This review from the UPenn group presented the clinical evidence of particle beam radiotherapy including neutron, carbon/neon and proton for the treatment of prostate cancer. A large body of evidence has demonstrated the efficacy and safety of proton therapy in prostate cancer. Based on outcome data from 160 studies, a recent systematic review and meta-analysis reported significantly lower rates of Grade≥2 acute GI toxicity with proton compared to photon in the setting of conventional and moderate hypofractionation, however photon was favorable in late GI toxicity in the ultra-hypofractionation settings. 

The same analysis also reported improvement in 5-year biochemical survival with proton in the moderate hypofractionation setting for low to intermediate-risk disease. However, the latest randomized phase III trial PARTIQOL reported no difference in patient-reported bowel QoL at 24-month, no difference in urinary or sexual QoL at any time point, and no difference in 5-year progression-free survival between proton and photon for low to intermediate-risk prostate cancer. Another large trial i.e. COMPPARE, a pragmatic prospective study led by University of Florida comparing the outcomes of proton and photon radiation in localized prostate cancer completed patient recruitment in October 2022 with 2,524 men enrolled. 

This study will report 3-year QoL, side effects, and cure rates for patients treated with photon or proton.