Proton Therapy, IMRT, and SBRT | Mark Scholz, MD | PCRI

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Many patients have been asking about proton therapy for prostate cancer and how it compares to more popular forms of radiation like IMRT and SBRT. Medical oncologist Mark Scholz, MD argues that while the theory behind proton therapy seems appealing, in practice, its results seem to be about equivalent with those produced by IMRT and SBRT.
0:10 What is proton therapy and how does it work?
2:45 Which criteria determine if a man would qualify for focal radiation therapy?
3:36 What are the side effect profiles of proton therapy, IMRT, and SBRT?
4:20 There are sometimes delayed side effects with IMRT and SBRT. Is the same true for proton therapy?
5:38 Since proton therapy was developed before IMRT, is it outdated compared to IMRT and SBRT?
7:11 Do you know of any other centers doing proton therapy?
7:34 Do you have any tips for making sure that a radiation oncologist is experienced and proficient in delivering radiation therapy?
8:20 Can radiation cause secondary cancers several years later?
Don’t know your stage? Take the quiz: Visit www.prostatecan...
To learn more about prostate cancer visit www.pcri.org
PCRI's resident moderator, Mark Moyad, MD, MPH, sits down with urologist Steven Gange, MD, FACS, to discuss the use of Cialis to treat lower urinary tract symptoms, bladder control drugs, and the use of supplements to treat benign prostatic hyperplasia (BPH, or prostate enlargement).
Dr. Steven Gange graduated from the UCLA School of Medicine in 1986. After his Urology residency training at the University of Kentucky in 1991, he entered the US Army as an academic urologist, teaching, and training residents. He joined Western Urological Clinic (now Summit Urology Group) in Salt Lake City, UT, in 1996. With over 25 years of clinical and research experience, he has developed an expertise in Men’s Health Urology, emphasizing minimally invasive procedures. He continues to be active as a Clinical Researcher and as such was the first Urologist in North America to perform the NeoTract UroLift for BPH, and the first in the world to perform UroLift under local anesthesia.
0:06 Cialis (tadalafil) as a treatment for BPH - Cialis (tadalafil) has an indication for the treatment of both erectile dysfunction and benign prostatic hyperplasia. Some men using Cialis have noticed an improvement in urinary symptoms, but it is not well understood why. Cialis is used, as opposed to a drug like Viagra, simply because Cialis lasts longer. A downside is that Cialis is expensive and it is also less effective for BPH than the alpha-blockers and 5-alpha reductase inhibitors.
2:28 Overactive bladder drugs - It often happens that a patient who is treated for urinary obstruction from BPH will continue to experience urinary symptoms due to overactive bladder. As the bladder begins to lose function, it will sometimes become hyperactive. Overactive bladder drugs relax the bladder so that it squeezes left often. Dr. Gange is unsatisfied with the side effect profiles of every bladder control drug with the exception of Myrbetriq, a beta-3 agonist.
4:55 Prostate supplements - There are no supplements that have outperformed placebo for BPH; however, placebos have performed so well that both Dr. Moyad and Dr. Gange are open to patients cautiously using supplements if they are improving symptoms.
Don’t know your stage? Take the quiz: Visit www.prostatecan...
To learn more about prostate cancer visit www.pcri.org
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Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website or call our free helpline at 1 (800) 641-7274 with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
The information on the Prostate Cancer Research Institute's RU-vid channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
#ProstateCancer #Prostate #MarkScholzMD

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29 сен 2024

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Комментарии : 61

@teedub998 Год назад

I had Proton beam Therapy for my prostate cancer in 2019 with Dr Rossi, in La Jolla. It was a very positive experience. My numbers have been good and there has been very little or no ED problems resulting from the treatment. BTW thank you so much for your videos. I hate that I didn't discover them until after my diagnosis and treatment for PC. I really wish more information could get out to the public that surgery is probably not the best choice for most prostate cancers and there are other alternatives that are just as good or better. Like I heard you say the surgeons run the field and they barely give you other options besides surgery. In my case my urologist pooh-poohed radiation therapy and was pushing for surgery. Luckily I had done my own research. Unfortunately I think the money making aspect of surgery i.e. The more they cut the more they get paid affects their recommendations.🙄

@2Majesties 2 года назад

I'm on Eligard and will be doing HDR brachytherapy. Why do external beam radiation for 5 weeks on top of HDRBrachy? Isn't that enough radiation?

