Proton-Beam Therapy for Prostate Cancer

The treatment options for prostate cancer include prostatectomy, external-beam irradiation, brachytherapy, cryosurgery, focused ultrasound, hormonal therapy, watchful waiting, and various combinations of these modalities. Because the prostate abuts the bladder and rectum, the dose distributions of external-beam irradiations and the accuracy of their placement play crucial roles in the probability of tumor cure and the incidence of posttreatment complications. Principal among the newer radiation technologies is proton-beam therapy (PBT), whose dose distributions make it possible to deliver higher tumor doses and smaller doses to surrounding normal tissues than from x-ray systems. However, as the 10-year cause-specific survival for early-stage disease treated by radiation therapy now exceeds 90%, and with severe late toxicities in the range of 2% to 3%, randomized clinical trials provide the only means to demonstrate improved outcomes from PBT. Short of the data provided by such trials, the efficacy of PBT can be gleaned only from reports in the clinical literature, and, to date, these reports are equivocal. In view of the current health care crisis and the higher costs of PBT for prostate cancer, it is reasonable to assess the viability of this in-vogue but not-so-new technology.