Prostate Cancer Treatment: External Beam Radiation versus Proton Beam Therapy
Posted Jun 25 2010 12:00am
Which prostate cancer treatment
produces less side effects, especially sexually: Proton beam therapy or external
beam radiation? I have heard conflicting reports on the value of one over
I elected to do external beam radiation and now am experiencing sexual
side effects. Later on, after I had finished my radiation, I heard of another
patient who went to Loma Linda in California for proton radiation, and he says he has
experienced no loss of sexuality.
If I had known this beforehand I would have
investigated proton radiation a lot more aggressively.
I did see a video clip on the internet from a Boston doctor, who said there was no advantage in doing proton
beam therapy over external beam radiation. This really influenced my decision-process so I did not look into it further.And of course, my doctor favored the external beam
radiation approach since he is associated with a radiation center.
I know I cannot do anything about my situation, but I wish there was more
information out there on both radiation approaches for men could make the
right decision for them.And it would be kind of a therapeutic for me to hopefully help other men get
the right information to make the right decision.
---B. A. (Houston, Texas)
Rabbi Ed’s Answer:
I’m sorry you’ve
come to the point where ED has become a part of your life as it has for most
patients after radiotherapy (external beam and seeding) as well as after surgical
removal of the prostate, - a prostatectomy.
your question, most proton radiation patients who have prostate cancer
treatment (about 6,000 a year in six U.S. locations thus far) seem to complain
of fewer sexual side effects, compared to patients who have undergone other
However to my
knowledge, most proton therapy patients, like those who choose other treatment
options, will exhibit some degree sexual
dysfunction, especially in terms of eventually being incapable of ejaculation.
So, while it’s true that using a proton beam enables doctors to destroy a prostate
tumor with pinpoint accuracy, a substantial number of proton beam patients
(though perhaps the minority) will also eventually lose their prostate's capacity to produce semen (1/3 is from the prostate and 2/3 from the seminal
It’s also true that up to half of external
beam patients will eventually get ED within 5 years of their treatment, and the
other half won’t!How that breaks down
for proton therapy patients has not been determined to my knowledge, though it
wouldn’t surprise me if at least ¼ of proton therapy patients eventually ended
up with ED as they get older.
It's true that unlike most proton beam
therapy efforts, external beam radiotherapy – even IMRT, can affect some
surrounding tissue, although less so than the original external beam
However, a couple of
years ago a Johns Hopkins report indicated that while proton therapy might
cause less sexual dysfunction, it can lead to the loss of bone density in the
hip area and hip fractures; so it may be a bit of a trade-off for some men, who may end up with better sexual function, but could be worse off in terms of their bone health.
report indicates that “Lateral overshoot in the region of the neurovascular (=nerve)
bundlesis …necessary to avoid the risk of under-dosage. Inthe
future, this potential disadvantage will likely be mitigatedby the
use of intensity-modulated proton therapy, although atpresent only
one center in the world is using this.” (http://jco.ascopubs.org/cgi/content/full/25/24/3565 ).
In simpler terms, proton therapy has a greater chance of destroying nerve
bundles that allow for erection, situated on either side of the prostate as the
tumor is eradicated. That will happen until further technological developments have helped
lessen this possibility.
have to ask yourself if your ED would have transpired anyway, regardless of your
type of treatment. ED is also a function of aging, diabetes, neuropathy, depression, or
plaque in your arteries, not to mention “losing it (sexual function) because of
not using it.”In addition it's the consequence of certain medications such as chlorestorol drugs like Lipitor or anti-depressions like Cymbalta.
Besides, if you had
any symptoms of ED before your treatment, you’re likely to be worse off
sexually than those who were in good shape before treatment; on the contrary you
are less likely to be fully functional sexually after the treatment ends. That
applies as well to surgical patients who had a tough time before surgery and then had a prostatectomy – and that includes me!
How can you and the rest of us get
around ED and a lower libido? Explore with your doctor if you are a candidate
for supplemental testosterone two years
after the treatment if not earlier. Also try to reframe “having sex” and seek to “make
love”, which is a broader goal that can enhance intimacy. Involving yourself in
sensate focus with your wife or partner with "whole body sex." In other words put greater emphasis on
touching each other physically apart from intercourse, as that can reduce
frustration, increase pleasure, and therefore makea big differencein enhancing intimacy.
I hope that
answers your question even though others might bring more medical details to this discussion. For an even more definitive response consult some
urologists who do proton therapy to see what the outcomes of proton beam
therapy have been in their experience. Still, be aware that like most patients,
doctors, - regardless of the treatment option they favor, tend to “root for the home team," so some
proton beam specialists might understate proton beam therapy’s potential
In addition check outmy book or other parts of this blog – Conquer Prostate Cancer
(.com), or consult a couple of books on prostate cancer and proton therapy at
Amazon.com. One book, called “You Can Beat Prostate Cancer” by Bob Marckini,
describes proton therapy and its impact at length.
If you learn
anything more definitive, please let me know.Meantime I wish you all the best for improved health.