Dear Sir:
I am writing to introduce you to MTPPI a 501(c)3
non-profit institute established in 1986. Among
other treatments, we are interested in studying
the causal relationship between the therapeutic
intervention epoetin in treatment of chronic
anemia among dialysis patients. This could
possibly be one of the most complete stories that
will ever be told about the "clinical benefit" of
a therapeutic intervention described in the
following:

The effect of epoetin dose on hematocrit. Kidney
Int. 2008 Feb;73(3):347-53.

Dialysis facility ownership and epoetin dosing in
patients receiving hemodialysis. JAMA. 2007 Apr
18; 297(15):1667-74.

Translating epoetin research into practice: the
role of government and the use of scientific
evidence. Health Aff (Millwood). 2006 Sep-Oct;25
(5):1249-59.

Factors influencing route of administration for
epoetin treatment among hemodialysis patients in
the United States. Am J Kidney Dis. 2006 Jul;48
(1):77-87.

Hematocrit was not validated as a surrogate end
point for survival among epoetin-treated
hemodialysis patients. J Clin Epidemiol. 2004
Oct;57(10):1086-95.

Epoetin requirements predict mortality in
hemodialysis patients. Am J Kidney Dis. 2004
Nov;44(5):866-76.

Challenges in establishing a clinically and
scientifically robust Epoetin policy. Clin
Nephrol. 2004 Jul;62(1):69-70.

We also have an epoetin safety paper in the works
addressing the relationship between mortality and
high dose levels of this drug. If you are
interested in receiving any of these papers
and/or hearing more about this topic, let me
know. If you know of groups interested in this
topic, I'd be happy to talk with them about the
implications of our research.

Sincerely,

Dennis J. Cotter
President
Medical Technology and Practice Patterns
Institute, Inc.
4733 Bethesda Ave., Suite 510
Bethesda, MD 20814
(301) 652-4005
fax: (301) 652-8335
dcott@mtppi.org

PROTON THERAPY....There is very limited use in
cancer therapy for this expensive technology. The
reults in treating prostate cancer are no better
than using IMRT or prostate brachytherapy which
cost a fraction of PROTON therapy. All of these
centers going up in the USA is madness. Until
their is data to support superior results which
their is not protons for prostate cancer should
not be funded. Dr. Mark Thompson

I am very concerned about the current rapid
proliferation of proton beam radiation without
sufficient evidence supporting its clinical
superiority over current modalities. I have
heard that MD Anderson Cancer Center is refusing
to conduct randomized trials for prostate cancer
comparing protons to conventional IMRT. In
addition, MD Anderson uses less image guidance
(IGRT) than most academic centers for prostate
cancer treatment. They obtain KV imaging of the
bones, but the prostate moves independently from
the bones. Therefore, they may even have less
accuracy in their prostate treatment than many
other centers. In addition, MD Anderson uses
only 2 lateral beams to treat the prostate. The
penumbra for proton beam is equal or greater to
that of photons beams. Therefore, since rectum
and bladder may be in the penumbra we would not
expect the complication rate of protons to be
less than that of conventional photons.
Dosimetric studies have shown that the
conformality of protons is not better than
current therapy with IMRT, especially since IMPT
(intensity modulated proton therapy) is not
generally available. Marketing of protons
includes overly optimistic statements about
possible safety of protons. This aggressive
advertising is necessary due to the enormous
capital investment of proton centers. The
unsuspecting patient will feel enormous financial
pressure to find money to pay for proton therapy
thinking that they have found additional safety
(certainly not proven). Finally, the current
charges for proton therapy, around $200,000 per
patient, would be very damaging to our health
care system if allowed to become more widespread.

CORRECTED: Proton therapy for prostate cancer
should not be a covered service, as superior
radiation treatment alternatives already exist,
are proven, and can be delivered at a fraction of
the cost. Proton therapy is not new: Facilities
have been used to treat cancer patients since the
1950''s. Almost all the proton centers in the USA
closed by the early 1990''s because there was NOT
ONE clinical situation in which protons had been
demonstrated to be superior to other radiation
modalities. Now a new company has come on board
with a better, more reliable proton-generating
machine, but the fact remains that there is no
proven benefit to protons over photons (x-rays)-
both are low LET (linear energy transfer)
radiations whose biological effectiveness is
nearly identical. The sole potential benefit of
protons, rather, relates to protection of nearby
normal tissues. This used to be a concern with
older photon (x-ray) techniques, but no longer:
Modern IMRT or IGRT photon techniques also
protect normal tissues greatly. Finally, the ONLY
published data on the use of protons for prostate
cancer comes from Loma Linda: Their long-term
local control rate was only 77%, compared to
better than 90% published with modern x-ray
techniques that include brachytherapy (seeds) as
a portion of treatment. In addition, the
complication rates between protons and modern x-
ray techniques are virtually identical. Using
protons for prostate cancer is akin to firing up
an Edsel to compete against a modern Toyota: The
Edsel may look pretty, but is too expensive to
run and is an antique from a bygone era
addressing problems which don't exist. You can
find better places to spend my money than on
proton therapy for prostate cancer. I am a
radiation oncologist with 28 years experience
treating prostate cancer. I know.

I would like to comment on the reimbursement of
proton therapy for prostate cancer. I was
optimistic at first, as a young academic
radiation oncologist, that the future of prostate
cancer treatment would include proton therapy
until I read with interest an article published
in the International Journal of Radiation
Oncology Biology and Physics by Eric Hall,
D.PHIL., D.SC in 2006 entitled, “INTENSITY-
MODULATED RADIATION THERAPY, PROTONS, AND THE
RISK OF SECOND CANCERS.” I have sent the article
as an attachment though the most impressive
aspects I will quote as follows; in addition,
please note figures 9 and 10 from the article
Int. J. Radiation Oncology Biol. Phys., Vol. 65,
No. 1, pp. 1–7, 2006. I quote page 6 paragraph
2,”the pencil beam of protons that emerges from
the cyclotron or synchrotron is made simply to
impinge on a scatter foil to produce a field of
useful size. However, the scattering foil
becomes a source of neutrons, which results in a
total body dose to the patient. The consequences
of this exposure are shown dramatically in Fig.
10. Passive modulation results in doses distance
from the field edge that are 10 times higher than
those characteristic of IMRT with X-rays.” Dr.
Hall wrote the text that all radiation
oncologists have used for the past 40 years to
learn the science of radiobiology (Radiobiology
for the Radiologist) and looms as probably the
single most influential voice in the field of
radiobiology. In addition, I do not think that
the patients are told at these centers prior to
their prostate cancer treatment that they will
have to be bathed in neutron contamination in
order to achieve what is a possible physical
advantage without concurring clinical evidence
over photon based radiation techniques.

Following this, I began to see many patients with
prostate cancer in my practice that followed the
numerous internet links available to them begin
to quote to me that “proton therapy is more
precise!” I explored these insights with them
and they usually answered that their information
came from www.proton-therapy.org (the website of
the National Association of Proton Therapy),
www.protons.com (the website of the proton
therapy and research center at Loma Linda) or
www.floridaproton.org (the website for the
Florida Proton therapy Institute in
Jacksonville). I can only quote their clinical
results from their press releases because other
than numerous articles on dosimetric quality and
prostate cancer treatment very little has been
published about clinical outcomes. I refer you
to the pubmed/medline website
http://www.ncbi.nlm.nih.gov/sites/entrez search
terms proton therapy prostate cancer on
8/10/2008. An example of such a press release
from Dr. Slater (the chairman at Loma Linda) on
the www.proton-therapy.org website is
representative of the lack of peer reviewed
justifications to reimburse more for proton
radiotherapy than for “standard” radiotherapy,
(“Unlike conventional radiation,” says Dr. Jerry
Slater, Clinical Director of Loma Linda's Proton
Therapy Center, “proton radiation has a well-
defined high-dose area which can be manipulated
to precisely surround an irregularly shaped
target such as the prostate gland. This inherent
characteristic of protons allows very little
scatter to the bladder and rectal areas, higher
doses to the prostate, and significantly less
side effects.” ) He also states that, (Dr.
Slater noted: "Our analysis shows that overall,
the disease-free survival rate is running above
90 percent at four years and the side effects are
considerably less than we would have expected."
Currently, some 80 patients are treated each day
at the Proton Center, with about half receiving
prostate cancer treatment. Patients come to the
center from all across the U.S., as well as from
numerous foreign countries.) Clearly, the press
releases from these institutions are causing
individuals to make the trip to their center,
which in the culture of capitalism is the reward
for a successful marketing campaign. However, as
a public funder the public interest should be the
first consideration. High quality trials should
be undertaken to prove that proton therapy is
worthwhile at all; disease free survival rates of
greater than 90% at 4 years are common among
successful prostate cancer treatments (often at
endpoints of 5 to 10 years). The problem with
such a quote is that in order to publish such a
result in a scientific journal and to have it be
little more than hearsay one needs to have at
least 2 years minimum follow-up on every patient
in addition the definition of disease free
survival should be stated and the patients who
are being “generalized” about should be risk
stratified according to an evidence based
guideline such as that of the National
Comprehensive Cancer Network, www.nccn.org.

I think innovation should be rewarded but proton
therapy is not innovative, it has been around in
clinical use for 18 years at Loma Linda and much
longer at the Massachusetts General Hospital. To
their credit a randomized trial was undertake
between 1996 and 1999 of a proton therapy boost
for prostate cancer and published in JAMA in 2005
(JAMA. 2005 Sep 14;294(10):1233-9). Of note,
from the article, “Only 1% of patients receiving
conventional-dose and 2% receiving high-dose
radiation experienced acute urinary or rectal
morbidity of Radiation Therapy Oncology Group
(RTOG) grade 3 or greater. So far, only 2% and
1%, respectively, have experienced late morbidity
of RTOG grade 3 or greater.” No statistical
difference was seen in late or early toxicity
with this mixed photon and proton approach, with
over 71% and 63% of the dose given with PHOTONS
in the 70.2 and 79.2 Gy arms respectively. With
the majority of dose given in this trial with
photons to manifest only a 1 or 2% toxicity rate
in both the acute and late setting means that the
advantage of a purely PROTON approach can, by
definition, only be on the order of 1 or 2%! The
current high public funder reimbursement for
proton therapy for prostate cancer is inspiring
the building of many facilities in the US (see
www.proton-therapy.org ), in addition to funding
an effective direct to medical consumer marketing
campaign which, as delineated above, has little
basis in clinical evidence.

As a young radiation oncologist, I think that it
is important that the foundations of innovation
for my field be more solid than claims of “more
precise” and “less side-effects” in the form of
press releases. Such claims should be proven in a
phase III setting before continuing what has
become a marketing nightmare for my patients and
their families.

As I witness the profound impact that our current
economic struggles are having on our communities
and my patients, the seemingly profligate
spending going on in the health care community
befuddles me. A recent summary of major building
projects in Southeastern Michigan published in a
business periodical showed that many of the
projects and some of the largest were in the
healthcare systems. It gives the appearance of
a “matrix-like” parallel reality going on in
health care. Our citizens are loosing their jobs
and homes. Many patients lack access to basic
care. Many patients seem to be dropping
healthcare coverage outright, and those who still
have it have an increasing financial burden that
they struggle to meet. I am seeing more and more
patients who cant seem to afford needed
medications including seniors covered by part D
(many of whom have fallen into the dreaded “donut
hole.”) There is an increasing disparity in
health care between the “haves and have nots.” In
the midst of all of this, the large health care
systems seem to have ready access to capital for
large projects. I realize that funding for these
comes through a different pathway but ultimately
the patients, the rest of our citizens, and all
of the employers in Michigan have to foot the
bill. When will that burden crush them? Has it
already?

I do not know why the Health Care System (or non
system as it were) has not collapsed yet, but
most of us feel that this cannot go on forever
and yearn for meaningful reform. For insights
into why the system is still able to function, I
would refer you to a recent publication in the
New England Journal of Medicine: The Amazing
Noncollapsing U.S. Health Care System – Is Reform
Really at Hand?
http://content.nejm.org/cgi/reprint/358/4/325.pdf


I assure you that the “System’s” perseverance is
not because of clever design or exceptional
performance. If its longevity were based on those
factors alone, it would have vanished long ago.

I am not an expert on proton beam therapy, and I
am not pretending to be one, but as you ponder
this decision, I would suggest the following for
your consideration:


· What is the strength of the evidence
supporting this modality over others or over “no
treatment?”
· How will those who propose to provide the
treatment assure that it is available to all
citizens who might benefit?
· How will those who propose to provide the
treatment prevent “indication creep,” such that
it does not end up being used where it has
marginal or no proven benefit and only adds cost?
If it is true that a half of the health care
dollars spent on an individual are spent in the
last 6 months of life, how will we protect
against this being yet another modality to add in
to that equation?

(http://www.ahc.umn.edu/img/assets/25857/end_of_li
fe.pdf
· How will those who propose to provide the
treatment avoid offering it under the guise of
hope? How will they control the “hype” and avoid
creating demand based on false hope? (As a
parenthetical, I would offer to you that most
health care advertising seems to fall squarely in
the category of “hype.”) How will we keep this
modality from becoming another example of what
Ian Morrison characterizes as “expensive
technology excessively and aggressively applied
to the affluent and well insured.”
· How many of these machines are needed in
this country? How many do other industrialized
countries have? As a side note, how does our
country compare to those other countries when we
compare the performance of the respective health
care systems?
· If the indications are limited and
circumscribed, would it make more sense for
patients to travel to other states who have
already installed the modality rather than
duplicating it in Michigan? Is Bloomington
Indiana, Chicago Illinois, or Pittsburg
Pennsylvania too far to ask patients to travel
for such specialized treatment? These areas
either have or will soon have this capability.
· Who are the investors in this initiative?
How do they intend to re-coup their investment?
How much usage beyond areas of clearly defined
benefit would it require for them to do so?
· Is it not true that this effort by
definition will have to compete for resources
against other pressing healthcare system needs
such as electronic communication and care tools
oriented towards chronic disease, or preventative
health tools and efforts? See Woolf SH, Johnson
RE. The Break-Even Point: When Medical Advances
Are Less Important Than Improving the Fidelity
With Which They Are Delivered Ann Fam Med
2005;3:545-552.
http://www.hvpa.com/Physician/education/woolfandjo
hnson_article_break_even.pdf

There can be no reasonable, non political way to
justify the continued non coverage of this
proceedure in the sub-population of asymptomatic
patients at high risk for carotid
endarterectomy. The body of literature
supporting the coverage of asx. high risk CAS is
huge, and of course there is no way to compare
real world patients who are forced, cajoled or
otherwise convinced to CEA, as there is no
similar restriction on the surgical world(not
even to inform them honestly about an equivalent
or superior alternative). How many non
endovascular surgeons are giving patients at
high risk for CEA an alternative as part of
informed consent?

I had the illusion that perhaps CMS had a
altruistic, broader view that if they just put
the brakes on for a short time, the furor would
settle and perhaps even the motivated surgeons
would catch on and acquire the skill set to
perform the endovascular approach. That illusion
would be unsupportable should this non expansion
of coverage be upheld.Sufficient time has
passed, and the mix of performing physicians has
stablized. The only remaining logical conclusion
is that the inevitable backroom politics
associated with a controversial new proceedure
has prevailed over the interests of medicare
recipients.

I WOULD support a strong arm tactic on CMS's
part to "suggest" to industry that they find a
way to make this proven proceedure more cost
effective, but NOT to continue the non coverage
policy.

This non cverage policy puts patients in the
middle of a debate between groups of physicians.
That debate was carried out at the FDA level
when this proceedure was approved for this group
of patients. Continued non coverage is
unsupportable, inexcusable and an embarassment
to a body supposedly committed to providing care
for its recipients. I continue to hope that
wisdom will prevail here, but I must admit, my
hope is fading. I think the CMS has asked the
endovascular community in this country
to "retrieve the witch's broom ". The community
has responded by laying a stack of legitimate
brooms at the wizzard's feet. Lets get this
overwith. Approve it and let us ge on with the
real mission -providing our patents with
appropriate care, whichever techniqe happens to
be best.

Proton Therapy for Prostate Cancer.

I'm a radiation oncologist. Protons offer a
significant benefit in several oncologic
situations. Prostate cancer is not one of those
situations.

Unfortunately, however, I do believe prostate
cancer treatment with protons significantly
offsets the lack of reimbursement in the other
clinical situations where protons are needed but
not reimbursed.

Proton Therapy for Prostate Cancer:

Proton therapy should not be used in the
treatment of prostate cancer. Proton treatments
are much more expensive than other radiation
techniques. There is no proven benefit in tumor
control or side effect profile to proton therapy
over IMRT or brachytherapy. In fact, the
opposite may be true: one article in JAMA showed
that when protons were compared to seed implants
the rate of Grade 2 rectal toxicity was twice as
high. Other data indicate that protons may be
associated with inferior biochemical (PSA)
control when compared to brachytherapy. Finally,
due to neutron contamination, protons may have a
higher rate of secondary cancer development in
the years to come.

[PHI Redacted] One difference between proton treatment and others is that you
leave feeling human and normal. That's worth everything.

Proton Beam Radiation Treatment for Cancer - Medicare Coverage:

As a health care professional, scientist [PHI Redacted] I feel strongly that Medicare should cover this state-of-the-art treatment. [PHI Redacted] 6 year cure from prostate cancer with zero side effects during treatment and since treatment. This can not be said of any other treatment option available for treatment of prostate cancer. I have read all the scientific literature and compared the results with all other treatment modalities. This treatment should be available to Medicare patients.

it works great and you can have all of your plumming afterwards ,,,, [PHI Redacted],,, It works dont be fooled .... and their no pain doing it ....

