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  • Review Article
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Proton radiation for localized prostate cancer

Nature Reviews Urology volume 6, pages 324–330 (2009)Cite this article

Abstract

Proton radiation is an emerging therapy for localized prostate cancer that is being sought with increasing frequency by patients. The physical properties of a proton beam make it ideal for clinical applications; the Bragg peak allows for deposition of dose at a well-defined depth with essentially no exit dose. Thus, high doses can be delivered to a target while largely sparing adjacent normal tissue. Proton radiation has proven effective in dose escalation for prostate cancer. This is important, as high-dose conformal radiation is now the standard form of external radiation for this disease. Intensity-modulated radiation therapy, which uses X-rays, is another means of delivering high radiation doses to the prostate and is currently the most widely used form of external radiation in the US. At present prices, it is probably more cost-effective than proton radiation; this could change. Clear dosimetric superiority of protons in the high-dose region has not yet been demonstrated. A dosimetric advantage may emerge as pencil-beam scanning replaces passive scanning, and intensity-modulated proton therapy becomes possible. This technique would be particularly well suited to partial prostate 'boosts', hypofractionation regimens and stereotactic delivery of radiation, all new approaches to prostate cancer that are being investigated.

Key Points

  • Proton beams deposit a large proportion of radiation dose within a short range, minimizing exposure of nontarget tissue

  • The earliest available means of dose escalation, proton radiation is now more costly than brachytherapy and intensity-modulated radiation therapy (IMRT)

  • The deep-pelvic location of the prostate, gland motion, and relatively large penumbra of proton beams at depth limit the potential of proton radiation in its current form

  • Technological advances are likely to increase the clinical utility of proton beam therapy, particularly in relation to hypofractionation, partial prostate boosting and in vivo dosimetry

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Figure 1: Combining proton beams with differing energies results in the summation of narrow, monoenergetic Bragg peaks into a broader, more clinically useful 'spreadout' Bragg peak.
Figure 2: The use of a large number of beams during intensity-modulated radiation therapy means that low doses of radiation are delivered to a large volume of normal tissue.

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Authors and Affiliations

  1. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    John J. Coen & Anthony L. Zietman

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  1. John J. Coen
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Correspondence to John J. Coen.

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Coen, J., Zietman, A. Proton radiation for localized prostate cancer. Nat Rev Urol 6, 324–330 (2009). https://doi.org/10.1038/nrurol.2009.83

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