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January 25, 2008
Last September, I wrote a story about prostate cancer that looked at some of the difficult decisions men in the early stages of the disease face and some of the treatment options available to them. Among those it mentioned: high-intensity focused ultrasound, watchful waiting, robotic surgery, brachytherapy, and (in general terms) radiation therapy. The story did not specifically mention proton beam therapy, a type of radiation therapy that uses nuclear technology to precisely shoot fast-moving ions into tumors. Some doctors say proton therapy reduces the risk of complications, such as impotence and incontinence, in relation to other types of radiation therapy. That omission prompted a flurry of chastening letters, primarily from men who have received proton beam therapy at Loma Linda University Medical Center in California. Proton beam therapy has been available since 1990, when Loma Linda started using it to treat patients. Whether it is actually better than standard radiation—or worth the extra cost—remains somewhat murky, the New York Times has reported. Various other sources suggest that more research ought to be done before concluding that this uncommon and expensive technology is significantly better than standard radiation treatment for prostate cancer. An editorial published recently in the Journal of Clinical Oncology, for example, looks at some of the complicated clinical and economic questions that remain.