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.

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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.