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Proton beam treatment looks like a very exciting therapy when it becomes available. This is a therapy I heard about at a recent presentation and the research oncologist felt that it will be very big in about 5 years (if the clinical trials work out). He imagined that cancer patients could go in and just get scanned for cancer and then have it targeted and kept under control by the proton beam therapy. The flip side of this is that a very good way to identify the cancer cells while the proton beam is working must be found too. There are already patients in clinical studies being treated at research centers.
All these new potential treatments on the horizon are the reason why I suggest to people with low grade prostate cancer to wait for better treatments to come along.
Re: Electromagnetic Radiation versus Kinetic Energy
I’m not going to get involved in any semantic argument about the technical differences between PBT (Proton Beam Therapy) and EBRT (External Beam Radiation Therapy), but I am curious about the logic of this statement:
Given this vast difference between properties of x-rays and protons it is not credible to compare them in so called "Comparative Effectiveness" studies.
Surely "Comparative Effectiveness" studies look at the err…… comparative effectiveness of therapies? Whether these therapes are described in correct scientific terms or not is neither here nor there to men who are considering the treatment options. What they want to know is pretty simple at the end of the day:
1. Which treatment gives me the best chance of ‘cure’ ?
2. Which treatment gives me the least chance of side effects?
That is what comparative effectiveness studies should give them. But regrettably there are no good studies that provide them with a clear answer to these basic questions.
I first heard about PBT (Proton Beam Therapy) when I was diagnosed in 1996. It seemed to me then, and still does, that it has great merit, but I am truly puzzled why Loma Linda, which has been carrying out this therapy for so many years does not release or publish their results in a way that they can be properly appraised for effectiveness.
Richard,
Given that the manufacturer, Varian, refers to it as:
"Proton therapy is a form of radiation treatment that uses beams of protons to deliver more targeted, precise doses than conventional photon beams." It is probably best not to confuse the situation by suggesting that it is not radiation when it is.
I suspect they call it radiation for the exact purpose of implying it is a substitute for well, radiation. There is a lot of overlap in the meaning of words when adverbs and adjectives are left out.
Here is a link to an online dictionary for "radiate".
http://dictionary.reference.com/browse/radiate
In all cases it means spreading out in all directions from a source. Where the scientists and medicine got on the wrong track is regarding usage of terms having to do with ionizing or non-ionizing "radiation". Something is ionizing if it has enough energy to strip atoms of an electron thus creating an ion. X-Ray and Gamma radiation can ionize thus the correct usage for medical terminology is "ionizing radiation". We are concerned about ionizing radiation as it scrambles DNA.
Now even though a high energy proton is a particle and goes in a straight line (unless steered magnetically) it can also strip electrons from atoms and thus is ionizing.
As such both X-Ray radiation and Proton particle beams are ionizing and so have been used interchangeably as "radiation" when they should not.
You are correct, if the charged Particle beam manufacturers utilize "radiation" for advertising you are probably correct in that it is too late to stop the madness. Yet, it is always OK to point out that it is not correct. How else will people learn?
Rather than argue the technical definitions and the potential theoretical differences between them, would it not be better to address the issue as to why there are no comparative studies between the various therapies on offer? And why you feel it would not be correct to have such studies.
After all, there are many such inexactitudes in life, let alone in PCa therapies e.g. the term “Robotic Surgery” for RALP (Robotic Assisted Laparoscopic Prostatectomy) implies that a Robot carries out the surgery without human intervention and the inexact phrase and implications drives some people up the wall. So too the term ‘Hormone Therapy’ with it’s conceptual links to the hormone therapy used by women to reduce the effects of menopause instead of the more precise ADT (Androgen Deprivation Therapy). No doubt other examples will spring to mind both in and out of the prostate cancer business – when did a car last have a trunk strapped to a ledge at the rear of the car? Does the term ‘automobile’ imply that the vehicle will travel on it’s own?
There have been comparitive studies done on Proton, IMRT and Brachy. The two largest are the ACER 2008 and the Prostate Cancer Study Group.