Before proton therapy is denied as a viable
treatment for prostate cancer, there are many not
doing enough research!!! Please make sure you do
an extensive study re: the after-effects of the
various treatment options before dismissing
protons. It is the ONLY option for those that
actually do their research! Perhaps incontinence
and impotence are not important issues for some
men, but they certainly have proved VERY relevant
to those who lose those functions with other
treatments! The ability of the protons to be
directed ONLY at the diseased tissue makes all
the difference.

It would be wrong to disallow proton therapy as a
viable option for insurance coverage. If you do
your research, you will find it is, by far, the
best option... if you're interested in
maintaining quality of life post-treatment!

[PHI Redacted]

[PHI Redacted] no side effects and no surgery; it would be a crime not to continue to have this covered under medicare. [PHI Redacted] Why make men suffer with less than this type of treatment?

[PHI Redacted] a successful proton radiation receipient that was treated for prostate cancer several years ago. [PHI Redacted]

The overwhelming majority of that evidence was that other treatment methods could cure the prostate cancer, BUT, and there always seemed to be a BUT, the issue of side effects would surface. Either some level of incontinence or sexual function issue was part of the conversation. [PHI Redacted] that was all the evidence needed to decide to use proton therapy which had almost no side effect issues [PHI Redacted]

Since having proton treatment, [PHI Redacted] have not had any issues of side effects limiting lifestyle in any way. [PHI Redacted] also free of prostate cancer according to doctors. [PHI Redacted] very satisfied with proton treatment. I hope that it will still be available for men who need Medicare to pay its cost.

[PHI Redacted] was treated by the Proton method (@ Loma Linda
CA) in 1996 and doing very well during these intervening years and can certaiinly vouch for this method of trestment.
Homer Lamborn

I am sending this e-mail to express my concern for removing medicare payments for Proton Therapy.

[PHI Redacted]

I believe the benefit of Proton Therapy was the reduction in side effects.

I am amused by the intellectual bias of the many posts that attack the positive outcomes of Proton Therapy. Until these doctors face the reality of Prostate Cancer in their own lives, their data will prove whatever they want it to prove.

[PHI Redacted] Prostate cancer at 53. Declining PSA with no side effects from treatment two years later. [PHI Redacted] Choice will drive the best treatment, not clever marketing as some have posted.

I have heard of a proposal to stop Medicare coverage of Proton Therapy for Prostate Cancer. I am not a doctor [PHI Redacted]. My story is very important because my doctors (three) told me that due to my other illness [PHI Redacted]; that I could NOT be treated by their methods because I would die on the operating table! They all agreed that I had approximately one year to live and it would be best to just go home and wait to die! They discussed all options of treatment BUT Proton Radiation Therapy. They contacted a reputable expert at Sloan-Kettering Cancer Institute who agreed with their recommendation. I started to get my final affairs in order and informed my Sunday School teacher that my time in his class was limited. Another student heard my situation and said that can;t be right and she would find a solution. She has become my ANGEL because she found Loma Linda Medical University which was conducting Proton Radiation Therapy for Prostate Cancer. She informed me and I contacted them. [PHI Redacted]. I have had NO adverse side effects from this treatment. Some of my friends have had surgery, X-ray, and seeds for their Prostate Cancer; and all of them suffer from bowel an bladder problems and also erectile disfunction. Please do not stop your coverage of this treatment. It appears that doctors want this coverage stopped because they lose your and my money! Hippocratic oath seems to be DEAD to them!

I believe that it is incredably important to retain the Medicare coverage for Proton
Radiation. Without it, the single best choice for many men diagnosed with prostate cancer will become unavailable.

[PHI Redacted] To a man, [PHI Redacted] very happy that we did not choose
the radical surgery alternative with all the horrible side effects. Regular radiation and seed therapy pale in comparison as well.

[PHI Redacted]

Eliminating this coverage from Medicare would deny men a very effective treatment with very low risk. Certainly costs can be saved elsewhere!

I have been in contact with numerous patients who
have been treated with proton beam radiation
therapy for prostate cancer. The evidence is
overwhelming that this form of treatment provides
the best outcome for the patient with respect to
collateral damage to healthy tissue and organs.
The patients have had minimal side effects common
to photon radiation or surgery. I am in favor of
the expansion of the number of treatment centers
utilizing this technology, and Medicare coverage.

RE: Proton Therapy

I am dismayed, though not surprized, at all the
postings claiming no advantage for Proton Therapy
from practitioners of competing modalities.
Apparently the profit motive is more important
than the science for some people. The facts are:

1) Proton Beam Radiation Therapy (PBRT) is at
least as effective as any competing treatment
modality; (I say "at least" because within the
last few years PBRT dosages have been increased,
but not enough time has yet elapsed to permit a
thorough analysis of any potential gains in
longer-term efficacy.) and

2) There are studies, both from researchers in
California and in Europe that clearly demonstrate
that PBRT results in fewer and less severe side
effects than do competing modalities.

I personally know of quite a few hundred men
treated with PBRT for PCa who have never
experienced a side-effect of any material
consequence; thus resulting in savings of untolds
hundreds of thousands or millions of dollars from
follow up treatments NOT required.

Finally...the cost of this treatment can and will
come down as more centers are built using newer
technology. As for now, those of us lucky enough
to have chosen PBRT are thankful for its
availability.

The accuracy and depth-control of proton therapy made it possible to treat enlarged prostate without the expense and adverse side effects of lutenizing hormone ablation drugs. [PHI Redacted] in relatively good health, the quality of remaining years has been greatly improved. No other treatment, approved by Medicare, that could
accomplish this, is available in the US.

[PHI Redacted] I have many friends that chose other treatment methods and are suffering a wide range of terrible side effects! [PHI Redacted] suffer none of these and strongly feel it is well worth, in the long run, any additional expense to have the Proton treatment method. I urge you to not preclude Medicare coverage for this excellent solution to prostate cancer!

The negative comments about proton therapy as it applies to
prostate cancer, made by several physicians, amount to hearsay and
are largely misleading in many of the details. The comments smack
of panic rather than sober logical statements.

The record of success, the preservation of quality of life of prostate
cancer patients, and the lack of debilitating long term effects
(requiring continued coverage by insurance companies) are
documented and absolutely important factors in any decision
regarding termination of insurance coverage of proton therapy for
prostate cancer.

[PHI Redacted] I am urging that reimbursement for treatment for prostate cancer via proton beam therapy remain intact. After doing some investigating, it seems that the majority of those that reimbursement be discontinued are those who are fully invested in some competing technology. I'm concerned about one's objectivity in those cases.

Furthermore I can state that since treatment have experienced absolutely no lifestyle change. [PHI Redacted] selected selected proton beam therapy because it appears, from a review of articles a found through a MEDLINE search, that, even though other treatment methods may have an equal success rate, the likelihood of negative side effects is less than with the other methods. All journal articles I have read that say that proton beam therapy should not be used because there are other methods with equal success rates, made no comment about the side effects. It's easy for a physician to recommend the cheaper method when he is not the one wearing diapers or a catheter.

During [PHI Redacted] treatment period [PHI Redacted] met a number of physicians (including urologists, oncologists and surgeons) who selected proton beam therapy for themselves. I respectfully encourage that current reimbursement for proton beam therapy remain in place.

[PHI Redacted] I fully endorse the proton beam therapy approach and support its further coverage under medicare.

I have had friends, relatives, and acquaintances who have had the radical prostate surgery, the Brachy therapy, and the standard radiation procedures. I can only give "first-hand" data that none of the above gave them the ultimate cure and quality of life that men would like to see after 60 years of age.

[PHI Redacted]

Sure, we would like to see massive studies done. but it enough for me that very large and significant institutions in the States and abroad have put up the investment necessary to make this procedure available. And with more research and development, maybe less expensive equipment can be made to do the same work.

I am but one data point in a potential and future study. [PHI Redacted]

My vote is to give proton-beam therapy for prostate cancer a thumbs-up for continued support and coverage!

I want to take this opportunity to comment on the Proton beam therapy for prostate cancer proposed rule change.

[PHI Redacted]

It is my understanding that the reason medicare is considering stopping the reimbursement for proton treatment is because there are other procedures that work equally as well with a lower cost. I disagree with this premis.

I can only use [PHI Redacted] as an example of the overall savings to the medicare system or the private health insurance system when all aspects of prostate cancer treatment protocal is taken into account. [PHI Redacted] This decrease in PSA level is, I am sure commensurate with all other forms of radiation treatment.

However, if you take into consideration post treatment (side effect) issues for all forms of treatment,I believe the cost to the medicare system would be lower when being treated with protons. [PHI Redacted] had no additional treatment costs incident with my prostate cancer treatment since the conclusion of treatment. Simply stated, [PHI Redacted] had absolutely no costs billed to insurance company other than normal follow up since [PHI Redacted] was treated. [PHI Redacted]

I believe this outcome is a result only due to the proton radiation treatment. Many studies have been done that clearly demonstrate, that when this aftercare aspect of treatment is taken into consideration, proton beam radiation treatment becomes far less costly to the medicare and health insurance system.

Yes, it is true that the proton beam kills the cancer cells the same way as the photon beam. The proton beam, however, is more precise and side effects therefore are far less severe than with the difuse photon beam. The photon beam, even when delivered by IMRT clearly kills far more healthy cells than the proton beam thereby creating a greater possibility of unfortunate side effects.

I was told by a physician at the leading major east coast urilogical center in the U.S. that no matter what form of treatment [PHI Redacted] chose [PHI Redacted] would be cured. When I heard this the decision was easy; statistically go with the least invasive procedure, that would do the least harm. Proton therapy was clearly the least invasive. My choice as of this date has proven correct. [PHI Redacted] quality of life is no different than prior to treatment and [PHI Redacted] cost of after care has been $0.00.

Once you take aftercare costs into account for all treatments including surgery proton beam will, in my opinion, prove to be the most cost effective prostate cancer treatment available. Medicare should, for this reason, continue to reimburse patients who seek proton beam radiation therapy for prostate cancer.

I would like to comment on the reimbursement of proton therapy for prostate cancer. [PHI Redacted] was treated with Proton Beam therapy which was completed 2 years ago. [PHI Redacted] made [PHI Redacted] decision to use this treatment after talking with many people that were successfully treated with proton beam at Loma Linda MC over the past 10 years. I also spoke with several friends and neighbors that had the tradition radiation or surgery. Without exception those that I spoke with that had traditional radiation or surgery have suffered unpleasant side effects.

[PHI Redacted]I have encourage several friends whom have been diagnosed with prostate cancer to go to Loma Linda. Several have and without exception are thankful they chose Proton Beam.

I believe in the long run and the absense of side effects, that Proton Beam will prove less costly and certainly improve the quality of life. My experience has been that the surgeons all recommend surgery and the radioligists recommend radiation and few are knowledgable of the success and benefits of proton beam.

My Uroligist commented it was experimental and too new for him to recommend and didn't have a clue that Loma Linda has been treating prostate cancer patients since 1996. I believe if you will do further research, and be objecttive of the comments made by surgeons & radiologist, that you will agree that Proton Beam is a very viable and beneficial treatment for those that are a candidates for the treatment.

Proton Treatment, Prostate Cancer

[PHI Redacted] received treatment in 1993, had a PSA of 6 that had rapidly escalated to 9. [PHI Redacted] received a PSA readout of 3 just recently. [PHI Redacted] have had no side affects or issues. [PHI Redacted] was advised by a physician to wait and see that [PHI Redacted] refused.

[PHI Redacted] healthy, well and very satisfied with [PHI Redacted] treatment and results.

[PHI Redacted] a prostate cancer patient who was treated with proton beam therapy ending on [PHI Redacted]. Since then [PHI Redacted] PSA has dropped gradually and is now at 0.98. [PHI Redacted] experienced no side effects from this treatment, i.e. no incontinence or rectal problems. [PHI Redacted]

From [PHI Redacted] contact with other patients under this treatment at the time of [PHI Redacted] treatment, they all indicate similar results. [PHI Redacted] was attracted to proton radiation therapy because of the number of testimonies by patience on the lack of side effects.

In Feb. and March of this year [PHI Redacted] received 45 proton beam treatments with the only side efffects being mild increase in frequency and urgency in urinating which ceased after treatment was completed. The total cost was $48,000 (including co-pays) as a 65 year old Medicare patient. [PHI Redacted] had no symptoms to deal with on recovery, no incontinence, nor erectile disfunction, no rectal bleeding, no exposure to infection, nothing. I can't put a value on the lack of side effects or recovery issues. At my age and hope of growing much older and staying active....priceless.

Proton Beam Therapy for Prostate Cancer

[PHI Redacted] was treated with protons in 2001 at the age of 66. [PHI Redacted] had subsequent PSA tests every year since [PHI Redacted] treatments and [PHI Redacted] PSA has held steady at less then 0.1 for the past 5 years and with normal DRE tests. [PHI Redacted] While being treated, [PHI Redacted] hiked the foothills in California every day. [PHI Redacted] worked out in the University athletic facility on some days and [PHI Redacted] did a lot of sight seeing during [PHI Redacted] 9 week stay. [PHI Redacted] and I have talked with many prostate cancer patients as I participate in senior's athletic progams for softball and volleyball. It saddens me when I meet men who have had surgery for their cancer and they are incontinent. I talked with one man who's cancer recurred after surgery and then he had photon radiation. He had to have both hips relaced due to the radiation. He cried while talking with me and seeing the shape that I was in - still playing volleyball with no problems.

I recommend proton therapy to all men who ask me for my opinion on what they should do. Unfortunately, most of them cannot afford to travel away from home and spend time away from their work if they are still working. I'm a black American. Prostate cancer is a major killer of black men. Prostate cancer killed[PHI Redacted] They did not get treated for their cancer because they did not want to live with the problems their friends had, and those who ended up with chemotherapy really scared [PHI Redacted] away from any treatments. So he died in pain when he probably could have been saved if he had known of a treatment like proton beam therapy and if he had seen the good results on some of his friends.

When [PHI Redacted] was looking for a treament the urologists all recommended surgery, a cryosurgeon recommended cryosurgery, and those doing photon radiation recommended their specialty along with those doing implants. However, I talked with many patients and those who had proton beam therapy were the happiest with their results and their resultant quality of life after their treatments. [PHI Redacted]

Prostate cancer is a family disease and the wives that I met in the waiting room each day,when [PHI Redacted] was being treated,were 100% behind the treatment their husbands were getting.

Please don't drop Medicare coverage for proton beam therapy. Many of the comments that I read talked about the high costs associated with proton beam therapy. There were some patients being treated when [PHI Redacted] was being treated who were paying the costs themselves. They were convinced that this was the best treatment for them. Don't take away Medicare coverage and take away the chance for a normal quality of life for those who cannot afford to bear the cost of proton beam therapy themselves. Medicare will be the only coverage many might have. All men should have the opportunity to get the best care possible for their afflictions. I think proton beam therapy is the best treatment for early stage prostate cancer.

Proton Therapy for Prostate Cancer:

[PHI Redacted] a proton beam radiation treated prostate cancer survivor. The Proton Beam treatment for prostate cancer is safer and as effective as other external beam radiation methods. It has fewer side effects and there is less collateral tissue damage than happens with x-ray beam radiation.

The only people who are denigrating proton beam radiation are those that don''t make any money from patients who go elsewhere for this superior treatment. Medicine is a business!

Before selecting proton beam radiation for [PHI Redacted] treatment [PHI Redacted] interviewed a couple of radiation oncologists who use x-ray beam radiation for their patients and they told [PHI Redacted] "That they could do just as well as proton beam", they did not say better. The over 3000 members of "The Brotherhood of the Balloon" for the most part can verify my statements about the lack of side effects and the quality of life enhancements of proton beam treatment.

The argumernt that there are few proton centers operating at this time is also bogus. There are several (at least 5) in operation including MD Anderson in Houston and many more being built including Walter Reed Army hospital in coordination with a major Pennsylvania University Medical Center.

Proton centers are expensive. They are used for very specialized cancer treatments that cannot be satisfactorily completed by other methods. Without the large number of prostate patients to carry the overhead, many children will not get the life saving proton treatments that they need.

Re: Proton Treatment for Prostate Cancer. [PHI Redacted] 65 year old man who was treated earlier this year for prostate cancer with proton therapy. [PHI Redacted] selected this form of treatment after six months of studying alternatives and [PHI Redacted] can attest to the fact that the proton treatment is ideal for a healthy man [PHI Redacted], who is concerned about the two common side effects of other treatments: incontinence and/or impotence. [PHI Redacted] completed the proton treatment regimen, and [PHI Redacted] can tell you that [PHI Redacted] NO side effects at all. The less expensive alternatives all seem to have statistics of between 10% and 40% incontinence and slightly higher impotence rates. Instead of preventing men from receiving this treatment method, the government should encourage the building of new treatment facilities and generate more competition in the proton field. This is truly the state of the art treatment that avoids surgery completely.

