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Proton Beam?

User
Posted 25 Jul 2019 at 23:13

Hi. I was diagnosed in May’19. Gleason score 3+4=7. Staging T3a. 

the treatment recommended by the urology consultant was hormone therapy, followed by HDR Brachytherapy, followed by four weeks of external beam radiotherapy, and I started the hormone treatment about a month ago.

I have not seen the oncology consultant to whom I’ve been referred yet because she is on holiday but I feel like I haven’t had a full conversation about the other treatment options.

I have been hearing a lot lately about Proton Beam Therapy and the Rutherford centre and would appreciate people’s thoughts.   

User
Posted 26 Jul 2019 at 08:51
Andy62 you are simply wrong when you state T3A is not "curable" with prostatectomy.

Selection criteria for T3a prostatectomy are well established and biochemical recurrence when the criteria are used are similar to T2 cancers.

User
Posted 26 Jul 2019 at 07:46

''As T3a, the cancer has broken out of your prostate, which means prostatectomy alone can't cure it, so you would need radiotherapy in any case."

Hi

I was gleeson 3+4 T2c which was upgraded to T3a post RP and path examination. Nerve sparing one side only was decided pre op. T3a was due to extracapsular extension. PSA has been undetectable since so no Adjuvant RT. The op was Jan 17.

I know it's slightly different because I started at DX of T2c but I thought worth a mention for others

 

Good luck

Cheers

Bill

Edited by member 26 Jul 2019 at 07:49  | Reason: Added info

User
Posted 22 Jun 2020 at 01:40

I think Proton Beam as a salvage treatment for failed RP might be suitable but only where there is a very well defined tumour where the dose can be accurately deposited. It has to be very precisely calculated so the tumour is within the optimum of the 'Bragg Peak'. With Photon (EBRT), radiation is deposited on the way to the tumour, on it and also after it. So the larger area covered by photons stands a better chance of hitting cancer cells where after RP a oncologist believes there is cancer somewhere in the pelvic area for example but there is not a well defined target. A PSMA or a high Quality MRI may be able to identify a tumour but this is unlikely with a low PSA.

I don't think that Proton Beam is used very much as a salvage treatment and there is a dearth of information on it being used this way.
It will be interesting to learn what your oncologist says.

Scroll down to figure 2 on this link to see the path of Proton Beam and the narrow small optimum peak to hit the target compared to the more gradual rise and fall of the radiation dose with Photons. https://www.floridaproton.org/what-is-proton-therapy/alt/alt

Please note that views vary on the effectiveness and side effects of Proton Beam compared with Photons as a primary treatment for PCa.

 

Edited by member 22 Jun 2020 at 02:08  | Reason: to highlight link

Barry
User
Posted 23 Jun 2020 at 00:23

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
Proton beam is looking like an exciting contender as a salvage treatment when radical treatment has failed; we have a couple of members who have travelled overseas for it. But the trial results as a primary treatment for prostate cancer have been very disappointing. As Bollinge says, Proton beam therapy is available in England only for hard to treat cancers such as ocular, head and neck cancers or for children who find external beam RT too difficult.

Hi Lyn,

Further to my RP a year ago, I was left with 32mm of positive margins around the bladder neck area. Have been having quarterly PSA tests, the last one came back at 0.10  My consultant has now arranged for me to have a consultation with an oncologist, as he ' fears there may be some residual disease' (as stated in a letter to my GP).

I will be speaking with the Onco this week about possible treatments. My consultant has arranged for another PSA test (at 6 weeks from last one), to see if any further progress, and if so then a PSMA PET scan will follow.

I would like to investigate if proton beam therapy would be a more successful, less damaging option, and I will be speaking to the Rutherford Cancer Centre people once I have had the Onco consultation.

I'd be keen to hear any further opinions/thoughts since your comments above from a year ago.

Many thanks,

Chris

 

Hi Chris, I don't reply to PMs - sorry. 

I am not an expert but I can't see that anything has changed since the NHS review in 2016; there has been no further research on proton therapy in the UK since then. The findings were that when it comes to prostate cancer, proton therapy is no more successful or precise than IGRT / IMRT and does not cause fewer side effects - in fact, they found that at higher doses, it caused more side effects that traditional RT. It also costs almost double. A proton beam session is almost an hour compared to 5-10 minutes for IGRT. So there is no motivation for the existing NHS proton beam facility to be used for prostates - far better that it is concentrated on helping people with usually hard to treat cancers such as ocular melanoma and some brain tumours. 

It will be interesting to hear how you get on at the Rutherford though  🤞 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Jun 2020 at 13:40

A Proton Beam session for PCa takes almost an hour! Where did you see that Lyn? MD Anderson " What to expect during proton treatment.
With proton therapy for prostate cancer, treatments typically take only 15 to 20 minutes each day" from https://www.mdanderson.org/patients-family/diagnosis-treatment/care-centers-clinics/proton-therapy-center/conditions-we-treat/prostate-cancer.html

 

As with Photon EBRT which is now available as a hypofractioned treatment, so too is Proton Beam. So Chris, I suggest you ascertain how many fractions you would be given and at what cost, also full requirement about preliminary tests and set up. You might also wish to contact the Proton Beam centre in Prague to make comparison but this would mean taking a holiday there, travel restrictions permitting. If you are prepared to share information with us it will be appreciated.

 

Edited by member 23 Jun 2020 at 13:41  | Reason: Not specified

Barry
User
Posted 14 Aug 2021 at 01:28

I keep an eye on proton beam, mainly because people ask me about it!