@ThePCRI 2 года назад

It depends on the individual case. If the risk of developing or having already developed metastases is relatively high, a combination of seeds, beam radiation, and ADT has been shown to have better cure rates than with just one form of radiation plus ADT. In less severe cases, delivering two forms of radiation raises the risk of side effects without providing a meaningful benefit to the cure rates. Some of our other videos, like the PCRI staging guide series on "Teal" (i.e. intermediate-risk) and "Azure" (i.e. high-risk) and our free helpline (pcri.org/helpline) can help you know which kinds of cases are sufficiently treated by one form of radiation and which ones are best treated with two forms of radiation, and then you can apply those principles to your individual case and discuss it with your doctor.

@gordonculp3646 Год назад

I was told that if you have photon for prostate you can never have radiation in the lower abdomen again if you develop another cancer in that area. Does this also hold for proton therapy. It just seems reasonable to me that the less radiation you get in the body to get the job done the better. What am I missing here?

@williamfeldner9356 2 года назад

I had Proton Therapy for Prostate Cancer (3+4) 2 years ago at Mayo Clinic in Rochester, Minnesota…… I could not be happier with the results and the standard of care at Mayo…. Wm. A. Feldner DDS

@davidfairrington706 2 года назад

William, May I ask your age and side effects for ED and continence? I’m 51 and undecided on the best treatment for me.

@williamfeldner9356 2 года назад

@@davidfairrington706 I was 65 when the cancer was found…. My PSA had been slowly rising at about .75 a year…. When it got to 4 I wanted it checked, my MD at Mayo was not that concerned but I insisted on an examination… A MRI revealed a small area of question but the Radiologist thought it was most likely normal tissue. On biopsy 14 cores, 1 was found to have cancer 3+4 = 7…. So I set out to find the best treatment with the minimal side effects…. From all my research I found proton therapy fit the criteria.. I had 5 treatments of protons in about 1.5 weeks time…. Side effects have been minimal, some radiation fatigue about 2 weeks after treatment, diminished in 3 weeks. I had 1 episode of An inflammatory urethra about 6 months after treatment treated with steroids. No urinary problems whatsoever other than discomfort when I had the inflammation. As for ED very minimal, most likely do to my advancing age…. If you are a candidate for proton therapy I would recommend it, I am very pleased with my results so far…. Best of luck to you, Wm. A. Feldner DDS

@antoniodelrey164 29 дней назад

What a great objective discussion of the various radiologies.

@dw566 2 года назад

Hi, I must complement you on your concise and informative videos. Alex seems to always ask just the most relevant and appropriate questions and Dr. Scholz's answers are direct and reflect not so much his opinion, but a through knowledge of current practice, studies and literature. My complements to both of you. I did a quick search and found very little RU-vid information on ASAP. Perhaps at some point you would consider a video addressing an ASAP pathology diagnosis, the longer term implications and progression, proper surveillance, and any other related topics. Again, great job and thank you!

@ThePCRI 2 года назад

Hello, I will add that to our list for future videos. Dr. Jonathan Epstein, probably the most renowned pathologist in in prostate cancer, mentions ASAP around 46:25 of this video in the context of active surveillance: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-9ff-94Z5Ykc.html. He argues that the presence of ASAP should have no bearing on deciding whether active surveillance is the proper course of action. The rest of the video might be helpful for you too. Take care, and feel free to contact our free helpline at pcri.org/helpline if you have any further questions.

@duaneluchsinger5736 2 года назад

Just had a PSMA pet scan. Showed 7 spots of highly active metastatic activity(3 back, 2 rib, left skull base, and 1 lymph node). Best path forward? Chemotherapy, immunotherapy, or proton beam therapy?Thanks all the very helpful info on this channel.