I read with concern the proposal by CMS to exclude proton therapy for prostate cancer from Medicare reimbursement. In 2004, [PHI Redacted]was diagnosed with prostate cancer at the time of [PHI Redacted] 68th birthday. [PHI Redacted] was promptly offered radical prostatectomy by the chief of urology at a well-known Boston hospital; he also told [PHI Redacted] that[PHI Redacted] would incur impotence and urinary incontinence as a result. However, based on conversations with a former colleague who had chosen proton therapy under similar circumstances and who incurred neither of these side-effects, [PHI Redacted] also opted for that treatment mode. As a physicist, [PHI Redacted] immediately grasped the ability of proton radiation to mitigate radiation side-effects to adjacent organs. Now, over 4 years later, neither [PHI Redacted] nor [PHI Redacted] wife could be anything but happy with the results. [PHI Redacted] PSA level rapidly declined post-treatment and it has leveled out at at 0.1 ng/dL; plus, [PHI Redacted] zero problems with impotence, incontinence or any other related dysfunction. Surgery and other treatment modalities all have their place, and the outcomes of the various treatments on prostate cancer per se may well be equivalent. But I strongly believe that lower levels of side-effects from proton therapy are a fact and this has a definite effect on Quality-of-Life issues. On behalf of all proton therapy patients, I urge you to reconsider your proposal.

[PHI Redacted] completed proton beam therapy for [PHI Redacted] prostate cancer on 8/4/08 and intuitively feel this was the best decision[PHI Redacted]. It would not be possible if Medicare did not cover it.

[PHI Redacted] treatment was actually HDR temporary seeds and then 28 proton treatments. [PHI Redacted] been suffering terribly from GI and GU side effects since [PHI Redacted] HDR. Because of the timing I do not believe it is caused by the protons.

Please continue to cover this superior treatment for the patient's sake.

[PHI Redacted]68 years old and consider [PHI Redacted] lucky to have choosen proton therapy over the other choices as it is non evasive and all the men [PHI Redacted] had spoken to prior to [PHI Redacted] choosing it indicted [PHI Redacted] that the results were outstanding. It has been 3 1/2 years since having proton therapy and [PHI Redacted] had no side effects and everything works as it should. [PHI Redacted] PSA score is .5 [PHI Redacted] so thankful that Medicare paid for the treatment as [PHI Redacted] might not have been able to afford this highly syccessful prostate treatment.

I have a 39 year medical background: Orthopedic Surgeon graduating from Medical School at The University of Texas in 1969; also I was a U.S. Air Force Flight Surgeon 1970-1972.

[PHI Redacted]diagnosed with prostate cancer 3 years ago and performed extensive research before reaching an obvious decision (Proton Radiation) to be treated by the best treatment available to not only cure [PHI Redacted] cancer but to let [PHI Redacted] continue a wonderful quality of life without urinary incontinence or impotence. These unwanted side effects are a significant factor in other forms of treatment.

Proton radiation was chosen primarily due to personally talking to over 100 patients treated by all methods. The overwhelming evidence of excellent long term results without side effects made my decision easy.

Please don't take away the ability for someone to make a well educated decision about their quality of life following cancer treatment. If you exclude this treatment it will obviously trickle down to private health and have a negative effect on thousands of lives. Thank you.

Please do not discontinue Medicare reimbursement for proton radiation therapy for treatment of prostate cancer! [PHI Redacted] spent months researching the various options available [PHI Redacted] for PC treatment and came to the conclusion that proton treatment promised the least offensive side-effects. [PHI Redacted] 2.5 years out of treatment and [PHI Redacted] PSA is down to 1.0 and [PHI Redacted] none of the other side effects which [PHI Redacted] had a 50/50 chance of experiencing from the current state-of-the-art treatments: impotence, incontinence, protracted recovery. Please give others the same chance [PHI Redacted] had to survive prostate cancer without serious side effects.

Simply put, this technology is AMAZING and should be supported by our government.

Please feel free to contact me if you have any questions.

[PHI Redacted] was diagnosed with prostate cancer 5 years ago. After much research into the various paths of treatment, he opted to have proton beam radiation. Today his PSA is 0.5 holding steady, and he has had no problems from the radiation. This was a painless, bloodless, safe treatment with no damage to healthy tissues.

[PHI Redacted] elected to have [PHI Redacted] prostate cancer treated by protron radiation in October of 2003 after researching all [PHI Redacted] options, including direct conversations with in excess of 60 men who were treated with other forms of therapy as well as proton. In addition [PHI Redacted] consulted with numerous other facilities who did not offer this form of treatment. Please note that the research [PHI Redacted] performed resulted in [PHI Redacted] ascertaining that almost all treatments eradicated the cancer, assuming that the cancer cells were encapsulated in the prostate organ. The major difference, however, was that the side effects from the other forms of therapy as reported by many patients resulted in undesirable side effects (ie. incontinence, impedency, etc.) whereas the proton form of treatment was essentially void of these undesirable results. It appeared that most urologists [PHI Redacted] consulted with (including my own who is the head of Urology at a major university hospital and who I had been a patient of for over 10 years) tried to discourage [PHI Redacted] by saying that they didn't know anything about it other than it 'wasn't any good'. Obviously their negative opinions were a result of their inability to provide this form of treatment as opposed to their personal knowledge and experience.

Proton Therapy,

Medicare and Medicad should continue to offer Proton Therapy as a treatment for Prostate Cancer.

Last summer, [PHI Redacted] completed proton therapy for prostate cancer and could not be happier with the outcome a year later. [PHI Redacted] insurance company approved the treatment plan and paid for proton therapy. If [PHI Redacted] insurance company had not approved the procedure, it would have been a real hardship [PHI Redacted] to incur the cost and may have prevented [PHI Redacted] getting the treatment. [PHI Redacted]would have had a hard time facing the reality that Proton Therapy was not an option because it was deemed too expensive by the insurance company.

And, is it really cheaper to have surgery to remove the prostate and then incur all of the cost on follow up visits/medications due to side effects and disfunctions that surgery causes. Yes, [PHI Redacted] initial Urologist said you need surgery and don't worry about incontience or impotence, "we have drugs for that". In my opinion this attitude is not doing what is right for the patient, but what is right for the surgeons/drug companies and their pocket books! Just take a look at who is responding against Proton Therapy. However, if the shoe was on the other foot and the prostrate surgeon had prostrate cancer, which treatment would he seek for himself? Let me tell you the answer from several DOCTORS I met who were going through treatment [PHI Redacted] last summer- Proton Therapy without a doubt!

[PHI Redacted] lived the nightmare of Prostate Cancer and survived without the complications that my friends are having who chose surgery. I thank my fellow coworker everytime I see him for telling me about Proton Therapy (He had the treatment 8 years ago! and is doing great). If it was not for him [PHI Redacted] would most likely be wearing diapers and impotent at age 43. I thank God for this coworker, the doctors/staff at the proton center, and the fact that this wonderful option for treatment was an approved procedure. I sincerely hope proton therapy will be available to anyone with this type of cancer. By far, this option is the best decision you will ever make. [PHI Redacted] continuing to enjoy life with absolutely no complications and [PHI Redacted]. [PHI Redacted]been able to continue working and supporting [PHI Redacted] family with little down time and no side effects. [PHI Redacted]was never sick, did not lose [PHI Redacted] hair, and played tennis everyday with [PHI Redacted] family after the treatment! I hope it will be the wave of the future in treating many types of cancer.

It would be a crime for anyone to take away this option for treatment under their insurance benefit.

Regarding Medicare Coverage of Proton Beam Radiation:

[PHI Redacted] opted for Proton Beam Radiation treatment for stage 2C prostate cancer in early 2002; because [PHI Redacted] could see from the published scientific evidence that it was the most accurate form delivering the highest dose of radiation with,the least chance of collateral damage. [PHI Redacted]

Now that M D Anderson, U of Florida Shands, Mass. General and several other leaders in cancer treatiment have made the commitment to construct these new Proton facilities; I am reassured that regardless of the cost, Protons are a superior modality. Medicare should not be looking for the cheapest treatment or excluding Protons from a doctor/patient's pallate.

[PHI Redacted] a recipient of very successful proton beam treatment for prostate cancer. [PHI Redacted] choices because of health and age were very limited and [PHI Redacted] research into a very highly researched subject included a consultation at Johns Hopkins. [PHI Redacted] I believe the total cost was in the neighborhood of $50,000. Statistically, the results of Proton Beam therapy was comparable to other therapies and much less invasive to adjoining organs, thus had fewer side effects. [PHI Redacted]PSA is and has been less than 0.1 since treatment. Honestly, I believe that this treatment is a life saver.

benjamin O randolph

I want to lend my support for the continued Medicare support for proton beam therapy for prostate cancer. [PHI Redacted] I can attest to the fact that the side effects are minimal to none. The effectiveness of the treatment, in terms of rendering the PSA to less than .01 in less than 6 months post treatment, in effect was a cure. The treatment itself, was painless and free from the side effects of other modalities. The loss of one's sexuality, incontinence, etc, were not problems[PHI Redacted] to deal with [PHI Redacted] other forms of treatment (traditional radiation, surgical removal of the prostate, cryosurgery, etc.). I am thankful I learned about proton beam therapy [PHI Redacted]

[PHI Redacted] a former Prostate Cancer patient. [PHI Redacted] PSA was 9.8 in May of [PHI Redacted]. The doctor said because of [PHI Redacted] Leukemia (CML), raditation was [PHI Redacted] only option to fight the cancer. After [PHI Redacted] spoke with the radiologist and heard the side effects to expect, [PHI Redacted]. [PHI Redacted] chose Proton therapy, Medicare paid for it. [PHI Redacted] had no side effects. Therefore, Medicare did not have to pay any additional expenses for follow-up care. [PHI Redacted]PSA was 0.8 and [PHI Redacted] doing very well. Many of my friends who chose other types of treatments are continuing to have health problems and ongoing treatments. I think in [PHI Redacted] case, Medicare saved money by paying for [PHI Redacted] treatment. When there is a better treatment, why not use it. When [PHI Redacted] told the first radiologist [PHI Redacted] choice, she said "we will all be doing it that way in the future."

I believe Medicare's proposal to stop paying for
proton beam therapy as a treatment for prostate
cancer is a serious mistake. The proposal is
based on a mistaken belief that it is too costly
and is not better than alternative treatments.
The 7 year study has been posted which shows that
proton beam therapy is every bit as effective, if
not more so, in treating prostate cancer as the
best alternative methods of treatment. Further,
those of us who have had their prostate cancer
cured by proton beam therapy know that there are
virtually no side effects with proton beam
therapy. That is not true of any of the other
forms of treatment. Many types of treatment will
kill the cancer, but proton beam therapy is the
only one with virtually no side effects, resulting
in a better quality of life for the patient.

It is interesting to note that the people who
support the position of stopping the payment for
this treatment are the professionals who offer an
alternative treatment. It looks like they are
trying to eliminate a superior treatment with
which they cannot compete.

I believe it would be a mistake to discontinue
tose payments. They are critical to allowing many
patients to obtain this treatment.

This comment relates to the use of Proton Beam treatment for Prostate Cancer. [PHI Redacted] was diagnosed with prostate cancer 6 years ago. After extensive research and interviews of many others diagnosed and various treatments, [PHI Redacted] chose Proton treatment. That proved to be the right choice. Limited side affects, great results, a PSA .02 within 1 year and still the same 5 years later. I personally have referred in excess of 10 people for same treatment with the same positive results. The consideration of not including this treatment makes no sense to me.

As a 69 year old, healthy, active man, [PHI Redacted] was diagnosed with prostate cancer in [PHI Redacted]. [PHI Redacted] due diligence on all available treatments including proton beam tehrapy. [PHI Redacted] research included contacting men who had selected each of the available protocalls to understand their experience and status after various lengths of time after their treatments. [PHI Redacted] also compiled information from personal friends and two family related members who had surgery, brachytherapy, andIMRT. [PHI Redacted] lost two very close friends who died of prostate cancer years after they had surgery - very sad and difficult deaths. [PHI Redacted] also compared the experiences of patients who chose other treatments. While many were fine, there were just too many whose experiences had changed their lives in a negative manner. [PHI Redacted] choose proton therapy and [PHI Redacted] in continuous communication with over 100 other proton graduates. All have experienced very little or no side effects and continue the quality of life that they enjoyed prior to proton therapy.(a very positive incentive)[PHI Redacted] now completing two years of post treatment[PHI Redacted] I am concerned that too many of the critics of proton therapy for prostate cancer are individuals/organizations with competing treatment alternatives.

[PHI Redacted] was successfully treated for prostate cancer with protons at Loma Linda Hospital four years ago. That hospital has ten years of scientifically accurate research attesting to it's extraordinary ability to successfully treat the patient with virtually no incontinence and less impotence than the alternatives as a result. It is understandible that there is resistence from the medical field, for there is safety in sticking with what you know and do.

Funding of Proton Therapy to treat Prostate Cancer; It would be a huge mistake to withdraw Medicare Funding for Proton Therapy for Prostate Cancer (PCa). [PHI Redacted] This is a wonderful, and highly effective treatment that leaves no side effects for over 95% of those treated. That statement cannot be made by any other PCa treatment regimen. Many doctors, particularly Urologists, do not want this treatment to be funded because it threatens their surgical livlihood. But if the truth is known, this is the most effective treatment available. I realize that only five Proton Treatment Centers are currently operating, but I understand that five more are under construction, and 40 more are in planning. To reduce the Medicare funding for this therapy, would be to deny the best treatment available to combat this disease for a huge number of men. Over 250,000 men are diagnosed with PCa each year, with over 40,000 deaths attributed to this dread disease. Thank you, Alfred Spruell, Capt.,USN(Ret)

I just read the postings to this forum on Medicare coverage of treatment of Prostate Cancer by Proton Bream Therapy. So far all were written by physicians who offer treatment other than Proton Beam. [PHI Redacted] was successfully treated by Proton beam therapy in the year [PHI Redacted] after 2 failed treatments by other mean beginning in [PHI Redacted]. All modes of treatment can kill the cancer. All will have side effects of the treatment. The proven fact is that of all patients within the same diagnostic groups (same PSA and Gleason score ranges) have less side effects when treated with Protons. (Loma Linda University Medical Center Published Studies.) The reduction of side effects and the maintenance of a high quality of life standard is the principle reason for continued use of Proton Therapy. I urge you to continue support of this medical necessity by Medicare.

I wish to speak in behalf of continuing Medicare coverage for proton therapy. [PHI Redacted] was diagnosed with prostate cancer in [PHI Redacted]. [PHI Redacted] received 40 proton treatments with no side effects or recurring problems. I have visited with other cancer victims and have not found anyone that had any other type of treatment with the success that [PHI Redacted] had with proton. All other patients suffer from some type of incontinence or become impotent. This is a painless treatment and to not allow medicare reimbursement is not in the best interest of those who are unfortunate to have the problems. I am truthful when I say that it is the only treatment I would have in the future.

It is interesting to note that the major opposition to proton radiation treatment for prostate cancer patients comes from physicians (primarily urologists) whose practices are threatened by this more advanced technology and one not available in their locale. It is important to remember that urologists are surgeons and, most (not all) will recommend surgical procedures rather than exploring those non-surgical options having fewer undesirable side effects with their patients. [PHI Redacted]This was my personal experience with three well known Dallas urologists I consulted in Dallas. One would hardly expect an economy car dealer to refer his prospective customer to the Lexus dealership.

While proton radiation is currently the more expensive treatment, the opening of new facilities nationwide will make this highly desirable form of treatment more cost effective. As more facilities are opened, the unit cost per treatment will be reduced substantially, making it available to many citizens at a lower cost not just the wealthy few. The important consideration is the improved quality of life provided to those having this option made available to them as compared to traditional surgical and external beam radiation treatments.

[PHI Redacted] I wish to say that the proton therapy treatment is the best for prostate cancer. I believe it's success rate is as good or better than any other modality, and it has negligable, if any, side effects. It is non invasive, also. The fact that so many facilities are on line already, or under construction, is testimony to it's recognized worth. For Medicare to stop reimbursements for this form of treatment is foolish in my opinion. More and more insurance companies are coming on board. Don't even think of reversing this direction.

[PHI Redacted] very satisfied recipient of proton radiation therapy in 2004. The absolute absence of any side effects and the diminished need for follow-up medical treatment makes this method of treating prostate cancer a very viable alternative. [PHI Redacted] PSA, lifestyle, and overall health are evidence of this being a superior treatment. Any attempt to reduce or eliminate the coverage for this methodology would be a grave mistake. In contrast, I would suggest that those advocating not covering proton radiation would educate themselves more completely by communicating with the patients who have been treated and comparing the cost of medication, follow-up procedures, and patient problems between those who have been treated by other methods with proton patients. [PHI Redacted] in excellent health without any pain, incision, medication, or side effects due to the proton treatment.

Proton Radiation for Prostate Cancer

While you are in the decision making process I implore you to seek out data on the relative rates of side effects such as impotence and incontinence.

If, as I'm reading there are no unbiased data, I suggest you leave things as they are until unbiased data is developed.

Also please consider "learning curve" effects. Protons are less used, and therefore there will be a steeper learning curve and cost reduction in the future compared to more mature technologies.

I'm an engineer and recognize that the Bragg Peak effects make protons inherently more directable than un-ionized particles. Stopping the use in prostate cancer will slow an inherently better technology from developing.

It would be like stopping development of semiconductor memory in the 1970s because it wasn't yet proven more cost effective than ferrite cores.

Please reconsider.

Thank you

[PHI Redacted] I can say with confidence, that proton treatment of prostate cancer was effective [PHI Redacted] since 2001-other than skin cancer, prostate cancer is the most common of cancers. In my view, until another treatment is proven superior (with less potential side affects)let's keep proton therapy available as an alternative to surgery & other forms of radiation and prostate cancer treatment.

As a 44 year veteran working in the insurance industry, I have seen far too many patients/clients who resisted (delayed) surgery or developed complications from surgery or photon radiation & thought they were cured, but the cancer returned and metastasised. In my personal conversations with medical professionals, it's been very difficult to find professionals (including MD's) who are unbiased about the cancer treatment process they've been trained in - proton thrapy was the perfect alternative for me, as well as for many of my friends who were treated for prostate cancer at Loma Linda.

