The Pros and Cons of Proton Therapy | Mark Scholz, MD | PCRI

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There are two different types of particles--photon and proton--that are commonly used delivered to deliver beam radiation therapy for prostate cancer to a patient. Photon is the most common of the two and is usually just called "IMRT," "SBRT," or some brand name. Proton therapy is more niche and expensive, but its proponents tout that since protons do not go past the tumor as with photon therapy, there is less radiation spillover, and hypothetically, fewer side effects. However, experiences in the clinical setting have shown that there is not a significant difference between the two forms of radiation and that the quality of the institution, the physicians, and the supporting staff may have more impact.
0:09 Is proton therapy a good treatment for prostate cancer?
1:52 How do the cure rates of proton therapy compare to the IMRT and SBRT radiation available using photons?
2:42 Can you use proton therapy to deliver focal radiation?
3:10 What are the side effects of proton therapy?
4:17 What should the PSA look like immediately after proton therapy and two years out?
5:30 Can you treat the seminal vesicles and lymph nodes with proton therapy?
6:04 For which stages of prostate cancer would proton therapy be appropriate?
6:38 Could proton therapy be used to treat oligometastatic disease?
7:04 Are balloons still inserted into the rectum during radiation?
8:26 Where can a person get proton therapy?
8:58 What factors should a patient consider when selecting a center for proton therapy or any other type of radiation?
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[@williamfeldner9356]

I had Proton Therapy at Mayo in Rochester, MN. Very happy with the results. No noticeable side effects at this point 2 years after treatment…….

[@JovinMyHeart4Eva]

May I ask what stage & what type of cancer you had before treated with Proton Therapy?

[@williamfeldner9356]

@@JovinMyHeart4Eva Gleeson ( 4 plus 3 ) equals 7, stage 1 no spread beyond the capsule………

[@Nooby427]

My brother is doing the same in Rochester too for a huge brain tumor that was removed by surgery.

[@perryc6053]

I had stage 3 gleason 3+4's (7) and 1 4+3(7) at the threshold of entering seminal vesticles

[@user-yi2pi1uf1z]

Six months after Proton Beam therapy with SpaceOAR my PSA went below 0.006, which is the sensitivity limit of the test, and stayed there. My oncologist was surprised it went so low.

[@iamric23]

Again, so awesome to have this as a quick and precise form of resource. We don't ask to be born, but once we get here, I feel it is everyone's obligation to help others with their own specialties. You two are doing this every time you sit down and have these conversations, and it is helping so many people, so thank you.

[@dlphcoracl9645]

The PCRI series with Mark Scholz MD are uniformly excellent. His information is current and state-of-the-art, he gives his opinions and recommendations very clearly and precisely without equivocating and has an uncanny knack of anticipating the questions a viewer will want answered.

[@tonifanum6234]

My husband had proton at the Mayo in Scottsdale Arizona. They did the gel an the balloon. Very happy with the outcome

[@raymondowens4685]

Okay

[@derekheuring2984]

A very good friend of mine had the same treatment there. Two years later he's cancer free and doing well .

[@LindaMadeline]

Toni Fanum I'm so glad that your husband is doing so well! My husband was diagnosed with 2 of 16 core biopsies, Gleason 3 + 4 grade 2 and Gleason 4 + 3 grade 3, respectively. We see the surgeon who did the biopsy and a rad. onc on 3/6 & 3/8. The surgeon already told us that he needs either surgery or radiation. (at UPenn). My questions are: Do some patients need HRT and Lupron after PBT? Is the gel the same as Space Oar and what is the balloon? Thank you for your help in advance.

[@annietruong3104]

Can I ask which doctor did the proton for you in Mayo in Scottsdale?

[@alanaldpal950]

@@LindaMadeline SpaceOar is an injected (procedure) and the first or most common “gel” that is used to put a temporary “spacer” between the rectal wall and the prostate and reduces the exposure and damage to the rectum. The balloon is separate and is used to protect the bladder. It is inserted (and removed) in the rectum for each radiation visit. Inflating the balloon pushes the bladder away. It is not painful but is a little uncomfortable and not fun that it has to be inserted before each proton treatment.

[@TechnoyGuide]

Thanks pcri for information about prostate cancer. My father is on abiraterone+ Prednisone scene december 2020. Psa decreased 144+ to 1.9

[@garywebb7481]

I had Proton treatment back in 2011 at the Proton center in Burlington, Indiana at the University of Indiana for prostrate cancer and have been cancer free ever since. PSA did slowly decreased to around .25. No major side effects. I’m glad I chose Proton over surgery , two of my friends died from prostrate surgery. I have tried to be a good champion of proton treatment ever since.

[@dmcarden]

wow, so sorry to hear about your friends, must admit the surgical approach always scared me. Question: since you did it since 2011, any ED impact?

[@derekheuring2984]

I have an appointment at the Texas Center for Proton Therapy in two days with Dr. Lee. I have been diagnosed high risk (4 + 4) but my tumor(s) are non-palpable which is good news I'm told. I have several questions I now know to ask thanks to this video.