All of the comparisons are comparing image guided (IG) proton beam with non-IG photons. Well, no one does non-IG photons in this country now. If the proton beam vendors can't produce a compelling advantage without having to compare with 5+ year older photon technology, that doesn't bode well. They did have IG earlier, but so does all photon beam treatment now.

Went to a presentation by an oncologist who used to send some of his private patients for proton beam, but he's stopped doing that. He wasn't very specific as to why, but I would have to assume the results were no better.

I followed a twitter conversation between several urologists who do salvage prostatectoies and proton beam treatments are now working through into their cases. They have already found that salvage prostatectomy is more difficult with hypofractionated photon treatment (more fibrosis around the prostate). Proton beam is much worse still, with it being much more difficult to dissect out the prostate from adjoining tissues. (One of them had done salvage RARP after a heavy ion beam, and that was worse still.) Another factor is that neighboring organs do end up damaged. The bladder in particular loses all its elasticity near the prostate, which means the lower section often has to be removed to reach bladder muscle that can be used to suture the urethra back on. This is not the case with regular photon beam radiotherapy. This was explained by one of the contributors as being due to proton beam treatment being very powerful at the edge of the target treatment volume, in contrast to regular photon beam radiotherapy which is most powerful in the middle of the target treatment volume, and decays away as you move outside of the target treatment volume.

While I share the view that it might seem to be most useful for salvage treatment (where it's not used as far as I know), it doesn't seem to be significantly better for radical treatment. It might have had a window where it was better 5+ years ago, but photon beam radiotherapy has been advancing very quickly.

Edited by member 14 Aug 2021 at 01:28  | Reason: Not specified

User
Posted 14 Aug 2021 at 01:54

The Rutherford centre only started administering Proton Beam Therapy in December 2018, just over two and a half years ago, so rather less experience than the facility in Prague that opened in 2012 or some of the other centres in Europe. The number of places offering Proton Beam has expanded and continues to do so for sure. Using 'pencil beam' rather than 'scatter' beams as previously has improved accuracy but that means that calculations on where to deposit the dose becomes even more important. As with EBRT, fewer but more powerful fractions have been trialled in Japan and also in the USA I believe but I don't know whether this has yet been adopted by The Rutherford.

I remember discussing with my Consultant when I had my EBRT in Heidelberg and Carbon Ion boost in Darmstadt in 2008, the rationale for a mixture of EBRT and Carbon Ions. ( I should just say that Carbon Ion treatment is similar to Proton Beam but much more powerful). The thinking was that the more precise Carbon Ion boost would be delivered to the tumour causing severe damage to the cancer's DNA, while the EBRT, which has a wider spread, would also reach further outside the identified tumour(s). The same rationale would apply to Proton Beam and EBRT. Nowadays, sometimes EBRT is given to augment Brachtherapy to serve in the same way.

So in summary, Proton Beam could produce a good result on its own provided tumors are completely defined, which is not always the case. Also, if the Proton Beam partly unloads on an organ, it could result in severe damage and produce after effects.

 

Edited by member 14 Aug 2021 at 02:20  | Reason: Not specified

Barry
User
Posted 14 Aug 2021 at 13:08

Actually IMRT and IGRT (Image Guided Radiotherapy) has been available for well over 10 years at some hospitals but what has changed is the type of Linac depositing the beams.  The Phillips system referred to in the link seems to be similar to the 'Rapid Arc ' system introduced a few years ago by Varian.  We have had members treated with the rapid arc system as shown here. https://www.varian.com/about-varian/newsroom/press-releases/varians-rapidarc-radiotherapy-technology-enables-pioneering

So if you had treatment using the Phillips system you linked to you would be treated with an advanced system.

Barry
User
Posted 15 Aug 2021 at 00:58
Are all 9 RapidArc at Mount Vernon or some, (or all) at Paul Strickland Centre which is on the Mount Vernon site? I had my PSMA scan at Paul Strickland although it was interpreted by a radiology doctor at Mount Vernon hospital., It would seem that despite the rather motley appearance of some of the buildings, this belies the good reputation the hospital has. Incidentally, a prior Choline scan led my consultant to believe I had cancer in an iliac node whereas the PSMA scan together with careful comparison of size and shape of the node from previous MRI's, suggested it was not affected. Had it been I would not be offered another HIFU which is now scheduled for later this month. So, as in a number of cases, the PSMA has led to a change in treatment from systemic to specific, the seen cancer being within my Prostate.

I haven't heard of the combined MRI and treatment linac being available in the UK, although it was referred to on this forum quite some time ago, probably in use in the USA. I know they administer one of the forms of FLA there whilst the patient is in the scanner which they describe as 'in bore', so another form of treatment used in conjunction with MRI. As I said in another post, introducing advanced equipment and means of treating Cancer in the UK, sometimes lag behind the USA and some other European Countries.

Barry
User
Posted 17 Aug 2021 at 03:02

I wonder why Britain, the fifth (or sixth?) richest country in the world has inferior proton beam capability to the formerly communist countries Poland and Czechia?

One might also question why our ‘world-beating’ NHS has less doctors, CT and MRI scanners per head of population than most Western nations.

Get rid of all the clip-board wielding pen-pushers on £160 grand salaries (never to be seen at weekends), and put someone from Tesco in charge of the whole bloody NHS, and remove it from political control.

