Comparing prostate cancer treatments

Dear Dr. Roach: I recently have been diagnosed with early prostate cancer. My Gleason score is 7. My urologist has informed me that he doesn’t think I am a good candidate for surgery, due to having atrial fibrillation. My radiation oncologist has recommended traditional radiation therapy. However, I am worried about the possible side effects. I am 72 and in otherwise good health. I am considering proton therapy and wonder if you have any thoughts. — R.O.B.

You have what would be termed intermediate-risk prostate cancer. Most experts would recommend radiation or surgery. Atrial fibrillation itself is not necessarily a reason NOT to get surgery; however, the side effects probably are less with radiation compared with surgery.

Radiation may be delivered from the outside, either with X-rays (traditional) or protons, or from the inside via internal radiation “seeds” implanted surgically, called brachytherapy. Cancer cells are more sensitive to radiation than surrounding healthy cells, so radiation has been an effective treatment for prostate cancer for decades. Unfortunately, healthy cells of the bladder and rectum still can be affected by radiation.

The research data has shown that there is not a survival difference comparing radiation and surgery. When comparing IMRT and proton beam treatment, there is no convincing evidence that proton beam therapy is more effective, but there is weak-tomoderate evidence of MORE side effects with proton beam.

All three options (X-ray, proton beam and brachytherapy) are reasonable, have similar effectiveness and relatively low side effect rates in the bladder and bowel, and higher in sexual function. However, I don’t see a reason to prefer proton treatment at the present time over IMRT.