The Pros and Cons of Proton Therapy | Mark Scholz, MD | PCRI

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There are two different types of particles--photon and proton--that are commonly used delivered to deliver beam radiation therapy for prostate cancer to a patient. Photon is the most common of the two and is usually just called "IMRT," "SBRT," or some brand name. Proton therapy is more niche and expensive, but its proponents tout that since protons do not go past the tumor as with photon therapy, there is less radiation spillover, and hypothetically, fewer side effects. However, experiences in the clinical setting have shown that there is not a significant difference between the two forms of radiation and that the quality of the institution, the physicians, and the supporting staff may have more impact.

0:09 Is proton therapy a good treatment for prostate cancer?

1:52 How do the cure rates of proton therapy compare to the IMRT and SBRT radiation available using photons?

2:42 Can you use proton therapy to deliver focal radiation?

3:10 What are the side effects of proton therapy?

4:17 What should the PSA look like immediately after proton therapy and two years out?

5:30 Can you treat the seminal vesicles and lymph nodes with proton therapy?

6:04 For which stages of prostate cancer would proton therapy be appropriate?

6:38 Could proton therapy be used to treat oligometastatic disease?

7:04 Are balloons still inserted into the rectum during radiation?

8:26 Where can a person get proton therapy?

8:58 What factors should a patient consider when selecting a center for proton therapy or any other type of radiation?

Who we are:

The information on the Prostate Cancer Research Institute's YouTube channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.

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[iamric]

Again, so awesome to have this as a quick and precise form of resource. We don't ask to be born, but once we get here, I feel it is everyone's obligation to help others with their own specialties. You two are doing this every time you sit down and have these conversations, and it is helping so many people, so thank you.

[dlphcoracl]

The PCRI series with Mark Scholz MD are uniformly excellent. His information is current and state-of-the-art, he gives his opinions and recommendations very clearly and precisely without equivocating and has an uncanny knack of anticipating the questions a viewer will want answered.

[HughPyper]

Six months after Proton Beam therapy with SpaceOAR my PSA went below 0.006, which is the sensitivity limit of the test, and stayed there. My oncologist was surprised it went so low.

[tonifanum]

My husband had proton at the Mayo in Scottsdale Arizona. They did the gel an the balloon. Very happy with the outcome

[williamfeldner]

I had Proton Therapy at Mayo in Rochester, MN. Very happy with the results. No noticeable side effects at this point 2 years after treatment…….

[derekheuring]

I have an appointment at the Texas Center for Proton Therapy in two days with Dr. Lee. I have been diagnosed high risk (4 + 4) but my tumor(s) are non-palpable which is good news I'm told. I have several questions I now know to ask thanks to this video.

[garywebb]

I had Proton treatment back in 2011 at the Proton center in Burlington, Indiana at the University of Indiana for prostrate cancer and have been cancer free ever since. PSA did slowly decreased to around .25. No major side effects. I’m glad I chose Proton over surgery, two of my friends died from prostrate surgery. I have tried to be a good champion of proton treatment ever since.

[PendeltonWhiskey]

I was treated for prostate cancer at the Seattle Proton Center.
Prior to Proton Radiation treatment: PSA = 12.35
After Proton Beam Radiation Treatment
Jan 26, 2021 blood draw: PSA = 0.21
May 6, 2021 blood draw: PSA = 0.1
Aug 05, 2021 blood draw: PSA = 0.07
Jan 19, 2022 blood draw: PSA = 0.04
Aug 24, 2022 blood draw: PSA = 0.02
Aug 30, 2023 blood draw: PSA = 0.04

I'm absolutely thrilled with the results and lack of complications. No incontinence, no impotence. I tell everyone I can that getting regular PSA counts saved me. My father and grandfather both died of prostate cancer so even though I was being told that (the belief at that time) there was no genetic component I didn't believe it and expected to get prostate cancer. DO NOT expect your doctor to pay close attention to your PSA counts. If you can't easily recite your most recent PSA count when asked, you're not doing it right. It had only been about a year since I'd had one but I had a feeling that I needed a PSA count and requested one done. It was just over 6 and that set the ball in motion. When I had the biopsy done a short time later it was 12.35. Once it got to 6 it had been skyrocketing. I'm convinced that because I felt that prostate cancer was inevitable for me and that I needed to be vigilant and get regular PSA counts done I saved myself and I wish the same for you. Good luck!

[TechnoyGuide]

Thanks pcri for information about prostate cancer. My father is on abiraterone+ Prednisone scene december 2020. Psa decreased 144+ to 1.9

[ikeferber]

This question is about the role of PSA in Active Surveillance. If one is on AS for a few years and multiple MRIs and biopsies indicate stable low risk (3+3) disease including low risk Decipher Score. The only negative seems to be an increasing PSA, at about 0.8 per year. Is there a PSA level or PSA density that would indicate consideration of radiotherapy.

[Barock-mtbc]

I am watching you from Europe and am pretty happy to check out that you, in America, have developed a superior technology of choice which is smarter
and more selective with the cells. Thank You. Proton Therapy might be a better treatment than conventional radiation one 🌿

[lilialantto]

Mayo Clinic in Rochester has the has a great procedure for Separator better that isn’t the balloon, its place once instead the ballon is “inflated” each procedure.

[dustbat]

I had this done in 2017 in Hampton Va. No side effects or pain. Treatment ran from oct to dec. Five days a week. I lived 100 miles away but felt it was best approach. Story is too long but I felt God wanted me to go there, so I did. Cannot speak about ED as that train had left the shed before 2017. Problem is now in 2024 cancer has come back. Did not know they would not operate on you once you have been radiated. Also the Proton people do not want anything to do with it now. Going to see Dr. Freeze Aug 24.🦇

[roberthuff]

Proton therapy and SBRT are both advanced radiation treatments with distinct features:

- **Precision**: Both offer high precision, but proton therapy may better spare surrounding healthy tissues due to its capability of stopping directly at the tumor.

- **Applications**: Proton therapy is favored for tumors near sensitive areas and in pediatric cases, while SBRT is commonly used for various body tumors requiring precise targeting.

- **Treatment Duration**: Proton therapy generally involves more sessions compared to SBRT, which can be completed in 1-5 treatments.

- **Cost and Availability**: Proton therapy is more expensive and less widely available than SBRT.

The choice between them depends on tumor specifics, patient factors, and treatment access.

[scoot]

Thank you Both! Always great videos and very informative! 🙏🇺🇸

[justme]

How do proton and photon radiation compare in terms of increasing the risk of urethral strictures? And does either approach have the ability to radiate the prostate while simultaneously avoiding or at least minimizing radiation exposure to the section of the urethra located within the prostate? If so, which works better—proton or photon—at protecting the urethra from radiation exposure, and why?

[joesimons]

I had Proton therapy in 2015 at the University of Washington. I had some side effects but at 73 I noticed ED (2023) but that it may be the aging process. I am not married so not problematic.

[khcopter]

I have had proton therapy two months ago. I finished 38 sessions for prostate. My big problem is fatigue. It’s been two months since the last session and I get better start feeling good and then I get real tired. When will that end?

[queencat]

My mom was diagnosed with squamous cell sarcoma in her left sinus, around her orbital nerve and to the base of her brain. She beat the cancer. Had 35 treatments of Proton therapy and it is eventually what hurt her in the end. She passed away in March.
-her throat was so weak from the radiation she couldn’t cough, swallow, talk, hear. She was supossed ti be getting better. Life is cruel

[rafaeltovar]

It will be nice to know how long takes for the treatment