companies will drop proton treatment for

PCa and some of the centers will go out of business.

If the studies show a difference in favor of proton therapy, then

we'll have to see what happens, but there will be more pressure

on insurance companies to pay for the treatment and there may be

arguments between men who say, " I want the best treatment " , and

insurance companies that say, " Well, it's only a little better. "

Health care is full of hard decisions for everyone.

> I for one after 20 treatements and with a couple of Alieve on

> Treatment day don't feel a thing. Sex life normal, urination

> 95% same as befor treatment, play golf, execercise drink my

> wine & have lived a normal life so far. Let us hope its

> succesful and the long term effects are the same as the current

> and we are all good.

> Just my personal experience.

Let us know how things progress.

Alan

[Guest guest]

TOM...looks like mine experience is very much like yours. I'm more tired end of the wee of treatments..but all the other side effects about like yours. I'm hoping for the same results...

THANK YOU... And..yes..the LUPRON..sure does what it isupposed to do...lol

Jim...

Subject: Proton therapy - Was Re: Cryoablation-- a good, if not solid, bet?To: ProstateCancerSupport Date: Sunday, May 30, 2010, 1:17 PM

Alan Brought up some good points, but all I can attest to is my experience. First knowing 3 persons personally who went through IMRT and 1 who went through Calypso - All 4 stated that Fatigue played a major role during treatmet with increaded problems voiding. Post they had no real issues though the ones who were on Lupron certainly felt the affects.I for one after 20 treatements and with a couple of Alieve on Treatment day don't feel a thing. Sex life normal, urination 95% same as befor treatment, play golf, execercise drink my wine & have lived a normal life so far. Let us hope its succesful and the long term effects are the same as the current and we are all good.Just my personal experience.> > > I am in the middle of Proton Therapy and so far no

issues.> > > This was on just the other night regarding other uses for> > proton where they state they need more data I believe they are> > speaking to the data on brain tumors not prostate as it is well> > into its second decade of use.> > > Great video though and I can personally attest to its ease of> > being treated with hope that when its all said and done I am> > cancer free.> > > http://www.cbsnews.com/video/watch/?id=6522160n> > That was an interesting video.> > As I understood the article citations posted here earlier, the> biggest controversy over proton therapy involves prostate cancer,> not pediatric cancers. The controversy is not over whether it's> safe and effective, but whether it is any safer or more

effective> than x-ray radiation.> > Proton therapy does seem safe and effective for prostate cancer,> but it costs more than x-rays, perhaps twice or even three times> as much. What do you get for the extra cost?> > The idea behind proton therapy is that a very high percentage of> the radiation energy is deposited in the target region, whereas> with x-ray beams, a lot is deposited in healthy tissue in front> of and behind the prostate target.> > All of that is true, but x-ray techniques are much better than> they were 20 years ago. Brachytherapy puts radioactive seeds> right in the target area and relatively little gets out of it. 3> dimensional conformal radiation and it's many variants (e.g.,> IMRT, IGRT, Cyberknife) use many different angles and intensities> in order to be sure that the prostate gets much more radiation> than

any particular tissues outside it. Furthermore, for some> patients, radiation is directed outside the prostate on purpose> in order to treat the area around the prostate and the seminal> vesicles - something that is done with x-rays even when protons> are the main treatment modality for the prostate itself.> > Finally, some of the key side effects of radiation have nothing> to do with damage to tissue outside the prostate, but with damage> to the prostate itself. Impotence and urinary restrictions are> both due to prostate radiation and, even in theory, proton> radiation offers no advantages over x-radiation in that area.> Both saturate the prostate with high energy radiation. Both kill> of tissue inside the prostate and cause inflammation and damage.> If they didn't, they wouldn't be effective.> > Prostate cancer is the bread and butter of proton

radiation> clinics. The number of prostate cancers is far greater than the> number of other types of tumor for which proton radiation is> essential - such as pediatric brain tumors and eye tumors. A> couple of 150 million dollar proton centers would presumably be> enough to treat all such tumors in the U.S. Spending another 1-2> billion to build centers for treatment of prostate cancer may not> be warranted if x-radiation clinics can be built for 10% or less> of the cost. But now that we have so many proton centers, with> more under construction, the hospitals and clinics are under> great financial pressure to pay off the loans and pay operating> expenses. The only way they can do that is by convincing> prostate cancer patients to be treated with protons.> > As a patient, choosing proton therapy is a perfectly fine choice> - if you have money or

insurance to pay for it. If you don't,> and you prefer radiation over surgery, then there are many x-ray> modalities that should be equally fine choices. You can pick a> good one from a good clinic and not be concerned that your chance> of success or your side effects will be measurably worse.> > For the insurance companies and for Medicare however the> situation is more complicated. Should they pay $100,000 for> treatment when there is evidence that a $40,000 treatment will> work just as well and be just as safe? Should premiums be raised> on all patients to cover it? Is this an example of why costs of> medical care are skyrocketing while results are not improving> commensurately?> > A lot of insurance companies have doubts about the cost> effectiveness of proton therapy for prostate cancer, but they> haven't wanted to go through the battles

to fight it. However as> the number of PCa patients demanding proton therapy increases,> the insurance company incentives to fight go up too.> > That is my understanding of the controversy.> > Alan>

[Guest guest]

gamlingman wrote:

> Just so we are clear I have not have had ANY side effects with the Proton it

is

> my friends who went throught the IMRT / Lupron / Calypso that had the fatigue

/

> Voiding issues.

>

> With the proton just some frequency but other than that A

Excellent Tom.

Keep it up.

Alan