Comparing Toxicity Following Proton Therapy and IMRT for Prostate Cancer

Dr. Bevan-Thomas discusses proton therapy for prostate cancer

462294327One of the challenges that physicians and patients patients face is trying to figure out what is the best therapy for their prostate cancer.

There are many different routes of treatment for prostate cancer, like surgery and radiation. There is a subset of patients who can may consider high intensity focused ultrasound. There is also cryoablation. But what Dr. Bevan-Thomas covers in this video we are going to cover right now is a controversial topic: proton beam therapy.

For more, watch Dr. Bevan-Thomas in this video.

Video Transcript

Dr. Richard Bevan Thomas:  Hey folks, this is Dr. Richard Bevan Thomas at prostate cancer live covering another topic and this topic is a somewhat controversial one.  One of the challenges that we have these days and certainly for patients is trying to figure out what is the best therapy for their particular cancer and now this always goes back in forth.  You have the surgeons that always talk about doing robotic surgery.  We have the patients actually you know the radiation oncologist that talk about radiation. 

There is a subset of patients who are actually considered high intensity focused ultrasound.  There is also cryoablation, so there is a lot that’s actually offered out there and of course there is also patients that we actually recommend that we follow and that’s what called active surveillance. 

Well, we are going to cover right now is actually a pretty big controversial topic which is proton beam therapy.  Now, proton beam therapy it was developed you know several years ago and what’s happened is that proton beam therapy is a little bit different than what we called our tradition.  This has been for prostate cancer wise.  There is IMRT.  Now, what we call mostly from a standard perspective how would treat prostate cancer these days are used to be extra beam radiation therapy and now what’s called IMRT, so most radiation centers when they talk about prostate cancer these days certainly in 2015 are talking about IMRT intensity, modulated radiation therapy and they actually use photons as apposed to protons okay, so lets go over that again. 

IMRT, intensity modulated radiation therapy pretty well almost our gold-standard I would say right now for treating prostate cancer and it’s got very few side effects.  You know there are side effects.  We are not going in to the details on that tonight because really we want to talk about the difference between IMRT versus proton beam therapy. 

Now, why is this important?  Most important for a number of different reasons is because what happens right now is that as time has progressed prostate cancer people who actually have these big centers USMD we have large center.  We have two IMRT volts that we actually used for multiple different cancers.  The big question is that is there a difference in recent terms of prostate cancer. 

If we consider proton beam therapy versus IMRT well and I know this is going to create a huge discussion and I certainly want to discussion on here because proton beam therapy has become a more excepted application for patients with prostate cancer.  It wasn’t originally developed for that, but the patients who are actually getting more and more proton beam therapy well the real question is that is it any better than IMRT again the traditional radiation therapy for prostate cancer, but what we know one thing unfortunately it is more expensive and that’s a big challenge and when we are looking at healthcare cost these days, we do know that it is more expensive and it’s more expensive because there is a lot more that actually goes into actually developing and delivering the proton beam therapy, so that’s part one. 

Part two is that we also know that you know they are both very effective in terms of treating prostate cancer and again we are not going to go on all the stats on this.  This paper that we are talking about is called comparing toxicity following proton therapy and IMRT for prostate cancer and we are going to link to this, so that you can actually look this up okay and so what is this find, this actually looked into the study, looking at patients who actually had proton beam therapy as well as IMRT and they did not see a difference in terms of the toxicity. 

The proton beam therapy composes proton right, the proton guys have said listen, it’s much fewer side effects, it’s what we did describe as a pinpoint radiation and so you do significantly better.  The IMRT group on this will say well look you know the proton therapy is more expensive and is not it really worth the added cost for this as well as the time and effort that actually goes into this and the answer is we don’t have a lot of data right now.  This was a great paper actually writing on this that say there was no really difference whatsoever in terms of certainly from disease, but just as importantly is actually is the side effect profile, is there any in difference.  Now, we are looking at this very-very closely and all urologist are because the bottom line is that if our patients want to undergo radiation therapy, we want the absolute best for them, but we are starting to see is that we have got to make sure that we have data and we actually have studies that shows that if we do surgery if this patient are we benefiting this patient by doing surgery on it. 

If we are doing radiation are they benefiting from that and of course the cost associated with that, so I would just caution patient.  I think the patients that are considering getting radiation therapy and are actually thinking about proton beam therapy, I think it’s important that you sit down with your doctor and your urologist and even the radiation oncologist and say what do you have?  Do you have information on this because right now this paper was fascinating in terms of looking at this and there are other studies as well that have looked at this well and we are really not seeing a significant difference, we want to make sure that we do best for our patients, but we also want to make sure that we are controlling cost and making sure that we are not changing the lifestyle of the patient, so they are not moving to another city for two or three months at the time undergoing these types of treatments which again right now unfortunately we just have limited data to really defend that.

Dr. Richard Bevan-Thomas
Dr. Bevan-Thomas is the Medical Director for Prostate Cancer Live. A graduate of Duke University, Rich received both a master’s degree in anatomy and his medical degree from St. Louis University School of Medicine. He completed residency training in urologic surgery at the University of Texas Houston Health Science Center and the renowned MD Anderson Cancer Center, also in Houston. In 2002, he received two top honors in his field; the Pfizer Scholar in Urology and the Gerald G. Murphy Scholar in Urology. Dr. Bevan-Thomas will remain on the leading edge of robotic surgery and cryosurgery at USMD Prostate Cancer Center and will continue offering patients the latest clinical trials in prostate cancer treatment. He continues his teaching and physician proctoring interests as well as instructing in robotic surgery.


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