Other researchers have attempted other retrospective studies but found the data from Loma Linda unreliable and lacking.
To date the studies show no advantage of Proton treatment as to effectiveness or side affects to the other forms of radiation currently used.
I read the ACER study and the AHRQ reports. If you look at the bubble charts and have any clue how to choose good data you toss the small bubbles and those that are obvious outliers. What's left shows Proton, Brachtherapy, and IMRT pretty much tied for 7-10 year effectiveness. The study did not adequately address secondary cancers and other quality of life issues although it did pay lip service. I telephoned one of the authors to ask if the report was conclusive enough that insurance companies should be using it to select one treatment over another. He was clearly alarmed that they were doing so as the only conclusion reached by the "quality of evidence" study was that more study is needed. No conclusions can be drawn...
hmmm
can we add attachments here? I posted an address in the Website box
VOLUME 26 NUMBER 2 JANUARY 10 2008
JOURNAL OF CLINICAL ONCOLOGY COMMENTS AND CONTROVERSIES
Should Randomized Clinical Trials Be Required for
Proton Radiotherapy?
Michael Goitein, Department of Radiation Oncology, Harvard Medical School, Boston, MA
James D. Cox, Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
[Note they call it Radiotherapy, which is incorrect]
....................................... lots of good words leading to the final paragraph.....
"We doubt that many of us, while healthy, would agree to
receive, for example, 25 Gy to a large fraction of our brain or abdomen in exchange for some thousands of dollars, with no
known or credibly hypothesized medical benefit. If we would not,
how can we ask our sick patients to do so? Once proton beam
therapy has become clinically available, is not the burden of proof
on conventional x-ray therapy? Should not its advocates have to
demonstrate that the cost savings achieved by using x-rays are not
accompanied by undesirable additional morbidity? Do the users of
x-ray therapy have the evidence to support such a claim?"
_______
Richard here:
Well, we already know that traditional X-ray radiation is a carcinogen. So, knowing that Proton therapy is not, the burden lies on traditional medicine to show why we should NOT use Proton therapy. The surgeons also have a very great burden with their known high morbidity rates and life long complications.
Pardon my confusion but how is it that the proton beam therapy is approved and legal, when it sounds from the discussion here that it has not been proven to be effective? Yet HIFU therapy is not FDA approved due to lack of sufficient data demonstrating effectivness. I must be missing something obvious.
It all comes down to definitions and timing (apart from vested interests.)
Proton Beam Therapy has been used for many years on a number of tumour sites - and for at least 18 years on the prostate. One of the anomolies of the regulations (as I understand it) in the US is that if a therapy is approved for one site, it can be approved for another.
HIFU in it's current form is a much more recent development and has not had time to deomstrate whether it can be used in curing prostate cancer without signficant harm.
But here we are talking about FDA approval. There are then other approvals - at State level and among the insurers. As far as I know, FDA approval does not automatically generate insurance approval for a new drug or therapy unless it can be demonstrated that the new item is more efficacious than the old.
Hope I've got that right - US regulations are very confusing for us aliens.
Sorry I do not know what the acronym HIFU is so I cannot talk to that.
Proton therapy is known effective and is as such paid for by both the VA and Medicare and most private insurances. But it has an up front cost that exceeds alternative treatments. Note I said "up front". Protons do not carry the lifetime of treatments required for side effects known from surgery and x-ray radiation or radioactive seeds and as such I argue it is the least costly treatment. Some in the medical world and insurance industry do not care about morbidity they only care about long term survival vice cost of first treatment (not follow up cost), typically a chemical survival time (low PSA) of 7-10 years. It is a squirrely way to do an analysis but you must understand that private insurers want to treat on the cheap and let the men age in to Medicare and Medicare has to suffer the burden of long term chronic morbidity of up front cheap treatments. That is really what the debate is all about. If Proton therapy were the same one time cost as IMRT there would not be resistance to it.
I am sorry I cannot answer the other part of your question.
