Radio therapy rethink

https://www.theguardian.com/society/2023/sep/30/radiotherapy-doses-for-prostate-cancer-could-be-cut-by-three-quarters-trial-finds

Article in Guardian.

also need for patient to attend less often.  If results are proven why not? It's not that long ago that 37 fractions moved toward 20 following the CHHiP Trial  which was also led by The Royal Marsden.

I was told they were experimenting in Japan using 5 fractions for Proton Beam Therapy a long time ago but there is a dearth of follow up information.

I may be in line for ht/rt soon so this looks like a massive improvement from my anticipated 6 weeks of rt and years of ht

There's always been a dearth of information on the benefits of proton beam for prostate cancer. The NHS did a review in 2016 from what information it could find around the world, and found the long term side effects (particularly rectal issues) were slightly worse than with then current standard (photon/X-ray) external beam treatment.

The reports from the US proton centres all compare their (then) current proton beam with obsolete standard external beam treatment, not image guided, to show how much better they are. I rather doubt the US was so far behind us they were still using non-image guided treatment - rather the benefits in the reports were due to non-image-guided versus image guided, and not photons versus protons.

There was also an interesting twitter thread where several salvage prostatectomy surgeons were discussing why patients who had proton beam treatment had so much more fibrosis and damage to surrounding organs than the those who'd had conventional (photon/X-ray) external beam treatment.

Finally, we had a talk from an oncologist in a local support group who had been sending some of his private patients to have proton beam therapy, but had stopped doing this. He was a bit hazy as to why, but the results were not as good as standard IG-VMAT (conventional image guided photon/X-ray external beam) treatment.

I have seen reports that many prostate photon treatment centres in the US which have reached their EoL are not being replaced.

Edited by member 30 Sep 2023 at 18:56  | Reason: Not specified

Taken at face value it tips the scales strongly to RT.  Although how many hospitals have the equipment and would PCa centres be set up at those with it. 

What is medium risk - I was medium upgraded to high after the op due to Gleason being higher.

Why no hormones? We're led to believe they're the final blow.

Salvage RT is mentioned above. You might think if a psma scan determined a single area this could be used if no other tissue is adversely affected.

5yrs results aren't conclusive but for older people at least it appears a good start.  With hormones or even a slightly increased number of treatments it can cover other cases.

This seems a great finding and just the start, it will be interesting to see how NICE administer it.

Edited by member 30 Sep 2023 at 22:43  | Reason: Not specified

Franci, I only saw the interview on the BBC Saturday morning, I am pretty confident the oncologist said no HT.  

Thanks Chris 

Edited by member 01 Oct 2023 at 10:18  | Reason: Changed this too Saturday,I didn't realise it was past midnight