Cheers, John.

Edited by member 18 Aug 2021 at 04:01  | Reason: Not specified

User
Posted 17 Aug 2021 at 09:50

Only Rutherford and The Christie have proton beam in the UK, that I know of, and UCLH is building one.

They sprung up in countries with large private healthcare, with the expectation of treating prostate and other high volume cancers profitably. They have failed to complete any randomised trials to show they perform better than photons for prostate cancer. NHS did some retrospective data research around 2016, and found they weren't performing better than photons for prostate cancer. Indeed, bowel issues even showed up slightly worse (but not statistically significant). Now that urologists are getting to see proton treated prostates in salvage prostatectomies, they're reporting significantly worse neigbouring organ damage than with modern photons.

There are some things for which protons are ideally suited, but the high volume profitable radical prostate treatments probably aren't their sweetspot. Quite a number of proton facilities in the US have been closing down, not considering it worth replacing machines at end of life.

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User
Posted 26 Jul 2019 at 01:25
I don’t think you’ll get anywhere near a proton beam on the NHS, in one of only two or three places in Britain that have a machine, as its use is usually confined to brain cancers.

Best of luck.

Cheers, John.

User
Posted 26 Jul 2019 at 01:41
Proton beam is looking like an exciting contender as a salvage treatment when radical treatment has failed; we have a couple of members who have travelled overseas for it. But the trial results as a primary treatment for prostate cancer have been very disappointing. As Bollinge says, Proton beam therapy is available in England only for hard to treat cancers such as ocular, head and neck cancers or for children who find external beam RT too difficult.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 26 Jul 2019 at 06:50

As T3a, the cancer has broken out of your prostate, which means prostatectomy alone can't cure it, so you would need radiotherapy in any case. You probably will benefit from the entry/exit wounds of the external beam RT, because those help to mop up micromets (spread that's too small to see on scans) near the prostate. The radiotherapy will be directed at pelvic lymph nodes too in some cases, certainly if any spread there is seen (you haven't said), and also if they think there's a chance there might be micromets in them. This is variously called "whole pelvis radiotherapy" (although that means something else to radiographers), or "prostate and nodes".

I'm not telling you to have that course of treatment - you should discuss options with your oncologist, but given what you've said (which is not complete, missing PSA results/dates, nodes and bone scan results), it is probably the best treatment available at the moment. You might also be offered chemotherapy which can further improve outcomes in some cases, at the cost of more initial discomfort and the risk of some permanent chemo damage to your body.

I am on the same path as you, 2/3rds through my EBRT, to be followed by HDR Brachytherapy (the order doesn't matter). This is becoming a common choice for what's referred to as high risk patients, i.e. T3 or more, or PSA > 20, or Gleason >= 8, as the trials which started well over 10 years ago have had good outcomes.

You didn't say what your PSA was before treatment. Mine was 57. I put off the RT until my PSA dropped to 0.1 on HT, because this also has been found to improve outcomes. (Actually, I was down do 0.18 when the RT was booked and 0.12 when it started, but that was near enough - they were originally going to start it when I was around 5.) Not everyone will be able to get it that low, but whilst the rate of decrease is high, it's probably worth waiting longer before starting the RT.

User
Posted 26 Jul 2019 at 07:46

''As T3a, the cancer has broken out of your prostate, which means prostatectomy alone can't cure it, so you would need radiotherapy in any case."

Hi

I was gleeson 3+4 T2c which was upgraded to T3a post RP and path examination. Nerve sparing one side only was decided pre op. T3a was due to extracapsular extension. PSA has been undetectable since so no Adjuvant RT. The op was Jan 17.

I know it's slightly different because I started at DX of T2c but I thought worth a mention for others

 

Good luck

Cheers

Bill

Edited by member 26 Jul 2019 at 07:49  | Reason: Added info

User
Posted 26 Jul 2019 at 08:16
I should have mentioned that my PSA was 14 and, although graded T3a the urologist said that it had not yet broken out but gave it that grade because it was on the verge of doing so.
User
Posted 26 Jul 2019 at 08:51
Andy62 you are simply wrong when you state T3A is not "curable" with prostatectomy.

Selection criteria for T3a prostatectomy are well established and biochemical recurrence when the criteria are used are similar to T2 cancers.

User
Posted 26 Jul 2019 at 09:38

Kevin, I am similar treatment plan to you, except mine is nearly finished.

G9, PSA 27 and T3b , spread into seminal vesicles as is common. 

HT started in Jan ‘18 , HD Brachy in July and followed by RT 23 sessions. Just 5 mins ago had my penultimate Prostap injection. Last in October. PSA at last count 0.08 so fingers crossed.

The HT is a bit of a mine field for most but it does a job. Look up my previous posts to see my troubles with HT.

I will be looking over my shoulder for years to come but at least I’m alive.

Seems to be becoming the most used treatment plan ......

Good luck on your journey.

Phil

User
Posted 26 Jul 2019 at 10:27

Originally Posted by: Online Community Member
Andy62 you are simply wrong when you state T3A is not "curable" with prostatectomy.

Selection criteria for T3a prostatectomy are well established and biochemical recurrence when the criteria are used are similar to T2 cancers.

Thanks francij.

My original hospital don't recommend prostatectomy alone for T3a (i.e you can have it if you really demand it, but they strongly advise against). They will do it as multi-modal (prostatectomy with reduced RT treatment), but then you have both sets of side effects, albeit limited on the RT front compared with just RT treatment.

