Probably needs its own thread
Based on Ronald Chen's SEER Analysis and recent publications like this, I really think preponderance of evidence is that protons are worse. How often do you need to give pts suppositories or send them for laser coagulation? I have treated at least two hundred prostate pts over the last 8 years, with IGRT/IMRT to 79 Gy with 5 mm margins, and cant recall a case, certainly not 21% (8% lazered). And kudos to UW for not lying or suppressing data.
(192 pts ) mostly pencil beam scanning
Early toxicity and patient reported quality-of-life in patients receiving proton therapy for localized prostate cancer: a single institutional review of prospectively recorded outcomes
"Gastrointestinal (GI) toxicity
One patient experienced late GR3 toxicity, which was managed with admission for transfusion and resolved after argon plasma coagulation. There were no GR 4 or 5 events. In the acute window, 5 patients reported transient GR2 bowel toxicity, mostly in the form of diarrhea and urgency. Late GR2+ bowel toxicity was seen in 34 patients with an actuarial two-year rate of 21.3% (95% CI: 13.9–28.0%) (Fig.
2). Most observed bowel toxicity was in the form of transient rectal bleeding (32/39 patients) treated with enemas/suppositories or laser coagulation, with the remaining 7 events were due to isolated rectal discomfort or diarrhea. Of the 32 patients who experienced GR2+ rectal bleeding, all events occurred in the late window. Seventeen received medical management with enemas or suppositories,
while 15 underwent argon photocoagulation or electrocautery. Bowel toxicity was
associated with anticoagulation use (HR = 3.45,
p = 0.002 without adjustment for repeated testing)."
