Bonus Myth: My urologist tells me I’m not a good candidate for proton therapy because I’m a young guy and that young men should have their prostate taken out surgically.

Lots of young men are being pressured to choose surgery because, they are told, they have many years to live, that radiotherapy of all types is only a temporary cure, and that their cancer will probably return … unless they have their prostate removed surgically.

If all the cancer is contained within the prostate and the prostate is removed, that statement is partly true—the cancer cannot return. But we’ve shown in our Mythbuster Series there is often cancer in the margins, the tissue around the prostate that is not removed by surgery.

Even Early Stage Cancer Can Escape the Prostate

According to the Partin tables, a patient with a PSA less than 10, a Gleason score 6, and stage T1c has a 67% chance of organ confined disease. That means there’s a 33% chance of cancer in the tissue surrounding the prostate. The tables also show that a Gleason 7, T2b patient has a 22% chance of organ confined disease (78% chance of cancer in the margins).  
Also, there have been documented cases where surgeons have, in fact, left prostate tissue behind during radical prostatectomy. If there is cancer in the margins or if cancerous prostate tissue is left behind, cancer will likely return. So, why not choose a treatment that will target cancer within the prostate as well as cancer in the margins? That’s proton therapy.

If Best for Children, Why Not Young Men?

All radiation oncologists seem to agree that the patients who benefit most from proton therapy are infants and young children. Why? Because proton therapy has been proven to both destroy cancer and protect surrounding healthy tissue. In a child, protecting surrounding organs, bones, and tissue is crucial, because when these healthy areas are damaged by radiation, that part of the body often stops growing. If the pediatric tumor is in the shoulder, arm, or leg, there’s a good chance that limb will not develop with the rest of the body. Also, because healthy tissue is not targeted, the likelihood of secondary cancers later in life is significantly diminished.

So, if proton is best for destroying cancer and preserving the quality of life in infants and young children, why wouldn’t it be best for destroying cancers and preserving quality of life in young men?

Young Men Are Better Educated Today

More and more young men are choosing proton therapy for their prostate cancer because they are better educated today than ever before. They know their chances of losing sexual function and having to wear a diaper for the rest of their lives is far greater with the surgical option than with any form of radiation therapy. If they’ve done their homework, they’ve learned that of all the radiotherapy options, proton is best because it targets the tumor and preserves healthy organs and tissue surrounding the prostate. And when that healthy tissue includes the rectum, bladder, and nerves for sexual function, it becomes even more important to a young man.

Clinical Study on Younger Men Showed Satisfaction with Quality of Life after Proton Therapy

In 2011, the University of Florida Proton Therapy Center reported on a clinical study involving 98 men with low, intermediate, and high-risk prostate cancer who were 55 years-old or younger when treated. These men were evaluated pre-treatment and post-treatment at six month intervals. After 18 months the study showed:

  • 21 percent experienced mild urinary side effects that were treated with prescription medication.
  • 3 percent experienced mild gastrointestinal side effects that were treated with prescription medication.
  • No patients experienced permanent incontinence.
  • No patients experienced significant rectal side effects.
  • 94 percent of those that did not receive androgen deprivation therapy were sexually active.
  • Only 2 patients were dissatisfied with their treatment decision.

Bottom line, according to the report, “Young men treated with proton therapy for prostate cancer have few significant side effects in the first 18 months after treatment.” The results were reported at the 52nd annual meeting of the American Society for Radiation Oncology.

Going to the Source—Young BOB Members

The Brotherhood of the Balloon consists of close to 800 members who were 55 or younger when treated. And we have more than 150 members who are in their 30s and 40s.

Many of our youngest members were treated within the past five years, but several go much further back, including one treated 15 years ago and another treated 21 years ago.

Last month we conducted a random “mini-survey” of the youngest in our group and asked questions about PSA, sexual function, urinary function, bowel function, and how they felt about their proton treatment decision.
Everyone who responded gave permission to use their names, and most offered to speak with any young men who are considering proton therapy.

The responses were surprisingly consistent:

  • PSA was either down to nadir or still dropping.
  • No change in urinary function
  • No change in bowel function (one reported some minor rectal bleeding)
  • Sexual function not changed at all, or has slightly changed, but not a problem (one respondent said, “Sexual function is better than before treatment, probably due to fihnding the love of my life after treatment.” Another stated, “I am not as ‘strong’ as before, and sometimes I use the ‘blue gold.’”)

Other comments from the young guys in our survey:

  • “I tell the guys that contact me that I know how they are feeling. I remember lying in bed next to my sleeping wife awake with my gut in knots. But with knowledge comes peace. So, with surviving being the number one goal, the next question is—what kind of life does one want after treatment?  Normal sex or not? Diapers or no diapers? Bowel problems or not? Infections or no infections? And on and on … For my wife and me it was an easy decision and one that we have not regretted!”
  • “I was concerned how treatment might impact my mild colitis. I have experienced zero bowel irregularity with the exception of mild tenderness one week during treatment.”
  • “I absolutely made the right decision. I frankly do not understand why anybody would choose any other treatment.”
  • “I feel fantastic about the decision to choose proton as a therapy. It’s really provided a fantastic QOL compared to what I read about alternative treatments.” 
  • “My feelings concerning having had proton treatment is one of being grateful—grateful for having lived at a time when the technology and the vision of Dr. James Slater were brought together so that I could benefit from the proton beam.”
  • “Bob’s book and website have truly helped me in my cancer journey. The monthly newsletter is both inspirational and informative and I enjoy the completeness of the coverage and stories. I’m happy to support the message of proton therapy and welcome the opportunity to help new members.” 
  • “Proton was the best decision of my life and it changed my way of living totally. I now have a much better and healthier way of living.”
  • “When you are 42 years old, as I was five years ago when I went to Loma Linda, you have to make a decision for, hopefully, the next 40 years. I would not like to spend this time dealing with incontinence or impotence (I love my wife too much). I can think of no better investment in the next 40-50 years of my life.”

And how about this comment …

  • “I actually fathered a child after my treatment—a healthy son, born August 2010.”

While this was a small sampling of our younger members, the responses are consistent with what we have been hearing from them in our regular communications and with the study mentioned above.

So, is proton therapy just for older men? Clearly, the answer is no.

Bonus Myth: BUSTED!

Any questions? Just ask.