User
Posted 26 Jul 2019 at 10:42

Firstly can I say that I am totally against limiting treatment options on cost grounds.

This TV program was broadcast earlier this week which I think highlights why Proton Beam is unlikely to become a mainstream treatment option in the near future.

horizon-2019-5-the-250-million-pound-cancer-cure

 

Alan

Edited by member 26 Jul 2019 at 10:43  | Reason: Addition

User
Posted 26 Jul 2019 at 14:02

Kevin sounds like your diagnosis was almost exactly the same as mine. 

I was 58 when diagnosed, no symptoms but showed PSA 14 on a blood test for kidney function. Biopsy came back 70% positive, 100% in left lobe 30% in right. Initial stage reported as T4, but after second scan changed to T3a (thank god or whoever would listen). 

I was recommended by my original Oncologist at Gloucester not to have radical prostatectomy if I wanted a good quality of life after the operation. I am very glad I took his word and shopped around for a different solution and I can only say all the consultants I met and/or talked to from several hospitals were incredible helpful and very honest in their views without trying to "sell" any particular treatment options.

I had 6 months ADT, HDR brachytherapy at Bristol followed by 6 weeks of daily EBRT ( less 2 bank holidays).

Now 3 years post treatment my PSA is 0.1, I feel fit and fine, just get a bit tired late in the afternoon, but on the whole it has been a great success. 

I can only go by my treatment experience but it was almost totally painless, one night in hospital, I was up and about totally pain free 24 hours after being discharged and back to work 3 days later.

User
Posted 27 Jul 2019 at 00:21

Alan,

Couldn't get your link to work. Did you check it does? I think you meant this https://www.bbc.co.uk/iplayer/episode/m00072kd/horizon-2019-5-the-250-million-pound-cancer-cure

Treatment within the NHS  is provided on a cost=benefit assessed basis, funds being limited.  Where patients are prepared  to pay for more exotic treatment, private facilities are more readily found, mostly abroad.  The prime example of this is in the USA.  If we didn't have a NHS in the UK there would almost certainly have been more advanced facilities built privately because of greater demand.  As it is, the Proton beam facility now operational at The Christie in Manchester and the near ready one at UCLH in London are years behind those operating in some other European and further afield countries.  Also, these are only able to treat with Protons whereas some of those abroad  can also treat with Carbon Ions  and potentially other atoms. So the UK is not only late to the party but the two facilities in the UK are limited in what they offer.  The Heidelberg Ionbeam Therapy Center (HIT) in Germany for instance  puts this into perspective as here https://www.youtube.com/watch?v=LeApaY7ctMo

For many years mainly suitable young people with tumors in their head were sent to the USA for Proton Beam treatment because it causes far less collateral damage than Photons but this advantage has not been shown to apply for Prostate Cancer.

 

 

Edited by member 27 Jul 2019 at 01:48  | Reason: Not specified

Barry
User
Posted 27 Jul 2019 at 09:24

Originally Posted by: Online Community Member

Alan,

Couldn't get your link to work. Did you check it does? I think you meant this https://www.bbc.co.uk/iplayer/episode/m00072kd/horizon-2019-5-the-250-million-pound-cancer-cure

Treatment within the NHS  is provided on a cost=benefit assessed basis, funds being limited.  Where patients are prepared  to pay for more exotic treatment, private facilities are more readily found, mostly abroad.  The prime example of this is in the USA.  If we didn't have a NHS in the UK there would almost certainly have been more advanced facilities built privately because of greater demand.  As it is, the Proton beam facility now operational at The Christie in Manchester and the near ready one at UCLH in London are years behind those operating in some other European and further afield countries.  Also, these are only able to treat with Protons whereas some of those abroad  can also treat with Carbon Ions  and potentially other atoms. So the UK is not only late to the party but the two facilities in the UK are limited in what they offer.  The Heidelberg Ionbeam Therapy Center (HIT) in Germany for instance  puts this into perspective as here https://www.youtube.com/watch?v=LeApaY7ctMo

For many years mainly suitable young people with tumors in their head were sent to the USA for Proton Beam treatment because it causes far less collateral damage than Photons but this advantage has not been shown to apply for Prostate Cancer.

 

 

Thanks for sorting out my link. I thought I had only edited the displayed text, but had also edited the actual link.

I wasn't aware of the limitations of our facilities.

Alan 

User
Posted 21 Jun 2020 at 18:57

Originally Posted by: Online Community Member
Proton beam is looking like an exciting contender as a salvage treatment when radical treatment has failed; we have a couple of members who have travelled overseas for it. But the trial results as a primary treatment for prostate cancer have been very disappointing. As Bollinge says, Proton beam therapy is available in England only for hard to treat cancers such as ocular, head and neck cancers or for children who find external beam RT too difficult.

Hi Lyn,

Further to my RP a year ago, I was left with 32mm of positive margins around the bladder neck area. Have been having quarterly PSA tests, the last one came back at 0.10  My consultant has now arranged for me to have a consultation with an oncologist, as he ' fears there may be some residual disease' (as stated in a letter to my GP).

I will be speaking with the Onco this week about possible treatments. My consultant has arranged for another PSA test (at 6 weeks from last one), to see if any further progress, and if so then a PSMA PET scan will follow.

I would like to investigate if proton beam therapy would be a more successful, less damaging option, and I will be speaking to the Rutherford Cancer Centre people once I have had the Onco consultation.

