Ralph Hafner of Minot was diagnosed with prostate cancer in late December. His physical had indicated elevated PSA levels in November, so he had a biopsy done.
"I was told the best cure would be surgery, so I scheduled it for the 9th of February. I was in Bismarck at my son's place and my brother-in-law brought a magazine over," Hafner said.
Hafner's brother-in-law, a dentist, had stumbled on an article in one of the magazines in his lobby. The article was written about a ProCure Proton Therapy Center. Proton therapy uses a proton beam to destroy cancer cells.
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Ralph Hafner of Minot undergoes a proton therapy cancer treatment.
"Proton therapy is different than radiation therapy. Using the positive charge of the protons, you can accelerate them to a set energy and they'll go a set distance. It's very precise. The protons will travel the distance that you set and stop on a dime, and have a sudden release of energy," Dr. Sameer Keole, medical director of the ProCure Proton Therapy Center, said.
"Radiation will keep going through the body, and can cause damage to healthy tissue around the tumor. Protons will go into the tumor and will explode like a death charge inside of the tumor," he added.
After reading about Proton Therapy, Hafner decided to give it a try. He cancelled his surgery and scheduled an appointment at the ProCure Proton Therapy Center in Oklahoma City.
"I felt so fortunate to hear about another option. I didn't want to go through with the surgery. I'd heard of so many side effects, but I thought I'd have to do it," Hafner said.
Proton Therapy has been used in the U.S. and Sweden since the 1950s, but didn't gain popularity until the 1990s. There are currently only seven Proton Therapy treatment centers in the country.
"Since the beginning, we have figured out better ways to accelerate and steer the protons. This is a complicated evolution of radiation therapy, and I think it will take a few decades before it becomes readily available," Keole said.
"It hasn't become more widely available because of cost, and there is a limited amount of expertise in the field. It's a matter of resources, both financial and from a personnel standpoint," he added.
When Hafner arrived in Oklahoma City for his treatment, he learned he would be recieving 44 treatments over the course of 9 weeks.
"Ralph's story was a common one for prostate cancer. He had a slowly rising PSA level that prompted his family physician to send him for a biopsy. The pathology showed that it was prostate cancer, not the most aggressive form, but it definitely required treatment," Dr. Elaine Nordhues, radiation oncologist for the ProCure Proton Therapy Center, said.
Nordhues explained that Hafner came in for a consultation to make sure he was a candidate for treatment, then a urologist placed three metal markers in the prostate so therapists could make sure the prostate was in the same position in the treatment field each day.
Before each treatment, Hafner would undergo a digital x-ray to ensure the markers were lined up, and CT and MRI scans to help therapists plan treatments and outline the locations of the prostate gland, the bladder and the rectum.
The treatments would treat the right side of the prostate during one session, then the left in another.
When the treatments begin, patients lay on a table with a cradle that stabilizes their legs and makes sure they don't move during treatment, Nordhues explained.
"The treatments only take a minute. They're virtually painless, and the patient is able to get up off the table afterwards and go about their business," she said.
"When you were done with treatment, you felt fine. You could go play golf, go exercise if you wanted to, or go sight seeing as soon as the treatment was over until the next day," Hafner said.
Some patients do experience side effects, Nordhues explained, with the most common being frequent urination, and less common side affects being softer stools.
"The do have some side affects, but the proton beam really seems to cut down on the number of side affects we have," Nordhues said.
After a treatment course is complete, a patient will return in three to six months for a follow up appointment to check for any recurrance of cancer. Follow up will continue for the first two years after treatment with regular PSA tests and digital rectal exams.
Hafner is optimistic about his treatment, and was pleased with the ProCure center.
"They treated you wonderfully, they just couldn't do enough for you. It was 100 percent patient centered," Hafner said.
Keole said he expects Proton Therapy to continue to improve and to be available in more centers.
"The field is working on streamlining the technology and working on ways to shrink down the technology; to make it more efficient and more affordable and easier to deploy to more centers," he said.