STEVE INSKEEP, HOST:
On a stormy Monday for the East Coast, it's MORNING EDITION from NPR News. I'm Steve Inskeep. Today in "Your Health," we look at a popular treatment for prostate cancer. Therapy using proton beams, is being promoted as the best new radiation therapy. And expensive proton centers are popping up all around the country. But as NPR's Rob Stein reports, there are many questions about how well proton therapy works, and whether it's worth the cost.
ROB STEIN, BYLINE: Bill Sneddon had a feeling he was in trouble. when his doctor called with his latest test results.
BILL SNEDDON: I just had a premonition that something's not right.
STEIN: And sure enough, Bill's instincts were right. He had prostate cancer.
SNEDDON: Well, it's an eye-opener, you know. I didn't know - I didn't know if I had to buy a yard sale sign, you know. It's - it's a shocking thing, you know. It's - always happens to someone else.
STEIN: After getting over the shock, Bill, a retired police chief, quickly started investigating his options - surgery, radiation. The next day, a golfing buddy told him about newest thing in prostate cancer, something really high-tech, called proton beam therapy.
SNEDDON: He told me that I should look into proton therapy. And I've known him a long time, so when he told me this is a treatment I should get, I knew this is the treatment I'd better get.
STEIN: So Bill was excited when he discovered a proton clinic had just opened up about an hour and a half from his house. That's where we met him, in the lobby of the ProCure Proton Therapy Center in Somerset, New Jersey.
(SOUNDBITE OF MUSIC PLAYING IN LOBBY)
STEIN: Hi, Bill?
STEIN: Hi. Rob Stein.
SNEDDON: How are you?
STEIN: I'm great. How are you?
STEIN: Bill's 68, and starting his second week of treatments.
SNEDDON: You walk in here, and right away, it puts you at ease.
STEIN: Sneddon looks more like he's at his country club than in the waiting room of a cancer clinic: big windows, high ceilings, a rock wall surrounding a blazing fireplace.
SNEDDON: It's like coming to a health club, or a five star-hotel - because there's no clinical atmosphere.
STEIN: And what about it, was appealing? What made you go forward with this?
SNEDDON: It was just the sense of confidence and assurance that I got, just talking with the representative.
STEIN: What Bill doesn't know is that proton therapy has become a kind of a poster child, in a big debate about the U.S. health system. Should doctors start using expensive, new treatments before it's clear how well they work, how safe they are, and whether they're worth the extra money? We'll get into that, in a moment. But right now, radiology therapist Jacqui Collins is ready to take Bill back for his treatment.
SNEDDON: This is my buddy here.
JACQUI COLLINS: How you doing today?
SNEDDON: I'm ready for you.
COLLINS: All right. We'll head on back.
STEIN: Beyond the relaxed atmosphere, and the cushy lobby...
SNEDDON: Isn't this nice? Look at the color coordination.
STEIN: ...the big draw, for patients like Bill, is how proton therapy works.
DR. HENRY TSAI: Mr. Sneddon, hi. How are you?
SNEDDON: I'm good. How about you?
TSAI: Good to see you - doing great.
STEIN: Dr. Henry Tsai is Bill's ProCure doctor. He says proton therapy's got a big advantage over other types of radiation. It delivers bursts of radiation in exactly the right spot.
TSAI: So it's sort of like the difference between using a bullet, which passes through a person; and like, a smart bomb that enters into a certain position, deposits its energy, and then releases the radiation to that location. So that way, the radiation's delivered just to the tumor, but not beyond it.
STEIN: And that, Tsai says, should minimize any damage to sensitive nerves and tissue around the prostate. The hope is, that should translate into far fewer nasty side effects, like impotence and incontinence.
SNEDDON: This is the dressing room.
STEIN: After changing into a hospital gown, Bill walks into the treatment room. It's very sci-fi - all sleek lines, no antiseptic smells. Bill climbs onto a motorized platform...
COLLINS: Is your head OK?
STEIN: ...and lies down, in front of a big nozzle that's sticking out of the wall. The nozzle's the business end of a gigantic machine down the hall - a 220-ton gizmo they had shipped over from Belgium. That huge, linear accelerator shoots out the proton beams.