I'd be keen to hear any further opinions/thoughts since your comments above from a year ago.

Many thanks,

Chris

Edited by member 22 Jun 2020 at 18:49  | Reason: Not specified

User
Posted 22 Jun 2020 at 01:40

I think Proton Beam as a salvage treatment for failed RP might be suitable but only where there is a very well defined tumour where the dose can be accurately deposited. It has to be very precisely calculated so the tumour is within the optimum of the 'Bragg Peak'. With Photon (EBRT), radiation is deposited on the way to the tumour, on it and also after it. So the larger area covered by photons stands a better chance of hitting cancer cells where after RP a oncologist believes there is cancer somewhere in the pelvic area for example but there is not a well defined target. A PSMA or a high Quality MRI may be able to identify a tumour but this is unlikely with a low PSA.

I don't think that Proton Beam is used very much as a salvage treatment and there is a dearth of information on it being used this way.
It will be interesting to learn what your oncologist says.

Scroll down to figure 2 on this link to see the path of Proton Beam and the narrow small optimum peak to hit the target compared to the more gradual rise and fall of the radiation dose with Photons. https://www.floridaproton.org/what-is-proton-therapy/alt/alt

Please note that views vary on the effectiveness and side effects of Proton Beam compared with Photons as a primary treatment for PCa.

 

Edited by member 22 Jun 2020 at 02:08  | Reason: to highlight link

Barry
User
Posted 23 Jun 2020 at 00:23

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
Proton beam is looking like an exciting contender as a salvage treatment when radical treatment has failed; we have a couple of members who have travelled overseas for it. But the trial results as a primary treatment for prostate cancer have been very disappointing. As Bollinge says, Proton beam therapy is available in England only for hard to treat cancers such as ocular, head and neck cancers or for children who find external beam RT too difficult.

Hi Lyn,

Further to my RP a year ago, I was left with 32mm of positive margins around the bladder neck area. Have been having quarterly PSA tests, the last one came back at 0.10  My consultant has now arranged for me to have a consultation with an oncologist, as he ' fears there may be some residual disease' (as stated in a letter to my GP).

I will be speaking with the Onco this week about possible treatments. My consultant has arranged for another PSA test (at 6 weeks from last one), to see if any further progress, and if so then a PSMA PET scan will follow.

I would like to investigate if proton beam therapy would be a more successful, less damaging option, and I will be speaking to the Rutherford Cancer Centre people once I have had the Onco consultation.

I'd be keen to hear any further opinions/thoughts since your comments above from a year ago.

Many thanks,

Chris

 

Hi Chris, I don't reply to PMs - sorry. 

I am not an expert but I can't see that anything has changed since the NHS review in 2016; there has been no further research on proton therapy in the UK since then. The findings were that when it comes to prostate cancer, proton therapy is no more successful or precise than IGRT / IMRT and does not cause fewer side effects - in fact, they found that at higher doses, it caused more side effects that traditional RT. It also costs almost double. A proton beam session is almost an hour compared to 5-10 minutes for IGRT. So there is no motivation for the existing NHS proton beam facility to be used for prostates - far better that it is concentrated on helping people with usually hard to treat cancers such as ocular melanoma and some brain tumours. 

It will be interesting to hear how you get on at the Rutherford though  🤞 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Jun 2020 at 08:54

Thank you Barry and Lyn, I really appreciate you sharing what you have found. I’ll report back with the views of photon vs proton once I’ve had the discussions. 
all the best,

Chris

User
Posted 23 Jun 2020 at 13:40

A Proton Beam session for PCa takes almost an hour! Where did you see that Lyn? MD Anderson " What to expect during proton treatment.
With proton therapy for prostate cancer, treatments typically take only 15 to 20 minutes each day" from https://www.mdanderson.org/patients-family/diagnosis-treatment/care-centers-clinics/proton-therapy-center/conditions-we-treat/prostate-cancer.html

 

As with Photon EBRT which is now available as a hypofractioned treatment, so too is Proton Beam. So Chris, I suggest you ascertain how many fractions you would be given and at what cost, also full requirement about preliminary tests and set up. You might also wish to contact the Proton Beam centre in Prague to make comparison but this would mean taking a holiday there, travel restrictions permitting. If you are prepared to share information with us it will be appreciated.

 

Edited by member 23 Jun 2020 at 13:41  | Reason: Not specified

Barry
User
Posted 23 Jun 2020 at 15:37
Gosh, I don't know - perhaps I remembered it wrong.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Jun 2020 at 20:56
Found it on the NHS website - it says 'up to an hour' so presumably longer for some cancers than others.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Jun 2020 at 22:49

Bearing in mind the well know advantages Proton Beam has for cancers of the head, it's disappointing that the treatment does not afford similarly good results for PCa than less exotic radiation. This is an impartial conclusion of the NHS. It's surprising that with Proton therapy having been done since the nineteen fifties, more comparisons haven't been made with surgery and conventional radiation. This site compares treatment that a large number of men had and how men fared according to whether they were low, middle or high risk. The results for risk do differ but if you look at the individual ellipse for each treatment, seeds, particularly with EBRT added seem to give best results while Proton Therapy is not up with the best albeit with fewer numbers. It also has to be remembered that this is for primary rather than salvage treatment. https://prostatecancerfree.org/compare-prostate-cancer-treatments/

 

Edited by member 23 Jun 2020 at 22:52  | Reason: to highlight link

Barry
User
Posted 24 Jun 2020 at 01:40
As you know, I am very interested in brain tumour research, and proton beam therapy is one of the most exciting things to have happened in that department for decades! Same for small children and hard to reach cancers. Unfortunately, there are nowhere near enough machines in the UK to meet demand but the NHS does fund travel to Prague or America for suitable patients.

