Overuse of Proton Beam for Prostate Cancer

Posted on: September 26th, 2018
by: Jennifer

At Chicago Prostate Cancer Center, patients ask, “What is proton beam?” and “Why do I hear commercials so often for this treatment?” Proton beam therapy (PBT) centers have opened over the past several years.  In the United States, there are 28 sites and an additional 16 in the planning and development stage.  The cost to operate these facilities are expensive, and the start-up cost begins at $20 million (Oncology Nurse Advisor, 2018).

Business developers interested in opening a PBT center have to make speculations when calculating if this is a worthwhile investment.  PBT sustainability, of this expensive form of radiation therapy, is determined through various factors.  Some factors include the number of patients treated annually, the quantity and different types of cancers treated, the incidence of these types of cancers, and percentage of payer type breakdowns, such as Medicare or commercial insurance since it affects reimbursement.

PBT is successful when treating children with cancer or tumors in the skull, spine, eyes, and head and neck since physicians do not want the radiation to reach surrounding organs (Oncology Nurse Advisor, 2018).  According to Tian et al. (2018) “PBT may improve patient survival by improving the local tumor treatment rate while reducing injury to normal organs, which may result in fewer radiation-induced adverse effects. However, the significant cost of establishing and maintaining proton facilities cannot be overlooked. In addition, there has been significant controversy regarding routine application of this treatment in certain types of cancer” (pg. 199). PBT has similar cure rates when compared to external beam radiation therapy and brachytherapy, although quality of life and cost effectiveness are not equal (Coen et al., 2012).

Treatment of prostate cancer, with PBT, is under scrutiny because no evidence shows this treatment is more successful than less expensive treatments such as LDR brachytherapy (Gran and Efstathiou, 2013).   Furthermore, Mahal et al. (2016) report “The use of proton therapy to treat patients with prostate cancer have more than doubled between 2004 to 2012, with striking racial disparities in its use noted despite robust multivariable adjustments. Long-term follow-up is needed to determine whether the increased use of proton therapy for prostate cancer is justified” (para. 2).  For financial stakeholders of PBT programs, there is a high incidence of prostate cancer, compared to the other cancers, and therefore, it is beneficial to include prostate cancer patients in the utilization of PBT proformas for their facilities.


Coen, et al., (2011, January). Comparison of High-Dose Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis. Genitourinary Cancer, (), 25-31.

Gray, P., & Efstathiou, J. (2013, June). Proton Beam Radiation for Prostate Cancer-is the Hype (and the cost) Justified? Curr Urol Rep14(3).

Mahal, B. (2016, May). National Trends and Determinants of Proton Therapy use for Prostate Cancer: A National Cancer Base Study. Cancer, ().

Oncology Nurse Advisor (2018).  Retrieved from https://www.oncologynurseadvisor.com/general-oncology/cost-vs-benefits-the-controversy-over-proton-beam-radiotherapy/article/747118/

Tian, et al. (2018, January). The Evolution of Proton Beam Therapy: Current and Future Status. Mol Clin Oncology, ().