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Proton Radiation For Prostate Cancer

Cancers Treated With Proton Therapy

Proton Therapy Intermediate-Risk (Teal) Prostate Cancer | Prostate Cancer Staging Guide

Proton therapy is useful for treating tumors that have not spread and are near important parts of the body. For instance, cancers near the brain and spinal cord. It is also used for treating children because it lessens the chance of harming healthy, growing tissue. Children may receive proton therapy for cancers of the brain and spinal cord. It is also used for cancer of the eye, such as retinoblastoma and orbital rhabdomyosarcoma.

Proton therapy also may be used to treat these cancers:

  • Central nervous system cancers, including chordoma, chondrosarcoma, and malignant meningioma

  • Eye cancer, including uveal melanoma or choroidal melanoma

  • Head and neck cancers, including nasal cavity and paranasal sinus cancer and some nasopharyngeal cancers

  • Spinal and pelvic sarcomas, which are cancers that occur in the soft-tissue and bone

  • Noncancerous brain tumors

Are You A Candidate

Whether your doctor recommends radiation depends on various factors, including your age, health, and personal preferences. The type of radiation is often dictated by your risk group and whether the cancer is localized or has spread.

Sometimes hormone therapy is given before radiation or along with it. ADT reduces levels of male hormones, called androgens, which can slow or even stop the cancers growth. Studies have found this one-two punch leads to higher survival rates than radiation alone among men with localized prostate cancer and a Gleason score of 7 or higher.

If you opt for surgery, your doctor may suggest radiation afterward, called adjuvant radiation therapy. “You have surgery to remove cancer, and then radiation to eliminate any remaining tumor deposits to keep cancer from returning,” says Dr. Anthony DAmico, a radiation oncologist with Harvards Dana-Farber Cancer Institute. Cancer that has grown beyond the prostate also may require post-surgery radiation.

After youve had radiation, youll have a prostate-specific antigen test every three to six months for five years and then annually after that to check for recurrence of the cancer. “If your PSA ever rises above 2, then imaging tests are done, and if needed, additional radiation or other appropriate treatment is given,” says Dr. DAmico.

Two Treatment Centers One Expert Team

Mass General has the only proton therapy site in all of New England, with two proton therapy centers.

Since the opening of the Francis H. Burr Proton Therapy Center in 2001, we have treated thousands of adult and pediatric patients with proton therapy. In 2020, we expanded clinical operations on our main campus location with the opening of a second center, the Gordon-Browne Proton Therapy Center, making Mass General the only institution on the East Coast to have two proton therapy centers. Both state-of-the-art treatment centers offer the latest technology for patients and are run by one talented, multidisciplinary team.

Both of our proton therapy centers are located on Mass Generalâs main campus in Boston, giving patients access to a wide range of world-class care and services.

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An Alternative To Traditional Prostate Cancer Treatment

Proton radiation for prostate cancer delivers precise doses of radiation with a lower risk of side effects. The difference is in the protons themselves. Since physicians have greater control over the distribution of the proton radiation dose, higher, more effective doses can be used.

And since proton therapy lacks an exit dose, and has a lower entrance dose than conventional X-rays, damage to critical tissue near the prostate is reduced, potentially lessening the likelihood of prostate cancer side effects like impotence, incontinence and gastrointestinal disorders. The figure to the right demonstrates the difference in radiation dose distribution between a conventional IMRT plan on the bottom and a proton plan on the top.

As apparent, much less of the pelvis is exposed to radiation with the proton plan, likely leading to a lower risk of secondary cancers in prostate cancer survivors. Also apparent is a lower dose of radiation to the rectum, which may lead to a lower risk of rectal injury with proton therapy.

Overview Of The Staging System

The power of proton therapy

After a thorough assessment by your oncologist, your cancer will be assigned a stage between I and IV. Prostate cancer stages are based on the American Joint Committee on Cancer TNM system. Using the TNM system, your oncologist:

  • Examines the tumor
  • Determines if the cancer has spread to any lymph nodes
  • Assesses whether the cancer has metastasized
  • Considers the prostate-specific antigen level from blood testing
  • Assigns a grade group based on how abnormal the cancer appears under a microscope

With this information in mind, you can better understand how stages are assigned and what they mean for patients in general.

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Limitations Of The Studys Design

The study leaders and other experts noted several limitations to the studys design.