I loved the report about what was needed at the Christie - the building had to be underpinned with 000s of tonnes of concrete to take the weight of the machine and a special sub-station was built to provide enough power!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 24 Jun 2020 at 08:13

Hi Barry,

you’re right, most surveys about proton beam are for for whole tumour. Not much out there about it’s use in the salvage field. 

User
Posted 13 Aug 2021 at 09:03

Hi.

I think things have moved along very quickly with proton beam therapy.

The Rutherford centre in Newport have been carrying out PCA treatment for some years now with success.

https://www.therutherford.com/treatments/proton-beam-therapy/

https://scitechdaily.com/proton-therapy-significantly-lowers-risk-of-side-effects-for-cancer-patients/

Yes, it's expensive and more research needs to be done but you have to judge the results.

https://vimeo.com/469887680/89f270815b

I'm doing further research but will chat with my urologist (I don't have an oncologist yet 😢) to see if my cancer is treatable this way. They have hinted that HT may not be necessary.... we'll see.

Bit disappointed that this site doesn't mention proton beam therapy as a viable form of treatment....I think it needs to catch up!

 

Meanwhile, here's some journal articles.

Articles with a focus on impotence:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3465790/

https://pubmed.ncbi.nlm.nih.gov/29359988/

https://www.oncolink.org/support/sexuality-fertility/sexuality/men-s-guide-to-sexuality-during-after-cancer-treatment

https://www.healio.com/news/hematology-oncology/20121127/10_3928_1081_597x_20120101_00_955064

Articles with a focus on bowel toxicities:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080851/

https://www.tandfonline.com/doi/full/10.1080/0284186X.2017.1388539

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349581/

https://ro-journal.biomedcentral.com/articles/10.1186/s13014-018-1127-6

 

 

Edited by member 13 Aug 2021 at 14:02  | Reason: Update

User
Posted 14 Aug 2021 at 01:28

I keep an eye on proton beam, mainly because people ask me about it!

All of the comparisons are comparing image guided (IG) proton beam with non-IG photons. Well, no one does non-IG photons in this country now. If the proton beam vendors can't produce a compelling advantage without having to compare with 5+ year older photon technology, that doesn't bode well. They did have IG earlier, but so does all photon beam treatment now.

Went to a presentation by an oncologist who used to send some of his private patients for proton beam, but he's stopped doing that. He wasn't very specific as to why, but I would have to assume the results were no better.

I followed a twitter conversation between several urologists who do salvage prostatectoies and proton beam treatments are now working through into their cases. They have already found that salvage prostatectomy is more difficult with hypofractionated photon treatment (more fibrosis around the prostate). Proton beam is much worse still, with it being much more difficult to dissect out the prostate from adjoining tissues. (One of them had done salvage RARP after a heavy ion beam, and that was worse still.) Another factor is that neighboring organs do end up damaged. The bladder in particular loses all its elasticity near the prostate, which means the lower section often has to be removed to reach bladder muscle that can be used to suture the urethra back on. This is not the case with regular photon beam radiotherapy. This was explained by one of the contributors as being due to proton beam treatment being very powerful at the edge of the target treatment volume, in contrast to regular photon beam radiotherapy which is most powerful in the middle of the target treatment volume, and decays away as you move outside of the target treatment volume.

While I share the view that it might seem to be most useful for salvage treatment (where it's not used as far as I know), it doesn't seem to be significantly better for radical treatment. It might have had a window where it was better 5+ years ago, but photon beam radiotherapy has been advancing very quickly.

Edited by member 14 Aug 2021 at 01:28  | Reason: Not specified

User
Posted 14 Aug 2021 at 01:54

The Rutherford centre only started administering Proton Beam Therapy in December 2018, just over two and a half years ago, so rather less experience than the facility in Prague that opened in 2012 or some of the other centres in Europe. The number of places offering Proton Beam has expanded and continues to do so for sure. Using 'pencil beam' rather than 'scatter' beams as previously has improved accuracy but that means that calculations on where to deposit the dose becomes even more important. As with EBRT, fewer but more powerful fractions have been trialled in Japan and also in the USA I believe but I don't know whether this has yet been adopted by The Rutherford.

I remember discussing with my Consultant when I had my EBRT in Heidelberg and Carbon Ion boost in Darmstadt in 2008, the rationale for a mixture of EBRT and Carbon Ions. ( I should just say that Carbon Ion treatment is similar to Proton Beam but much more powerful). The thinking was that the more precise Carbon Ion boost would be delivered to the tumour causing severe damage to the cancer's DNA, while the EBRT, which has a wider spread, would also reach further outside the identified tumour(s). The same rationale would apply to Proton Beam and EBRT. Nowadays, sometimes EBRT is given to augment Brachtherapy to serve in the same way.

So in summary, Proton Beam could produce a good result on its own provided tumors are completely defined, which is not always the case. Also, if the Proton Beam partly unloads on an organ, it could result in severe damage and produce after effects.

 

Edited by member 14 Aug 2021 at 02:20  | Reason: Not specified

Barry
User
Posted 14 Aug 2021 at 08:45

Hi 

Thanks for that.

