What are the Long-Term Side Effects of Proton Therapy in Prostate Cancer?

Newer radiation technologies, such as proton therapy, are helping to minimize long-term side effects for patients with prostate cancer and beyond, according to Dr. Curtiland Deville Jr.

Emerging evidence in other cancers show benefits from proton therapy, including reduced hospitalizations in esophageal cancer and fewer feeding tube requirements in head and neck cancer. While research is ongoing in prostate cancer, the most common side effects patients face include urinary, bowel and erectile function issues — areas where reduced radiation exposure could help, Deville said in an interview with CURE.

Deville is an associate professor of radiation oncology at Johns Hopkins University School of Medicine, medical director of the Johns Hopkins Proton Therapy Center and clinical director of radiation oncology at Sibley Memorial Hospital in Washington, D.C. In addition, he is co-director of the Kimmel Cancer Center Prostate Multidisciplinary Clinic at Sibley Memorial Hospital.

Transcript:

Question: Many patients worry about the long-term side effects of radiation therapy. What are some of the advancements in technology and techniques, such as those you research, that are helping to reduce these risks and improve quality of life after treatment?

Answer: That's the ultimate goal with prostate cancer management, really all of our radiation delivery. We call it the therapeutic ratio. But the goal is either to kill more cancer or to reduce the side effects, and ideally, you can do both. Many of our treatments from a radiation standpoint, and particularly where protons come in, we can do very well at getting dose in whether we use protons or photons. And so, the question with protons, because there's less collateral exposure to tissues, it's really a question of, can we improve the side effect profile? Can we reduce those side effects of treatment? And that's where we have been doing well.

There are many tumor types where we're seeing more evidence that patients who receive proton therapy have experienced less side effects. Esophageal cancer is a good example of that where some early studies show less rates of hospitalization or head and neck cancer needing less feeding tubes, and those sorts of things. So, as our technology is advancing as our targeting is improving as our sparing of normal healthy tissues is getting better, that is translating to seeing less side effects.

For prostate cancer we're still learning and studying — trying to determine what are those exact benefits. For prostate cancer, the main side effects are urinary issues or bowel issues or erectile function issues, and so really trying to preserve and reduce the dose to those areas may translate to benefits in those areas. And then one of the main benefits, potentially with proton therapy — although it's a rare side effect — is the creation of a new cancer from radiation treatment is a risk. Because protons are exposing those surrounding tissues to less radiation, we can potentially lower the risk of generating a new cancer in the future.

Transcript has been edited for clarity and conciseness.

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