Modern proton therapy in prostate cancer: precision in practice

Area of Science:

• Radiation Oncology
• Medical Physics
• Oncology

Background:

• Proton therapy (PT) utilizes the Bragg peak for precise radiation delivery, crucial for prostate cancer due to nearby critical organs.
• Evolution from passively scattered PT (PSPT) to intensity-modulated PT (IMPT) has refined treatment precision.

Purpose of the Study:

• To review the evolution of PT techniques for prostate cancer.
• To evaluate the dosimetric and clinical implications of PT across various treatment scenarios.
• To compare PT with conventional photon-based radiation therapy (XRT).

Main Methods:

• Review of dosimetric studies comparing PT (especially IMPT) with XRT (IMRT, VMAT).
• Analysis of clinical outcomes data for prostate-only and high-risk prostate cancer treatments.
• Inclusion of data on hypofractionated PT and FLASH PT.

Main Results:

• IMPT demonstrates superior normal tissue sparing and reduced integral dose compared to XRT.
• Excellent disease control and low toxicity rates observed in prostate-only treatments.
• Favorable toxicity profiles reported for IMPT in high-risk prostate cancer and postoperative settings.
• Hypofractionated PT shows no significant increase in toxicity.
• Emerging evidence suggests reduced rectal symptoms and lower secondary malignancy risk with PT.

Conclusions:

• Modern PT, particularly IMPT, is a precise and evolving modality for prostate cancer management.
• PT has the potential to optimize oncologic outcomes and preserve quality of life.
• Further randomized and cost-effectiveness studies are needed to define PT's role against advanced photon techniques.