I am surprised that you are not aware of what HIFU is, since it has been a big issue for some years now. There is a brief summary here HIGH INTENSITY FOCUSED ULTRASOUND (HIFU)
I'd also be interested if you could clarify your statement referring to ....typically a chemical survival time (low PSA) of 7-10 years.
Are you seriously implying that survival time of a man with a low PSA (just what that has to do with survival is beyond me - perhaps you meant a low Gleason Score?) is 7-10 years?? Or do you mean the time to chemical failure, as opposed to survival time - a pretty substantial difference in those terms!!
Anyone using the the words "magic bullets" has been brain washed.
Proton Therapy has its good points and bad points. In particular if there is any doubt that the PCa is outside the prostate, PT is about as useless as any other targeted treatment.
Treatment must match the conditions presented by a man. And we are all so different, with respect to PCa.
Still waiting for my mild HBOT chamber to arrive. On ordered since last Nov.
Not brainwashed here. I am a rocket scientist and know the "magic bullet" reference is a term used to help the unaided understand. It was my invention not a reference to some other description, please read my entire postings.
You are correct that if the cancer has metastasized then PT is automatically contraindicated as a wide area and perhaps systemic treatment may be required. Now, to make it really plain...
If you are treating a solid tumor not metastasized, whether in the prostate or elsewhere. The unique capability of Protons to stop at a point in space (currently controlled within 1 millimeter) represents a "magic bullet". That proton does not radiate other parts of the body and does not exit. It travels to the targeted spot (controlled by aiming and initial velocity) and stops right there, delivering its energy to both cancerous and normal cells, similar to X-Ray radiation in effect, except that it is at a point vice a wide area. MD Anderson and other facilities have the capability to do pencil beam scanning which assures that only a defined volume is treated.
It is a law of physics known as the Bragg's Peak. Since it is kinetic and moves like a bullet with the added property of a precise stopping point I, myself, called it a Magic Bullet.
There are a few tumors for which Protons are the only alternative such as in solid tumors of the brain in children (no sane person uses X-ray radiation on a child's' brain when Protons are available) and for tumors of the eye. MD Anderson has begun using Proton Therapy on early stage breast cancers where biopsies show it has not gone to the lymph nodes and the tumor appears as a contiguous contained mass. In such cases the properties of Protons represent Magic Bullets, not literally, but effectively so.
Good luck with your HBOT chamber. Please keep us informed as I know nothing about that.
Please try to understand that these posts are read by a lot of intelligent people, from many different backgrounds. They are looking/hoping for the truth and any posts that get carried away a bit with detailed info which may or may not match what they have read before is going to be torn apart, nit by nit until the truth (or best we can do) is laid out before us.
That said, my profession is ... woups ... was radiation physics. I remember a lot, also have forgotten alot, cus I don't use it any more. Particle physics is not precise. Most of the energy is delivered where you want it, but a surprising amount goes elsewhere...like from the beam transmitter device to the target and even beyond the target. You are talking about probabilities, as to where the energy is deposited. Any cell that happens to be in the path of a photon will be destroyed, whether it is in the target, before the target or after the target. Company Reps selling PT pick a small part of the truth and blow it way out of proportion to sell their product. I've gone around with several men who think that GOD created PT and it is good for everyone ..... period. I can't (don't care ither) change their minds and I've sorta stopped trying (Really Joe, then what is all this gobbly-gook you've written?).
Si Joe, probabilities, we agree! And yes God did develop protons, X-rays, and all that other stuff, assuming you believe in God. I would say he's a singularity.
One thing we do know. The known safe dose of ionizing radiation is 0.00000000000000000000.... so please give me less of it. I'll take the low probability of a tiny Proton's stray energy any day over the known by physics near 100% probability of X-Ray radiation stray energy, most energy goes where it is not wanted.
So, a recovering physicist eh? I like that I hope you have a ponytail while surfing in an exotic place. I keep trying to leave this engineer biz but find there are no jobs for ex-engineers so I keep going back, one more time, each time.