It would seem that as the availability of proton treatment centers increase around the country, and the # of cancer patients being treated increase, the costs should also decrease over time.

Rationing health care & eliminating coverage for proton treatment of prostate cancer is NOT the answer. Not now!

Please, let's not "throw the baby out with the bath water". Until a treatment evolves that proves to be better, keep proton treatment reimbursement available to the nearly one qtr million men who are diagnosed with PC annually. Rationing health care in this area - makes no sence to me. The cost of alternative treatments to proton therapy for prostate cancer could prove more costly in the long run-when one considers the higher degree of failure of other forms of treatment.

Proton Prostate Treatment

[PHI Redacted]was diagnosed with prostate cancer, and completed the 45 session proton treatment regimen. [PHI Redacted] experienced no pain, incontinence, impotence, bleeding, loss of energy, or any side effects that may affect patients undergoing prostate treatment. The non-invasive proton treatment for [PHI Redacted] was superior in terms of cancer free status and low PSA post-treatment, and lack of any unpleasant or damaging side effects during and post-treatment, as compared to men whom I know who underwent surgery, brachytherapy, and conventional radiation. The democracy of the proton treatment is attested to by some other proton patients who were refused surgery/brachytherapy/conventional radiation (S/B/CR) due to particulars of their cases, such as large prostate, previous S/B/CR treatment, Gleeson or PSA scores, etc. I urge you to retain proton treatment for prostate cancer as an approved Medicare benefit.

[PHI Redacted] received proton radiation therapy for prostate cancer last year. I have been in the engineering medical field for 35 years and did very extensive research on the methods and outcomes of variuos prostate cancer treatments. [PHI Redacted]had a good outcome with quick reductions in PSA levels. [PHI Redacted]had no side affects of any kind. [PHI Redacted] quality of life is fantastic and future is bright. I know many others who have had other treatment options and have had significant side affects. The long term no-cost followup of having no side affects offsets any added cost of the treatment. What price do you assign to the quality of life?

Proton beam therapy for prostate cancer:
I have studied the subject matter thoroughly. As a
scientist, I have access to the primary medical
literature, and I have carefully scrutinized over
100 publications on the subject. I have also had
discussions with over 20 men who had so-called
conventional treatments (radical prostatectomy,
various forms of external beam radiation, and two
forms of brachytherapy), in addition to 30 men who
had proton therapy. My conclusions are that,
indeed, as argued by several contributors to this
compilation, all forms of treatment are equally
successful. The difference lies in the side
effects, particularly posttreatment.

My particular concerns with respect to treatment
are the minimization of the chances for urinary
(i.e. incontinence) and sexual (i.e. erectile
dysfunction) complications. My research shows that
proton radiation offers a much better chance of
avoiding such complications than conventional
treatment. Some adverse medical literature
notwithstanding, there are numerous reports in
primary publications, most significant among them
those by doctors/researchers without a vested
interest in any of the forms of therapy, which
point to the superior aspects of proton radiation
in these respects. These papers show that it has
become a standard alternative to other methods,
that quality of life issues have become paramount
for men afflicted with prostate cancer, and that
the choice of treatment should be left to the
patient.

The statement that there are no rigorous studies
the compare modern conventional IMRT with proton
radiation therapy is correct. What is incorrect,
indeed disingenuous, is to construe this as an
argument against proton radiation as a treatment
choice. There are no studies that show that
conventional treatment is better or even equal to
protons. However, there is unequivocal science.
Nobody can argue with the existence of the Bragg
peak and therefore the corresponding reduction in
exposure of nontarget tissue.

I therefore would have to vehemently disagree with
the proposal to stop Medicare reimbursements for
proton therapy in the treatment of prostate
cancer.

[PHI Redacted] recieved Proton radiation for prostate cancer from [PHI Redacted]. The results are nothing short of fantastic. [PHI Redacted] experienced no side effects while recieving treatment and no side effects after treatment. There probably is no difference in the effacy of Photon treatment versus Proton treatment as far as eradication of the prostate cancer. There is however, a very big difference in the side effects and the resultant quality of life between Proton radiation and Photon radiation. Bowel burns, incontinence, bladder burns,and erectile disfuntion are uncommon with Proton radiation. This NOT true with IMRT Photon radiation. When [PHI Redacted] was advised that needed to recieve radiation and was directed to Photon radiation, was told that would become impotent and that incontinence was likely and that bladder burns and bowel burns could occur. Instead chose Proton and couldn't be happier. Don't take the shortsighted view. These recurrent issues of Photon radiation will cost much more in the long run of a persons life. I am a board member of the Prostate Cancer Educational Council and I see these issues associated with Photon radiation all the time. Many hospitals across the country are considering installing Proton Radiation centers. There is a very good reason this is happening. Fred Bruno

I believe that proton therapy has the most
benefits to the ordinary patient. The non
invasive treatment allows the patient to carry on
a normal lifestyle without weeks or months of
physical side effects that are present with other
treatments for prostate cancer. I would compare
it to breast treatments for the importance of the
treatment to the individual.

re: Medicare reimbursements for proton therapy for treating prostate cancer

[PHI Redacted]was diagnosed with prostate cancer. After six months of rigorous medical research, plus personal interviews with professionals in the field, as well as anyone [PHI Redacted] could locate that had gone through treatment for prostate cancer such as friends or friends of friends, [PHI Redacted] came to the only conclusion that made any sense for proton therapy. [PHI Redacted] considered nerve-sparing surgery, seeding, 3-D conformal radiation, and proton therapy. [PHI Redacted] chose proton treatment because of the following indisputable facts: less invasive than surgery, less chance of complications from surgery, less recovery time, and less chance of adverse side-effects such as incontenance and impotency with effectively the same success rate as surgery. HMO refused to pay for treatment because they said proton therapy was not necessary, more costly, and that no current, comparative studies have been conducted to prove it was better than conventional prostate cancer treatments. [PHI Redacted] paid for [PHI Redacted] treatment, then lodged a formal complaint, and eventually, because of solid evidence to the contrary, was reimbursed by HMO. [PHI Redacted] healthy and fully functioning.

I notice on this website that most of the people opposed to this therapy are professionals in direct competition. I think it is very, very important that Medicare research the facts and the data and not rely on personal opinions to guide them. This, of course, is my personal opinion, but I wanted to convey to you my alarm at the possibility that Medicare would not continue to cover proton therapy because I feel it is a highly viable choice for those who qualify.

[PHI Redacted] did extensive research before deciding on pursuing Proton Radiation Therapy for [PHI Redacted] treatment for many reasons, several of which are: Proton Radiation treatment, according to the reseach reports read, proved to be be highly effective in 90+% of cases completed. It has now been used for 18 years with excellent results. [PHI Redacted] did not experience any side effects such as impotence and incontinence and was able to carry on all normal activities during treatment including bike riding, snow skiing, hiking, swimming and working out at the gym. [PHI Redacted] cancer free for the past 6 years and continue to do all activities as before. I know that the PSA is indicative and controversial as a measure of success, yet is a measure that is availble. PSA has been 0.7 for the past 3 years. [PHI Redacted] completely satisfied with treatment choice and highly recommend Proton Radiation Therapy to friends and anyone who asks about their treatment choices.

I am extremely disturbed tha CMS is considering redacting that treatment and considering not paying for it in the future. Without Medicare it would have been an exteme economic hardship [PHI Redacted] to use Proton Radiation Therapy as my treatment choice. Please continue to pay for this exellent and effective treatment.

Regarding Proton Therapy for Prostate cancer:

I graduated with an MD degree in 1960. Two members of my class
developed prostate cancer about the same time in 2001. One had
proton treatment and never missed a day of work and had virtually
no symptoms during treatment or since. The other was off work
for weeks and had a period of incontinence for weeks. Their
experience and that of other proton therapy patients that I have
talked to convinces me that there is a significant benefit to proton
treatment for this condition as well as spinal cord tumors etc.

Proton radiation therapy for prostate cancer.

[PHI Redacted] was diagnosed with prostate cancer after a biopsy. PSA=14.9 and a Gleason score of 9. [PHI Redacted] was accepted for proton and photon therapy at Loma Linda University after Medicare and secondary Insurance carrier agreed to pay for it. [PHI Redacted] 9 week treatment ended [PHI Redacted]. [PHI Redacted] just had a 4 month complete evaluation. PSA 0.2, clear Ct scan and no sign of cancer. All urinary problems are gone, ([PHI Redacted] Sexual function has returned to an almost normal state. [PHI Redacted] I would hate to see Medicare turn it's back on such an important and effective prostate cancer treatment option. Roger Harris

I believe that Proton Therapy is a valid and
useful treatment for prostate cancer. As a
graduate mechanical engineer and retired NASA
employee, I feel that my experience qualifies me
to do the research necessary to sort out the true
facts regarding proton therapy.

I have done so and it is apparent that those
individuals who seem to be saying that proton
therapy centers should not be built, and that
Medicare should not reimburse a patient for the
cost of proton therapy. are serving their own
purpose and not that of the individual patient.

Proton therapy is uniquely applicable to treat
many forms of cancer, including prostate cancer.
When the cost of follow-on care is included for
radical prostatectomy (surgery), the cost of
proton therapy suddenly seems much more
comparable.

It appears to me that there is an element of fear
(loss of income) apparent in those who suddenly
are speaking out against proton facilities. So
long as Loma Linda University Medical Center was
alone in providing the treatment, then after
about ten years, Massacusetts General Hospital
joined them, the threat was so small as to be
ignored. There were no complaints and protests
about the use of protons and the insurance
coverage of same for over fifteen years.

Now, with the advent of more amd more proton
centers, it suddenly has caused a great uproar!

I say foul! Those of you with a medical and/or
scientific background should study the real
issues here and when you do you will become
proton advocates instead of enemies.

Fuller Jones

How about listening to a patient who went through Proton Beam therapy for Prostate Cancer instead of just listening to Drs who have a vested interest in their own treatment methods. [PHI Redacted] oncologist recommended and was within days of surgery. By accident [PHI Redacted] learned of proton beam therapy. After much research [PHI Redacted] approached the surgeon and asked him what he would, and he said surgery is always on option later if the proton bean doesn't work so go with the proton beam for now. Not only was it successful, but PSA levels have dropped from a high of about 5.0 to .1 - now after 5 years since treatment. No Loss of function, no surgery, etc. How could you not want to continue this coverage through medicare? You should be encouraging more proton beam centers not less. Yes, the building of a cyolotron is expensive...but it beats the hell out of the prospects of surgery or broad beam radiation especially when caught early. Please be sensible...

[PHI Redacted] prostate cancer survivor with an undergraduate degree in engineering. [PHI Redacted] choice of treatment was Proton Therapy at Loma Linda University Medical Center.

More than eight years after treatment [PHI Redacted] cancer free, [PHI Redacted] psa is below 0.10 and [PHI Redacted] do not have any problems with side effects.

I can not speak with scientific authority since I am neither a oncologist or physicist but based on [PHI Redacted] experience, proton treatment for prostate cancer was definately worth the cost.

receive Proton Radition Therapy for a very aggressive type of Prostate Cancer in . Readings were over 5 for Psa and a Gleason count of over 9. This preculeded from having seeding done. Regular Radiation would have caused other problems because of the . Removal of the prostate was not a good solution as would have been intontinent . already had some urinary problems because of the previous surgery. Proton Radiation was only home. was accepted as a patient after Eurologist, Gastroentologist and Internist all recommended that have this treatment. They all contacted LLUMC on behalf. At this date a PSA of 0.02. treatment was in May, and June of . what received in treatment was not only only hope but probably saved from either being further disabled or havine cancer continue to take life. How can you say it is too expensive. Is it better to have people go through procedures that lessen their quality of life for a few dollars? Please reconsider this proposal!!!!

After a biopsy in 2006, [PHI Redacted] was told that [PHI Redacted] had prostate cancer. [PHI Redacted] was shocked. Being an engineer, [PHI Redacted] wanted more data. [PHI Redacted] first recommendation was surgery. [PHI Redacted] researched the complications and rejected this option. [PHI Redacted] then had a consultation with an oncologist that specialized in radioactive seeding. These complications were not acceptable[PHI Redacted]. [PHI Redacted] then consulted with a radiologists on the merits of intensity modulated radiation. This seemed [PHI Redacted] to be better than seeding or surgery, but had its own complications. I heard from a friend about his success with protron treatment and visited the Loma Linda Cancer Center. I live near Loma Linda in California so I was able to visit and to learn more about proton treatment. As an engineer, I understand the difference between photon and proton radiation. That convinced [PHI Redacted] to go with protron treatment. After treatment, [PHI Redacted] gone from a PSA of 6 to 0.45 and continuing to drop. Just as important [PHI Redacted] not been inflicted with any side effects of the kind that worried [PHI Redacted] with the other treatments. Please continue to let all prostate cancer patients to make the choice that is right for them. Do not eliminate the financial ability for those on medicare to opt for the proton treatment. Thank you.

In [PHI Redacted] had a PSA of 25. After consulting with a urologist [PHI Redacted] was informed that surgery was [PHI Redacted] only viable option. After research [PHI Redacted] decided to undergo proton therapy. Side effects were and are minimal and [PHI Redacted] PSA for 2 years has been between 0.00 and 0.04.

I understand that reimbursement for proton beam therapy for prostate cancer is in danger of being reduced or eliminated. I wish to voice my concern that the most effective treatment out there will be unavailable to the people who would benefit the most. [PHI Redacted] The sad stories of friends and loved one's who have had on-going complications from other treatments and the dearth of complaints from the dozens of proton graduates I know have convinced me that the research and antidotal evidence I have discovered is accurate. Proton treatment is far away the preferred treatment.

[PHI Redacted] was diagnosed with prostate cancer. [PHI Redacted] PSA was 6.1 and had a Gleason score of 9. (4+5) [PHI Redacted] prostate was the size of a grapefruit. After considering all available options, [PHI Redacted] chose proton radiation at Loma Linda because the morbidity rate was similar to other options but the risk of side effects seemed to be reduced. After proton, conventional radiation, and two years of hormone ablation therapy, [PHI Redacted] PSA is 0.45 with no side effects. [PHI Redacted] will always be grateful to the wonderful people who helped [PHI Redacted] through treatment and to those who developed this technology so that [PHI Redacted] enjoy the quality of life [PHI Redacted] after treatment more than five years ago. The increasing number of proton radiation centers is clearly a good thing. As time goes on, as the technology improves, and as knowledge expands, this outstanding treatment will become available to even more people who hear their Doctors say, "The results of your biopsy were positive. You have cancer." Proton therapy works. "Side effects" are more than just words.

[PHI Redacted] diagnosed with prostate cancer but [PHI Redacted] refuse to accept the barberic choices that are offered as conventional protocol. [PHI Redacted] found out about the proton beam therapy and [PHI Redacted] desire is to have that option available to me. However, [PHI Redacted] a member of Kaiser Permanente and they refuse to cover the cost. The cost is far more that [PHI Redacted] can affore to pay for [PHI Redacted]. Since Kaiser's policy perpetuates this archaic and brutal protocol and does not permit the less invasive and far superior therapy of proton beam there is a chance that [PHI Redacted] will succumb to the prostate cancer. However, it is better to die that to undergo the conventional choices of cut, burn or poison. [PHI Redacted] plan is/was to change medical providers so that [PHI Redacted] can use [PHI Redacted] Medicare to cover the cost of the proton beam therapy. I hope that nothing happens to prevent the Medicare coverage for proton beam therapy and, possibly, resulting in [PHI Redacted] death.

This comment is in support of Proton Beam Therapy (PBT) for treatment of prostate cancer. Early in was diagnosed with prostate cancer and the local medical practitioners each predictably recommended treatment using their area of expertise; surgery, conformal beam xray radiation, or seeds. When found out about PBT looked for diverse sources of information and, using background in engineering and physics, concluded that PBT was the obvious treatment which had the highest probability of success with the least side effects. When announced decision to use PBT, the local medical practitioners tried to convince that the treatment was "experimental, unproven, a thing of the past and if it was any good why weren't there many more centers delivering PBT." As expected, health insurance Co. refused to approve it, but, thankfully, was able to move to Medicare and obtain the PBT. It has been 7 years since treatment. There was no discomfort, pain, or side effects during treatment and none over the 7 years since. family doctor has reported continuing improvement in prostate condition via blood test and digital examination annually. Now that the success of the PBT treatment has been broadly recognized, there are many more centers opening both in the U.S. and other countries.

Before a decision is made to deprive Medicare patients of this excellent treatment, CMS should at least undertake an unbiased evaluation of PBT vs. other treatments which are supported by practitioners who have a vested interest in removing PBT from the choices available to Medicare cancer patients. While undertaking this evaluation, CMS might also subsidize studies aimed at cost reduction of PBT, since cost seems to be the only remaining argument in use against PBT. Just as other arguments have proven false, I wonder if this one will also prove false when such things as re-treatment, etc. are considered relative to the other treatments available.

[PHI Redacted] had treatment 11 years ago with no side effects.Many of the men that have other treatment have adverse side effects that I would prefer not to have. I feel that [PHI Redacted] received the best treatment possible.[PHI Redacted] welcome the chance to share [PHI Redacted] experience with anyone considering prostate treatment.

In [PHI Redacted] received proton radiation for prostate cancer.[PHI Redacted] satisfied with the results. [PHI Redacted] no major side effects. [PHI Redacted] walk a couple miles most days with [PHI Redacted] walking group at work. [PHI Redacted] also use weight resistance training two to three times a week, and use [PHI Redacted] Nordic Track ski-machine two to three times a week.