I'm not rushing into anything but will research further...

Meanwhile my nearest RT centre looks quite good.

https://sbuhb.nhs.wales/news/swansea-bay-health-news/swansea-cancer-centre-the-uk-leader-for-high-tech-radiotherapy-technique/

 

 

 

User
Posted 14 Aug 2021 at 13:08

Actually IMRT and IGRT (Image Guided Radiotherapy) has been available for well over 10 years at some hospitals but what has changed is the type of Linac depositing the beams.  The Phillips system referred to in the link seems to be similar to the 'Rapid Arc ' system introduced a few years ago by Varian.  We have had members treated with the rapid arc system as shown here. https://www.varian.com/about-varian/newsroom/press-releases/varians-rapidarc-radiotherapy-technology-enables-pioneering

So if you had treatment using the Phillips system you linked to you would be treated with an advanced system.

Barry
User
Posted 14 Aug 2021 at 13:18

Hi, thanks Barry.

Yes, looks fairly new . Phillips Elektra?

Plus the 360 degree rotation.. .

I'm still ploughing thru journals ..ignoring ones that are old! IMRT does seem to have a few advantages over proton therapy (apart from the £30k+).

I'll keep reading...

User
Posted 14 Aug 2021 at 16:36

Barry, yes I was treated with RapidArc, or to use the generic name, Image Guided VMAT. All of Mount Vernon's 9 machines in 2019 when I was treated were Varian RapidArc, the oldest being 2009, although that one has been replaced since then. Since I was treated, high definition RapidArc has appeared, with (I think) higher resolution multi-leaf collimators (which do the beam shaping).

There's been astonishing progress in external beam [photon] radiotherapy, because Varian and Elektra are continually trying to leap-frog each other.

And I haven't even mentioned MR-LINACs yet, which are now appearing. (They are combined LINACs and MRI machines, and use real time MRI to do the imaging).

User
Posted 15 Aug 2021 at 00:58
Are all 9 RapidArc at Mount Vernon or some, (or all) at Paul Strickland Centre which is on the Mount Vernon site? I had my PSMA scan at Paul Strickland although it was interpreted by a radiology doctor at Mount Vernon hospital., It would seem that despite the rather motley appearance of some of the buildings, this belies the good reputation the hospital has. Incidentally, a prior Choline scan led my consultant to believe I had cancer in an iliac node whereas the PSMA scan together with careful comparison of size and shape of the node from previous MRI's, suggested it was not affected. Had it been I would not be offered another HIFU which is now scheduled for later this month. So, as in a number of cases, the PSMA has led to a change in treatment from systemic to specific, the seen cancer being within my Prostate.

I haven't heard of the combined MRI and treatment linac being available in the UK, although it was referred to on this forum quite some time ago, probably in use in the USA. I know they administer one of the forms of FLA there whilst the patient is in the scanner which they describe as 'in bore', so another form of treatment used in conjunction with MRI. As I said in another post, introducing advanced equipment and means of treating Cancer in the UK, sometimes lag behind the USA and some other European Countries.

Barry
User
Posted 15 Aug 2021 at 08:33

Hi.

Thanks Barry

I don't think there are any MRI linac treatments available for NHS patients yet....Genesis and Rutherford operate sone in Windsor and Liverpool but you have to pay and it's anything from £25-40k

Being scanned, as-you-go, seems ideal, with mS adjustments if anything moves.

The kit in Swansea seems pretty good.

 

User
Posted 15 Aug 2021 at 14:10
MR LINAC is available to NHS patients at a few hospitals now, although possibly only as part of a trial like PRISM. St James's Leeds has had MR LINAC since 2017; I think Royal Marsden had their first one installed even earlier.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 16 Aug 2021 at 21:07

Originally Posted by: Online Community Member
Are all 9 RapidArc at Mount Vernon or some, (or all) at Paul Strickland Centre which is on the Mount Vernon site?

Paul Strickland is just the scanner centre - they do CT, PET, MRI scanning (and maybe stuff I don't know about too). They can do Nuclear bone scans, but MVCC usually requests full body MRI scans or PET scans instead which they regard as better. They only do Nuclear bone scans when it's required as part of a multi-site trial protocol.

The LINACs are all part of the Mount Vernon Cancer Centre - also on the Mount Vernon Hospital site, but separate organisations. The Mount Vernon Cancer Centre and Paul Strickland Scanner Centre work closely together, although the Mount Vernon Cancer Centre also has its own MRI and CT scanners for RT planning.

Planning is underway to move the MVCC to a new purpose built building at the new Watford General, with the LINACS being dispersed more across the catchment area, probably a couple of new ones at Luton or Stevenage, one (the newest) staying on the existing Mount Vernon Hospital site, and new ones at Watford, including an MR-LINAC, and the Cyberknife and brachytherapy suites which are MVCC specialities. Splitting up the LINACS is because of the excess travel times from patients further from Mount Vernon, but they will all be run from MVCC on site at Watford General. Provision will be made for the Scanner Centre to move to Watford too, but Paul Strickland is a separate charity so it will be up to them if they want to. If not, a new scanning facility will be needed colocated with MVCC. MVCC on its new site will also take on specialist blood cancer treatments, which is something it doesn't currently do but will be able to once it's on a site with acute (A&E) facilities.