@ThePCRI 2 года назад

Is that castrate-resistant or castrate-sensitive? That is, were you already on hormone therapy prior to the lesions bring discovered? We have this video, our 2021 ASCO Update, that discusses the best protocol for men with newly diagnosed metastatic disease: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-57ehJkVUqMU.html. While the addition of immunotherapy could be beneficial, it is only approved for men with castrate-resistant disease. If you have further questions, feel free to contact our helpline at pcri.org/helpline.

@stevef7814 2 года назад

@@ThePCRI I don't understand the limiting of options. If not castrate resistant you must shot of your hormones and experience all the horrible side effects.

@notofthisworld5998 4 месяца назад

Its not about limiting options. It's Because the hormone treatment is more effective.

@janetstarr10 Месяц назад

Can we just stop for a moment to appreciate this guy's taste in ties? Excellent.

@j.johnson2293 Год назад

Would you get radiation if nothing showed up on The Pet Scan but your PSA is .3 after prostectamoy?

@rampar77 2 месяца назад

I had IMRT at 72. and I think it was the best treatment. Along with ADT, ED is really irrelevant for any one over 65. Energy loss and other side effects were more bothersome.

@sandraredmond4812 2 года назад

Where can we find a directory of the different types of proton beam facilities

@michaelyarmas4423 2 года назад

I have advanced PC. 6 years out of radical prostatectomy also had 7 weeks of radiation a year later. cancer is back but locally.psa 3, with doubling very three months. one iliac lymph node and thickening of bladder wall. so cancer in two places. (had pet F18 bone scan and ct) I am told I am not a candidate for more radiation My question is, can I get Brachytherapy planted in the area to knock out the cancer? currently on Hormone therapy with Eligard, Abiraterone, and prednisone. after a month and a half psa down to .6 ~ Thank you for any insight on this.

@ThePCRI 2 года назад

Hello, our free helpline might be able to provide you with some information on this. Some specialized centers, e.g. UCLA, have been doing salvage brachytherapy, but it might be hard to find unless you are willing and able to travel and I am not sure which cases are considered good candidates. You can find our contact information at PCRI.org/helpline. Has your doctor mentioned the PSMA PET scan?

@antoniodelrey164 5 месяцев назад

I thought I saw a video where the doctor was more in favor of Proton Therapy. Seems to me he changes his opinions from video to video. Same with Focal Therapy. He changed his opinion on it also…

@salsamink 2 года назад

Location radiation question? Prostate cancer that has spread to the right side of hip. Which radiation would be recommended for treatment to the hip? Would there be a risk for bowel or urinary issues due to spill over when treating the hip?

@ThePCRI 2 года назад

Hello, the patient advocate on our helpline should be able to help you with your question. You can find our contact information at pcri.org/helpline. If the radiation is well-performed, there should not be much risk of side effects if they treat an oligometastic lesion in the bone, but the patient advocate can tell you more.

@salsamink 2 года назад

@@ThePCRI Thank you so much! The helpline really took his time to answer my questions and gave me some resources.

@williamsignorile4986 Год назад

My Gleason score was 6/7 and on only one side is my cancer I am now on lupron for the next 3 months and then I will be given 5 treatments with Cyberknife I am 66 yrs young fdny My worry is that I am told since I was as sept 11, 2001 I am very worried about other cancers I feel healthy now but 20 lbs over my weight . My question is would I be at risk of long term weight gain putting me at risk of an early end thank you

@harshaparpyani3653 2 года назад

Sir, My father is on hormone therapy.. lupron with zytiga.. After 3 months of treatment his psa is 1160.

@duaneluchsinger5736 2 года назад

One more question: PNC 27 peptide treatment for advanced prostate cancer, available in Mexico. I’ve read several favorable articles on this treatment. Thoughts?

@ThePCRI 2 года назад

I can add that our list for future videos. Although it looks like there may have been some promising laboratory studies for specific situations in certain cancers, I cannot find any that were looking at prostate cancer nor am I able to find any evaluating its use in humans for any type of cancer, which is the most important type of study for determining whether a treatment is safe and effective; there are lots of substances that can kill cancer cells in a lab, but are not safe or do not produce an anti-cancer effect once they are studied in humans, and so large Phase III clinical studies are almost always required before a treatment is FDA-approved. Maybe there are some studies that I am not aware of, and so I will go ahead and add it to that list.

