Posted: January 1, 2013

The article from the Journal of the National Cancer Institute which created the recent stir about proton-beam therapy in prostate cancer has finally been published in print and is available.  You can view the abstract; the full article is by subscription only.  Basically what the article says is that despite a doubling in expense for the new treatment, toxicity at one year is about the same.  Shorter-term toxicity may be slightly better with protons.   It is too early to say whether proton therapy offers a higher chance of cure, because the treated patients will need to be followed for 10-15 years for a reasonable analysis to take place.   Tale home message is that this is a technology in search of a purpose.  Don’t be fooled by the hype.  Protons may turn out to be slightly better but right now the economics is driving the marketing.

Update in 2020: the above post was written in 2013.  Since then it has become clearer that proton therapy does not contribute to a better outcome in terms of survival from cancer.  A surprising result came from Japan where they use Carbon Ion therapy, similar to Proton Beam therapy but even more potent.  They found a lower incidence of second cancers compared to traditional external beam radiation, and, very surprisingly, compared to radical surgery.  An abstract of the article can be found here.  Dr. Stark can provide the entire article if you fill out the form on this page and ask him.   Those cancers in the bladder and rectum are especially difficult to treat after the prostate has been irradiated. Interestingly, cancers that were not in the radiation field, specifically stomach and lung, were most reducted.  Rectum and bladder were next.  Dr. Stark was a skeptic in 2013; his skepticism about the efficacy was borne out, but a surprising benefit has emerged nonetheless.  The final chapter on this has not been written, nor has a comparable study been done using proton beam instead of carbon ion therapy.