Proton Therapy for Prostate Cancer: Current State and Future Perspectives

Overview

Journal Br J Radiol

Publisher Oxford University Press

Specialty Radiology

Date 2021 Sep 24

PMID 34558308

Citations 6

Authors

Yao-Yu Wu

Kang-Hsing Fan

Affiliations

Soon will be listed here.

Abstract

Objective: Localized prostate cancer can be treated with several radiotherapeutic approaches. Proton therapy (PT) can precisely target tumors, thus sparing normal tissues and reducing side-effects without sacrificing cancer control. However, PT is a costly treatment compared with conventional photon radiotherapy, which may undermine its overall efficacy. In this review, we summarize current data on the dosimetric rationale, clinical benefits, and cost of PT for prostate cancer.

Methods: An extensive literature review of PT for prostate cancer was performed with emphasis on studies investigating dosimetric advantage, clinical outcomes, cost-effective strategies, and novel technology trends.

Results: PT is safe, and its efficacy is comparable to that of standard photon-based therapy or brachytherapy. Data on gastrointestinal, genitourinary, and sexual function toxicity profiles are conflicting; however, PT is associated with a low risk of second cancer and has no effects on testosterone levels. Regarding cost-effectiveness, PT is suboptimal, although evolving trends in radiation delivery and construction of PT centers may help reduce the cost.

Conclusion: PT has several advantages over conventional photon radiotherapy, and novel approaches may increase its efficacy and safety. Large prospective randomized trials comparing photon therapy with proton-based treatments are ongoing and may provide data on the differences in efficacy, toxicity profile, and quality of life between proton- and photon-based treatments for prostate cancer in the modern era.

Advances In Knowledge: PT provides excellent physical advantages and has a superior dose profile compared with X-ray radiotherapy. Further evidence from clinical trials and research studies will clarify the role of PT in the treatment of prostate cancer, and facilitate the implementation of PT in a more accessible, affordable, efficient, and safe way.

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References

Pugh T, Choi S, Nogueras-Gonzalaez G, Nguyen Q, Mahmood U, Frank S . Proton Beam Therapy for Localized Prostate Cancer: Results from a Prospective Quality-of-Life Trial. Int J Part Ther. 2019; 3(1):27-36. PMC: 6871578. DOI: 10.14338/IJPT-16-00006.1. View

Georg D, Hopfgartner J, Gora J, Kuess P, Kragl G, Berger D . Dosimetric considerations to determine the optimal technique for localized prostate cancer among external photon, proton, or carbon-ion therapy and high-dose-rate or low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2014; 88(3):715-22. DOI: 10.1016/j.ijrobp.2013.11.241. View

Chera B, Vargas C, Morris C, Louis D, Flampouri S, Yeung D . Dosimetric study of pelvic proton radiotherapy for high-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2009; 75(4):994-1002. DOI: 10.1016/j.ijrobp.2009.01.044. View

Xiang M, Chang D, Pollom E . Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity-modulated, or proton beam radiation therapy. Cancer. 2020; 126(15):3560-3568. DOI: 10.1002/cncr.32938. View

Vargas C, Hartsell W, Dunn M, Keole S, Doh L, Eisenbeisz E . Hypofractionated Versus Standard Fractionated Proton-beam Therapy for Low-risk Prostate Cancer: Interim Results of a Randomized Trial PCG GU 002. Am J Clin Oncol. 2015; 41(2):115-120. DOI: 10.1097/COC.0000000000000241. View

Kerkmeijer L, Groen V, Pos F, Haustermans K, Monninkhof E, Smeenk R . Focal Boost to the Intraprostatic Tumor in External Beam Radiotherapy for Patients With Localized Prostate Cancer: Results From the FLAME Randomized Phase III Trial. J Clin Oncol. 2021; 39(7):787-796. DOI: 10.1200/JCO.20.02873. View

Cohen A, Lapin B, Wang C, Helfand B, Victorson D, Novakovic K . Variation in Testosterone Levels and Health-related Quality of Life in Men Diagnosed With Prostate Cancer on Active Surveillance. Urology. 2016; 94:180-7. DOI: 10.1016/j.urology.2016.03.056. View

