What to Expect from Proton Therapy for Prostate Cancer

Conventional radiation treatment is also known as photon treatment, which is different from proton therapy.

In conventional radiation treatment, high-energy X-rays are used to target and destroy cancer cells in the prostate. However, X-rays can damage healthy tissue as they pass through your body. This can lead to complications in nearby organs such as the bladder and rectum.

In proton therapy, radiation is delivered in proton beams. The key difference from X-rays is that proton beams stop once they’ve delivered their energy to the target.

By using proton therapy, doctors can target prostate cancer more precisely and at great intensity with less risk of damaging surrounding tissue.

A 2020 comparative study found that people who had proton therapy had a significantly lower risk of physical complications compared with those receiving traditional photon therapy.

Anyone who can have radiation therapy can have proton therapy. Proton therapy can be used as primary treatment for early stage prostate cancer or as part of a total treatment plan for prostate cancer. It’s also an effective treatment for people who require pelvic radiation therapy after undergoing previous therapies.

Which treatment you should have is not as simple as comparing proton therapy to chemotherapy, surgery, or hormone treatments. Each serves a specific purpose.

Your treatment will depend, in large part, on how aggressive the cancer is and its stage at diagnosis. Other things to consider are:

• previous treatments
• age
• other health conditions that might interfere with certain treatments

Proton therapy is more expensive and not widely available. Your doctor will look at the total picture when recommending treatment.

Radiation therapy

Proton therapy can be just as effective as conventional radiation therapy. One benefit is that it’s less likely to damage other organs. It also produces fewer side effects than radiation therapy, chemotherapy, or hormone therapy. Proton therapy can be used as a first-line therapy or along with other treatments.

However, research on the effectiveness of proton therapy is in its early days, and long-term data is still lacking.

Surgery

If the cancer has not spread outside the prostate, surgery is a common treatment choice. Surgeons can remove the cancerous tissue through an open incision on the abdomen or the perineum, the area between the anus and scrotum.

If possible, they may also perform a laparoscopy, a less invasive type of surgery. This procedure uses small cameras, a device called a laparoscope, and small tools to remove cancerous tissue with minimal incisions.

Normal activities can be resumed within a few weeks. Side effects can include urinary incontinence and sexual dysfunction.

Hormone therapy

Hormone therapy can reduce male hormones that fuel prostate cancer. A doctor will typically recommend this when cancer has spread outside the prostate or when prostate cancer returns after you’ve had other treatments. It’s also an option if there’s a high risk of the cancer coming back, or it can be used to shrink the tumor before radiation.

Side effects of hormone therapy include:

• sexual dysfunction
• lowered libido
• shrinkage of testicles and penis
• hot flashes
• bone thinning
• loss of muscle mass

Chemotherapy

Chemotherapy is not a standard treatment for early stage prostate cancer. However, it might be an option if the cancer has spread outside the prostate and hormone treatment is not working.

Chemotherapy is unlikely to cure prostate cancer, but it can help slow progression. Some potential side effects are:

• fatigue
• nausea
• hair loss

Proton therapy facilities are growing in number, but the treatment is still not available everywhere. Your doctor can let you know if there’s a proton treatment center near you. If there is, there are a few things to think about beforehand.

Treatment usually means going in 5 days a week for up to 8 weeks, according to Macmillan Cancer Support. This timeline is similar to conventional radiation therapy. Although the actual proton therapy treatment only takes a few minutes, you should probably block 45 minutes to an hour for the whole procedure. Radiation centers are typically able to work around your schedule.

Before you start treatment, you’ll have an initial consultation so the radiation team can make a plan for future visits. They’ll determine exactly how you’ll need to be positioned during therapy by using a series of images and other data.

Therapy may involve the use of something known as a customized immobilization device. These are casts, cradles, and other supports that keep you still during therapy. These may be made of plastic, foam, or other materials.

These devices are necessary to make sure that protons are delivered precisely to improve your outlook.

Before treatment, a doctor may insert a hydrogel spacer between the prostate and the rectum to provide another layer of protection from radiation effects.

Since delivering the protons to the cancer cells is the goal of therapy, a lot of time is spent on positioning your body and adjusting the equipment before each session.

You’ll have to remain perfectly still while the proton beam is delivered, but it will only take about 1 to 3 minutes. It’s noninvasive, and you won’t feel anything. You’ll be able to leave right away and continue your normal activities.

Pencil beam scanning is one of the most common ways to deliver proton therapy for prostate cancer. Another common method is double-scattered beam therapy.

With pencil beam scanning proton therapy, medical professionals are able to manipulate and focus the proton beams to a greater extent. This results in a more precise dose of radiation than double-scattered therapy, sparing surrounding tissue even more.

However, the difference in outcomes is minimal, according to current literature.

Side effects may include fatigue and skin redness or soreness where you had treatment. You may also have issues with incontinence or gastrointestinal side effects. Erectile dysfunction is another risk of radiation treatment.

Is proton beam therapy safer than other options?

Due to the concentrated nature of the radiation in proton therapy, there are usually fewer side effects than in conventional radiation therapy. That’s because there’s less damage to healthy tissue around the tumor.

People who have proton therapy may have a significantly lower risk of short- and long-term complications compared with people receiving traditional photon therapy, according to a research study. These findings show a two-thirds reduction of adverse events in the 90 days after treatment, as well as a significantly reduced risk of having difficulties moving and performing daily activities.

However, long-term data is lacking on the safety of proton beam therapy. Furthermore, due to the high cost of treatment, current research has been limited in terms of demographics.

If you’ve been through first-line treatment but still have cancer, your doctor will adjust your treatment accordingly.

After surgery, radiation, or chemotherapy, you may be cancer-free. However, you’ll still require monitoring for any signs of cancer recurrence. If you’ve been taking hormone therapy, you may also need to continue to do so.

Periodic prostate-specific antigen (PSA) testing can help figure out the effectiveness of hormone therapy. The pattern of PSA levels can also help monitor for recurrence.

The process of recovery is different for everyone. Much of recovery depends on the stage of diagnosis and the extent of treatment. Your age and general health also play a role. Your doctor will take all these factors into consideration to give you an idea of what to expect, including:

• the schedule for follow-up exams and tests
• how to deal with short- and long-term side effects
• diet and other lifestyle recommendations
• signs and symptoms of recurrence

Proton therapy is a newer treatment for prostate cancer with potentially fewer side effects than other treatments, but it’s more expensive and not as easily available. Ask your doctor if proton therapy is a good option for you.