@BrijeshPatel-ms4vh 2 года назад

My father found single metastatic at right pubic bone region on june 2021 PSMA PET CT. After that he ungergoes SBRT immediately and two ADT at three months interval. Now recent PSA pathology reports show incrrase in PSA level 0.05 to 0.17 . Our question is if we found metastatic at same location can we go for sbrt for same place as a curity treatment? What are the alternative if we can not go for SBRT at same place again.

@ThePCRI 2 года назад

I will add this to our list of questions for future videos. To clarify, was the SBRT directed to the prostate or to the metastatic lesion?

@BrijeshPatel-ms4vh 2 года назад

@@ThePCRI Thank you for your valuable reply and support. SBRT where given at metastatic lesion.

@alexfrazer9480 2 года назад

What treatment is available for ductal prostrate cancer, Gleason 9.

@ThePCRI 2 года назад

I will add this to our list for future videos. In the meantime, feel free to contact our free helpline at pcri.org/helpline. We have patient advocates who are trained to help patients research their questions.

@dannyjohnson4871 2 года назад

@@ThePCRI I was recently diagnosed with intraductal carcinoma in three of sixteen cores (Epstein confirmed). Two of my cores were graded as Gleason 9, one 20% and one 40% (Epstein confirmed them at Grade Group 5). MRI and scans did not indicate spread beyond the prostate. My PSA was 7 at the time treatment began. I am being treated at a leading cancer treatment center. I pressed in January to have a PSMA Pet scan, but the physician skirted me over and over. Cost and lack of approval by Medicare being his answer. I really wish I had insisted on the PSMA Pet can prior to beginning treatment. I also pressed for hormone therapy, IMRT and brachytherapy. I did prevail in this area. I have been on Lupron for 4 months (12 months prescribed). I have received 15 of 22 IMRT treatments. And, I am scheduled for brachytherapy in 3 weeks. I also requested my primary care physician prescribe bicalutamide 50mg throughout my treatments. I have three questions: 1) how soon/when/or why should I have a PSMA pet scan after completing my treatments. I assume when or if the PSA begins to act up. 2) since I have intraductal carcinoma, should i be taking a second generation hormone treatment medication in addition to Lupron? 3) I am not currently under the care of an Oncologist, should I find one? Again, like the other issues, I requested access to an Oncologist, but was not heard. The response being, "What would he/she do at this point?"

@AlexHerrera-l3s Год назад

I am in the middle of trying to decide if it is time to move onward from Active Surveillance to treatment of some sort. My oncologist recommends that I should continue with Active Surveillance. Currently I have 4 cores tested for cancer. 3 cores with 3+3 and 1 core with 3+4. The 3+4 core was just recently diagnosed 4 months ago via biopsy. It has been 6 years total since I have been diagnosed with cancer all 4 cores were 3+3 until 4 months ago. With the one core that is now 3+4 I have started to consider treatment. I have also learned from a support group that I should get another another opinion, mpMRI. Currently I see my oncologist at the VA Medical Center in San Diego. I have asked if they have mpMRI but I can't get a straight answer. Do you have any insight about the VA Medical Center?

@bayougal9279 Год назад

We are in the same boat and under the care of the VA system. Do you have any answers yet?

@dlphcoracl9645 Год назад

Just tossing in my two cents, FWIW...... . You should proceed as if you have Gleason 3 + 4 and forget about the number of biopsy cores that are 3 + 3, especially since this represents a significant change from your biopsy results six years earlier. Perhaps more important, have the 3 + 4 biopsy core sent to Veracyte Labs SD in San Diego, CA 92121 for their Decipher Prostate Biopsy Genomic Classifier. This is a more sophisticated method of obtaining an expert 2nd opinion on the 3 + 4 pathology and it will determine if it is more or less aggressive than suggested by the 3 + 4 Gleason. If they report that the 3 + 4 biopsy core has genomics suggesting a more aggressive cancer, I would strongly consider some form of radiation therapy, especially proton beam therapy. The addition of ADT hormonal therapy (testerone blockade) in combination with the radiation therapy should also be discussed.

