Myth #4: Proton therapy is not recommended for patients with a high Gleason score.
Over the years, we have received numerous phone calls and e-mails from men who were told by their urologists they were not candidates for proton therapy because their Gleason score was 8, 9, or 10. Next, they are often told that surgery is the best option for them. Nothing could be further from the truth, in our opinion.
If prostate cancer is contained within the capsule, we would argue that proton is the best treatment to choose. Why? Because proton therapy has been proven to destroy localized cancer and it leaves the patient with a higher quality of life after treatment. You may recall that in a recent survey, 97% of our members reported the quality of their lives after proton treatment was the same as or better than before treatment. No other prostate cancer treatment option can claim this—certainly not surgery.
But—and here is a very important “but”—what if the cancer is outside the prostate, and still localized within the prostate bed?
Cancer Left Behind With Surgery
It’s not uncommon for prostate tissue to be left behind during surgery—both open and laparoscopic. Dr. Charles Myers talks about this in one of his recent weekly videos. If this tissue happens to be cancerous, then the patient will have a recurrence.
But what about cancer in the margins? This is always a possibility, more so than most people think. If you visit the Partin Tables on the Internet, and find your pre-treatment PSA and Gleason scores, you can determine the probability of cancer in the margins around your prostate. In Bob’s case, at age 57 when diagnosed, with a PSA of 7.9, Gleason score of 3+3=6, and a clinical stage of T1c, the probability was 30.5% that there was cancer in the margins. For men with higher PSAs and higher Gleason scores, the probability increases dramatically. Let’s say you are the same age, with a pretreatment PSA of 9.0, Gleason score of 4+4=8, and a staging of T2b. In this case, there’s an 86% chance the cancer has spread outside the prostate.
Why is this important? There are many reasons. Cancer that spreads outside the prostate is not removed during surgery. Period! Typically this cancer is microscopic and cannot be seen with the naked eye, so surgeons cannot just remove it. So, the likelihood of cancer returning for Gleason 8, 9, or 10 patients after surgery is high.
Why is proton better? Because, when doctors treat with protons, they not only treat the prostate, the capsule and local seminal vesicles, they also treat a margin around the prostate. At Loma Linda where Bob was treated, they treat a 12 mm margin (about ½ inch). This is a huge benefit, in our opinion, because studies have shown that when cancer escapes the gland, it typically stays within a few millimeters of the capsule. This cancer in the margin is targeted and destroyed by proton radiation. The same can be said about other forms of radiation that target both the prostate and a margin around the prostate.
Proton radiation, often used in conjunction with photon radiation and hormonal therapy for advanced, localized cancers (Gleason 8, 9, 10) has a much better chance of destroying all the cancer than does surgery.
Take a Look at BOB Membership
We have about 700 members of our group with a Gleason score of 8 and higher, about 200 of these are in the 9 or 10 category. A great many of these men were treated 10 or more years ago and the overwhelming majority of them are doing fine today.
How about BOB member, Bob Reimer? Bob was diagnosed with advanced prostate cancer, PSA 61, Gleason score 10. His local doctor told him to get his affairs in order because he probably had 18 months to live. Bob would have none of that. He did his homework, chose proton treatment at Loma Linda (in combination with photon and hormonal therapy), and today―more than 14 years later―Bob is doing fine.
Not everyone with aggressive cancers have this outcome. There is a higher percentage of recurrences at these levels, but nowhere near what they would be if surgery alone had been chosen.
We actually have a reference call list of BOB members with high pre-treatment Gleason scores. When someone contacts us with a high Gleason score and has been told by his local doctor he’s not a candidate for proton treatment, we put them in touch with some of the men on this list and we encourage them to talk with several men with high Gleason scores who chose surgery or other treatment options … if they can find them.
Myth #4: BUSTED!
Any questions? Just ask.