Hoppe B, Michalski J, Mendenhall N, Morris C, Henderson R, Nichols R . Comparative effectiveness study of patient-reported outcomes after proton therapy or intensity-modulated radiotherapy for prostate cancer. Cancer. 2014; 120(7):1076-82. PMC: 4103169. DOI: 10.1002/cncr.28536. View

Beckendorf V, Guerif S, Le Prise E, Cosset J, Bougnoux A, Chauvet B . 70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial. Int J Radiat Oncol Biol Phys. 2010; 80(4):1056-63. DOI: 10.1016/j.ijrobp.2010.03.049. View

10.

Shipley W, Verhey L, Munzenrider J, Suit H, Urie M, McManus P . Advanced prostate cancer: the results of a randomized comparative trial of high dose irradiation boosting with conformal protons compared with conventional dose irradiation using photons alone. Int J Radiat Oncol Biol Phys. 1995; 32(1):3-12. DOI: 10.1016/0360-3016(95)00063-5. View

11.

Jahreiss M, Aben K, Hoogeman M, Dirkx M, de Vries K, Incrocci L . The Risk of Second Primary Cancers in Prostate Cancer Survivors Treated in the Modern Radiotherapy Era. Front Oncol. 2020; 10:605119. PMC: 7691574. DOI: 10.3389/fonc.2020.605119. View

12.

Dowdell S, Metcalfe P, Morales J, Jackson M, Rosenfeld A . A comparison of proton therapy and IMRT treatment plans for prostate radiotherapy. Australas Phys Eng Sci Med. 2009; 31(4):325-31. DOI: 10.1007/BF03178602. View

13.

Lee W, Dignam J, Amin M, Bruner D, Low D, Swanson G . Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer. J Clin Oncol. 2016; 34(20):2325-32. PMC: 4981980. DOI: 10.1200/JCO.2016.67.0448. View

14.

Vargas C, Fryer A, Mahajan C, Indelicato D, Horne D, Chellini A . Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2007; 70(3):744-51. DOI: 10.1016/j.ijrobp.2007.07.2335. View

15.

Takagi M, Demizu Y, Terashima K, Fujii O, Jin D, Niwa Y . Long-term outcomes in patients treated with proton therapy for localized prostate cancer. Cancer Med. 2017; 6(10):2234-2243. PMC: 5633560. DOI: 10.1002/cam4.1159. View

16.

Hughes J, Parsons J . FLASH Radiotherapy: Current Knowledge and Future Insights Using Proton-Beam Therapy. Int J Mol Sci. 2020; 21(18). PMC: 7556020. DOI: 10.3390/ijms21186492. View

17.

Zamboglou C, Drendel V, Jilg C, Rischke H, Beck T, Schultze-Seemann W . Comparison of Ga-HBED-CC PSMA-PET/CT and multiparametric MRI for gross tumour volume detection in patients with primary prostate cancer based on slice by slice comparison with histopathology. Theranostics. 2017; 7(1):228-237. PMC: 5196899. DOI: 10.7150/thno.16638. View

18.

Widmark A, Gunnlaugsson A, Beckman L, Thellenberg-Karlsson C, Hoyer M, Lagerlund M . Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial. Lancet. 2019; 394(10196):385-395. DOI: 10.1016/S0140-6736(19)31131-6. View

19.

Davis E, Beebe-Dimmer J, Yee C, Cooney K . Risk of second primary tumors in men diagnosed with prostate cancer: a population-based cohort study. Cancer. 2014; 120(17):2735-41. PMC: 4195444. DOI: 10.1002/cncr.28769. View

20.

Munck Af Rosenschold P, Engelholm S, Ohlhues L, Law I, Vogelius I, Engelholm S . Photon and proton therapy planning comparison for malignant glioma based on CT, FDG-PET, DTI-MRI and fiber tracking. Acta Oncol. 2011; 50(6):777-83. DOI: 10.3109/0284186X.2011.584555. View