Proton therapy treatment preserves quality of life for men with prostate cancer
Two studies led by The University of Texas MD Anderson Cancer Center have found that proton therapy preserves the quality of life, specifically urinary and bowel function, in men treated with this targeted radiation modality for prostate cancer.
Both studies, led by Andrew K. Lee, M.D., M.P.H., associate professor in MD Anderson's Department of Radiation Oncology, will be presented in a poster session at the 54th Annual Meeting of the American Society for Radiation Oncology (ASTRO).
"As oncologists, we obviously want good cancer control outcomes, but we also want to ensure that patients maintain a strong sense of continued quality of life after treatment, which can be very personal and subjective for each patient," said Lee.
"With this research, we looked at the well being of prostate cancer patients, post-treatment, and it was important that we obtain this information directly from men who actually underwent the therapy, rather than from their treatment providers," Lee continued. "In our own practice, we've observed that patients have done very well as measured by disease control and quality of life metrics. Our findings, both the wider-perspective multicenter study and the research conducted solely at MD Anderson, validate what we observe in our clinic."
The first, a multi-institutional study, and one of the largest quality of life studies of its kind ever conducted in such a patient population, involved more than 1,000 patients treated with proton therapy for various stages of prostate cancer. The men had all received proton therapy, with or without hormone therapy, at one of five proton therapy centers across the country. All participants were at least one year to more than 10 years post-treatment. The men completed the Expanded Prostate Cancer Index Composite (EPIC) survey, a comprehensive and validated tool designed to assess a patient's health-related quality of life, including function and bother after prostate cancer treatment. (The survey uses a scoring system of 1 to 100 in several quality of life areas; higher EPIC scores correlate with better function and quality of life.) The self-reporting was independently conducted by the patient, unaided by their respective treating institution.
This cohort of prostate cancer patients was compared to a cohort of 112 healthy men, all of whom did not have prostate cancer. The median age of those with prostate cancer and those without the disease was 65 and 64.8 years old, respectively.
In the post-treatment analysis, Lee and his colleagues found that men with prostate cancer treated with proton therapy reported excellent urinary and bowel summary scores, 89.8/100 and 92.7/100, respectively, similar to the healthy men, 89.5/100, and 92.4/100, respectively.
When comparing sexual function in both cohorts, the researchers found a statistically significant difference in the healthy men, compared to in those treated with proton therapy.
"However, when further analyzing these scores, it's important to note that decreased sexual function is more often associated with those proton patients who also received hormone therapy, had higher Gleason scores, were older at time of treatment, and/or greater years post treatment," Lee noted.
"In general, our patients are interested in learning how they will do compared to those treated with other modalities, but, more importantly, they want to know how they are going to do relative to their own normal state of health. With such a large data set, this study offers us a guide to have that discussion with patients considering proton therapy."
The second study focused only on patients treated at MD Anderson for prostate cancer with proton therapy; the findings complement those of the multi-center study. All of the men were treated for localized prostate cancer with proton therapy with or without hormone therapy between 2006 and 2009.
For this prospective study, Lee looked at the quality of life scores of 299 men receiving one of two proton doses: one cohort (100 men) received 75.6 Gray Equivalents (GyE) at 1.8 GyE/fraction; the second cohort (199 men) received 76 GyE at 2 GyE/fraction. The median age of both groups was 65 years old. Study participants completed the EPIC survey before receiving proton therapy, and at periodic intervals following their therapy.
Lee and his MD Anderson colleagues found a small but statistically significant difference in both groups in urinary and bowel function from their baseline scores to their scores at three years post-treatment; however, these changes were not clinically significant. No meaningful difference in quality of life changes between the dose groups was noted, except for sexual bother.
The researchers also assessed for toxicities in these patients. The three-year cumulative rates of Grade 2 urinary side effects, defined by Lee as those requiring some medical intervention (e.g. alpha blockers), were 24.1 percent and 17.6 percent for the 75.6 GyE and 76 GyE groups, respectively. The three-year cumulative rates of grade two rectal side effects were 10 percent and 13 percent for the first and second cohort, respectively. Only two men had Grade 3 toxicities, requiring additional medical or procedural intervention.