For instance, this observational study cant establish a cause-and-effect relationship between proton therapy and fewer side effects. In addition, all of the study participants were treated at a single institution, which can make it difficult to generalize the findings to a larger population.

Those are very significant limitations that shouldnt be understated, Dr. Buchsbaum emphasized.

Although single-institution studies have inherent limitations, Dr. Baumann noted, all patients in this study received high-quality treatment at a large academic medical center, regardless of whether it was proton or traditional radiation therapy, which suggests that the benefit of proton therapy that we saw is meaningful.

Also, because patients were not randomly assigned to treatment groups, there were differences between patients who got proton and traditional radiation, and that may have skewed the results.

For instance, patients who received proton therapy were, on average, older and had more health issues.

The proton therapy group may also have included more patients from privileged backgrounds, Drs. Park and Yu noted. Socioeconomic status and social support can affect treatment outcomes, they wrote.

In addition, fewer people with head and neck cancerwho are more likely to suffer from radiation-associated side effectswere included in the proton therapy group, the editorialists added.

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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Why Choose Memorial Sloan Kettering For Proton Therapy

  • MSK radiation oncologists have vast experience in using proton therapy. Over the last five years, our specialists have used proton therapy to treat more than 2,000 MSK patients with a range of cancers. This is far more than anyone else in the New York City region. MSKs radiation oncology group has been at the forefront of developing the treatment guidelines and training specialists at other institutions how to properly use protons.
  • Patients at MSK are cared for by a multidisciplinary team of cancer experts which includes radiation oncologists, medical physicists, oncologists, and surgeons that is among the most experienced in the world. This team will ensure that each patient receives the optimal treatment for his or her unique case.
  • The MSK radiation oncologists who will practice at NYPC specialize in each type of cancer that can be treated effectively with proton therapy.
  • Our experts are currently using pencil beam scanning technology, which is the most advanced form of proton therapy delivery. Pencil beam scanning allows proton therapy to be delivered in the most-focused form, reducing exposure to nearby healthy tissues in some cases more than any other form of radiation. The New York Proton Center offers pencil beam scanning with the smallest diameter and highest precision.

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Reirradiation For Recurrent Cancer

Benefits of Proton Therapy for Prostate Cancer

For patients who develop local or regional recurrences after their initial radiation therapy, physicians are limited in their treatment options due to their reluctance to deliver additional photon radiation therapy to tissues that have already been irradiated. Re-irradiation is a potentially curative treatment option for patients with locally recurrent head and neck cancer. In particular, pencil beam scanning may be ideally suited for reirradiation. Research has shown the feasibility of using proton therapy with acceptable side effects, even in patients who have had multiple prior courses of photon radiation.

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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

Proton Therapy Faqs For Prostate Cancer

Proton Therapy FAQs for Prostate Cancer

The outlook for patients diagnosed with prostate cancer has improved in recent years. Through advancements in technology, imaging, and treatment delivery, researchers have found ways to better characterize tumors and tailor treatments to each patient. No longer are there one size fits all treatment solutions. The multidisciplinary prostate cancer treatment team can discuss care strategies that might include surgery, hormone therapy, chemotherapy, immunotherapy, and various forms of radiation.

Radiation is a powerful tool in the treatment of prostate cancer. It is a curative alternative to surgery or may be indicated after surgery to treat patients with high risk features or biochemically recurrent prostate cancer in the adjuvant or salvage setting. It can also used to treat oligometastases sites of spread or considered to retreat areas of previous disease.

Why Radiation Therapy for Prostate Cancer?

Radiation therapy kills cancer cells and surrounding tissues using high-energy photons or particles. Radiation therapy may be used:

  • To eradicate early-stage cancers confined to the prostate gland
  • As a treatment to prolong survival for men with advanced or recurrent prostate cancer
  • Alone or in combination with other treatments, such as androgen deprivation , in more advanced cancers that may have spread beyond the prostate
  • As a way to slow cancer growth and palliate pain or bleeding in cases of advanced cancer

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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.

