Pricier therapy no better for early prostate cancer

A new study suggests that expensive, high-tech proton beam radiation doesn’t do any more for men with prostate cancer than the most commonly-used option.

Proton beam radiation, heavily promoted by facilities that perform the treatment, also came with a higher risk of certain side effects compared to intensity-modulated radiation therapy (IMRT), researchers found.

“This paper is the strongest evidence yet that proton beam (therapy) is not only not better, but probably not as good as IMRT,” said Dr. Matthew Cooperberg, a urologist from the University of California, San Francisco, who didn’t participate in the new research.

The findings suggest that men have multiple radiation options when it comes to treating early, localized prostate cancer.

Though not covered in the new study, their options also include surgery - or getting no treatment at all and waiting to see how the disease progresses, researchers said.

Dr. Ronald Chen of the University of North Carolina at Chapel Hill and his colleagues used data from a nationwide cancer registry covering treatment records for men insured by Medicare who were diagnosed with prostate cancer starting in 2000.

At that time, less than one percent of prostate cancers that hadn’t spread beyond the gland were treated with IMRT, a minimally-invasive treatment meant to limit damage to the surrounding organs. The rest were treated conformal radiation, the previous standard of care.

Prostate cancer is the most common cancer in men in the UK - it accounts for nearly a quarter (24%) of all new male cancer diagnoses. Although there has been a huge rise in prostate cancer incidence over the last 20 years, this has not been reflected in mortality rates. Much of the increase in incidence can be attributed to the incidental discovery of prostate cancers following transurethral resection of the prostate (TURP) and, more recently, the use of prostate specific antigen (PSA) testing.


In Europe and worldwide

Worldwide, an estimated 899,000 men were diagnosed with prostate cancer in 2008, and more than two-thirds of cases are diagnosed in developed countries The highest rates are in Australia/New Zealand, Western, Northern Europe and Northern America, largely because the practice of prostate specific antigen (PSA) testing and subsequent biopsy has become widespread in those regions .

By 2008, almost 96 percent of men got the high-dose, targeted radiation.

Intensity-modulated radiation was tied to an approximately 10 to 20 percent lower risk of stomach problems and hip fractures compared to conformal radiation therapy, which exposes more organs around the prostate to radiation. But it also came with a 12 percent higher risk of erectile dysfunction.

Over the course of each year after radiation, 2.5 percent of men who’d received IMRT needed more cancer treatment - suggesting their disease came back - compared to 3.1 percent of men in the traditional-radiation group.

Prostate Cancer Statistics

What is the chance for a diagnosis of prostate cancer:

For a man in his 40s - 1 in 1000
For a man in his 50s - 12 in 1000
For a man in his 60s - 45 in 1000
For a man in his 70s - 80 in 1000

- Each year in Australia, close to 3,300 men die of prostate cancer - equal to the number of women who die from breast cancer annually. Around 20,000 new cases are diagnosed in Australia every year.

- Each day about 32 men learn news that they have prostate cancer - tragically one man every three hours will lose his battle against this insidious disease

- One in 9 men in Australia will develop prostate cancer in their lifetime

- Prostate cancer is the most common cancer in Australian men and is the second most common cause of cancer deaths in men

That was based on records of close to 13,000 men age 66 and older.

In a smaller analysis, Medicare patients who got proton beam therapy, the most high-tech type of radiation offered, didn’t fare much better or worse than those who had IMRT - except that proton-treated men had more stomach-related side effects.


The use of both of those technologies has driven up the cost of prostate cancer treatment by hundreds of millions of dollars, the researchers wrote in the Journal of the American Medical Association.

But with conformal radiation fading from popularity, patients’ radiation choice now tends to come down to IMRT versus proton therapy - which is available at far fewer cancer centers because of the technology required.

Researchers said that proton beam facilities can cost $100 million or more to build. A round of proton beam radiation treatment costs insurers up to $100,000 per patient, while IMRT is billed at about $50,000.

“Here we have more expensive therapy that is not proven to give a better outcome,” said Dr. Eric Klein, a prostate cancer researcher at the Cleveland Clinic, who didn’t take part in the new study.

Researchers agreed that policymakers, including those that decide how much Medicare will pay for various treatments, should reevaluate the evidence for cancer outcomes - including whether proton beam therapy is worth its hefty price tag.

“There’s a trend in this country of adopting newer, costly, promising treatments, without very much evidence to prove they’re better,” Chen told Reuters Health.

“What our data provides the patients is evidence that IMRT is a good prostate cancer treatment,” he said. Until more rigorous studies are available, “That’s the type of radiation that they should seek.”

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