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Wednesday, May 17, 2023

Innovative Care for Prostate Cancer


Proton Stands Out Among Options

Radiation oncologists are physicians who specialize in treating cancers and benign disorders with radiation therapy.

Doctors often refer patients to us who have been diagnosed with prostate cancer so we can review treatment options, but it’s not unusual for patients to call with a self-referral or even to request a second opinion.

Since Willis-Knighton Cancer Center is the only location in the state with proton therapy, we hear from patients throughout the state and from the surrounding area. For example, a man from New Orleans called us directly. He was sexually active and a poor candidate for prostate surgery, so he had been researching other options and decided to contact us about proton therapy. We explained that if he wanted to stay close to home for his treatment, conventional radiation was a very effective and equivalent option to surgery. However, we also shared that proton therapy (also called particle therapy) with our Proteus One scanning unit would be a good alternative. He subsequently came to Shreveport for a 90-minute consultation and decided to remain here to receive proton therapy. It was an excellent option for him, and he was glad he made the trip.

Why would he choose proton therapy? Protons use high-energy particles to destroy cancer. Unlike conventional radiation therapy, which uses X-rays, protons deliver much less radiation to the patient. That means fewer side effects and a lower risk of complications. This reduced risk is because protons deposit all their cancer-killing energy directly into the cancer, not the surrounding tissue. While conventional radiation can be very effective, it’s well-known that it will expose a larger area of the patient’s body to the radiation beams.

Prospective trials at Massachusetts General Hospital and the University of Florida showed that proton therapy treatment resulted in lower gastrointestinal and genitourinary toxicity rates than conventional therapy.

The reduction in radiation exposure and side effects are well known, but studies have also demonstrated excellent long-term control of the disease. One large study at the University of Florida showed that five-year control rates with protons were superior when compared side by side to prior results obtained with surgery or IMRT/conventional radiation. A recent publication revealed that patients treated with protons demonstrated excellent disease control with a 10-year survival rate of 91.3%.

Prostate cancer is the second most common cancer in men and the second leading cause of cancer death after lung cancer in American men.

This year 34,000 men will die from the disease. Ideally, all patients should have an evaluation with both a urologist and a radiation oncologist. Treatment options vary and can include active surveillance, focal ablative procedures, surgical resection, systemic treatment with hormone therapy (and occasionally chemotherapy) or radiation therapy delivered with multiple techniques, which include proton therapy.

While all of these treatment options are available at Willis-Knighton, our innovative use of advanced technologies and conventional IMRT – and the forward-thinking of our team, administrators and board of trustees – allowed us to introduce proton therapy in Louisiana. Today, we are one of only 30 locations in the United States that offer protons.

Protons can be particularly useful in treating prostate cancer because the gland is located near several critical structures, including the bladder and rectum. Using protons, those structures get less exposure, diminishing urinary and bowel dysfunction. Erectile dysfunction and bladder leakage are notably lower. The best candidates for proton therapy are men whose cancer is still localized to the gland or regional lymph nodes.

However, it can be used in more advanced cases. It is also given after surgery in patients with recurrence who are at high risk for recurrence. Even though proton therapy has limited availability, it is now considered a standard option for prostate cancer. Because Medicare covers proton therapy, it is accessible to older patients.

Many highly regarded cancer centers, including Massachusetts General, Loma Linda, the University of Pennsylvania, the University of Florida and MD Anderson, were early sites, with Willis-Knighton becoming the 14th proton facility in the country. Our program at Willis- Knighton opened before those at prestigious centers like Memorial Sloan Kettering, Johns Hopkins, Mayo Clinic and St. Jude’s.

We are proud to have been at the forefront of this innovative therapy. Our success can be attributed, in large measure, to the team we have developed in the Willis-Knighton Cancer Center Radiation Oncology Department. The team continues to receive national recognition. Just a few years ago, a paper the department submitted describing the commissioning of our Proteus One received the 2019 George Starkschall Award for the best medical physics publication in the United States. Our department also serves as an educational site for medical physics residents and is an international proton training site. For instance, the only proton center in Spain sent their team for training in Shreveport.

Despite this international attention, it’s interesting to hear that local patients are often unaware that this innovative technology is available here and that we’ve been the leading edge of proton therapy.

We are proud of the results we achieve here and the benefits we bring to patients in the Ark-La-Tex. We’re a nonprofit community

Protons can be useful in testing prostate cancer.

health system dedicated to improving healthcare services for our community, making this highly specialized option available to a wider range of people. It’s why the former head of the international proton research group PTCOG noted that Willis-Knighton Radiation Oncology has “helped democratize proton therapy.”

Lane R. Rosen, MD, FACRO, is director of radiation oncology for Willis-Knighton Health System. Second opinions are provided in the department by contacting (318) 212-4639. Any patient who is a candidate for proton therapy is referred to a Willis-Knighton urologist to assist with preparation for treatment.


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