Before the proton radiation treatment, [PHI Redacted] local urologist had recommended [PHI Redacted] a second opinion; radiation or proton radiation since [PHI Redacted]. [PHI Redacted] checked with a local Harvard and University of Michigan trained MD, radiation oncologist, who reviewed [PHI Redacted] lab information, but [PHI Redacted] decided against Thera-Seeds.

I just received an email that the CMS has made a proposal to Medicare to discontinue reimbursement for proton treatment of prostate cancer. [PHI Redacted] living proof that this procedure is the BEST. [PHI Redacted] had the procedure in [PHI Redacted]. While [PHI Redacted] there, at least 1/3 of the 140 being treated during that 2-mth period were there because they had surgery and the cancer came back. Loma Linda "cleaned" them up.

[PHI Redacted] had an HMO policy which initially said they would cover [PHI Redacted] treatment as the secondary insurance but once got to Loma Linda, they decided not to. To make a long story short, the Federal Judge decided in [PHI Redacted] favor (after several contested letters by [PHI Redacted] to their staff physician who initially said the procedure was experimental but later rescinded that statement). Medicare paid 80% and [PHI Redacted] insurance paid $5000. Had it not been for Medicare, [PHI Redacted] would not have been able to receive the proton radiation beam treatment.

Not only do they have a 95% cure rate, the treatments are painless (lasting 1 min and 45 seconds 5 times a week)and you are not incontinent, impotent nor radioactive. [PHI Redacted] carried on normal life during the 40 treatments. It''s nearly 7 years now and [PHI Redacted] PSA is 0.11.

I''ve had several friends who opted for surgery and yes, the cancer came back. We''ve had some local doctors open a clinic specifically for prostate cancer treatment. Their quote in the local newspaper was "Medicare covers this treatment better than insurance companies and we wanted to make sure the $$$$$ came to us".

To date they have built a facility in TX, FL, Boston, Indiana and Seattle, WA is going to build one. The medical profession is going to have to accept the fact that this is a proven treatment and surgery, chemo, photon radiation or seeds are not the answer - plus the fact that there is no guarantee that one is cured after you have endured such radical treatment.

[PHI Redacted] was diagnosed shortly after [PHI Redacted] arrived home from Loma Linda and after going to 3 urologists, he asked the third one why they weren''t telling men about the proton radiation beam procedure. The Dr.''s comment was "What would happen to my practice if I sent my patients 1000 miles away?"

Tell me what is more important to the doctors in the USA?

Please DO NOT take away Medicare''s help to so many men who are being diagnosed with prostate cancer.

I would like to address the issue of discontinued coverage for Proton Beam Therapy for Prostate Cancer. I believe it would be a disservice to men diagnosed with Prostate Cancer. [PHI Redacted] was diagnosed with Prostate Cancer in [PHI Redacted]. After extensive research on the available treatments [PHI Redacted] chose Proton Beam Therapy. There have been studies showing the effectiveness of the treatment and the quality of life post treatment. In [PHI Redacted] case quality of life was very important. Since receiving the treatments [PHI Redacted] cancer seems to be gone. [PHI Redacted] experienced NO side effects. There was no pain, no incontinence, no bladder or rectal bleeding, no impotence. The only evidence that points to [PHI Redacted] receiving Proton Beam Therapy is [PHI Redacted] PSA test results and [PHI Redacted] personal Physicians reports which show the cancer is gone.

I understand that CMS has made a proposal to stop
Medicare reimbursement for Proton therapy for
Prostate cancer treatments. Why?

Don't prostate cancer patients deserve a chance to
receive the best available treatment? Are you
looking to cut costs by condemning men to inferior
treatments with More severe side effects? If so,
you will incur additional Medicare expenditures to
treat those severe problems (I know four men who
have had surgery and all need ongoing treatments
to deal with their incontinence.... two of them
have had the cancer recur).Is it your plan to
condemn prostate cancer patients to problems for
the rest of their lives?
Proton therapy is the new "gold standard" in
regards to treating this type of cancer.

I am writing my senators and representative in
regards to your plan.

Gene Horner
ghornerhb@mac.com

[PHI Redacted] had Proton Beam Treatment for prostate cancer from [PHI Redacted].[PHI Redacted] was 63 at the time. Treatment was given at the center at Loma Linda, California. [PHI Redacted] PSA has been below .5 since [PHI Redacted]. There have been no side effects. No moneys have been spent since treatment was concluded, other than semi-annual check-ups at small costs. [PHI Redacted] [PHI Redacted] also retained excellent bladder control. The treatment was painless. When adding to the cost of other prostate cancer treatments, the cost of follow up care, plus a monetary value for the pain and the loss of potency and continence, the beam treatment is probably not all that much more expensive anymore.

Dear Sirs:

I am quite perplexed that some wish to stop Medicare coverage of proton beam theoropy for the treatment of prostrate cancer. [PHI Redacted] recieved proton theropy a year ago. [PHI Redacted] PSA was 5.4. The treatment [PHI Redacted] recieved was in no way a drudgery. 45 treatments were administered over nine weeks. The beauty of and advantage of proton beam theropy over all the other options is that NO ill side efects were encountered during or after the treatment. The quality of [PHI Redacted] life if anything was enhanced during the treatment. Since the treatment [PHI Redacted] PSA has dropped to 2.6 at four months, and is now at 1.5 after ten months. [PHI Redacted] kept in contact with many of the 150 patients who were undergoing treatment at the same time[PHI Redacted]. ALL have reported similar drops in their PSA, and NONE have reported ANY side effects from the treatment.

I would urge you that quality of life during and after prostrate cancer treatment must be a high consideration when determining whether or not to fund the treatment. To my knowledge, no other form of treatment yeilds such a high percentage of positive results nor such a low rate of side effects which impair quality of life.

Please continue the Medicare coverage of Proton Beam Theropy for prostrate cancer treatment. It was truly a Godsend [PHI Redacted], and I would be greatly saddened if men who follow [PHI Redacted] were to be denied the quality of life [PHI Redacted] enjoy by having Medicare coverage of this wonderful treatment stopped.

Re: Proton therapy for prostate cancer.

I am concerned about the campaign to eliminate Medicare coverage for the treatment of prostate cancer by proton radiation.

[PHI Redacted] was diagnosed in 2002 with prostate cancer and obviously was concerned that treatment would be effective and also allow a normal life after treatment. [PHI Redacted] read several books, spoke with people who had various treatments, sought counsel from various physicians and came to the conclusion that there were several treatments that would probably rid [PHI Redacted] the cancer - none that were 100%. Every treatment had some side effects but proton therapy is very effective and allows the quality of life to continue almost the same as before treatment. What do I mean when I write "quality of life"? This means [PHI Redacted] did not fear rectal burning or tissue injury, incontinence for an extended period, impotence for the rest of [PHI Redacted] life or other everyday problems. [PHI Redacted] spoke with others who had various treatments. Everyone who had surgery suffered from impotence, all but one had extended incontinence and recovery from surgery required a great deal of time. Those who had conventional radiation suffered from impotence or partial impotence, some had intestinal bleeding or real problems with diarrhea, some had incontinence of varying degress. Seed implants were also troubled with various side effects.

One of the physicians [PHI Redacted] consulted explained [PHI Redacted] the 'medical philosophy of doctors'. He stated that the medical profession is dedicated to patient survival and in the case of cancer, to rid the body of the cancer. He indicated that 'quality of life' after treatment is not a priority.

[PHI Redacted]

Starting in [PHI Redacted], [PHI Redacted] began proton therapy at Loma Linda Mediacal University, finishing [PHI Redacted] There have been no symptoms of cancer in six years and there were/are no side effects - none! [PHI Redacted] because Medicare and [PHI Redacted] supplemental insurance paid for the treatment, the "quality of life" continues.

[PHI Redacted]the treatment did not cost a lot more than surgery and certainly was much less stressful!

As a final comment, [PHI Redacted] asked one of the urologists why he had not suggested proton therapy as one of the alternatives available. The answer was, "if we sent our patients out of state, we would all probably go broke"!

I wonder if the campaign by physicians to remove proton therapy from Medicare covered procedures is motivated more by financial concerns than by empathy for patients suffering from a potentially fatal disease.

I hope that "quality of life" will become part of the criteria when ascertaining what medical procedures should or should not be covered.

I understand that Proton Beam Therapy is being reviewed by the Governing Medicare Policy board for elimination of coverage due to spurious reasons of not being significantly better than the typical treatment (i.e. Prostate Removal). [PHI Redacted] a recipient of Proton Beam therapy. [PHI Redacted] treatement occured at the age of [PHI Redacted]. Although [PHI Redacted] had private insurance, [PHI Redacted] had to struggle to get [PHI Redacted] treatment covered. [PHI Redacted] able to jsutify this to [PHI Redacted] private Carrier Blue Cross Blue Shield at the time in large part due to the fact that Medicare was covering this treatment. Had this no been the case [PHI Redacted] would have had to pay out of [PHI Redacted] pocket fo what is clearly a superior treatment over surgery. After much study it was clear [PHI Redacted] that [PHI Redacted] urologists did not give a damn about surgical side effects like incontenance or sexual function loss and worse that he was not up to speed on advanced non invasive treatments. Also it was clear that Porton Beam therapy had significantly less treatment side effects and was able to achieve equal if not superior efficacy compared to surgery. [PHI Redacted]6 full years past [PHI Redacted] treatment and maintain a PSA below 1.0 usually .7 to .9. Also, [PHI Redacted] still able to have adequate sexual function and have zero side effects with urination etc.

[PHI Redacted]

I am strongly opposed to elimination for medicare coverage for Proton eam therapy and strongly feel that this movement to eliminate Medicare benefits is a marked conspriracy of the Urologists who rail against this program due to loss of income an worse sheer hubris and the well known medical conditioned called "Not Invented Here". [PHI Redacted] spoken to several Urologist since [PHI Redacted] treatment and despite y [PHI Redacted] success tey consisitently stick to their one and only position of cut cut cut and lets schedule it tomorrow before the patient discovers there are options. Losing Medicare Funding for Proton Beam therapy sentences thousands of men to serious side effects and significant loss of "Quality of Life".

Please here my comment and continue to fund Proton Beam Therapy.

Well this has been a very interesting read. [PHI Redacted] [PHI Redacted] Urologist was a surgeon and of course he wanted [PHI Redacted] to get a Radical here locally with in the next three months. So, much research was taken on [PHI Redacted]. Prostate cancer seems to be a very different beast than most other cancers. What [PHI Redacted] learned was a Urology Surgeon wants surgery and a radiologist wants you to have Radiation. It seems everyone wants to have good mortality stats for they''re portfolio and the hell with the quality of life issues. [PHI Redacted] decision to have proton therapy was based on getting information from post treatment patients of many different therapies including Proton Therapy and also there is a good chance that no treatment is appropriate. When [PHI Redacted] Dentist spoke [PHI Redacted] about Proton Therapy it was all over. [PHI Redacted]PSA was well below one and on a down hill trajectory the last [PHI Redacted] checked and of course with very minor side-affects. The plumbing still works. [PHI Redacted] still feel for [PHI Redacted] it was an appropriate treatment decision. One should interview any medical personnel that have had this treatment. [PHI Redacted] And there''s plenty data on potential side- affects from other therapies. Life is still a gamble nothing is for certain.

Please continue paying for proton therapy. It
is the most logical treatment for many kinds of
cancer.

I believe Medicare Coverage should continue to cover Proton Therapy Radiation for prostate cancer and a variety of other diseases. The alternative radiation therapys may be acceptable for physicians and patients who do not have access to proton therapy. [PHI Redacted] 5th year since diagnosis and treatment of prostate cancer with proton therapy. The advantage of proton therapy and surgery is in the cure plus the elimination of significant negative after effects. Also, to my knowledge no one has ever died from proton treatment. However, a significant number die from surgury. I know a man in his mid- fifties who recently had prostate cancer surgery who had a stroke on the operating table and now is disabled for life. We often say if it will save one life it will be worth it.

Recognizing the conflicting interests of contributors to this discussion, I comment only as [PHI Redacted] who did [PHI Redacted] homework prior to treatment for prostate cancer. I am convinced of the superior three dimensional targeting with protons based on physics, and the resultant lack of collateral damage as evidenced by [PHI Redacted] absence of ANY symptoms or side effects during treatment and persisting at 18 months post-treatment, with all signs pointing to success. If I can get the same or better cure rate, and better quality of life, what's not to like about protons? I only hope that conclusive comparative studies will soon be completed to confirm my belief in proton treatment.

[PHI Redacted] 82 year old man in Louisville ,Ky who had 41 Proton Beam treatments in Jacksonville ,Fl. in [PHI Redacted] and now a PSA reading of .23 and a lot better quality of life since [PHI Redacted] prostate cancer is gone. [PHI Redacted] not have afforded the cost of the treatments without Medicare coverage as [PHI Redacted] secondary insurance would not have paid unless Medicare paid first so I strongly recommend that you re-consider and continue to allow payment for Proton Beam patients! Thank You

Proton Therapy: [PHI Redacted] had Proton Therapy in the summer of [PHI Redacted] at Loma Linda, at age 68, with a PSA of 8.4. [PHI Redacted] thoroughly researched all [PHI Redacted] options at that time. [PHI Redacted]had no side effects and in good health seven years later with a PSA of 0.06. I would recommend this Proton treatment to everyone! - George

[PHI Redacted] treated in 2oo6 For Prostat cancer at Loma Linda Hospital in Calif. It was the best treatment with no down side. It wold be a mistake to not allow this great treatment for medicare patients.
Ken Kalin

In 5 months, [PHI Redacted] PSA went from 5.9 to 1.27 as a result of Proton Therapy. The main advantage of this treatment is the fact that [PHI Redacted] experienced no side affects. As we look to the future, less invasive treatments should be investigated.[PHI Redacted] was covered by [PHI Redacted] employer's health insurance; however at [PHI Redacted] current age [PHI Redacted]; it culd have been a Medicare situation if [PHI Redacted] retired. Protn Therapy should not be eliminated from Medicare coverage.

I strongly oppose the elimination of funding for proton therapy by Medicare. For thirty-three years, I served as Associate Professor then Professor of Medicine at the University of Tennesee College of Medicine. [PHI Redacted] diagnosed with prostate cancer in [PHI Redacted] and had proton treatment in 1996. In the nearly 12 years since that treatment, [PHI Redacted] PSA has remained in the range of 0.3-0.4. It was 11.6 prior to treatment. During that 12 year perion, [PHI Redacted] able to maintain a fully functional lifestyle with no side effects from the treament. I realize that [PHI Redacted] experience is anecdotal but through the newsletter of the proton therapy alumni group, I have been able review hundreds of similar cases. It is obvious that those espousing conventional radiation therapy are beginning to feel the competition and wish to destroy this treatment modality for economic reasons regardless of the obvious benefit to society. The minimal morbidity and the positive effects on lifestyle must be considered along with the obvious effectiveness of proton therapy in making any decision about future funding. I have reviewed numerous papers on the topic and the statement that there are no comparitive studies with older forms of treatment are not true. While the effectiveness of proton therapy may be no better or worse than other forms of treatment, the difference in lack of morbidity and maintenance of lifestyle are striking with proton therapy far superior. I strongly urge that the CMS take these factors into consideration and continue to fund proton therapy.

re: Proton beam therapy for prostate cancer

As one who has been researching Proton Beam Therapy, specifically existing facilities, I am dismayed at the prospect of coverage no longer being extended to this treatment option for prostate cancer patients.

As one who has taught a rationale Problem Solving and Decision Making course for the past 15 years, I used those same methods in looking at [PHI Redacted] a course of treatment for early stage prostate cancer. With the evidence of little to no urinary incontinence (a major concern among patients) and statistical cure rates (cNED and bNED) at least as good as radical prostatectomy, the choice is clear. This falls into the category of equal benefit but less side effects and risk, or "duh!, choose it!"

It also appears to me that those entering early comments against this treatment have a vested interest in competing treatment options. But look at the more recent comments from those with patient-side experience. If you're researching an automobile to purchase, who do you believe more; the manufacturer, the competing manufacturer, or those who have bought into the product?

I urge you to continue coverage for this treatment option for prostate cancer.

Regarding Medicare Payment for Protons

[PHI Redacted] Nine years ago, [PHI Redacted] was treated for Prostate Cancer at Loma Linda University's Proton Treatment Center, in California, started on [PHI Redacted] and finished on [PHI Redacted]. Each day, the actual Proton treatment was less than 5 minutes.

Traditional radiation treatments use X-Rays up to and including “Cyberknife” while protons are NOT X-Rays, and have the unique capability of being more precisely controlled for application to the cancer or benign tumor.

I believe that a decision must be made to allow and even expand financial support of proton Therapy by Medicare. [PHI Redacted]

“Market Forces” will come into play as more Proton Centers are added to the medical community and cost reductions based increased availability and changes in the customer base. Protons are the rapidly growing approach to treat Prostate Cancer and many other diseases with Protons as below and should not be denied to anyone.

Protons are the real deal and treats Choroidal Melanoma, Pituitary, Acoustic Neuroma, Meningioma, Astrocytoma,Other Brain, Head and Neck, Prostate, Other Pelvis, Craniopharyngioma,Orbital, Paraspinal Tumors, Chordoma/Chondrosacoma, Sarcoma, Other chest,AVM, Other Abdominal, SNVM, Breast, Lung, & Liver.

Sincerely yours,

Alomost 9 years ago [PHI Redacted] had proton radiation therapy for prostate cancer. [PHI Redacted] free from cancer today and have continued in [PHI Redacted] profession during these nine years. Side effects were minimal and the results phenomenal.

