Despite being the current medical director of Oklahoma City’s ProCure Proton Therapy Center, Dr. Larson admits he had to first become a convert.
Over the years, more sophisticated screening methods have emerged allowing cancer to be treated before it spreads throughout the body. Radiation therapy has evolved as well. Methods such as intensity modulated radiation therapy (IMRT) increased the effectiveness of radiation treatment while reducing the side effects.
“When I began treating patients with protons I simply didn’t believe it would improve upon IMRT,” Larson said.
Still, the veteran radiation oncologist became part of the founding team that helped bring the proton therapy center to Oklahoma in 2009.
“When we built this center I really didn’t think I would care about using it for prostate cancer because IMRT worked so well,” he said. “Since then I have changed my opinion. Patients simply have an easier time getting through treatment.”
Cutting down on side effects
In fact, men worry more about the side effects of prostate cancer treatment than the treatment itself. The ProCure team hears about many men who regret their decisions to have surgery or standard radiation cancer treatment. Some didn’t know about proton therapy, or they opted for whatever treatment was recommended to them at the time. Today they are dealing with long term side effects including incontinence and erectile dysfunction.
“There is no difference in cure rates between the various types of prostate cancer treatment, but it is the side effects you don’t want to deal with,” Larson said.
Radiation to the bladder and rectum caused by conventional prostate radiation treatments can cause long term difficulty with both urinary and bowel function. Because proton therapy focuses the radiation on the tumor itself, patients have a greater chance of avoiding those problems.
Treating prostate cancer with surgery can result in urinary incontinence and impotence. Proton beam treatment virtually never causes incontinence and is much less likely to cause impotence.
Moreover, proton therapy is a relatively non-invasive outpatient procedure. Most ProCure prostate cancer patients report little or no fatigue and say that they are in and out of treatment in about 30 minutes for their once-a-day therapy sessions, allowing them to continue working and leading an active lifestyle.
How proton therapy works
Both protons and x-rays destroy cancer cells by preventing them from dividing and growing. The difference is in their deliveries. With standard x-ray treatment, such as IMRT, an entire area of both cancerous and healthy cells gets exposed to radiation. However, in proton therapy, the radiation beam can be limited to not travel beyond the tumor. Proton therapy eliminates up to 60 percent of excess radiation delivered to normal tissues surrounding the prostate compared to IMRT.
“It allows us to treat the patient every day with radiation with fewer and significantly lower side effects,” said Larson, who also uses other modalities of treatment for his patients.
Being an advocate for your health
Larson said a patient’s best advocate is the patient himself.
“Get more than one opinion,” he said.
Ask lots of questions, don’t be satisfied with just one medical opinion, and don’t automatically rule out a treatment option because insurance carriers may or may not cover treatment.
Unfortunately, despite proton therapy being an established and proven form of therapy, many people in the medical profession are not familiar with it or are simply satisfied with the modalities they are already using.
“Ninety-five percent of them (physicians) don’t know any better,” Larson said.
Understanding your options
These days, men have many different prostate cancer treatment options available to them. Which one they choose, however, can depend on a number of different factors, including their age, general health, psychological state, feelings about potential side effects and, most importantly, the specific circumstances of their cancer.
Among these options, “active surveillance” has emerged as an increasingly important alternative to surgery, or radiation treatment for men diagnosed with low risk prostate cancer. It is important for men to understand what it means.
While the lifetime risk of receiving a prostate cancer diagnosis is about 1 in 6, the lifetime risk of death from the disease is only 1 in 30.
“You may not need to treat some of these men for many years,” Larson explained.
Management of low risk prostate cancer through active surveillance appears feasible and safe in these cases, he said.
Screening for prostate cancer
In the past 25 years, the five-year survival rate for all stages combined has increased from 68 percent to nearly 100 percent, according to the American Cancer Society. However, it can become dangerous if it goes undetected.
“Back in 1982, men were diagnosed with prostate cancer because they felt symptoms. Most of these men were incurable then,” he said.
With the emergence of effective screening options such the prostate-specific antigen (PSA) blood test, chances to effectively treat prostate cancer have increased.
Yet, screening for prostate cancer has become a controversial issue the past few years. Critics point to complications of biopsies and the over-treatment of those with indolent disease.
While Larson understands the concerns, he feels strongly that people should discuss regular screening with their doctors.
During prostate cancer awareness month, take the opportunity to evaluate your risk factors and discuss what is right for you with your doctor.
Urologists like Dr. Fredrick J. Snoy can provide treatment recommendations if you are experiencing symptoms. Please contact our office for an appointment if you would like to discuss with Dr. Snoy, (505) 872-4091