So Many Choices... Summary of Protons v. Surgery v. Seeds

What to do, what to do? So many choices, so many options. Surgery? Do nothing? Radiation?


If surgery, what type? Traditional radical prostatecomy (cut the whole thing out with a surgeon's skilled hand) or robotic prostatecomy (same surgery but using a tiny robot that is controlled outside the body)?



"Do nothing" is called by various names -- "watchful waiting", or, more euphamistically, "active surveillance".



Radiation comes in many different varieties. The purpose of radiation, like surgery, is to destroy your entire prostate. Early prostate cancer stays in your prostate (almost always) but noone knows where it is - sorry, baby, that entire prostate has gotta go. Unless you want to run a greater risk of a recurrence.

What flavor of radiation beam do you want? The traditional photons or protons. Photons are what an xray machine makes and is the traditional type of radiation therapy. For protons, remember your high school physics class. The atom is made from protons, neutrons and electrons. For proton therapy, the protons need to be separated from the rest of the atom and accelerated to such a speed that they can enter the body.



How do you wanta get your radiation? From the outside or the inside? You can only get it from the inside with "seeds" aka brachytherapy. These are tiny radiactive seeds that are surgically implanted in your prostate and are designed to destroy your prostate over time as they release radiation. How they get all your prostate without destroying other things is always a question. The skill of the doc inserting them in your prostate is obviously a key -- gotta get them in the right place so they won't move later on.



Radiation from outside the body comes in different forms. The usual problem with radiation therapy is that it's like trying to use dynamite to remove the curtain wall between your kitchen and the family room -- it tends to destroy things like the plumbing and electrical wiring in your bedroom at the same time as that wall you want gone. The trick with most radiation is to have it just destroy the curtain wall rather than parts of the rest of the room. Proton beam treatment comes from outside in. So do all types of photon radiation. There are a multitude of types of external photon radiation. Each designed to limit the "collateral damage". They go by a variety of different names, with an alphabet soup shorthand names. Here are a few:

• EBRT ("External Beam Radiation Therapy") -- this is just a general name for external radiation therapy.
• IMRT ("Intensity Modulated Radiation Therapy") -- think about a stick of dynamite that can concentrate its explosive charge where it is most needed and, at the edge of the wall, has a much smaller impact
• 3D-CRT ("3 Dimensional Conformal Radiation Therapy") -- you must be getting the picture by now, this is a way to view the prostate precisely ("3D") and to "conform" the beam to the shape of the prostate so as to not have it damage surrounding areas.

I have not explored all the radiation therapies...for reasons I will explain later.

I will explain later why I chose proton therapy.