Proton Therapy for Prostate Cancer

The Wall Street Journal recently ran a story about the growing number of health insurance providers who have decided they will no longer cover pricey proton therapy for the treatment of early-stage prostate cancer. Touted by some as the newest state-of-the-art treatment for prostate cancer, proton therapy has actually been around since the 1950s. The first U.S. center for proton therapy opened in California in 1990, but it has only been during the last few years that it has been aggressively promoted as an alternative to intensity modulated radiation therapy (IMRT) that is often prescribed to treat early-stage prostate cancer.

Like IMRT, proton therapy is a form of radiation that destroys cancer cells by preventing them from dividing and growing. Instead of using photons harnessed during IMRT, proton therapy uses protons—positively charged atomic particles. The protons are manipulated to release their energy at the precise depth of the tumor—radiation does not pass beyond the back edge of the tumor and into healthy tissue. Once the protons reach the center of targeted cancer cells, they permanently damage their DNA. No longer able to divide and fuel tumor growth, the cancer cells die.

Proton therapy requires a very large and very expensive facility where protons can be separated from water molecules, injected into a giant electromagnetic device called a cyclotron, accelerated between two electrodes to nearly the speed of light, and finally transported to treatment rooms where they are shaped and focused to target the patient’s tumor. Cost for an eight-week course of therapy can range from $32,000 to $50,000. Proponents of proton therapy say it’s worth the cost because it targets prostate cancer more precisely while minimizing radiation to the bladder and rectum—reducing post-operative side effects. But as The Wall Street Journal article reports, these claims haven’t been validated.

“Proton therapy has proven effective in the treatment of pediatric brain cancers. But currently, there is no objective medical evidence that indicates proton therapy is more effective in eradicating prostate cancer or reducing side effects such as erectile dysfunction or incontinence that sometimes accompany treatment,” says Peter LaNasa, M.D., a board-certified radiation oncologist and director of radiation oncology for USMD Prostate Cancer Center.

The April 2012 issue of Radiotherapy and Oncology published a study by members of the American Society for Radiation Oncology that found “no suggestion” that proton therapy is superior to X-ray radiotherapy (IMRT) in the treatment of prostate cancer. A second study of nearly 13,000 men published in the April 2012 Journal of the American Medical Association indicated that prostate cancer patients treated with proton therapy were more likely to face gastrointestinal side effects than those treated with IMRT.

More recently, the January 2013 edition of Journal of the National Cancer Institute published findings by James Yu, a radiation oncologist at Yale School of Medicine. Dr. Yu reviewed the Medicare records of nearly 55,000 prostate cancer survivors and found evidence that proton therapy may be associated with small reductions in urinary side effects—but only within the first six months of treatment. After that, he found no difference between proton radiation and IMRT.

In light of these finding, a growing number of health insurance providers are reevaluating their reimbursements for proton therapy. The Federal Medicare program pays more than $32,000 for proton therapy compared with about $19,000 for more conventional radiation options for prostate cancer. At least three major insurers have recently decided to stop covering proton beam therapy for early stage prostate cancer or are reviewing their policy—and Medicare may not be too far behind.

“In this era of cost-conscious medicine, accountable-care providers need to make sure we are providing our patients with treatments that have proven efficacy,” Dr. LaNasa says. ““There are many effective, tissue-sparing treatments currently available—including state-of-the-art IMRT using radiosurgical systems that provide precise, image-guided targeting of the prostate while minimizing radiation to adjacent organs such as the bladder and rectum. If you’ve been diagnosed with prostate cancer, the most important thing you can do is talk with your physician to determine which option is best suited to your individual case and has the potential to deliver the best possible outcome.”

For more information about prostate cancer treatment options, please call us 1-888-PROSTATE.

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