At the time [PHI Redacted] was diagnosed with cancer a good friend and [PHI Redacted] were similarly diagnosed. Each of them opted for other forms of treatment. Each of them has experienced a return of their cancers. One is holding it at bay through hormones, complete with hot flashes and other side effects. The other will apparently wait it out and let the disease take its toll. According to my own research, no treatment for prostate cancer has the long-term success rate of proton particle radiation

[PHI Redacted] was devastated by a diagnosis of prostate cancer. Initial research revealed a range of treatments with relatively similar cure potential. In my detailed research, I read several books, talked to dozens of prostate cancer survivors and read several hundred first person accounts of treatment. My conclusion was that proton beam therapy was as effective as any other treatment but with significantly fewer side effects. Two other observations:

1. The best treatment for you is the one you choose after doing appropriate research.

2. Everyone you talk to is biased- doctors based on what they do and patients even more so on what they did.

Please do not take the proton option away from future Medicare recipients who are diagnosed with prostate cancer.

[PHI Redacted] was treated for prostate cancer in [PHI Redacted] with Protons and Photons. [PHI Redacted] PSA at treatment time was 32. [PHI Redacted] 5 years out from treatment,PSA undectable. Since the time of [PHI Redacted] treatment [PHI Redacted] had NO side effects. This continues to this day. I am aware that there are meany treatments available for PC. I am also aware that most if not all may have very negative side effects. None of the men recieveing treatment at the time [PHI Redacted] treated (about 150)reported any severe side effects.

I am a 75 year old who promotes Proron treatment at every opportunity. I will be very upet if it is made less available.

Two issues have been brought up by others in
this commentary that should be addressed:

1) Regarding the concern that proton therapy for
prostate cancer has no additional benefit above
and beyond conventional IMRT photon treatments,
please take into account the recent report from
the Harvard Dept. of Radiation Oncology which
shows a 50% reduction in secondary malignancies
associated with proton treatments as compared
with photon treatments. This report follows:
_________________________________________________
____________________
C.S. Chung, N. Keating, T. Yock, N. Tarbell,
Comparative Analysis of Second Malignancy Risk
in Patients Treated with Proton Therapy versus
Conventional Photon Therapy, International
Journal of Radiation Oncology*Biology*Physics
Volume 72, Issue 1, Supplement 1, Proceedings of
the American Society for Therapeutic Radiology
and Oncology 50th Annual Meeting, American
Society for Therapeutic Radiology and Oncology
50th Annual Meeting, 1 September 2008, Page S8.
www.sciencedirect.com/science/article/B6T7X-
4T85W5M-10/2/096f1b7ef9fa2085f4daa917e93c7361)
¡°Background: Compared to photon radiation,
proton radiation improves dose distribution to
the target and decreases dose to adjacent normal
tissues. The most common method of delivering
proton radiation involves passive scattering.
However, passive scattering produces secondary
low-dose neutrons, which may induce late
radiation-induced malignancies. The magnitude of
second cancer risk in patients treated with
proton radiation compared to photon radiation
therapy has not been reported to date.
Purpose/Objective(s): To quantify the risk of a
second malignancy associated with the use of
proton radiation therapy compared to photon
radiation therapy.
Materials/Methods: Matched retrospective cohort
study of 1,450 patients treated with proton
radiation therapy from 1974-2001 at the Harvard
Cyclotron in Cambridge, MA, and patients treated
with photon therapy in the Surveillance,
Epidemiology, and End Results (SEER) cancer
registry. We matched patients by age at
radiation treatment, year of treatment, cancer
histology, and site of treatment. We restricted
the study to patients with ¡Ý1 year of follow-up.
The primary endpoint was the risk of a second
malignancy in any site after radiation therapy.
Results: We matched 503 Harvard Cyclotron
proton patients with 1591 photon patients from
the SEER registry. 6.4% of proton patients (32
patients) developed a second malignancy, while
12.8% of photon patients (203 patients)
developed a second malignancy. The median
duration of follow-up was 7.7 years in the
proton cohort and 6.1 years in the photon
cohort. The median age at treatment was 56 years
in the proton cohort and 59 years in the photon
cohort. After adjusting for gender and the age
at treatment, treatment with photon therapy was
significantly associated with an increased risk
of a second malignancy (Adjusted Hazard Ratio
2.73, 95% CI 1.87 to 3.98, p < 0.0001).
Conclusion: The results of our preliminary
analysis indicate that the use of proton
radiation therapy is associated with a
significantly lower risk of a second malignancy
compared to photon radiation therapy. Additional
analyses are required, and ongoing close
surveillance of these patients is necessary,
given the prolonged latency period for the
development of second cancers.¡±
_________________________________________________
__________________________

2) The other issue being discussed is the issue
of neutron production and whether proton
treatments at therapeutic doses cause greater
neutron production than photon (X-ray)
treatments. This notion was dispelled recently
by Dr. Harald Paganetti of Harvard University
(Mass General Hospital). As clearly indicated in
the video at
http://www.oncolink.org/tv/astrola/astroplayer.ht
ml, Dr. Paganetti shows that IMRT photon
treatments actually yield a higher, rather than
lower, rate of neutron production than proton
treatments under normal conditions.

Intellectual honesty compels everyone concerned
to take these reports into account in evaluating
the relative virtues of proton treatments vs.
photon treatments. As far as costs are
concerned, economic cost-benefit analyses should
be performed to evaluate long-term costs as it
may be shown that proton treatments actually
result in lower cost to insurers, including
Medicare and Medicaid, than other forms of
treatment because of the increased ability to
avoid damage to non-target tissues.

Patrick D. Greany, Ph.D.
pgreany@ufl.edu

[PHI Redacted] a three year prostate cancer survivor who received Proton Beam Therapy at Midwest Proton Radiotherapy Institute in Bloomington, Indiana. [PHI Redacted] found Proton Beam Therapy to be a God send as far as cure rate as well as NO SIDE EFFECTS. Medicare and Medicaid should continue to provide this treratment option to men with prostate cancer.

I beleive that if more centers were built that people would be served as well as with competition, the cost would decrease. Thank you, Rick Otey

[PHI Redacted] completed proton radiaton at Loma Linda Hospital in California August [PHI Redacted].[PHI Redacted] last follow up PSA last year was still undetectible.Several of my friends locally used radiation offered by the local hospital.One is dead today and I know he did not feel well in his final months.I also recommend Loma Linda Hospital because of the care and attitude of the staff at all levels.Loma Linda has collected data from [PHI Redacted] on [PHI Redacted] Psa tests,why don't you ask them for their 10-15 year data bank.John Archer

[PHI Redacted] was treated with proton beam radiation theraphy for prostate cancer at the end of [PHI Redacted] through the month of [PHI Redacted] up to the 15th, 2008,45 treatments in total. [PHI Redacted] follow up after 4 months of therapy and [PHI Redacted] PSA was 0.054. No side effects up to now. [PHI Redacted] suffer from other diseases, no prescribed medications after treatment, being a 77 year old man. Isn't this a blessing!

[PHI Redacted] so greatful to received the treatment of [PHI Redacted] choice with no side effects at all. [PHI Redacted] Continue with [PHI Redacted] passion of working with children and youth and [PHI Redacted] spiritual life is connected with God.

I am in favor of the expansion of the treatments centers utilizing this technology, and Medicare coverage.

RE the proton radiation treatment for prostate cancer. [PHI Redacted] had the "traditional" treatment of prostate cancer which was surgical removal of the prostate along with seminal vesicles and lymph nodes, and four years after the surgery the prostate cancer teturned. [PHI Redacted] was all set to get "conventional" radiation treatments for the returned cancer and [PHI Redacted] found out about the possible side affects from this (incontinence and impotentcy) [PHI Redacted] asked radiologist if there wasn't a better way to do this. He replied "If I were you, I would consider proton radiation therapyit has virtually no side affects". [PHI Redacted] then researched the facilities that offered proton treatments, read more about the process and decided to have the proton radiation treatments done. I am happy to say that after two years of having the proton radiation treatments the prostate cancer is gone (PSA count is ZERO)and [PHI Redacted] NO side affects. Furthermore, if [PHI Redacted] urologist had suggested proton radiation treatments initially instead of surgery, [PHI Redacted] would have had it done then and avoided the EXTRA COST of having to go through the proton radiation when the cancer returned. There are many [PHI Redacted] who have had the cancer returned that could have been prevented if proton radiation treatments had been done instead of surgery or other methods. Considering this, the cost of post surgery radiation treatments multiplied by thousands of cases makes proton radiation treatments a feasible way to go. I highly recommend that you retain the current poicy of having this type of treatment covered by your program. Thank you for your consideration and allowing my comments. Steven D. Hodgdon

re: Proton Therapy

[PHI Redacted] a previous proton therapy patient treated for prostate cancer over five years ago and suffering no side effects, [PHI Redacted] this this treatment offers better post-treatment quality of life than competing therapies. I have several friends who have been treated with the "gold standard" of radical prostectomy and every single one of them has had problems with either incontinence, impotence and/or severe infections. They find it hard to believe [PHI Redacted] received [PHI Redacted] therapy and never missed a single day of exercise or normal daily activities.

It's interesting that so many negative comments on this subject are from doctors invested in the competitive technologies. The success of proton treatment is evidenced by the rapidly expanding number of proton centers being constructed. "Build a better cancer treatment and they will come!"

[PHI Redacted] there is no question in my mind that Proton Radiation Therapy is far superior to any other form of prostate cancer treatment. When [PHI Redacted] first learned that [PHI Redacted] had prostate cancer [PHI Redacted] began research to determine what treatment would be the most beneficial to in the short term and the long term. [PHI Redacted] spent hundreds of hours researching and through all of this research found a bias and lack of information forthcoming from the medical profession regarding Proton Radiation. I almost missed finding out about this treatment until a friend told me about their experience and their results with Proton Radiation. [PHI Redacted] was ready to have surgery with a prominent West Coast surgeon who never mentioned the alternative of Proton Radiation, although he advised [PHI Redacted] of every other alterntative to surgery. The MD's and medical college professors intentionally ignore Proton Radiation and based on [PHI Redacted] personal experience it is difficult to understand why.

The treatment has been around long enough to prove that statistically it is better than every other form of prostate cancer treatment with less chance of long term disabilities such as incontinence and impotence. At a time in our lives when the quality of life becomes important it is incredible that CMS is considering not paying for Proton Radiation Treatment for Medicare patients. Men who need this treatment have paid years of payments toward Medicare and they deserve to have Medicare pay for a treatment that is proven to eliminate prostate cancer and is far superior to any other treatment available today.

I had one friend who had surgery and he learned several years later that the cancer was outside of the prostate and he had to go through severe chemotherapy and radiation treatment. Had he had Proton Radiation Treatment there is a high probability that the ongoing treatment and the cost of that treatment would have been avoided. I had another friend who was advised by an MD that his recommended treatment was to "wait and see". While he was "waiting and seeing" he died. Had he had the Proton Radiation Treatment that could have been avoided. Another friend was convinced by his surgeon to have surgery over Proton Radiation. Now he wears a diaper and will for the rest of his life. His quality of life is so dismal that in hindsight he wished that someone in the medical profession had advised him about Proton Radiation Therapy. There are thousands of men just like these who were sold by their MD's on a mediocre treatment for Prostate Cancer and now their quality of life is diminished by long term diabilities that could have been avoided had the medical profession advised them of the benefits of Proton Radiation Therapy. In talking to all three of these friends of mine none of them was ever advised of the benfits of Proton Radiation by anyone in the medical profession.

[PHI Redacted]a cancer survivor who knew that there was a high probability that [PHI Redacted] cancer had gone outside of the prostate survived because of Proton Radiation Treatment I can say without reservation that this treatment allowed [PHI Redacted] to continue [PHI Redacted] quality of life. After [PHI Redacted] learned what [PHI Redacted] Gleason reading represented that there was a probablility that [PHI Redacted] cancer may be outside of prostate asked surgeon if he could guarantee he would be able to cut out all off the cancer that was potentially in and outside of prostate. His answer was that he could not. Since Proton Radiation kills the cancer cells not only within the prostate but also for a large area outside of the prostate that was enough evidence to convince that Proton Radiation was far superior to surgery or any other form of treatment. had to determine this fact for it was never brought to may attention by any medical professional outside of the Proton community.

While [PHI Redacted] was going through this treatment [PHI Redacted] was the Chairman and CEO of a public company that required services. [PHI Redacted] was able to go through treatment and to continue working without any break in schedule. It was hard [PHI Redacted] but it was possible. Surgery could have afforded this benefit.

The Proton Radiation treatment centers around the world are maxed out and even if Medicare decides not to pay for this treatment these centers will continue to increase in numbers and will continue to serve men like [PHI Redacted]. The reason being is that Proton Radiation Treatment is without question the best form of treatment for Prostate Cancer and for many other forms of cancer. The simple fact is that it works. To take the availability of Proton Radiation Therapy away from Medicare patients is wrong. Prostate Cancer patients have paid money for years to qualify for Medicare and Medicare needs to be their for them with a treatment for Prostate Cancer that they know works. Proton Radiation Therapy should be available to all men not just the ones who can afford it without Medicare.

Proton Therapy: [PHI Redacted] underwent this procedure just over a year ago. [PHI Redacted] PSA was 17.2 before beginning treatment,since then it has been checked at 6 month intervals and has been 0.3 both times. There are no lasting side effects. Everything works normally, which cannot be said for my friends who underwent any other form of prostate cancer therapy.

As far as [PHI Redacted], and any other prostate cancer patient that underwent this therapy that I have communicated with, there is no other treatment nearly as good!

PROTON THERAPY for PROSTATE CANCER: [PHI Redacted] was treated with Proton Therapy in [PHI Redacted]. [PHI Redacted] suffered no significant side effects during or after treatment, which is more than I can say many who have chosen other treatment modalities. Since being diagnosed and treated, [PHI Redacted] spoken with others who chose IMRT, Brachy therapy, or surgery, and have found that not only were those courses of treatment more difficult, but in some cases recovery was long, painful, and extended. Issues of incontinence and impotence were also more common. Issues of "quality of life" are, to me, more important than cost.

I find it interesting that members of the medical community who are against Proton therapy for Prostate cancer are typically practitioners of some other method of treatment. They don't quibble about cost when it is they who are collecting the fee. It is disturbing to me to see that medical professionals are less interested in the outcome for the patient and his quality of life, than they are in ensuring their own income stream.

I would recommend proton therapy for prostate cancer to anyone based on [PHI Redacted] experience, and that of others I know who have had the same treatment. I also base my recommendation on what I know of the results of other treatments, and the quality of life issues during and after treatment. It would be a shame for the best alternative to be unfunded; I urge you to continue to help provide the best health care to Americans.

[PHI Redacted] had proton radiation ten years ago at 57 years of age and I can say that without a doubt it was the best action that [PHI Redacted] could have taken to treat cancer.

[PHI Redacted] had no negative side effects and [PHI Redacted] cancer free. Proton radiation in my "un- professional" opinion is the best treatment for this type of cancer.

Many of my friend that had other types of treatment have commented to me - "why didn't you talk me into proton treatment!" All who have said this to me have had major side effects from their form of treatment.

I realise that this information is based upon personal feelings without the benefit of professional study, but [PHI Redacted] would have the same treatment again.

To begin with, [PHI Redacted] was assured that Medicare would cover 80% of [PHI Redacted] Proton Therapy costs; they covered LESS than 50% & [PHI Redacted] paid the balance. The program is totally successful & was worth every cent!! Had [PHI Redacted] had to pay the entire bill, would have. This is truly the ONLY non-invasive procedure available & more such treatment centers should be in placeSOON!! Why have "the knife" when it is totally unnecessary! This would be a dreadful mistake if Medicare pulls out; instead, MORE Insurance programs should include & cover expenses for this most ourstanding, successful therapy.

I have been informed that CMS has made a proposal to stop Medicare reimburseents for proton therapy for treating prostate cancer. I would like to please ask them to reconsider their proposal. [PHI Redacted] had prostate cancer and after much research and talking to others that were treated with various other options [PHI Redacted] chose to have proton therapy. I believe for [PHI Redacted] it was the only choice to make. [PHI Redacted] have completed therapy and had first PSA test and everything is great. Please remember in your decision making that the personal feelings of the patient is more important than only the dollar. A stress free and illness free treatment is the only way to go for the patient. Thank you

I am concerned about the possibility the Proton Beam Radiation Therapy is even being considered of disqualification for payment by the Medicare Organization.

[PHI Redacted] was diagnosed with prostate cancer and found out research before selecting a treatment was worth the time and effort.

Thanks to a friend who discovered the Proton Beam type treatments and was treated at Loma Linda U. Medical Center I did more research.

Two urologist suggested treatment of IMRT radiation but research indicated this was invasive with the risk of side effects. The many "side effects" heard about from various other patients convince to select the Proton Beam treatments.

[PHI Redacted] received the treatments and was able to talk one on one with some of the alumni of these treatments. Several had "no side effects" many had very minor side effects which were dissipating in a month or 2.

I am happy to report after treatments at Loma Linda Medical Center,[PHI Redacted] had very minor side effects which have sub sided within 2 months.

The impact of Medicare coverage would have made it extremely difficult to obtain the benificial Proton treatments as [PHI Redacted] retired on S.S. payments and a very small pension. [PHI Redacted] spoke with some other patients while be treated and they were in a similar situation.

