Crafting an Individual Treatment Plan for Patients With Prostate Cancer

In a recent interview with CURE, 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 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, his is co-director of the Kimmel Cancer Center Prostate Multidisciplinary Clinic at Sibley Memorial Hospital.

Transcript:

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 non-invasive, 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 towards photons or more towards 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.

Transcript has been edited for clarity and conciseness.

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