Proton therapy technology is becoming a more available treatment for prostate cancer.
Therefore, it is essential to know why advocates defend its application and what skeptics have to say against it.
Health sciences are constantly evolving. But as medical knowledge increases, there will always be a gray zone with many skeptics and advocates.
Proton beam therapy is currently a source of controversy. And such contradicting positions among researchers often leave urologists and patients unsure about what to do.
That is the reason why we crafted this article. We are not advertising or talking against proton therapy.
Instead, we’re condensing the available evidence in a summarized piece to give readers the information they need to decide on prostate cancer treatment.
Is it helpful to use proton therapy for prostate cancer?
Who is the best candidate?
What are the side effects, and how can you prepare for this procedure?
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What is proton therapy?
Proton therapy is a branch of radiation treatment. It works like radiation therapy and can treat different types of cancer. Similar to radiation therapy, proton therapy can be a standalone therapy against cancer. However, in most cases, it is combined with additional methods to fight off cancer cells.
To understand proton therapy, it is essential to understand the basics of radiation therapy.
In conventional radiotherapy, you have high-energy X-rays passing through the body. The X-ray radiation is placed in the area where cancer is. Thus, it should destroy cancer tissue. But in doing so, normal tissue is also destroyed or similarly affected.
In prostate cancer, placing a radiation beam targeting the prostate gland exposes the rectum, the bladder, and other organs. As such, external beam radiation therapy complications include urinary symptoms, rectal bleeding, diarrhea, and more.
In an attempt to solve this problem, intensity-modulated radiation therapy (IMRT) was developed. It is known to cause less damage to surrounding tissues. Another option is using proton therapy treatment, which delivers radiation traveling in proton beams.
In proton radiation, the organ receives protons charged with radiations instead of independent waves. Instead of passing through and going beyond the organ, the proton beam stops when it has reached the target. It does not go beyond that point, and the risk of damaging nearby tissues reduces. Your healthy tissue will still receive radiation, but the dose will be lower, and the side effects should be more limited (1).
Who is a good candidate?
In most cases, you will be a good candidate for proton therapy if you were initially offered radiotherapy as an option. Patients who receive radiotherapy usually have no problems being a candidate for proton treatment. They are usually patients in an early stage or those with localized prostate cancer. It is also useful to keep advanced cancer under control for as long as possible and treat recurrent prostate cancer cases.
However, some patients may not benefit from proton therapy if they have one of these problems (2):
- In patients with hip replacements, because proton beams often can’t reach beyond the prosthesis. In some proton therapy centers, these patients can still get a session when a hip replacement is limited to one side. But bilateral replacement makes it impossible to treat the patient with proton beam therapy.
- In patients with advanced prostate cancer in which treating the pelvic lymph nodes is fundamental. Since proton beam radiation is less likely to reach other tissues than the prostate, it is not applicable when treating surrounding lymph nodes.
- In overweight patients, because the proton beam can only go through a determined depth. This depth depends on the beam’s energy, and some centers may have a higher energy device that solves the problem.
As noted above, proton therapy is a branch of radiotherapy for cancer. But this type reduces the exposure of healthy tissue to radiation. That is the main benefit of this type of therapy.
The biochemical failure rate (recurring cancer after treatment) is almost the same in proton cancer as brachytherapy, radical prostatectomy, and other modalities. Thus, if you’re adequately chosen as a candidate, you get these benefits without compromising the resolution of prostate cancer.
Patients with prostate cancer may have these benefits after going through proton therapy:
A reduction in the risk of urinary incontinence
Urinary problems are common after conventional radiotherapy. Since proton therapy is directed to the prostate and does not go any further, it reduces the risk of urinary incontinence and leakages (3).
A reduction in the risk of erectile dysfunction
Similarly, the blood vessels to the cavernous bodies remain untouched after proton therapy. Thus, it is less likely to experience erectile dysfunction (3).
Fewer gastrointestinal side effects
Using proton beam therapy delivered with pencil beam scanning reduces gastrointestinal side effects in the medium and long term.
These patients are less likely to suffer from diarrhea, rectal bleeding, and similar side effects.
Painless treatment and faster recovery
Proton therapy is painless compared to other treatment modalities. It is usually performed on an outpatient basis and does not reduce the patient’s energy level. Thus, it won’t require any downtime and lasts no more than 15 minutes.
With the benefits listed so far, proton therapy can be a promising cancer therapy. If that is the case, why is conventional radiotherapy still around? Why are there people against this procedure?
Choosing the correct procedure for you depends on multiple variables. There is no such thing as a perfect therapy without any risk or side effects.
