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Proton Therapy in Prostate Cancer Compared to Conventional Photon (x-ray) Therapy – The COMPPARE study

Babita Jyoti, M.D.

May 19, 2023

The role of radiation therapy in the treatment of localized prostate cancer is well established.  Most patients receive conventional photon (x-ray) such as Intensity Modulated Radiotherapy (IMRT). Proton beam therapy is a specialized form of radiation that is only available at the few Proton centers in the US. There is a substantial amount of data supporting the use of conventional IMRT in localized prostate cancer. There is also data from large single-institution studies reporting promising results from the treatment of localized prostate cancer with Proton therapy. However, there has never been a large multi-institutional clinical trial comparing these two treatment modalities head-to-head.

The promise of proton therapy is reduced dose to surrounding normal tissue and thus less collateral damage in the future due to the unique physical properties of protons.  The positively charged proton particles have the ability to deposit dose deep in a patient and stop, without an exit dose, unlike conventional x-rays that do not stop at the tumor.  Do these reduced doses translate into better Quality of life? How comparable is the disease control? These questions are being addressed by the COMPPARE study.

The COMPPARE study is a multi-institution study expected to start accrual in November this year and anticipate about 3000 patients will be recruited by April 2024. These patients will be followed for 2 years. The primary outcomes measured include prostate cancer specific quality of life symptoms including bladder, bowel, and sexual function symptoms. The secondary outcome measures include prostate cancer recurrence rates. This will be the first head-to-head comparison on proton and photon therapy in localized prostate cancer.

Ackerman Cancer Center, along with several other proton centers and non-proton centers will be participating in this prospective study. Patients receiving proton therapy have an option to choose to receive the standard 8 week treatment versus the shorter 4 week treatment with higher doses per day thus resulting in a biologically equivalent dose to the standard treatment. This will further address the question of effectiveness of the shorter length of treatment.

I am excited about this opportunity to objectively evaluate the benefits of proton therapy in prostate cancer and directly compare it with conventional, standard radiation therapy.

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