The "negative" comments I find on this comment page seem to be from health professionals who have either not done research since the Proton Radiation Therapy by LLU began in 1991. They obviously have not read the recent report data concerning proton therapy by Loma Linda U.. Currently LLU is treating 44 types of cancer with an excellent success rate and most patients verify they only had none or minor side effects. [PHI Redacted] had two episodes of breast cancer and received photon radiation treatments 2 times and after 6 years has radiation burns on her chest. She was very interested in the Proton treated patients for breast cancer she spoke with while [PHI Redacted] was undergoing treatments. She was surprised they only need 10 treatments and they had "no" side effects.

The bottom line: Medicare should continue to support this cutting edge treatment of the Proton Radiation which is so beneficial to many people & their quality of health.

Dear Sirs,

[PHI Redacted] was diagnosed with prostate cancer in June of [PHI Redacted]. Living in Sun City West, Arizona,a retirement community, I have many friends who have had prostate cancer and have experienced a variety of treatment regimens from radical surgery, conventional radiation, Chryotherapy, hormone therapy and wait and monitor. After talking with many of these friends and investigating other forms of treatment. [PHI Redacted] elected proton beam therapy. In March of [PHI Redacted] completed 45 treatments without experiencing any side effects except for slight fatigue which is now gone, and most recent PSA was .5. [PHI Redacted]

Comparing [PHI Redacted] experience with my friends and acquaintances who had other therapies I highly recommend proton beam. One friend opted for the wait and monitor system. He eventually died from prostate cancer.Others are experiencing erectile dysfunction and or incontinence and or bowel problems and all experienced negative side efffects while participating in the original therapies.

I think quality of life after treatment should be a factor in determining what treatment method to select.

Proton beam therapy cures prostate cancer and [PHI Redacted] the side affects are
minimal. Other therapies also work, but many of my friends have experienced debilitating side affects.

If Medicare doesn't continue to cover the cost, only the wealthy will have access to this
treatment because of its expense. That is extremely unfair.

Proton beam therapy for Prostate Cancer:
The notice CMS is planning to discontinue helping
with the treatment of prostate cancer by Proton
beam therapy is unthinkable. This treatment with
little or no side effects has been provided for
years with great results and is in demand so that
large sums are being spent to construct new
ficilities.
Workers have purchased insurance(Medicare) most
of their working lives to cover such expense and
now to have Medicare not cover some of the cost
is not treating then in good faith.
I urge this objective be reconsidered.

[PHI Redacted] received Proton Therapy for Prostate Cancer and had no adverse side effects. I feel that Medicare should continue to cover this form of treatment. Initially Proton Therapy may be more expensive, but in the long run it will be cheaper due to the fact that most patients that receive Proton Therapy Treatments do not suffer from the known side effects caused by other form of treatment. This is not only beneficial to the patient, but to Medicare and other forms of insurance as their overall cost will be less in the long run as there will not be additional health problems associated with other forms of treatments. I feel that receiving Proton Therapy for [PHI Redacted] Prostate cancer was the best decision that [PHI Redacted] ever made. I hope and pray that Medicare will continue to provide coverage to all of the men that will be diagnosed with Prostate Cancer in the future. At the present time there are only 5 Proton Therapy Centers operating in the country, but there are at least 10 additional Proton Centers in the process of coming on line in the near future. As these new centers become available, the cost of treatment will eventually go down.

In [PHI Redacted], [PHI Redacted] was diagnosed with prostate cancer. [PHI Redacted] was offered several options for treatment, chose proton therapy. The treatments caused no pain or discomfort during or after the treatments. [PHI Redacted] Routine follow-up exams and lab tests show no cancer. Now [PHI Redacted] live a normal life. I can recommend proton therapy as the best treatment for prostate cancer. Medicare helped make [PHI Redacted] treatment possible.

Proton Treatment of Cancer

As an Engineer, with a BS from the U. S. Naval Academy and an MSIE from Stanford University, CA,[PHI Redacted], I feel I am well qualified to comment on the mistaken approach CMS wants to take. The rational is solely to avoid paying the cost of Proton treatments instead of using that better treatment regimen that has far better results for the Dollar. The cost rational instead of the patients well being is a cheap shot at cancer sufferers.

I have seen and read most of the comments by "Doctors" who have one main goal, make money from their barbaric methodology of treating Prostate Cancer. Three percent of all their touted methods result in absolutely disastrous side effect to ones quality of life, let alone the likely hood of reoccurrence of the Cancer. One example of the many men going though treatment[PHI Redacted], was a gentleman 45 years old who had a total radical prostectomy. Guess what, his cancer came back. I cannot say it was the result of incompetence on the part of the surgeon, but that procedure has horrible side effect. Nerves are cut, yes accidently, by incompetence, leaving the individual in depends, or worse and his ability to have a continuing love life with his wife is gone for good. Is it worth that chance, no way in hell? That is an antiquated procedure, which should be ethically prohibited.

IMRT, although less likely to sever nerves, photon radiation is a killer in itself. Why, the radiation goes in one side of the body to the cancer. It does not stop there but continues out the other side of the body destroying absolutely good tissue for no good reason other than making money by that procedure.

Cryo, Bronco, Radioactive Seeds and the rest are just as destructive or just an ineffective at the three percent level or even higher.

[PHI Redacted] had 45 78 gray scale proton radiation treatments with absolutely 100@ NO SIDE EFFECTS!!! starting treatment with a Gleason 7 cancer even though the PSA was only 2.0. Can the other old treatments do that? No way. Sorry doctors, slice and dice are not for anyone with a brain. Why is that procedure successful, it is a matter of physics. The beam is constrained to the outline of the prostate in [PHI Redacted] case. A 3-D scan of the prostate is sent to a physics lab to lathe out the material that constrains the distance the protons travel as vies separately from the left and right side of the incoming radiation. As the depth of the cuts is less where the beam is to go the farthest without exiting the opposite side of the prostate, all energy is expending within the prostate destroying the ability of the cancer to recreate itself. Different depths of course a made for the opposite side, thus ensuring again the radiation does not leave the prostate. What a wonderful concept compared to IMRT and then the Seeds, which have been known to travel to a patients lungs.

You cannot control the depth of penetration of photon radiation like one can with protons, that is pure simple physics.

As for studies on results, the initial facility at Loma Linda University Medical Center with any kind of patient handling capability has been doing this since 1990. They have amassed tremendous amounts of data relating to incoming PSA levels versus survival rates as one example. All one has to do is take off their blinders from praising ancient technology and get the data from that university. Two new facilities are up and running although he Florida center stupidly bought a cheap Belgian Cyclotron versus a U. S. Made Synclotron. Why do I say stupid? A Synclotron goes radioactively cold in minutes not days like in the Cyclotron. Repairs are made and the system is usually up and running that same afternoon. Disturbance to patient treatment is minimal. That is particularly compounded when that repair didn't solve the problem. The Cyclotron again has to wait 2 days before it can be accessed again. At 150 patients a day, financial losses are significant as well as being a detriment to the patients.

Several of my Academy classmates have had prostate cancer and every one, IMRT, Robotic Surgery, etc. all have had horrible quality of life consequences as a direct result of the procedure.

Why any Hippocratic Oath taking doctor would put a patient through such hell for the sake of their making money when there is a magnitude better way of curing that kind of cancer.

One glaring example of incompetent surgery. The 45-year-old [PHI Redacted] has a wife who had a tumor on her optic nerve. The surgeon blew it and severed a facial nerve. Now her left eye looks upward at a 45 deg angle to the right and her pretty face is totally distorted on the left side. Two days before her husband was finished with his treatment, one gentleman came out of his last treatment session for exactly the same problem, tumor on his optic nerve. He was hollering, I can see, I Can see, as he was swing this Bola, the physical device that was put through the lathe to limit depth of the proton penetration. Not only that, his face had a grin from ear to ear. You should have seen the look on that lady's face, and if she would have known about Protons for treating cancer, she too could have been saying I can see with a smile on her face. Such butchery should be prohibited.

In short, do not ever stop funding Proton Therapy for treating cancer, as not only can it do prostate treatment, but brain, nerve and other such tumors without the damage of a slipping scalpel. A better alternative to Proton therapy, there is none, the only reason for the old methods is the entrenched blinded doctors wanting money for their method without regard to new technology, and what is really the best treatment with no side effect on a patients continuing life.

[PHI Redacted] opted for proton therapy because, in the absence of clinical trials, [PHI Redacted] became convinced through experiential data and anecdotal evidence obtained from dozens of personal interviews with patients and practitioners that proton therapy would provide with the fewest side effects. [PHI Redacted] had a dramatic drop in PSA and no side effects whatever, which makes [PHI Redacted] yet another satisfied proton customer. Naturally, [PHI Redacted] was also greatly influenced by the fact that unlike IMRT, protons would expose far less healthy tissue to radiation damage. Any patient presented with the option between the two would choose protons if it were available. Access to this relatively benign, successful therapy should certainly not be restricted to wealthy cancer patients alone.

Rather than criticize the proliferation of proton facilities, skeptics might consider the cost savings that will inevitably result as treatment regimes involve fewer, stronger, doses, and collateral damage is diminished through the use of more precise patient positioning and tumor localization techniques.

My comment is in regard to Medicare considering no longer providing coverage for Proton treatment to prostate cancer patients.[PHI Redacted] completed Proton treatment three years ago having been diagnosed with that condition. [PHI Redacted] not experienced one single noticable side effect since the conclusion of series of forty four Proton treatments. [PHI Redacted] recently underwent a colonospsy that showed there was no evidence damage to intestinal tract. To remove Proton treatment from the Medicare choices of coverage for those diagnosed with prostate cancer would deprive thousands of american men of obtaining the single option of them continuing to live a quality life of normalacy following prostate cancer treatment. I am a veteran of the United States Navy , a retired police lieutennant with a degree in criminal justice. [PHI Redacted] did not choose Proton treatment without first giving consideration to all existing options for prostate cancer treatment. Please totally compare the existing options and rule in favor of keeping Proton treatment as a covered procedure under the Medicare program. All American men should have the option of selecting Proton treatment as a viable option among the numerous choices currently offered for treatment of prostate cancer.
Thank You, Bruce W. Miller

I am more than a little disturbed that medicaid or medicare are being advised to discontinue coverage of proton radiation therapy for prostate cancer. The urging seems to come from other professionals who offer competing therapies. [PHI Redacted] I can see why; it works better than any other form of treatment available today. It is a little more expensive than other treatments at this time, but this is changing; more facilities are being built and the use of the technology is expanding. All I can say is, that the results are worth every penny spent.

It has come to my attention that some powerful forces are trying to stop Medicare and Medicade funding for Proton Radiation treatment for Prostate Cancer.

I don't know what their motives are but their efforts are certainly very regretable. [PHI Redacted] recieved treatment at Loma Linda Medical Center for Prostate Cancer. The results were phenominal. [PHI Redacted] PSA is now 0.03. Digital exams show very positive results. [PHI Redacted] no side effects from this treatment. About one year post treatment [PHI Redacted] did have some rectal bleeding. That is cured and caused no problem. Know many folks who had other type treatments. None had as fine an outcome as [PHI Redacted] experienced.

When you look at cost you should look at all cost including extra hospital stays, various morbidity issues, etc.

[PHI Redacted] treatment was funded by Medicare as it should be. [PHI Redacted]

We don't need those who want to push their favorite program to kill one that has immense value.

[PHI Redacted]82 years old and in excellent health, which [PHI Redacted] attribute primarily to Proton Beam therapy at Loma Linda University in [PHI Redacted]. Prior to that time, [PHI Redacted] had been dianosed with prostate cancer and you are welcome to review [PHI Redacted] then current condition, along with the treatment modalities.

However, prior to undertaking treatment at Loma Linda, [PHI Redacted] interviewed Medical professionals (Doctors) in competing technologies in search of the best treatment with fewest negative problems, without regard to cost or inconvenience of treatment location. Without exception, Doctors in competing technologies always recommended their specialty as being superior.

[PHI Redacted] was fortunate in having a technical (BS- Physics/UCLA) as well as a legal background (JD- WSU) which allowed [PHI Redacted] to evaluate the various approaches to ameliorate the cancer.

[PHI Redacted] now 8 years post treatment and have no side effects from the treatment.

I urge a careful study, in addition to the negative remarks from professionals in competing technologies, before you discontinue the remarkable treatment now available at Loma Linda and other facilities.

Two interesting commentaries follow: (1) When [PHI Redacted] evaluated the various options to treat the prostate cancer, [PHI Redacted] was fortunate enough to interview a well-known MD/Professor at a renowned institution for his advice. He recommended Proton beam therapy, although it was not offered at his institution. (2) Before [PHI Redacted] had heard of Loma Linda Proton beam center, had heard of MD Anderson treatment center and almost traveled there for surgical removal of the prostate cancer. However, [PHI Redacted] was shocked to learn that they would not treat because of age. At that time [PHI Redacted] was 74. They told [PHI Redacted] that they were not accepting patients over 65!

To sum up, [PHI Redacted] very positive results from experience at Loma Linda and urge you to not eliminat this treatment as it has saved [PHI Redacted] life and other lives of similarly treated people.

I think it would be a grave error to not fund proton therapy for prostate cancer. [PHI Redacted] I can attest to the fact that it is the best treatment available. [PHI Redacted]

[PHI Redacted] received proton radiation treatment during [PHI Redacted], and very satisfied with the results: no incontinance or impotence, no pain during treatment, and presently a PSA level below 1.0.

[PHI Redacted] also had prostate cancer. One [PHI Redacted] died of prostate cancer in 2006. [PHI Redacted] treatment was reimbursed by Medicare and Tricare [PHI Redacted].

Please continue Medicare reimbursement for this highly effective treatment with no painful side effects.

[PHI Redacted] experienced proton beam radiation therapy treatment for prostate cancer, and can honestly say that the side effects, with the exception of minor urinary discomfort, were basically non-existant. After nine months [PHI Redacted] PSA droppped to 1.7 from 7.5, urine function is normal and sexual functions remain good. [PHI Redacted] fellow patients share the same views. At first [PHI Redacted] Medicare Advantage plan would not approve proton therapy, but appeal was later upheld. [PHI Redacted] was determined not to settle for anything less. I strongly urge Medicare to continue their coverage of proton therapy treatment for prostate cancer so that others diagnosed with this illness can have the same opportunity.

[PHI Redacted]

I had [PHI Redacted] who had surgery and had considerable discomfort and incontinence for the rest of their lives. One had reccurance of cancer which caused his death. Also, [PHI Redacted] had surgery about 8 years ago, his PSA is going back up now. He has had incontinence and depression and other problems related to that treatment.

While it is true that other modes of treatment are cheaper initially, if you consider recurring medical costs and suffering, as well as loss of function and quality of life, the Proton Therapy seems to be a much safer and better method of treatment to me.

It seems a shame to me that some doctors who provide other forms of treatment often want to discredit Proton Therapy. Of the dozens of fellow patients that I became acquainted with in Florida, all seemed thrilled to be there and to have found that method. Many had stories of how their doctors at home had called Proton Therapy "experimental" and discouraged them from doing it. Yet nobody that I met had any incontinence or impotence when they were done.

The call to have more studies is valid. I hope accurate data can be compiled to compare the various treatment methods. From [PHI Redacted] experience, my guess is that Proton Therapy will show to be far easier on the patient, with better long term sucess.

I hope Medicare doesn't decide to quit funding Proton treatment. I'm sure it is a superior treatment for certain brain and spinal tumors as well. [PHI Redacted].

I am not a doctor or a nurse or medical practitioner of any kind. So, I feel like I'm battling the Goliaths (Doctors) who have already addressed this topic: - Proton Therapy for Prostate Cancer- here in this comment forum. Their education, knowledge and years of experience seem to carry a lot of weight no matter who's reading these comments and many of them (that I've come into contact with) seem to want to be crowned immediately. I'm just a [PHI Redacted] of a [PHI Redacted] with prostate cancer who would like to see Medicare leave the choices for treatment of prostate cancer up to the person whose life and well-being are at stake.

I know 2 other men who have prostate cancer and who have both been treated with seed implants. Both have and, in at least one case, are still experiencing much discomfort from the procedures they had done (in different parts of the USA). [PHI Redacted], on the other hand, who had Proton (and Photon) treatments, NEVER once experienced any problems whatsoever and 2 years after treatment has a PSA of .01. Luckily, [PHI Redacted] had private insurance, but if [PHI Redacted] had been a little older, would be relying on Medicare.

I would like to think that Medicare would pay at their normal rate no matter what treatment a person chooses. Maybe some facilities are better than others at providing this Proton treatment. Generally speaking, so are hospitals and doctors. It's up to the consumer to choose the best according to their judgment.

Why would Medicare want to get into the "doctoring" business by dictating what kind of treatment a person should get? Unless someone can prove that Proton Therapy is a TOTAL waste (which no one has argued), the proliferation of negative comments point to a kind of egocentric envy.

[PHI Redacted]I am amazed that Medicare would consider removing this effective prostate cancer treatment from its payment list! [PHI Redacted], along with the thousands of other prostate cancer survivors who were cured by proton beam therapy (without the side effects of incontinence, impotency and cancer reoccurance associated with other prostate cancer treatments) over the past 15 years that proton therapy has been approved and provided would be very concerned about future prostate cancer patients not having the proton beam therapy option.

The negative comments/critiques I have read in these public comments seem to have come from individuals in the medical field whose livelihood depends on the income they derive from providing treatments other than proton beam therapy! Comments from those sources should be suspect! Taxpayers should be concerned that, if Medicare does not provide payment for the proton beam treatment for men in the future who have prostate cancer, they will be paying taxes to provide medical treatment to deal with the side effects that often result from prostate treatments other than proton treatment. We all know men who have suffered impotency, incontinence and cancer recurrance after surgery or radiation seeds. Compare the side effects/after effects of prostate cancer patients treated with proton versus other prostate cancer treatments. Don''t allow proton beam tharapy to be derailed by professional jealousy or greed! Dr. Dale Fitzner

[PHI Redacted] received the proton treatment for prostate cancer last year. [PHI Redacted] had no adverse problems from this treatment. One year after the treatment [PHI Redacted] had two PSA tests. The first was 1.4 and the second was 1.1.

