Proton Therapy for Prostate Cancer

Proton therapy is a precise treatment for prostate and other cancers that delivers high doses of radiation directly to targeted areas. In prostate cancer patients, proton therapy targets the prostate gland and also the pelvic lymph nodes. At Texas Center for Proton Therapy, our radiation oncologists and their teams use images from the patient’s dedicated treatment planning computed tomography (CT) and sometimes magnetic resonance imaging (MRI) to direct proton beams at the targeted region. The unique physical properties of proton treatment minimizes exposure to healthy, normal tissues.

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Benefits of Proton Therapy for Prostate Cancer

Proton therapy can treat tumors in sensitive areas of the body. The treatment’s accuracy works to eliminate cancer cells while minimizing exposure to non-targeted, healthy tissue near the prostate. As a result, men get the benefit of extremely precise targeting with a lower risk for potential side effects.

Notable benefits of proton treatment for prostate cancer:
  • The high-energy, precisely-targeted proton beams can deliver high doses of radiation to destroy cancerous cells, reducing recurrence rates for many cancer cases.
  • Proton therapy is non-invasive and may result in fewer side effects than some other treatments, including impotence, incontinence, and rectal/bowel side effects.
  • Patients can maintain their current quality of life during and after treatment.
  • It is sometimes used to treat areas that are near previously irradiated regions.
  • Compared to intensity-modulated radiation therapy (IMRT) proton therapy patients are exposed to less overall radiation, roughly the equivalent of 20,000 pelvic X-rays.
  • Texas Center for Proton Therapy offers imaging with a 3 Tesla MRI to help most appropriately stage prostate cancer patients.
Choosing Proton Therapy for Prostate Cancer

Choosing Proton Therapy for Prostate Cancer

Survivor Ed Stewart explains why he chose Texas Center for Proton Therapy to treat his prostate cancer.

Pencil-Beam Scanning Overview

Pencil-Beam Scanning Overview

Dr. Andrew Lee, the first physician to use pencil-beam scanning in North America, explains this type of proton therapy treatment.

Pencil-Beam Scanning

Unlike some proton therapy centers, all prostate cancer patients at Texas Center for Proton Therapy receive the benefit of pencil-beam proton therapy. Pencil-beam scanning is ideal for patients with tumors in sensitive areas, such as prostate cancer, because it uses an ultra-fine proton beam with pencil-point precision to delicately apply the radiation to the targeted areas.

Proton Therapy Candidates

Treatment for prostate cancer varies by patient and may depend on how advanced the cancer is and whether it has spread to other parts of the body. In many cases, proton treatment is an ideal option for many prostate cancer patients. Proton therapy can also treat prostate cancer in more extensive targets, such as the pelvic lymph nodes, while minimizing exposure to the bladder and bowel. Texas Center for Proton Therapy also uses protons to treat patients that may need radiation after radical prostatectomy. Patients who receive proton therapy for prostate cancer may also experience fewer side effects than those receiving standard radiation therapy.

Proton Therapy

Conventional X-Ray Therapy

Red: High Radiation Dose
Green: Intermediate Radiation Dose
Blue: Low Radiation Dose

Prostate Cancer

Most prostate cancer begins in the gland cells in the prostate. Known as a silent killer because men often do not have symptoms in early stages, prostate cancer is the most common form of cancer other than skin cancer among men in the United States and is the second leading cause of cancer deaths among men. If prostate cancer is detected early and before the cancer spreads, patients have a nearly 100 percent chance of survival after five years. Survival rates for all stages of prostate cancer have increased since the 1990s, but stabilized in recent years.

Prostate Cancer Statistics

  • One in eight men will be diagnosed with prostate cancer in his lifetime.
  • One in 41 men will die from the disease, making it the second most common cause of cancer death in men.
  • In 2020, 248,530 new cases of prostate cancer will be diagnosed in the United States, with 34,130 deaths.
  • In Texas, an estimated 15,459 new cases of prostate cancer will be diagnosed in 2021, and 2,215 men will die from the disease.

Prostate Cancer Risk Factors

Cancer affects men in all walks of life and doesn’t discriminate by age. Some factors may increase cancer risk.

