Proton beam therapy – not necessary – and more expensive.

I have previously posted a blog on the various ways to eliminate prostate cancer with “new improved” techniques. One of these is the use of proton beam treatment. This continues to be something patients ask about, because they know a family member or neighbor who had a “great outcome” using protons. In one study, the number one thing influencing the choice of therapy is just such experience – a trusted friend with a good outcome – regardless of what the modality of treatment was. Since 75% of patients are very satisfied with their treatment outcome these days, you can see that this is not much of a way to choose treatment. The reality is that surgery, radiation, and active surveillance all have pros and cons but that cure rates are roughly  the same.

Proton beams are unique from a physics point of view because they deliver most of their energy in a more precise way related to the Bragg Peak. If you don’t have time to click on that link, think of it as a particle traveling into the body, then exploding near the place you want to kill cells. A picture of how the energy enters the body and is deposited at various depths is shown in this figure from the Wikipedia article:

Those red and blue lines compared to the pink line that represents how a standard photon beam penetrates and deposits energy are the advantage of protons. But what if you could use many many photon beams entering the body from different angles? Where they cross, you would get a buildup of energy that would look much like the proton beams. And, just like your car is now more of a computer than it was 10 years ago, the standard radiation therapy machines can do just that. It is called IMRT or IGRT, and the efficacy and normal tissue sparing look much like proton beam treatment, only at much lower costs. To generate protons, you need a cyclotron that costs 10-50 times as much as a routine radiation therapy machine. And hospitals, constantly vying for patients in our broken health care system are willing to bet that buying one will drive business their way.

This week an article appears that looks at the supposedly improved side effects from using protons. It shows that it is a fallacy. Proton beam treatment compared to standard IMRT is not less toxic, no more effective, and twice as expensive. My advice for patients who choose radiation therapy for treating their prostate cancer is to find an excellent IMRT facility in their home neighborhood with highly trained radiation oncologists and shun the hospital systems that are trying to lure patients with claims about protons. Only by choosing wisely will Americans begin to deliver a message to the hospital and care systems that are driving Medicare and other payor systems into bankruptcy.