In an editorial published in the January 2, 2013, issue of the Journal of the National Cancer Institute, Theodore Lawrence and Mary Feng discuss a recent study that compared proton radiotherapy and photon radiotherapy for treatment of prostate cancer in Medicare patients. Lawrence and Feng identify the shortcomings of the retrospective, population-based study of the prostate cancer therapies but say attention must be paid to the fact that the toxicities of the treatments are comparable and may not justify the 70% higher cost per patient of proton radiotherapy. The editorialists urge prospective trials to compare the therapies and caution against our rush to the new and more expensive therapy where supporting data are lacking.
Proton therapy has generated much excitement among physicians and patients. During the period from 2006 to 2009, the number of prostate cancer patients treated with protons nearly doubled (1) and use continues to rise. There are 11 operational proton facilities in the United States, opening at a rate of more than 1 per year over the past 6 years. Why is everyone so excited? There are at least three reasons. Two are clear, and one is complex.