We have several men in our US TOO! group who have had Proton beam at Loma
Linda and were
satisfied with the treatment they received from the staff and so far are
doing well.

Keith Lundy from our group here has had proton beam treatment.
Bev

You picked a good time to ask your question, recently Loma Linda
published a paper in which they reviewed their proton experience and
provided actuarial bNED rates projected out to 10 years. Their
conclusion was that proton therapy (PT), as practiced at Loma Linda,
"yielded disease-free survival rates comparable with other forms of
local therapy, and with minimal morbidity."  Walsh's surgical results
are then referenced.

However, IMO, interpretation of their results and substantiation of
their conclusions is made difficult by the following factors.
1. In the early days, LL used both PT plus external beam photon
therapy.  In the study, 731 men received the combination therapy and
524 received PT only.  The groups were not broken out but lumped into
one group for analysis.
2. 53% of the LL men were T1abc or T2a.  60% of the men had PSA =< 10.
93% of the men had GS =< 7.  In summary, there was a preponderance of
low-risk men in their study.  Further, men with GS 5-7 were lumped
together and not broken out, making comparisons with other treatment
modalities problematical.

The LL authors note an actuarial disease-free survival rate of 81% at
10 years post PT for men with initial PSA between 4.1 and 10.  Only 4%
of the men in the LL study were staged T3, 96% were staged T2b/c or
lower (roughly 25% each T1c, T2a, T2b, T2c).  If one looks at the
Hopkins nomograms one will find 10-year disease-free survival rates of
72%, 84%, 91% and 95% for men staged T2b/c, PSA between 4.1 and 10 and
GS = 4+3, 3+4, 6 and 5 respectively.  Of course the surgical outcome
only gets better as the stage moves down to T2a (78%, 88%, 93% and
96%) and T1c (83%, 91%, 95% and 97%).  While direct comparison between
the PT and surgical outcomes is not possible with the LL data at hand,
it seems fairly evident that the surgical outcomes are likely to be
significantly better.  Further, the LL authors used the ASTRO
definition of failure.  As I've mentioned before

http://groups.google.com/groups?hl=en&lr=&ie=UTF-8&selm=1807c7b7.0409091554.1724
4640%40posting.google.com

the ASTRO definition is much more forgiving then the PSA >0.2
definition of failure.  Taking this difference in failure definitions
into account will only serve to further improve the surgical
biochemical outcomes in comparison to the PT results.

For low-risk men, surgery and SI+EBRT, as practiced at RCOG, have
similar 10-year actuarial biochemical disease free outcomes.  So I
don't understand how the LL authors can say that PT yields results
comparable to other forms of local therapy when in fact they appear to
have significantly poorer results than surgery or SI+EBRT for low-risk
men.

Today, for young men with PCa whose primary treatment goal is to live
out their normal allotment of years, I'm not sure that PT would be the
best treatment option.  However, the LL authors do note that trials
with higher dose rates are already underway.  They also note that
intensity-modulated PT (IMPT) is just around the corner.  Both of
these modifications may well serve to further improve the efficacy of
this treatment...Best wishes and good health, Ron