@Nick-o5f 6 месяцев назад

User-nz please check with a Loma Linda university center

@JimRedican-hx8ed 3 месяца назад

Get a Decipher test

@RH-xd3nx 2 года назад

So what are your chances of getting a secondary cancer from radiation therapy under the age 60 ?...and is it wise?

@Ponyexpress1861 2 года назад

The risk is not 0 but I understand it is very small. I had 5 sessions of SBRT radiation last September at age 64, the total dosage was 36.25 gys whereas many men have regular external beam in many more treatments often 30-40 and the end dosage is higher. Everything is essentially risk versus benefit. I decided on treatment now because of my risk factor, with a PSA over 30 and 4 cores of cancer grade 7 but one being a 4+3.

@RH-xd3nx 2 года назад

@@Ponyexpress1861 thank you for insight 🙏

@holy_trinity_GP_legends Год назад

@@Ponyexpress1861did you simultaneously have ADT? What side effects did you have through SBRT and ADT?

@stevef7814 2 года назад

Dr. Bahn told me 600% increase probability of rectal cancer and 400% increase in bladder cancer. Said he'd personally knows of many patients who experienced this.

@ThePCRI 2 года назад

I'm not sure when he said that, but most of the data that found increased risk of rectal and bladder cancer were from patients who had received conformal radiation as opposed to the precise forms of radiation that are available now. If you would like to discuss further, we have patient advocates available who can share information about it. You can find our contact information at pcri.org/helpline.

@stevef7814 2 года назад

@@ThePCRI it was 5 years ago, so cases were from 90s radiation. He said he was seeing it 15 to 20 years after radiation treatment. My father died from bladder cancer in 2011, and had radiation in 1997 for Gleason 7 that had not metastasize. Thank you for your reply.

@stevef7814 2 года назад

@@ThePCRI There are no 15-20 year stats on newer imrt/smrt/proton I assume. Not sure year of transition.

@ThePCRI 2 года назад

Different forms of IMRT were FDA cleared/approved around the year 2000, but I'm not sure when its use became widespread. There have also been a lot of refinements since then, for example, radiation oncologists, dosimetrists, etc. have gotten a lot of experience, and in 2015, "SpaceOAR" was FDA-cleared, which is a gel that separates the prostate and rectum and thus lowers the dose to the rectum. There are also possible advances on the horizon too, for example, UCLA using real-time MRI imaging during the administration of the radiation so that it can be stopped or adjusted depending on movement inside the body that previously would not have been appreciated. (It remains to be seen, however, whether it makes a difference since the amount of radiation misapplied may not have been enough to cause side effects, and so the MRI may be expensive and unnecessary.) Our patient advocate may have more recent studies on IMRT in general, but yeah, 15-20 year follow up using SpaceOAR, the latest imaging, and radiation oncologists with decades of experience on the IMRT or SBRT machines, unfortunately, are not available yet. In contrast, we have some videos with radiation oncologist Mack Roach, MD, who said that there were cases, using the old technologies in the 90s, that they would completely miss the prostate if, for example, the patient was obese. He said they only had a single slice of a CT scan printed out to figure out where to aim, and they would use crayons to map it out.

@dainiuszaldokas 2 года назад

Photon therapy has as much as a 50% chance of serious side effects while proton has only 5%. I’m speaking from personal experience

@sandraredmond4812 2 года назад

Where did you have it done? How do you know there is less side effects?

@dainiuszaldokas 2 года назад

@@sandraredmond4812 Loma linda. I did extensive research on the subject including men who had conventional radiation. I don’t have any side effects from the treatment

@sandraredmond4812 2 года назад

Do they have the intensity modulated method ? How many weeks did it take ?

@dainiuszaldokas 2 года назад

@@sandraredmond4812 can’t speak to the method. It was 12 years ago. Took 2.5 months

@sandraredmond4812 2 года назад

Would you be willing to talk to me ?