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Health & Medicine for Senior Citizens

Pricey New Prostate Cancer Proton Therapy Raises Questions About Safety, Cost

Proton therapy targets more precisely, should minimize damage to nerves and tissue; hope is it translates into fewer side effects, but has become center of intense debate

By Rob Stein, NPR News (The KHN Blog)

Oct. 29, 2012 - Bill Sneddon had a feeling he was in trouble when his doctor called with his latest test results.

“I just had a premonition that something’s not right,” said Sneddon, 68, of Ocean Township, N.J.

And, sure enough, Sneddon’s instincts were right. He had prostate cancer.

“Well, it’s an eye-opener, you know. I didn’t know if I had to buy a yard sale sign, you know,” he said. “It’s a shocking thing … It always happens to someone else.”

After getting over the shock, Sneddon, a retired police chief, quickly started investigating his options, including surgery and radiation. The next day, a golfing buddy told him about a new kind of radiation treatment for prostate cancer.

This story comes from our partner ‘s Shots blog.

“He told me that I should look into proton therapy. And I’ve known him a long time, so when he told me this is a treatment I should get, I knew this is a treatment I better get,” Sneddon says.


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Growing evidence that questions U.S. Preventative Services Task Force recommendation against PSA screening in all men - Aug. 23, 2012

No PSA Testing May Triple Cases of Advanced Prostate Cancer, Spread

Data very clear: not doing PSA will result in many men with far more advanced prostate cancer spread to other parts of the body

July 30, 2012 - Eliminating the PSA test to screen for prostate cancer would be taking a big step backwards and would likely result in rising numbers of men with metastatic cancer at the time of diagnosis, predicted a University of Rochester Medical Center analysis published in the journal, Cancer. Read more...

Debate About Recommendation Against PSA Test for Prostate Cancer to Continue

The recommendation by U.S. Preventive Services Task Force against PSA screening for men of any age for prostate cancer stirs swirl of controversy: says special report in NCI Cancer Bulletin

By Carmen Phillips, National Cancer Institute - June 5, 2012

More links to prostate cancer reports below story


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So Sneddon was excited when he discovered that the ProCure Proton Therapy Center had recently opened in Somerset, N.J., about an hour and a half away from his house.

“It’s like coming to a health club or a five-star hotel,” Sneddon said recently as he waited for the next round of his nine weeks of treatment.

Sneddon looked more like he was at his country club than in the waiting room of a cancer clinic. The lobby has big windows, high ceilings, a rock wall surrounding a blazing fireplace. Relaxing music was playing.

But beyond the comfortable atmosphere, what really draws patients like Sneddon to proton therapy is how it works.

“It’s sort of like the difference between using a bullet, which passes through a person, and like a smart bomb that enters into a certain position, deposits its energy and then releases its radiation to that location,” says Henry Tsai, a radiologist at ProCure who’s treating Sneddon.

Because proton therapy can be targeted much more precisely, it should minimize any damage to sensitive nerves and tissue around the prostate. The hope is that it translates into far fewer side effects, such as impotence and incontinence.

But proton therapy has become the center of an intense debate. Critics say it’s an example of a big problem with the U.S. health system: Doctors start using expensive new treatments before anyone knows whether they work, whether they’re safe, and whether they’re worth the extra money.

“There’s a concerning trend of us building new and expensive new technology and using it for a common cancer like prostate without proving, really, that it’s equivalent to the existing technology,” said Ronald Chen of the University of North Carolina at Chapel Hill.

“New treatments can — even though they’re promising — can potentially not be better and can even be worse,” Chen said. “I think we have to do careful studies before we adopt new treatments.”

The ProCure clinic is the newest of 10 proton centers around the country, and there are perhaps 10 more on the way. That has many experts worried.

“There’s no convincing evidence that it’s better. The jury really is out on this new technology,” says Anthony Zietman, a cancer radiologist at Harvard Medical School. “It might be better. I feel it’s probably the same. It might even be worse.”

And Zietman can’t help but worry about how much it costs: at least $50,000 for each patient, which is about double the price tag for regular radiation.

Here’s why: Those huge proton machines are incredibly expensive. They cost between $100 million and $200 million to build.

“There’s almost no other medical device … that I can think of that comes close to a proton treatment facility,” Zietman said.

Doctors developed proton therapy for tumors in really sensitive places, such as in the eye, on the spine or in a child’s brain.

But then Medicare started paying for it for prostate tumors — so more proton centers started promoting it for that.

“Any institution that forks out that kind of money and makes that kind of investment is obviously going to want to recoup that investment fairly rapidly,” Zietman said.

And new proton centers started opening up. All this means that the health care system is suddenly paying a lot more to treat prostate cancer with a therapy that so far doesn’t look significantly more effective than other options — and may be worse. In fact, Chen reported the results of a study over the summer that suggested proton therapy might cause more side effects, such as bleeding from the bowel, pain and severe diarrhea.

“Unfortunately, this is like driving a Ferrari to the grocery store and asking your next-door neighbor to pay for the Ferrari,” said Peter Grimm of the Prostate Cancer Treatment Center in Seattle.

Now, proton therapy has lots of fans. In fact, doctors are presenting new studies at the American Society for Radiation Oncology‘s annual meeting in Boston this week that they say show how well it works. They say data from thousands of men provide powerful evidence that the therapy is effective and safe.

