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
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.
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.
Data very clear: not doing PSA will result in many men with far more advanced prostate cancer spread to other parts of the
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...
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
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
“There’s almost no other medical device … that I
can think of that comes close to a proton treatment facility,” Zietman
Doctors developed proton therapy for tumors in
really sensitive places, such as in the eye, on the spine or in a
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
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.
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
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.
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