  • Age: Men age 65 and older account for about 60 percent of all prostate cancer cases diagnosed. The likelihood of developing prostate cancer increases after age 50.
  • Family History: Men with close relatives (father or brother) who have had prostate cancer are more than twice as likely to develop the disease.
  • Race: U.S. and Caribbean Black men have the highest prostate cancer incidence rate worldwide. Black men have a 60 percent higher rate of prostate cancer in the United States than Caucasians, for reasons that are unclear.
  • Genetic Factors: A gene mutation on BRCA-1 or BRCA-2 or having Lynch syndrome may denote an increased risk, but it is only a small percentage of cases.
  • Diet: Men who consume high amounts of high-fat foods, dairy products, and few fruits and vegetables have a higher risk of prostate cancer.

Prostate Cancer Symptoms and Signs

The following may be symptoms of prostate cancer but could be linked to other health conditions. If these symptoms are present, men are encouraged to consult their physician for proper testing:

  • Weak or interrupted urine flow
  • Sudden urge to urinate
  • Difficulty controlling urination 
  • Painful or burning urination
  • Blood in urine or semen 
  • Pain or pressure in rectum
  • Frequent pain or stiffness in spine, pelvis, hips, ribs, thighs, or other bones
  • Painful ejaculation
  • Decrease in amount of fluid ejaculated
  • Frequent urination, especially at night
  • Difficulty having an erection
  • Difficulty fully emptying bladder
  • Weakness or numbness in legs or feet
  • Anemia

Prostate Cancer Stages

Tests to diagnose and stage prostate cancer may include a prostate-specific antigen (PSA) blood test or digital rectal exam (DRE), and biopsy.
  • Stage I: The cancer is confined to a limited area of the prostate.
  • Stage II: The cancer is still confined to the prostate but is slightly more advanced.
  • Stage III: The cancer has spread to tissue surrounding the prostate; may include seminal vesicles.
  • Stage IV: The cancer involves organs outside of the prostate, including the lymph nodes.
  • Recurrent/Relapsed: The cancer has returned (recurred/relapsed) following treatment.

Prostate Cancer Screening

Men should discuss with their physicians the risks and benefits of prostate cancer screening to make an informed decision about testing. Most men should consider regular prostate screenings beginning at age 50. Men at high risk (African Americans and men whose father, brother, or son was diagnosed with prostate cancer before age 65) should consider testing beginning at age 45. Consider screening at age 40 if more than one first-degree relative was diagnosed at an early age. Prostate screenings can include the PSA (prostate-specific antigen) blood test and DRE (digital rectal exam).

Texas Center for Proton Therapy now offers a new, FDA approved test to screen for prostate cancer – including metastatic or recurrent forms of the disease, which may be difficult to detect with a conventional CT scan, MRI, or bone scan. This new testing option, called piflufolastat F18 or PSMA PET, is the newest FDA-approved imaging agent for detecting prostate cancer via PET scan. The imaging agent helps detect and stage prostate cancer by attaching itself to prostate-specific membrane antigens, which are highly expressed in prostate cancer cells.

Prostate Cancer Treatment

Prostate cancer may be treated by different members of the cancer care team. Treatment options vary depending on how advanced the cancer is and if it has spread to other body parts. Physicians will determine the most appropriate treatment for each patient, including surveillance, surgery, radiation therapy, proton therapy, hormone therapy, chemotherapy, vaccine treatment, bone-directed treatment, immunotherapy, and cryotherapy.

Axumin® Imaging 

Some men will have persistent or recurrent disease after their initial therapy, such as surgery and radiation. In these cases, early detection can optimize further treatment and help identify those who have the best opportunity for care. 

Texas Center for Proton Therapy offers Axumin® imaging in combination with scans, such as position emission tomography (PET) imaging, for prostate cancer detection in patients with recurrent or persistent prostate cancer after initial treatment. 

What Men Should Know About Prostate Cancer

What Men Should Know About Prostate Cancer

Dr. Andrew Lee, medical director at Texas Center for Proton Therapy, answers commonly asked questions about prostate cancer screening, diagnosis and treatment.

Twin Brothers Both Choose Proton Therapy for Cancer Diagnoses

Twin Brothers Both Choose Proton Therapy for Cancer Diagnoses

After serving in Vietnam, the Horton brothers found themselves both facing a prostate cancer diagnosis, but several years apart. The two men both chose proton therapy as their treatment option, but in different states. John overviews his experience at Texas Center for Proton Therapy.

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