[@murrayherron3893]

Hey Derek, I was just about to share this video with you. Good job on the research. MLH

[@alshunneson]

Derek, I'm just getting started with TCP and Dr. Lee: Sent in some records, etc... How'd your treatment go, and any side effects? Thanks!

[@barrie888]

very high quality content , tks

[@queencat4877]

My mom was diagnosed with squamous cell sarcoma in her left sinus, around her orbital nerve and to the base of her brain. She beat the cancer. Had 35 treatments of Proton therapy and it is eventually what hurt her in the end. She passed away in March. -her throat was so weak from the radiation she couldn’t cough, swallow, talk, hear. She was supossed ti be getting better. Life is cruel

[@roseivory8496]

I'm sorry to hear about your Mom. Please accept my deepest condolences. I recently lost someone very close to me from cancer as well and I'm trying to deal with the grief by finding out as much as I can about treatment options. May I ask you a question about your Mom's cancer journey? Thank you in advance for taking the time to read my comment. I wish you all the best during this most difficult time.

[@Thedirtylittlesecret]

My condolences 💐.

[@vmtz2001]

So sorry for your loss. I thought proton therapy only affects the tumor itself.

[@antoniodelrey164]

So sorry for your loss…

[@joesimons7387]

I had Proton therapy in 2015 at the University of Washington. I had some side effects but at 73 I noticed ED (2023) but that it may be the aging process. I am not married so not problematic.

[@ikeferber7685]

This question is about the role of PSA in Active Surveillance. If one is on AS for a few years and multiple MRIs and biopsies indicate stable low risk (3+3) disease including low risk Decipher Score. The only negative seems to be an increasing PSA, at about 0.8 per year. Is there a PSA level or PSA density that would indicate consideration of radiotherapy.

[@lilialantto57]

Mayo Clinic in Rochester has the has a great procedure for Separator better that isn’t the balloon, its place once instead the ballon is “inflated” each procedure.

[@salsamink]

Thanks for info.

[@Barock-mt8bc]

I am watching you from Europe and am pretty happy to check out that you, in America, have developed a superior technology of choice which is smarter and more selective with the cells. Thank You. Proton Therapy might be a better treatment than conventional radiation one 🌿

[@enisar61]

Could you make a video about gama knife therapy in prostate cancer? Thanks for all videos.You are giving very useful information about prostate cancer

[@miab6045]

Good informative videos. Thank you.

[@rafaeltovar4383]

It will be nice to know how long takes for the treatment

[@richhahn2443]

The number of treatments and time period would be helpful.

[@danieldodson5071]

It can depend. My proton therapy was 28 daily treatments. They can also due 5 high dose treatments. Some machines may require 38 or 44 treatments. It depends on the diagnosis, type of machine, amount of radiation needed, etc.

[@1958zed]

Can proton therapy be used in a post-surgery salvage setting?

[@patpegasus]

Yes I will do that in january, from France Regards

[@sandraredmond4812]

What do you know about nano knife?

[@pierreturner8122]

Can proton be used with enlarged prostates?

[@RH-xd3nx]

Does proton work for biochemical recurrence?

[@PendeltonWhiskey]

I was treated for prostate cancer at the Seattle Proton Center. Prior to Proton Radiation treatment: PSA = 12.35 After Proton Beam Radiation Treatment Jan 26, 2021 blood draw: PSA = 0.21 May 6, 2021 blood draw: PSA = 0.1 Aug 05, 2021 blood draw: PSA = 0.07 Jan 19, 2022 blood draw: PSA = 0.04 Aug 24, 2022 blood draw: PSA = 0.02 Aug 30, 2023 blood draw: PSA = 0.04 I'm absolutely thrilled with the results and lack of complications. No incontinence, no impotence. I tell everyone I can that getting regular PSA counts saved me. My father and grandfather both died of prostate cancer so even though I was being told that (the belief at that time) there was no genetic component I didn't believe it and expected to get prostate cancer. DO NOT expect your doctor to pay close attention to your PSA counts. If you can't easily recite your most recent PSA count when asked, you're not doing it right. It had only been about a year since I'd had one but I had a feeling that I needed a PSA count and requested one done. It was just over 6 and that set the ball in motion. When I had the biopsy done a short time later it was 12.35. Once it got to 6 it had been skyrocketing. I'm convinced that because I felt that prostate cancer was inevitable for me and that I needed to be vigilant and get regular PSA counts done I saved myself and I wish the same for you. Good luck!

[@khcopter]

I have had proton therapy two months ago. I finished 38 sessions for prostate. My big problem is fatigue. It’s been two months since the last session and I get better start feeling good and then I get real tired. When will that end?

[@timman3351]

you seem like an old person with a kind soul who would trust other people but this person seems like a scammer. He said the reason he believes his method is good as the other methods is because he said so. In modern day that is not good enough. You must be credible and have papers published why its you and why you should give him your money. Lots of things are fake on the internet.

