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I am very close to making a choice in treatment for a GS 3+4 PCa, and, in spite of the controversy about the real benefits, I like Proton the best of any. However, I notice that most authorities show PT gives a much higher dose of radiation to the hip region than with any other IMRT, so am wondering if there is a high probability of hip problems later on. Having read all the papers I can find on the possible benefits and side effects of PT, I cannot find any stats on this, and since the procedure has been in use for 23 years, why is no one talking about it? I understand that there have have been changes in all treatments through the years which make comparisons of the probability side effects hard to compare, but I am under the impression that firing the proton beams through the hips, and the inability to reduce the dose to normal tissue through that area has not changed substantially through the years. Is anyone aware on statistics on this?
Homer,
If you have researched your various treatment options and favor proton therapy, I can only assume you have seen the comparison graphs showing the energy delivered by proton vs. photon (X-rays). The occurrence of the "Bragg Peak" effect, allows a lower energy level to be initially delivered through the hip joint area and a higher level to be delivered deeper at the tumor. I had proton therapy three years ago and because I had a large GS 8 tumor, I was given 45 treatment instead of the normal 39. Although it's been only three years I can report both of my hips are excellent. I also keep in touch with several others who received proton therapy when I did and no one has experienced hip joint problems. I am sure that if you contact any of the proton centers (I was treated at UFPTI), they would share any data related to hip injury with you.
Homer:
I agree with Joe H. I was also treated at UFPTI, i.e. six years ago. I did a fair amount of research before and following treatment, and this is the first time I have seen a reference to hip problems associated with PBRT.
Being interested in proton therapy, I suspect you are familiar with the name Bob Marckini. Mr Marckini is highly responsive to persons considering proton therapy. I suggest you contact him on line and express your concern. If you do so, please share his reply on this thread.
Regards Don O.
I noticed you don't mention any examples of men that had hip joint trama from this treatment. I assume that means that you are concerned about the "possibility" of this occurring. It is not listed as a side effect for proton treatment. I would like to suggest contacting Scripts in southern California. It is a new proton radiation facility that uses a pencil beam technology. I believe this can be considered IMPT. Dr Rossi is managing this facility and he came from Loma Linda. Lots of experience with proton treatment for prostate cancer.
Many Thanks for your response, guys,
Besides your thoughts on my question, it was good to have some opinions on UFPT, and proton in general. I just shot off my question to the email on protonbob site, didn't see an address for Bob M himself.
Since my initial post, I did run across a five year study on this by the folks at UFPT(which is where I'm considering getting treatment since I'm in Florida)
I found this report while searching on the pubmed.com site:
http://informahealthcare.com/doi/pdf/10.3109/0284186X.2012.762995
Also from that site found a paper which was a good overall survey of proton, and also mentioned a 2 year hip trauma trial, possibly the same trial at an earlier date.
http://www.cancernetwork.com/oncology-journal/proton-therapy-prostate-cancer
The five year study says that hip fractures were no more frequent than normal for the group, but they mention 13% of the cohort reported hip pain, some requiring meds for it. Their study was not too explicit about the cause of pain.
In any event, 5 years and only looking at 382 men seems superficial, when as we know, over 10,000 men have gone through proton treatment over the past 23 years.
I also inquired of YANA member Cal Jones, as he is the earliest Proton survivor on the site. He's out 13 years now and had no mention of hips in his story. Perhaps it has never really been a problem to anyone.
Fred, did you have the pencil beam treatment? I see in the literature it has potential of being a quantum improvement over the passive method, but so new, wonder if it is too early to go a great distance to try it? I'm thinking it might be better to use old technology with a team that is good at it than be the on-the-job training for a new one. I asked Dr. Mendenhall at UFPT about it, and he doesn't feel the pencil beam is presently an advantage for prostate cancer. They will be adding one to their facility soon, though.
Thanks, guys,
Homer
I did not have proton treatment but I did a lot of research on it. Pencil beam is not exactly that new. I believe M.D. Anderson has been doing it for over 10 years. I like the idea since it makes better use of Brad's Peak. I would not quarrel with your decision to go with the older technology.
BTW.... I chose ADT3 (G7) as my primary treatment to avoid all long term side effects. I am expecting at least a 5 year vacation. Some men are getting over a 10 year vacation . I had a needle biopsy after 13 months of treatment and they could find no cancer.
I am three years removed from standard proton beam therapy (PBT) at MD Anderson, with a stable low PSA and no side effects to speak of. They were offering pencil-beam at the time, but only for Gleason 7+ cases (or for men whose prostate gland was atypical in shape). Dr. Andrew Lee (my radiation oncologist) stated there was no observable advantage to pencil-beam treatment for Gleason 6 patients.
I was tremendously pleased with the standard PBT treatment and wouldn't hesitate to make the same decision again if I had to. The hip issue never came up, and by the way, since I am an avid runner I did inquire about any adverse effects in that region of the body. Dr. Lee indicated no issue -- and time has borne that out so far. I run 3-4x per week, about 20 miles in total.
I am in a Men's Cancer Support in South Australia. There are from 8-10 regulars. Of those, two members ( aged late 70's -80's ) who received EBRT, maintain they now have restricted ROM and pain, which they attribute exclusively to Rad Therapy.
Back on the subject of Proton Beam, I received this from the Bro. of Balloon site. Seems pretty conclusive, although accompanied by the usual "We ain't no doctors" disclaimer:
Homer,
The reason you haven't seen much published on this is that it has been a non problem for the past 24 years. We have more than 7,000 members in our group. in the past 14 years, two have indicated they had hip problems, but it was never confirmed to be from their proton treatment. Lots of men have hip problems as they get older. We see no increase in that number in our membership.
Multiple surveys of our group show extremely high quality of life after treatment.
Keep in mind that although the protons travel through the hips, very little radiation is deposited on the hips. Almost all of the radiation is deposited in the prostate. When IMRT is used, most of the radiation is deposited on healthy tissue in the torso, including the hips.
I hope this is helpful.
Deb Hickey
Brotherhood of the Balloon