“If cost were the same, there would be no debate about providing less radiation to a patient, which is always better,” said Leonard Arzt of the National Association for Proton Therapy.

While the debate continues, men like Bill Sneddon are lining up to get it.

After changing into a hospital gown, Sneddon walked into a sleek, new treatment room. It’s very sci-fi-looking. No antiseptic smells.

Sneddon climbed onto a motorized platform and lay down in front of a big nozzle that was sticking out of the wall.

The nozzle is the business end of a gigantic machine down the hall: a 220-ton gizmo that was shipped over from Belgium. That huge linear accelerator shoots out the proton beams.

Glowing red laser lights criss-crossed Sneddon’s body. The technicians use the lasers, X-rays and three little gold pellets that Tsai injected around Sneddon’s prostate gland to make sure he’s positioned just right. The key is to make sure the proton beam zaps his prostate gland and, hopefully, nothing else.

“There’s absolutely no sound that’s emitted from the proton machine. There’s no sensation on the skin to indicate that the treatment is being received,” Sneddon said during the treatment.

In less than a minute, he was done.

Some of this information is reprinted from with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.

“I’ve had a couple days where I very easily could have fallen asleep through the whole procedure,” said Sneddon, who so far said he feels great, with no signs of any side effects.

Sneddon figures it’s the insurance companies who are behind all the questions about proton therapy. Medicare and his private insurance are covering his bills — he doesn’t even know how much it costs.

So he’s even urging a friend who just found out he has prostate cancer to check out ProCure.

In the meantime, a big, carefully designed study is just getting going to try to settle the issue. But the results won’t be ready for years.

Links to More on Prostate Cancer in

Four New Drugs Will Change Prostate Cancer Care, Colorado Expert Says

Hope this will lead to making prostate cancer a disease a patient is more likely to die with than from, By Garth Sundem, Feb. 16, 2012

Researchers Find Possibility of Heart Disease Causing Prostate Cancer

Duke researchers find evidence linking prostate cancer and coronary artery disease - Feb. 8, 2012

Why Observing Prostate Cancer Gaining Ground On Surgery: NIH Panel Says Not Cancer

‘Some think these tumors should be rebranded as something else, such as idle tumors’

By Richard Knox, NPR’s Shots blog - Dec. 9, 2011

Delay of Treatment for Low-Risk Prostate Cancer Gets Nod from NIH Panel

Recommends active monitoring but details of strategies not determined, Dec. 8, 2011

Cardiovascular Deaths Not Linked with ADT for Prostate Cancer but Lower All- Death Risk May Be

Study should be 'generally reassuring' to most men with unfavorable-risk prostate cancer considering ADT, because it was associated with improved survival  - Dec. 7, 2011

Prostate Cancer Patients Considering Suicide May Find Help in New Concept

Patients who have these negative thoughts before surgery are more likely to have a lower perceived quality of life 3 months afterwards

Oct. 31, 2011

Influential Panel Giving Thumbs Down To Routine PSA Test for Prostate Cancer

See links to other comments and reports on this recommendation

By Scott Hensley, NPR News, Oct. 10, 2011

New Models Predict Likelihood of Erectile Function Return After Prostate Cancer Treatment

Problem still there but it helps men make better informed decisions with realistic expectations - watch video report

Sept. 20, 2011

New Surgery-Free Treatment for Enlarged Prostate Avoids Sexual Dysfunction

Prostatic artery embolization as effective as popular TURP surgical method; more than half of senior men have enlarged prostate; also silodosin a new treatment for prostatitis

May 18, 2011

Ten Ways to Improve Communications, Make Better Decisions About Your Cancer Care

Michigan researchers outline how to improve communication about the risk

Sept. 20, 2011

Concern Is Growing That the Elderly Get Too Many Medical Tests; Little Benefit

Growing skepticism about widespread, routine screening for cancer and other ailments of people in their 70s, 80s and 90s

By Sandra G. Boodman, Kaiser Health News

Sept. 13, 2011

Prostate Cancer Patients Live Much Longer with Hormone Therapy Added to Radiation

Larger graphs of prostate cancer cases and deaths 1987-2007 below story

ADT therapy works well with intermediate grade cancer, not so well with low grade; only two grades tested in this trial

July 15, 2011

Medicare Bites Bullet to Cover Expensive Provenge, Prostate Cancer Drug for Bad Cases

CMS also to continue expensive breast cancer drug, Avastin; Sipuleucel-T activates immune system to defend against prostate cancer; first approved autologus cellular immunotherapy

July 1, 2011

Cancer Death Rates Continue Decline That Began in Early 1930s Says Cancer Society

Cancer Statistics 2011 shows among men the reduction in lung, prostate, and colorectal cancers is nearly 80% of decline; among women, almost 60% of decrease in breast and colorectal - see chances of seniors getting cancer - June 17, 2011

Drug Approved to Treat Nail Fungus Found to Delay Chemo in Advanced Prostate Cancer

Itraconzole slows prostate cancer progression but has potential of serious side effects - June 3, 2011

Rising PSA Levels May Sometimes Lead to Negative Biopsies But Usually Means Cancer

News study shows nearly 70 percent with rising PSA eventually get prostate cancer - May 18, 2011


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