COLLINS: You're OK without a blanket today?
SNEDDON: Oh, yeah. I'm fine today.
STEIN: Glowing, red laser lights crosscross Bill's body. The technicians are using the lasers to make sure the proton beam zaps his prostate gland and hopefully, nothing else.
(SOUNDBITE OF BELL)
STEIN: It's time for everyone to leave the room, so technicians can do an X-ray, to make sure Bill's positioned just right.
UNIDENTIFIED TECHNICIAN: And then now, we just took a second X-ray, just to verify that the table went to the correct position.
STEIN: We hand Bill a recorder, so he can narrate the rest.
SNEDDON: Um - on the table, and the table now is remotely being positioned so that the proton machine can be lined up.
(SOUNDBITE OF EQUIPMENT)
STEIN: The ProCure clinic is at the epicenter of the debate over proton therapy for prostate cancer. It's the newest of 10 proton centers around the country. There's already maybe 10 more on the way. And that has experts like Anthony Zietman worried. He's a cancer radiation specialist at Harvard.
DR. ANTHONY ZIETMAN: There's no convincing evidence that it's better. The jury really is out on this new technology. It might be better. I feel it's probably the same. It might even be worse.
STEIN: And he can't help but worry about how much it costs - at least $50,000 for each patient, about double the price tag for regular radiation. Here's why: Those huge proton machines are incredibly expensive. They cost between 100 million and $200 million to build.
ZIETMAN: There's almost no other medical device that I can think of, that even comes close to the cost of a proton treatment facility.
STEIN: Now, doctors developed proton therapy for tumors in really sensitive places - like in the eye, or on the spine, or in kids' brains. But then Medicare started paying for it, for prostate tumors. So more proton centers started promoting it for that.
ZIETMAN: Any institution that forks out that kind of money, and makes that kind of investment, is obviously going to want to recoup that investment fairly rapidly.
STEIN: And new proton centers started opening up. All this means that the health care system's suddenly paying a lot more; to treat prostate cancer with a therapy that so far, doesn't look any better - and may be worse. In fact, last summer, one study suggested proton therapy might cause more side effects- like bleeding, pain and severe diarrhea. Peter Grimm's a prostate cancer specialist in Seattle.
DR. PETER GRIMM: Unfortunately, this is like driving a Ferrari to the grocery store, and asking your next-door neighbor to pay for the Ferrari.
STEIN: Now, proton therapy has lots of fans. In fact, doctors are presenting new studies - at a cancer meeting in Boston, this week - they say show how well it works. They say data from thousands of men, provide powerful evidence that it's effective and safe. Here's Leonard Arzt, at the National Association for Proton Therapy.
LEONARD ARZT: If costs were the same, there would be no debate about providing less radiation to a patient, which is always better.
STEIN: While the debate continues, men like Bill Sneddon are lining up to get proton therapy. The technicians at ProCure finish positioning Bill; using the red laser lights, an X-ray, and three little, gold pellets that Dr. Tsai injected around his prostate.
SNEDDON: The proton...
(SOUNDBITE OF BELL)
SNEDDON: ...treatment will start.
STEIN: Bill continues with his narration...
SNEDDON: There's absolutely no sound that's emitted from the proton machine. There's no sensation on the skin, to indicate that the treatment is being received.
(SOUNDBITE OF PROTON MACHINE)
STEIN: In less than a minute...
SNEDDON: And it's over.
STEIN: Bill gets up, and heads for the dressing room.
SNEDDON: I've had a couple days where I very easily could have fallen asleep through the whole procedure.
STEIN: And so far, Bill tells Dr. Tsai, he feels great. No side effects - nothing.
TSAI: Otherwise, that's the end of our visit today.
SNEDDON: That's it?
TSAI: Yup. I'll let you get going, OK?
TSAI: Any plans today?
SNEDDON: No. Just going to...
STEIN: Bill figures it's the insurance companies who are behind all the questions about proton therapy. Medicare, and his private insurance, are covering his bills. He doesn't even know how much it costs. So he's even urging a friend who just found out he has prostate cancer, to check out ProCure. In the meantime, a big, carefully designed study is just getting going; to try to settle the issue. But the results won't be ready for years.
Rob Stein, NPR News.
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