Dr. Curtiland Deville Jr.

Proton therapy may reduce urinary, bowel and sexual side effects in prostate cancer by minimizing radiation exposure to healthy tissue, per Dr. Curtiland Deville Jr.

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.

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?

 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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Dr. Curtiland Deville Jr. discusses the importance of crafting an individualized treatment plan for patients with prostate cancer.

Crafting an Individual Treatment Plan for Patients With Prostate Cancer

, Dr. Curtiland Deville Jr. discussed the importance of crafting an individualized treatment plan for patients with prostate cancer.

Patients and providers, Deville explained, can find themselves selecting from a “menu of options,” which can include surgery and forms of radiation, such as proton therapy.

“When we see a patient, we want to develop an individualized and very customized treatment plan for them,” Deville explains.

Deville is 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.

I think of protons as just another tool that we have. We have all the available treatment options for prostate cancer here at Sibley and at Johns Hopkins in radiation oncology. When we see a patient, we want to develop an individualized and very customized treatment plan for them. Very often, I might tell a patient that we may not conclude this conversation by stating that one specific treatment is definitively better for them; we may have a menu of options. Our job is to go through that menu and then try to rank and see what might suit this individual better.

Patients may ask me, "Well, what would you do at the end of the day?" Or when I was younger, they might say, "What would you do for your father?" And I used to like to say, "What my father would do is different than what my uncle would do in the same situation." So, it’s not necessarily about us imposing our own preferences but really trying to understand the patient in front of us and what they value and what their preferences are.

For prostate cancer, patients truly have a tremendous amount of treatment options available to them, which can include surgery or radiation. If they are deciding on a radiation pathway, we may have internal forms of radiation known as brachytherapy, which can be done with seeds or catheters; it’s called low-dose radiation or high-dose radiation.

If they are less interested in an invasive approach and prefer an external approach that is completely noninvasive, then we can consider our photon or proton therapy. There are sometimes contraindications to proton therapy that make treatment delivery harder, such as if the patient has bilateral hip implants, meaning they've had hip replacements on both sides. In that case, it’s very challenging to deliver proton therapy.

So, there may be factors as we evaluate an individual case that steer us in one direction more toward photons or more toward protons. But ultimately, if the patient is a good candidate for proton therapy, we can review the logistics, the potential side effects and all the details regarding the program and how we would develop a treatment plan for them.

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Dr. Curtiland Deville Jr.

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

Crafting an Individual Treatment Plan for Patients With Prostate Cancer

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