Three years post-treatment, both groups reported high satisfaction rates with their proton therapy, 91 percent and 93.5 percent.
Lee and his colleagues hope to compare the findings in the multi-center trial to patients who received other treatment modalities. He also plans to perform an analysis of a larger group of MD Anderson proton patients with longer follow up.
Besides Lee, other authors on the all-MD Anderson study include: Seungtaek Choi, M.D., Quynh Nguyen, M.D., TJ Pugh, M.D., Benson Mathai, Steven Frank, M.D., Karen Hoffman, M.D., Deborah Kuban, M.D., Sean McGuire, M.D., Ph.D. and Mark Munsell.
Other authors on the multi-institutional study include: Lawrence Levy, Seungtaek Choi, M.D., and Quynh Nguyen, M.D., all from MD Anderson; Carl Rossi, M.D., Scripps Proton Center; David Bush, M.D. and Jerry Slater, M.D., Loma Linda University Medical Center; Nancy Mendenhall, M.D., University of Florida Proton Therapy Institute; Sameer Keole, M.D., Radiation Medicine Associates; and Anthony Zietman, M.D., Massachusetts General Hospital.
For the multi-institutional study, the EPIC survey was distributed by ProtonBOB, a prostate cancer advocacy organization. None of the authors report financial declarations.
Provided by University of Texas M. D. Anderson Cancer Center
- Proton therapy effective prostate cancer treatment Jan 05, 2012 | not rated yet | 0
- Proton therapy is well-tolerated in prostate cancer patients Nov 02, 2009 | not rated yet | 0
- Adding proton therapy 'boost' to X-ray radiation therapy reduces prostate cancer recurrences Nov 02, 2009 | not rated yet | 0
- Study questions proton therapy for prostate cancer Feb 01, 2012 | not rated yet | 0
- IMRT better for sparing bladder when treating prostate cancer Oct 09, 2007 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Why is zone 1 in liver more prone to ischemic injury?
May 23, 2013 Hi, Is it because around central vein, there is only deoxygenated blood from the vein where as in the periphery there is hepatic artery. Also why...
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013 As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
- More from Physics Forums - Medical Sciences
More news stories
Researchers from London's Kingston University have begun a two-year study which could help prolong the lives of people with colorectal tumours.
Cancer 22 minutes ago | not rated yet | 0
Transformative research from Western University has identified new hormones in the body which may suppress breast cancer and stimulate the regression of breast tumors.
Cancer 1 hour ago | not rated yet | 0
(Medical Xpress)—Curtin University researchers have found evidence that targeting specific cells in the body can reverse the effects of cancer on the immune system.
Cancer 1 hour ago | 5 / 5 (1) | 0
A leading expert in childhood cancer at The University of Nottingham is spearheading a Europe-wide lobby of the European Parliament to try to make it easier for doctors to develop and test new treatments on children and young ...
Cancer 2 hours ago | not rated yet | 0
(AP)—Researchers examining the incidence of brain cancer at jet engine manufacturer Pratt & Whitney in Connecticut say they have found no statistically significant elevations in the rate of cancer among workers.
Cancer 3 hours ago | not rated yet | 0
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
40 minutes ago | not rated yet | 0 |
How can healthy people who hear voices help schizophrenics? Finding the answer for this is at the centre of research conducted at the University of Bergen.
32 minutes ago | 3 / 5 (1) | 0
New research presented today shows that formation of new neurons in the hippocampus - a brain region known for its importance in learning and remembering - could cause forgetting of old memories by causing a reorganization ...
12 minutes ago | not rated yet | 0
Ernie Pyle – an iconic war correspondent in World War II – reportedly said "There are no atheists in foxholes." A new joint study between two brothers at Cornell and Virginia Wesleyan found that only ...
15 minutes ago | not rated yet | 0
(Medical Xpress)—Research by Stanford scholar Emma Seppala at the Center for Compassion and Altruism Research and Education found that post-traumatic stress disorder decreased in veterans who participated ...
42 minutes ago | not rated yet | 0
The individualisation of drug treatments to support patients to self-manage their conditions is a concept that sits at the heart of policy, but a recent study in BMJ Open shows that there is no concrete defini ...
32 minutes ago | not rated yet | 0