I need some clarification. Are you considering UNM and MDA for Proton or just MDA? Is IMRT the Photon alternative?

There is no cancer control advantage for proton over photon. In any case why would you want the conventional 45 fractions? Consider combination brachytherapy and IMRT and reduce this to 25 fractions of external beam. Havbe you been assessed for mono-therapy with either SBRT with 5 or 6 fractions or HDR brachytherapy with two fractions?

I appreciate everyone's input. Yes I am considering treatment in 3 locations traditional Photon at Santa Fe Cancer, UNM Cancer or Proton at MD Anderson. I don't want to pick the most convenient but the best treatment. PSA Test on June 18th. MD Anderson Proton wants them at zero to start treatment end of July. most recent was 12.7 on Finasteride. If PSA not low I will test again in a month. I am still not sure if my co-pay insurance will cover Proton or type of Proton treatment MD Anderson will recommend (scattered on Pencil beam). They are recommending 48 low dose treatments rather than alternative high dose shorter treatments due to my previous TURP and scarring. Tall Allen thank you very much for the chart. I will print it and refer to it often. The dose verses toxicity is always the question. I believe cost is going to move treatment to the shorter high dose methods in the future. This is happening in Europe. It is more convenient for the patient, but there will be folks like me with prior conditions that will require lower dose methods. John TX & JNF thanks, I am starting to believe there isn't much difference between Proton and Photon. I was impressed with the SpaceOAR results especially for preventing ED. It seems worth it. Onward through the fog!

MD Anderson is rated by many as the top cancer hospital in the country. It's certainly in the top five.
It would be very appealing to me to be treated in one of the finest cancer hospitals in the country. You said you are starting to believe that there isn't much difference between Photon and Proton. MD Anderson does both. Why not ask the RO there that you've consulted with what he/she recommends for you and why?

I assume you've already had discussions with them about your candidacy for either LDR or HDR brachytherapy and neither are appropriate for you. And you've already explained why SBRT is not appropriate. That seems to leave IMRT or Proton as your two options.

It would be extremely difficult for someone to talk me out of going to MD Anderson and having the Pencil beam therapy. I believe that's the better choice. I'm not an engineer — not a scientist— and may be a victim of Proton propaganda, but that's how I feel. If my insurance didn't cover it, that would be a game changer. As for working at home, it is quite easy as you know to set up a work station in your temporary residence in Houston for the 2 1/2 months. It's not ideal, but workable. My wife did it in Florida for 2 months. She missed her home office but it sufficed.

Good luck on your decision-making. Side effects are the primary differentiator. Either treatment has similar cure rates.

Post Edited (hrpufnstuf) : 5/31/2018 9:33:02 AM (GMT-6)

It is probably too late, but SBRT/CyberKnife has similar positive outcomes as proton therapy.
But, it is 5 sessions over 5 days.