[@jonah3359]

im still experiecing low energy,fatigue 1 and half years later,although cancer treated successfullly.

[@vmtz2001]

@@timman3351proton therapy is an accepted and established therapy that’s FDA approved. What makes you think there is no science behind this.

[@PendeltonWhiskey]

@@vmtz2001 that was a troll

[@PendeltonWhiskey]

those affects are probably caused by the hormone treatments you got and should wear off, I think within six months

[@richardamedome609]

If after three years of receiving the radiation therapy and are receiving the Lupron Depot injection which gives a PSA reading of 0.1 for the 3 years but then the PSA begins to rise will the oncologist recommend another radiation therapy.?

[@joemaxwell1044]

Just wondering if you found an answer. My thoughts would be to try another drug instead of Lupron

[@richardamedome609]

@@joemaxwell1044 Thanks.

[@sivakumarachanta]

Hi. I am a 64 year old diagnosed with prostate cancer with Gleason score from 6 to 8. I underwent 25 sessions of Proton beam therapy, over 5 weeks @ APCC Chennai with rectal balloon insertion to create space between rectal wall and prostate. But after completion IMPBT, last week- , my rectal column feels inflamed with constant urge to pass stools. In addition the frequent urge to pass urine( no incontinence yet). When can I expect these symptoms to subside/ wear off ?

[@Energyequalsmc2]

What medications, if any, are you taking to alleviate these symptoms?

[@sivakumarachanta]

@@Energyequalsmc2 Urispas 200 mg twice day. Symptoms subsided after 6 weeks from end of proton therapy. Concurrently I am on Lupron depot injections once in 3 months( started off in july2022, ), 6 injection in 18 mths( last one due in Oct 2023)!

[@sivakumarachanta]

@@Energyequalsmc2 Tk u. I do weight training 3 times a week and cycling 30 kms once a week.

[@notofthisworld5998]

Focal surgery would be HIFU and cryoablation

[@rafaeltovar4383]

I don’t understand your comment

[@asianguy6174]

Photon rays go right through the body. Photon rays are limited to the tumor.

[@vmtz2001]

I believe you meant the proton therapies are limited to the tumor

[@johnolenczak1552]

Spaceoar May cause painful adhesions, Barigel I believe doesn’t cause this

[@PendeltonWhiskey]

Spaceoar didn't bother me but my understanding is that it eventually is absorbed by the body. Am I right?

[@larrythompson4911]

What r some treatments for ED after radiation.

[@ThePCRI]

We have this video (and some others) on treating ED after prostate cancer treatments: kzbin.info/www/bejne/nGW4g3ake816oMk You are also welcome to contact our free helpline at pcri.org/helpline.

[@gordonculp3646]

If proton beams are hitting less healthy tissue than photon that's a good thing to me. Radiation of any kind has been described as inflammatory to the body for decades so why splash photon beams onto the bladder, rectum, pelvic bones, etc.? The main question I have is why comparative studies have not been done. Sounds like a turf battle between photon and proton specialists. THAT is not doing any good for patients.

[@funnycatvideos5490]

it's all about money they're not trying to cure anything. do you really think they want a cure for something that is making billions of dollars?

[@johnmchale8308]

@@funnycatvideos5490 as much as I want to believe that common decency and fate would dictate to find a cure because it will hit home sooner or later.......

[@Zakariah1971]

Proton induced apoptosis

[@billking2314]

Resulting ED. What are the recomenged treatment options to treat ED after prostrate radiation treatment??

[@ANG53066]

Can proton therapy cure brainstem glioma

[@koof1776]

No but Fenbendazole can. Google "Joe Tippens" story pls~

[@billychi6961]

There is no scattered x rays with proton therapy. You can probably be in the room and suffer no increase radiation dosage in proton therapy room assuming you stay out of the beam

[@jfool3852]

Hi Billy. This is not true. Proton therapy will have secondary proton and neutron radiation from protons colliding with other atoms and scatter (including any air gap from the exit of the vacuum beam pipe to the target). This is why a patient must be searched alone in the treatment area. And thick concrete walls, floor and ceiling are all surrounding the room as this is good material for shielding neutron radiation

[@vmtz2001]

@@jfool3852you’re not getting this confused with photon therapy? My understanding is that the radiation quickly leaves the body

[@perryc6053]

I completed my Proton therapy 1 year 9 month ago. I had 0 side effects. This Dr. Like many is spouting old info. The major studies he says haven't been done were completed in june 2023 You should look up what Federal Judge Scalera was quoted saying about Proton therapy.

[@dmcarden]

I believe for radiation it may take a few years for ED to set in (vs. immediately with surgery)

[@tomslick2058]

Who the frick cares about ED your older usually. when you live longer without side effects.

[@PendeltonWhiskey]

I was 65 when I had Proton therapy and ED was the least of my worries. What I didn't want to have was incontinence and thanks to Proton beam I don't have that. I don't have ED either.

[@rudolfschmidt942]

I want to know where Dr. Scholz buys his ties.