How Proton Therapy Effectively Treats Prostate Cancer

Proton Beam Therapy for Prostate Cancer

Proton therapy treats prostate cancer with high doses of radiation that are more accurate, and potentially more effective, than traditional radiation. Our targeted proton beams focus most of their destructive energy at the tumor site, therefore causing less damage to healthy surrounding tissue as they enter the body. Because of this, proton therapy patients dont have to worry about many of the side effects and additional healthy tissue damage that is commonly associated with X-ray therapy.

an effective cancer treatment alternative

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What Is The Recovery And Outlook After Proton Therapy

Most people return to their daily activities immediately following a proton therapy session. Many people see benefits from this procedure within 2-8 weeks. The tumors response to proton therapy depends on the type of cancer you have and its location within your body.

If you are diagnosed with cancer, ask your doctor about proton therapy as a possible treatment option. Your doctor will help you determine whether this treatment is a good option for you.

Last reviewed by a Cleveland Clinic medical professional on 05/26/2021.

References

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Safety And Efficacy Of Proton Therapy

Many people with locally advanced cancers are treated with a combination of chemotherapy and either traditional or proton radiation. For patients getting chemotherapy and radiation at the same time, finding ways to limit side effects without making the treatment less effective is a high priority, Dr. Baumann said.

He and his colleagues analyzed data from nearly 1,500 adults with 11 different types of cancer. All participants had received simultaneous chemotherapy plus radiation at the University of Pennsylvania Health System between 2011 and 2016 and had been followed to track side effects and cancer outcomes, including survival. Almost 400 had received proton therapy and the rest received traditional radiation.

Those who received proton therapy experienced far fewer serious side effects than those who received traditional radiation, the researchers found. Within 90 days of starting treatment, 45 patients in the proton therapy group and 301 patients in the traditional radiation group experienced a severe side effectthat is, an effect severe enough to warrant hospitalization.

In addition, proton therapy didnt affect peoples abilities to perform routine activities like housework as much as traditional radiation. Over the course of treatment, performance status scores were half as likely to decline for patients treated with proton therapy as for those who received traditional radiation.

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Side Effects During Treatment

Undergoing EBRT is similar to having routine X-rays and no more uncomfortable. Radiation cannot be seen, smelled, or felt. Patients are usually able to continue with their normal daily activities during treatment. But many do experience side effects. If youâre having conventional radiation treatments, side effects generally donât appear until the second or third week. They may show up earlier if youâre having prostate SBRT, LDR, or HDR brachytherapy.

Because radiation therapy is a local treatment, any side effects will primarily involve the area where the radiation is directed. With prostate cancer, patients may experience some or all of the following:

  • Increased urination frequency

Proton Therapy Advantages And Disadvantages

Proton Therapy, IMRT, and SBRT | Mark Scholz, MD | PCRI

Proton radiation may represent an incremental improvement over IMRT due to the reduced exposure of surrounding normal body tissues to radiation. Therefore, in the situations outlined above where IMRT would normally be considered, men may prefer to choose proton radiation over IMRT. The purported advantages of proton radiation over IMRT remain theoretical and clinically unproven. No head to head studies comparing the IMRT and proton radiation exist.

Disadvantages associated with proton radiation are related to its high cost and the fact that not all insurance programs cover proton radiation. In addition, there are relatively few centers doing proton radiation, so geographic inconvenience can be a major factor considering that numerous visits are required over a 5 to 9-week period.

Men considering treatment for prostate cancer need to do their homework. Side effects from radiation can be irreversible. The selection of optimal radiation varies with patient circumstances. Many factors need to be considered when radiation is contemplated.

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Possible Risks And Side Effects Of Brachytherapy

Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.

There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.

These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.

Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.

What To Expect With Proton Therapy

The first step in your care is a consultation. During consultation, we review your medical history, perform a physical exam, decide if any additional tests are needed, discuss all radiation options that may be appropriate for your treatment plan, make recommendations, and answer questions.

Patients with prostate cancer typically undergo a minor procedure to place three small markers in the prostate, called fiducial markers. These markers allow the treatment team to accurately align the treatment each day to the location of the prostate. Your doctor will also determine if you are also eligible for placement of a special hydrogel between the prostate and rectum , which creates additional space between the prostate and the rectum to further reduce radiation exposure to the rectum and dissolves after a few months.

After placement of the markers , most patients return another day for a simulation or planning session. During this visit our radiation therapists will help position you the way you will be treated each day. A CT scan will be done to create a picture of you in the treatment position to design your radiation plan. Some patients also undergo an MRI during this visit to help identify the target for treatment. It normally takes 10 days for the team to design the proton treatment plan and perform the quality assurance checks before treatment begins.

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