Prostate Cancer Radiation: Proton beam costs twice as much, twice as good? NO

A recent retrospective study looked at outcomes in prostate cancer treated with Proton radiotherapy (PRT)  vs intensity-modulated radiotherapy (IMRT).

And the results:

We identified 27,647 men; 553 (2%) received PRT and 27,094 (98%) received IMRT. Patients receiving PRT were younger, healthier, and from more affluent areas than patients receiving IMRT. Median Medicare reimbursement was $32,428 for PRT and $18,575 for IMRT. Although PRT was associated with a statistically significant reduction in genitourinary toxicity at 6 months compared with IMRT (5.9% vs 9.5%; odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38 to 0.96, P = .03), at 12 months post-treatment there was no difference in genitourinary toxicity (18.8% vs 17.5%; OR = 1.08, 95% CI = 0.76 to 1.54, P = .66). There was no statistically significant difference in gastrointestinal or other toxicity at 6 months or 12 months post-treatment.

Medicynical Note:  There is a build it and they will come mentality in medicine that applies to new approaches that are costly and have little benefit.  In this case Proton Beam radiotherapy has a word of mouth that it is less “toxic”,  fostered in part by institutions that invested in this prohibitively expensive equipment. 

It appears, however, that the benefits of this modality are overstated, as often is the case with medical “advances,” and that the nearly 100% additional expense of proton beam treatment  is not justified in prostate cancer.

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