User
Posted 16 Aug 2021 at 23:40
Thanks Andy, very interesting. I only saw the part of the Paul Strickland centre that did the PSMA scan. It was on a weekend, the car parks were almost empty and there was hardly anybody about. Even the the Paul Strickland Centre was locked up when I arrived. Let's hope more benefit overall from the proposed changes. I haven't seen anybody post about being treated in the UK on the MR-Linac but I suppose it's a relatively small number and only a slight chance that a man would also be a member on this forum.
Barry
User
Posted 17 Aug 2021 at 03:02

I wonder why Britain, the fifth (or sixth?) richest country in the world has inferior proton beam capability to the formerly communist countries Poland and Czechia?

One might also question why our ‘world-beating’ NHS has less doctors, CT and MRI scanners per head of population than most Western nations.

Get rid of all the clip-board wielding pen-pushers on £160 grand salaries (never to be seen at weekends), and put someone from Tesco in charge of the whole bloody NHS, and remove it from political control.

Cheers, John.

Edited by member 18 Aug 2021 at 04:01  | Reason: Not specified

User
Posted 17 Aug 2021 at 08:21

Yes, it's pretty new stuff...readily available with private health... Genesis and Rutherford, Royal Marsden?

Hopefully it will filter down.

The kit at Singleton looks good...I'll probably stick with them....I'm still waiting for the PSMA PET scan...nearly 7 months on now...still, at least the last 2 scans were negative! And once on the HT, they like to wait a couple of months for the cancer to shrink.....but why 3 years in HT? 

 

User
Posted 17 Aug 2021 at 09:50

Only Rutherford and The Christie have proton beam in the UK, that I know of, and UCLH is building one.

They sprung up in countries with large private healthcare, with the expectation of treating prostate and other high volume cancers profitably. They have failed to complete any randomised trials to show they perform better than photons for prostate cancer. NHS did some retrospective data research around 2016, and found they weren't performing better than photons for prostate cancer. Indeed, bowel issues even showed up slightly worse (but not statistically significant). Now that urologists are getting to see proton treated prostates in salvage prostatectomies, they're reporting significantly worse neigbouring organ damage than with modern photons.

There are some things for which protons are ideally suited, but the high volume profitable radical prostate treatments probably aren't their sweetspot. Quite a number of proton facilities in the US have been closing down, not considering it worth replacing machines at end of life.

User
Posted 17 Aug 2021 at 11:15
The only decent size data review I have seen found that proton beam was not reliable as a radical treatment for prostate cancer (partly because prostate cancer is a dispersed collection of cells rather than a distinct lump) but performed slightly better as a salvage treatment. What proton beam therapy is brilliant for is the hard to reach tangible masses such as ocular, head / neck or brain tumours, or for childhood cancers where it can be almost impossible to keep a small child still for a length of time without putting them in a fixed shell. The NHS proton facilities are quite rightly prioritised to patients who will benefit most.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 18 Aug 2021 at 15:03

Yes, when radiating the head you are not going to get the movement that can and often does happen with Prostates. So if the position of the Prostate changes or the physicians/mathematicians who calculate the disposition of the Proton unload according to the Bragg Peak relative to the tumour miscalculate slightly, instead of all heavy damage being caused to the tumour, some can cause severe collateral damage to other organs.  This could explain why in some cases side effects have been more pronounced with proton beam.  I know this was a particular concern when I had my Hadron treatment in Germany.  I had an MRI and 5 CT scans as part of a week of a setting up process prior to 6 fractions of carbon ion treatment, which has a much greater RBE than even Protons.  Furthermore, I was bolted into an individually formed body restraint from head to my knees that was bonded to a board which in turn was screwed to the linac platform for each image guided fraction.  (The opportunity was also taken to use this for for my EBRT too, which was not much welcomed by those who administered the IMRT as in addition to having to secure me in my fiberglass body suite with plastic bolts, they had to bolt my wooden frame to the linac platform and remove it for the next patient each time). So in addition to to having to do this for 30 fractions of IMRT, they did this for additional CT scans between some fractions too.

Barry
User
Posted 18 Aug 2021 at 16:53

There are probably several reasons for this John.  The cost of labour is a lot lower in these former communist countries and as well as treating their own people, these facilities serve as magnets to attract people from abroad due to relatively lower cost of treatment.  Also, this is helped to some extent by location, being in a large block and where the cost of accommodation is not exorbitant. Actually, the same has happened with dentistry.  A number of these countries, of which Hungary and Czechoslovakia and to lesser degree Poland have also become successful in Dentistry and in particular dental implants which are a lot cheaper than in many other countries.  So the question really is why in terms of equipment we lag behind countries like, Germany, France, Italy, The Netherlands and a few others.  I have to say here that I think most people understandably prefer to have treatment at no cost at the point of need or having paid contributions for the NHS want to then pay additional treatment costs for private treatment.  Furthermore, private treatment has not developed for many years to compete with the NHS on a sufficiently wide basis.  It still can't do all the NHS can on a wider front so sometimes patients have to be treated at NHS facilities regardless of means or insurance cover.  Then the NHS doesn't have the means or skill base to cover for all basic treatment adequately or at reasonable cost, the reason why I had most of my dental implants in Hungary.  The idea that the NHS was filled with unproductive pen pushers was suggested recently on a car forum I am on.  Figures were produced to show that other leading European Countries spend more per capita on health than the UK and that productivity actually increased with more managers. With few exceptions, You can get almost any treatment you want in the UK now as long as you or your insurers are prepared to pay for it and accept that some of it might be in a hospital that is generally a NHS one. 

Barry
 
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