In the case of proton therapy, it is crucial to understand and discuss with your doctor the following risks (4):
- Proton therapy has the same risks as conventional radiation therapy. Patients may have urinary symptoms, constipation, and similar issues. The risk is lower, but it is not zero risk. You can still experience similar side effects to those of conventional radiation therapy.
- Some studies suggest that proton therapy might weaken hip articulation, increasing the risk of fracture. This is because proton therapy avoids firing radiation to the rectum and delivers the total radiation dose in only two fields. One of them goes through the femoral neck and head. One study showed no increase in fracture risk, but the patient had newly-reported pain in the hip articulation. Thus, even if there is no immediate fracture risk, patients with hip conditions may aggravate their symptoms or experience new problems (5).
How to prepare for proton therapy
First of all, it is vital to locate the nearest center because proton therapy is not available everywhere.
This type of treatment is turning into a popular alternative to radiotherapy, but you might need to travel to get your treatment. In that case, you need to make a few decisions in advance and might need to ask someone else to drive for you.
If the center is far from home, you might need to stay in the city in question.
The treatment requires going to the medical center every day, 5 days a week, for a minimum of 4 weeks.
If you can drive to the medical center and back home, it will be easier to get your treatment, and the procedure itself takes 15 minutes.
However, you probably want to save 45 minutes to 1 hour, considering the preparation, talking to the nurse or doctor, and any unexpected event.
Once you arrive at the medical center for the first time, the radiation oncology team will schedule an initial consultation. During that time, a radiation oncologist will interview you and evaluate your medical images and records. After they determine the appropriate position and angle to receive proton therapy, you will start your treatment.
The team will likely use an immobilization device to ensure that the protons reach the exact location. It is also very likely that the team will spend considerable time in achieving the proper position.
Throughout the procedure, you want to stay still. It will not be a very invasive procedure, and, likely, you won’t feel a thing.
After each session, you can return to your normal activities. Thus, you don’t need to schedule any downtime or free days after proton therapy.
Proton Therapy vs. Other Prostate Cancer Treatments
Is proton therapy superior to hormone therapy or chemotherapy? The answer might not be that simple because it depends on what you need.
Each treatment method has its pros and cons. They also have specific applications, and using them or not in a determined patient depends on comprehensive studies that evaluate what works better for most.
However, for educative purposes, let’s make a brief comparison between proton therapy and other prostate cancer treatments:
Proton therapy vs. radiation therapy
Proton therapy is a type of radiation therapy. Both are equally effective, but proton therapy is an innovative way to reduce side effects in healthy tissues. They are both used as a standalone treatment or in combination with other modalities.
Proton therapy vs. surgery
We can use surgery and proton therapy in the same prostate cancer patient, and each has its purposes.
The surgery takes out cancer localized in the prostate and not spread to other organs. We might use proton therapy to make sure that there are no remaining cancer cells after surgery.
Proton therapy vs. hormone therapy
Unlike surgery, hormone therapy is a common treatment option when prostate cancer has spread to other tissues.
In these cases, proton therapy has limited utility because it is designed to treat localized prostate cancer.
Still, even in advanced prostate cancer, proton therapy can slow the progression of the primary tumor.
Proton therapy vs. chemotherapy
Like hormone therapy, doctors only use chemotherapy when cancer spreads to other tissues. In these cases, proton therapy will probably have minimal use.
Recovering from prostate cancer treatment
Whether it is proton therapy, surgery, chemotherapy, or traditional radiation, recovering from prostate cancer treatment can be particularly difficult, sometimes painful, and tiresome.
In the case of proton therapy, you won’t have any downtime. But even if the risk of side effects is lower, you can still experience a few.
The recovery process depends on hundreds of variants. Even the most skilled physician cannot predict everything. The cancer stage at diagnosis, the type of treatment, and your overall health and age are all important.
Throughout this recovery time, it is important to report symptoms to your doctor. If they are side effects to the treatment, your doctor will install supportive treatment to make them easier to tolerate.
You will also go through PSA testing and follow-up visits to monitor the outcomes of your therapy.
Diet and lifestyle recommendations are essential to achieve a full recovery from cancer and cancer treatment.
Thus, always follow indications and ask your doctor whenever you have a doubt or concern about your treatment or recovery process.
Proton therapy is an alternative to traditional radiotherapy that delivers radiation to prostate cancer with reduced damage to the surrounding tissue.
As such, it has a lower risk of side effects with a similar rate of effectiveness.
Indeed, you can still get severe side effects after proton therapy, depending on several factors.
Studies suggest hip pain as a side effect after proton therapy, and some researchers suggest that hip fractures can be a possibility.
Still, the technology has proven safe and effective for most patients, and the number of medical centers offering proton therapy is growing as you read this article.