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Urology 2019

Proton beam therapy can help to win the war against prostate cancer

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Dr Jason Lester

Senior Consultant Clinical Oncologist, Rutherford Cancer Centre South Wales

Prostate cancer is now the most common cancer in the UK. Each year in the UK, 47,000 men are diagnosed with prostate cancer. It accounts for 26% of all new cancer cases in men, and the disease kills more men than breast cancer kills women.

Approximately one in eight men will get prostate cancer at some point in their lives[1]. While survival rates for prostate cancer have been improving, there has been a significant increase in incidence. Since the early 1990s, prostate cancer incidence has increased by 41% and is projected to rise further in the coming decades.

The most common treatments for men with localised prostate cancer are surgery, to remove the prostate gland, and radiotherapy. The treatment of localised prostate cancer is effective, and most men will be cured of their disease. A key challenge, however, is minimising side effects from treatment, which is important to help men maintain a good quality of life.

A new type of treatment with more accurate radiation

High energy proton beam therapy (PBT) is now available in the UK to treat men with localised prostate cancer. Conventional radiotherapy uses high energy X-rays called photons to destroy cancer cells. PBT uses beams of protons to achieve the same effect.

Side effects from conventional radiotherapy are as a result of radiation damage to the normal tissues near the cancer. Unlike conventional radiotherapy, the properties of protons allow them to enter and travel through tissue with minimal dose deposition in normal tissue on the way to the target, and minimal dose to the tissues beyond the target. This means PBT can reduce the risk and severity of side effects compared to conventional radiotherapy.

Proton beam therapy is the preferred treatment option for children

Because of the precision of PBT treatment, it is currently the preferred option for treating cancers in children because there is almost always less radiation dose to normal tissues compared to conventional radiotherapy, and this reduces the chance of serious complications. In adults, PBT is used to treat cancers that are near critical structures, such as the optic nerve or spinal cord, where conventional X-ray treatment may cause damage.

As demand for precision radiotherapy grows, there is debate about the benefits that PBT can offer other cancer patients, including those with prostate cancer. A recent study by the University of Pennsylvania revealed that the risk of side effects was two-thirds lower for PBT patients compared to those treated with conventional radiotherapy. Researchers leading the study also highlighted that reduced toxicity with PBT did not come at the expense of reduced effectiveness.

Three centres in the UK able to offer PBT therapy

In early 2018, the Rutherford Cancer Centre in South Wales became the first clinic in the UK to treat prostate cancer patients with high energy PBT. There are now two new Rutherford PBT centres in Reading and Newcastle. In addition, there is an NHS PBT facility at The Christie NHS Foundation Trust in Manchester.

Dr Jason Lester, an oncologist from the Rutherford Cancer Centre South Wales, who has treated a number of patients with PBT, including prostate cancer patients, says: “While proton beam therapy is not a magic bullet that can treat all cancers, we have seen that it can be a very effective treatment for prostate cancer. To date, we have seen no significant long-term side effects from treatment.”

[1] Prostate Cancer UK

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