[PHI Redacted] more that satisfied with the proton treatment and would recommend it to anyone who has prostate cancer. There was no discomfort as [PHI Redacted] had the treatments.

Some of my friends who have had other forms of treatment, including regular radiation have had severe problems after those treatments.

I request that you nor take proton teatment from your list of approved treatments for prostate cancer.

Five years ago [PHI Redacted] let doctors talk [PHI Redacted] into surgery to try and get rid of prostate cancer. [PHI Redacted] been incontinent for five years now and the cancer has come back. [PHI Redacted] just finished proton radiation therapy and PSA is on the way down.

The five years [PHI Redacted] lived with incontinence could have been avoided and could have been free of cancer five years ago with no side effects. If only the six doctors [PHI Redacted] consulted had told about Proton Radiation Therapy. Proton Radiation Therapy is painless and free of side effects. I have talked face to face with at least 30 men who have been cured for one to five years after treatment, and they still have no side effects. What more could one ask?

[PHI Redacted] disgusted with the doctors have consulted with this problem. Initially, [PHI Redacted] doctors did not even mention the proton option. After [PHI Redacted] mentioned it they get angry and won't discuss it, or they deny knowledge of it. I have had men tell me that their doctor just left the room and didn't return, or would not return phone calls after the patient mentioned proton therapy, or told the patient to find another doctor. I believe they are afraid they will lose business. It's obviously about money. What happened to "do no harm?" Gayle Teague

[PHI Redacted] I believe the cestation of payment for Proton Beam Therapy for the treatment of Prostate Cancer would be a huge mistake. [PHI Redacted] thoroughly researched the different forms of cancer treatment availbale, when diagnosed. The absolute deciding factor for [PHI Redacted] after consulting with patients who had been treated with proton beam therapy versus those treated with normal xrays, surgery, and hormone treatment, was the apparent almost total lack of side effects associated with proton beam therapy. Listening to the tales of major life impacting side effects from other patients not treated with Proton beam therapy, convinced [PHI Redacted] to opt for that treatment. [PHI Redacted] enjoyed a completely normal life style afer completion of treatment.(2 1/2 yrs)

I strongly second the comments made by Prof. Peter Vollhardt (9-2-08). His comments regarding the Bragg Energy Peak are particularly pertinent. In my opinion the treatment may be expensive, but please remember , " you get what you pay for".

[PHI Redacted] received Proton therapy last fall. [PHI Redacted], and felt that the treatment much was much less invasive then regular radiation treatment. [PHI Redacted] was considered a high risk patient, with a Gleason score of 7 and a PSA of 10.7. Almost a year following treatment [PHI Redacted] PSA is still 0.0.

I have talked with patients that had general radiation and their side effects have been more dramatic then [PHI Redacted] or other Proton treated patients that I have talked with.

Many of the patients receiving Proton treatment [PHI Redacted] were also receiving Medicare[PHI Redacted], but it was interesting to note that their were also many younger patients receiving Proton treatment because it was considered the better treatment to receive.

[PHI Redacted] was diagnosed with prostate cancer in 2006, at age [PHI Redacted]. Testing established that [PHI Redacted] was otherwise in good health.

I bagan my own research, interviewing many doctors, representing many treatments, from traditional surgery to robotic (DaVinci method) surgery, to the newest types of traditional radiation (photon)and seed implants. I found each of them encouraged their own specialty as, "proven the best".

I also interviewed many men who had been through those various treatments. Most had unfortunate side effects. Some would even qualify their treatment as not successful.

I was quite discouraged, until I was told about Proton Therapy treatments by a nationally recognized oncologist who had treated prominent persons in Washington DC. While he did not administer proton therapy himself, he told me it is unquestionably the best treatment for prostate cancer. I spoke with him personally, as he is related to a personal friend I have known for years.

After [PHI Redacted] proton therapy was completed in [PHI Redacted], PSA dropped from a pre-treatment reading of 13 as a high, to 1.27 in 6 months, then .08 in one year. In addition, ALL SYSTEMS WORK!

Since then, I have spoken with men who have had various treatments, as well as many others who have had proton therapy. By this measurement, In my judgement, proton therapy is by far the safest, most effective treatment, with little or no side effects. It would be immoral to eliminate this therapy from Medicare's approved list.

[PHI Redacted] went thru the protron treatment at Loma Linda Medical Center in CA. Please, please don't listen to urologists, most of whom don't recomend or understand proton treatment and are only looking out for themselves and their pocket books bcause they do sugery not proton radiation treatment. Patients do not go thru any pain or recovery time or the primary side effects that surgery patients do. Radical prosectomy surgery always results in incontinance short term, sometimes permenently and always experience a total loss of sexual potency, that means no erections or orgasums ever again with or without drugs. Does this sound like a comparable treatment to you? No!!!!! Proton radiation almost never results in incontenance and over 70% of proton radiarion patiants can still have sexual potency with and without drugs like viagra. The costs of proton radiation will come down in time as more facilities come on line. The American Cancer Society approves this process and so should everyone else. The statistical survival rate of proton radiation treatment collectively has improved over time and is equal to or better than surgery today and is the future for treating this form of cancer and many other forms of cancer. You need to research this more before making any decisions that could affect future patients with prostrate cancer. Go to Loma Linda and talk to the staff there and get the statistics and the facts - PLEASE.

My experience with Proton Therapy for the treatment of prostate cancer is that there have been NO side effects during or following treatment.

There have been no continence or bowel control problems and no erectile function effects. No pain or discomfort at any time. During treatment, [PHI Redacted] needed no "Care Giver" at any time.

Following the proton treatment there was no recovery time and [PHI Redacted] was 100% ready to resume normal activities the day returned from treatment.

I don't think other therapies can begin to compete with Proton Therapy's lack of adverse impact on the patient's life during or after treatment.

I am writing this comment on Proton Beam Radiation treatment for prostate cancer as [PHI Redacted]. [PHI Redacted] last treatment was on [PHI Redacted] and most recent PSA, taken on [PHI Redacted], was .28. I have had several friends undergo just about all the other treatments available and I have been able to compare not only the results of the cancer treatment, but also the resulting side effects of the treatment. Without exception [PHI Redacted] quality of life side effects have been superior to the other treatments, this is easy [PHI Redacted] to say as [PHI Redacted] have not suffered any side effects at all. Since defeating prostate cancer is the goal of all treatments and the information that I gained through research before selecting treatment told [PHI Redacted] that all treatments will be effective if the cancer is caught early and has not escaped the prostate, what is left is the quality of life after treatment. If you read of all the possible side effects that prostate cancer patients can suffer, I belive you would want for yourself the treatment that leaves you with a quality, normal life! I would therefore submit that Proton Beam Treatment should continue to be paid for through medicare

[PHI Redacted] was diagnosed with prostate cancer and chose proton beam therapy treatment after carefully examing all available treatments. I strongly believe this treatment is superior to alternative procedures; especially when I compare the outcome with friends and acquaintances who have chosen alternative options. With Proton Beam Therapy you have no lost working time, no incontinents regarding sexual activity or inability to restrain a natural discharge such as urine, no scars, and no pain. [PHI Redacted] biopsy was much more invasive than the prodedure. [PHI Redacted] PSA is down to .4 Anyone who would like to hear more - give me a call.

Proton treatment for Prostate Cancer

The value of Proton Beam treatment for prostate
cancer appears to be beyond dispute if patient
satisfaction with the lack of side effects counts
for anything.

The value of the proliferation of Proton Beam
treatment centers is an entirely different
issue. Is there a health need for two such
treatment centers just west of Chicago? or two in
Oklahoma City?

Is there anything that the Federal government can
do to restrict the number of centers without in
effect giving a monopoly to the ones permitted to
be built and operated and funded with tax dollars?

The best answer to skyrocketing treatment costs
is prevention. Two papers published in JAMA in
1993 found a statistical relationship between
vasectomy and subsequent prostate cancer. Among
men who had vasectomies for more than 22 years,
there was an 85% increased risk. Should
Medicare restrict or reduce its prostate cancer
funding for those who have voluntarily had a
vasectomy and subjected themselves to this risk?

Such logic would require its application to other
areas of tax-supported health care. If done
gradually and with compassion for ignorance, this
might be the greatest step the federal government
could do to reduce the incidence of self-induced
disease.

I am very diappointed to hear that CMS has proposed to stop Medicare reimbursements for Proton Therapy for treating Prostate Cancer. [PHI Redacted] was diagnosed with Prostate Cancer. [PHI Redacted] PSA 7.0 Gleason of 5.0. [PHI Redacted] recieved Proton Theraphy in [PHI Redacted] with the help of Medicare. [PHI Redacted] had no side effects, Cancer is gone, in [PHI Redacted] PSA is 0.02. [PHI Redacted] healed and feel great at age 79. I feel sorry for any man who has Prostate Cancer and is denied treatment because Medicare will not help with payment. It is the best treatment for Cancer a man can get.

[PHI Redacted] treated for advanced prostate cancer at LLU s proton treatment facility and cured. [PHI Redacted] PSA went from 34 to less than0.9. [PHI Redacted] disease fre 4 yrs after treatment. [PHI Redacted] not had to be treated with expensive proceedures to deal with complications and side effects. Proton therapy is VERY cost effective. Not covering the treatment option would be shameful and lead to more expensive treatment options,not to consider the guality of life issues. How dare you consider not provideing coverage of this proceedure! We will not stand for it!!!!!!!! YOU will be the ones that GO!!!!!

During a routine examination, [PHI Redacted] family doctor noticed a small rise is PSA 2.7 to 3.7 in a 12- month period. To be on the safe side, she referred [PHI Redacted] to an urologist. A biopsy was taken and the results were t1c and a Gleason of 3+3 = 6. For various reasons, [PHI Redacted] chose Proton Therapy.

It has been three weeks since [PHI Redacted] completed the 45 proton treatments. The treatment was painless and [PHI Redacted] experienced no side effects.

Proton beam therapy for prostate cancer.

The call came on Friday, [PHI Redacted]. This is Dr. XX calling with your biopsy results the voicemail said. When he heard this he knew it probably wasn’t good news. Doctors never called before, it was always the nurse or the office with test results. Eventually reaching the doctor hours later, the fear was confirmed. “There is an adenocarcinoma in the left base involving one core with a Gleason score 3+3=6.” “It appears to be localized, but we don’t know for sure” “. ”Call my office and schedule a prostate cancer consultation for Monday”. As he hung up with the doctor, the knot in his gut was a lot harder and bigger all of a sudden. He turned to his wife and said simply “I got it” and walked out of the room.

All the time, he was suppressing the memories of seeing his grandmother crying when her son, his uncle, was dying of cancer years ago. Although he was a young boy and didn’t understand all what was going on, he knew it must be pretty bad for his grandmother to be so upset. Here was a woman who raised 13 children baking bread and making dinners on a wood burning stove; never a complaint and never a harsh word. How cruel it was years later for her to die of the same cancer that took her son. He could remember her screaming and his Dad and his aunts and uncles crying when they went to see her. The doctor explained it was cancer and the only thing he could do was to try to ease her pain with drugs. The cancer had spread and she was dying.

So these memories and memories of other aunts and uncles dying of cancer started a panic he tried to suppress. Cancer was always a death sentence. No one knew how it happened and, years ago, people stayed away from people dying of cancer for fear it might be contagious. Sounds somewhat primitive, but that is how people thought years ago.

[PHI Redacted] People get calls like this every day with worse news. What is a prostate anyway? How important is it? I guess it could be removed, no big deal. Let’s go on the Internet and do some research. I have all weekend and I should be able to find some answers before Monday.

As he researched the disease, there was a lot of information to take in. What a prostate is, what it does, where it’s located and treatment options. So he did what he always did when facing a problem. Identify the issues, find the solutions and put the data in a spreadsheet. It also helped keep his mind focused away from the bad memories and the “superstitions” of cancer.

Using the internet as a resource, he was accumulating a tremendous amount of information; radical prostectomy, laparoscopic surgery, nerve sparing da Vinci prostatectomy, external beam therapy, intensity modulated radiation therapy, 3D conformal radiation therapy, low dose or high dose seed implant radiation, cryosurgery, hormone therapy and proton therapy. He decided to sort the data by procedure, advantages, disadvantages and of course survival rates.

As he built his spreadsheet for Monday’s meeting, the side effects and post treatment statistics for surgery and radiation therapy were quite depressing. It seemed that he was going to have to deal with issues of incontinency and impotency as well as cancer. The chances of one or both happening seemed a given. However, the one treatment called proton therapy seemed to offer cure rates similar to surgery with less side effects than the other radiation therapies and less likelihood of incontinency and impotency. He decided to ask his doctor about it on Monday and see what he would recommend. So on Monday he asked the doctor, “What would you do if you were me?” The doctor recommended daVinci prostatectomy or seed therapy. “Given your age of 53, you are a good candidate for either one.” What about proton therapy he asked? It seems to offer a cure rate similar to surgery but with less chance of side effects as well as less chance of incontinency and impotency. The doctor was somewhat familiar with proton therapy, but it wasn’t a topic covered in as much detail as other procedures when he was in medical school. By the time the consult was completed, there appeared to be four choices, daVinci surgery, seed implant, watchful waiting and proton therapy.

He knew he would need to tell his family and friends what was going on so he called a number of them over the next few days and gave them the news. It’s somewhat curious how telling someone you have prostate cancer leads to others telling you of a father, grandfather, uncle or brother who had it and were doing fine years later. When he asked if anyone of them had proton therapy, all said no. They had surgery or radiation, never heard of proton therapy. In speaking with the men who had surgery or radiation, the details were a little different. Yes, the cancer was gone but there were some other things gone as well. In one on one conversations, it was revealed that there were still problems with incontinency and of course impotency. The incontinency was better though, as many were using only one or two pads a day not five like they had been. Their sex life was more regimented than they would and some men needed to inject Viagra directly into their penis. “Be sure you are going to have relations with your wife as you don’t want to do this on a whim” was one comment. Not good. All the talk of being better seemed to have an air of avoidance or resignation of the issues so tightly tied to being a man.

Time to talk to the proton therapy candidates and see what the true story was here. He couldn’t believe what he was hearing, and not just from the younger men, but older men as well. There were some issues during treatment, but they were short term. Not only was there no significant side effects during treatment, there seemed to be no long term side effects. This can’t be right he thought. How can you have treatment for cancer and not experience problems or side effects? He also talked to men who had surgery or hormone therapy that were undergoing proton treatment currently to eliminate the last bits of the cancer.

More and more he was convinced that proton treatment was the best way for him. It seemed to offer the benefits of surgery with the least risk of short term and long term side effects or diminishment of quality of life. It wasn’t the case of avoiding pain, though no one likes pain. It was more of a sense of logic and elegance that proton therapy could treat the disease, targeted to the specific area of concern and leave all the healthy tissue untouched. It seemed like to him using a specific tool for a specific job unlike the other options that seemed like using an elephant gun to kill a mosquito.

So he went for a consult and found he was a viable candidate for proton therapy and started down the road. Pod forming, CT scans, marker implant and virtual simulation all led to first day of treatment many days ago. Not once have there been any regrets or worry and the feeling of being cured and feeling blessed and lucky to have this treatment available are overwhelming.

There is a sense of sadness for all the other men who could have benefitted from this treatment and didn’t know about it. But there is a sense of hope and optimism that, for all the men who choose proton therapy, they will tell others. They will provide the first hand information and understanding to help more men deal with the issue of prostate cancer with a sense of hope, dignity and quality of life.

When [PHI Redacted] was diagnosed with prostate cancer with a PSA of 7.0 and a 7.5 Gleason Index, investigated options. I talked to many men who had surgery or regular radiation. They all had similar side affects, i.e., incontinence and impotence for several years following treatment. [PHI Redacted] chose proton radiation because of no side affects combined with it's very high cure rate. Eight years later [PHI Redacted] cancer free. If Medicare had not approved proton radiation, could not have afforded the treatment. Since [PHI Redacted] treatment, I have told eight men who had prostate cancer and also opted for proton radiation. They have all had the same positive results. All of them would not have been able to afford it had Medicare not covered it.

Proton Radiation

At age 72, I believe the Lord led [PHI Redacted] to proton treatment for prostate cancer. I also believe that proton radiation has cured [PHI Redacted] prostate cancer as evidenced by three years post treatment semi-annual PSA readings of The number of years that life has been extended remains to be determined. I am very grateflull that Medicare coverage made this option possible.

[PHI Redacted] urologist advised that cancer was too far advancaed for surgery to be an option and recommended controlling cancer cell activity with hormone therapy. This stop-gap non-cure option was not appealing as the best method for dealing with this dreadful disease. Fortuntely I learned about proton beam treatment and both Medicare and Tricare=for-Life agreed that it was an appropriate investment in [PHI Redacted] health care.

The cost of health care for our nation is rising at alarming rates. To consider reducing options for aging souls as a "balancing-the'budget" measure seems unfair to those whose contributions have made Medicare possible in the first place.

In [PHI Redacted] case, this cancer may have been the result of being exposed to agent orange in Viet Nam. Not that [PHI Redacted] should be treated any diffently than anyone else, I will be extremely disappointed if Medicare chooses to eliminate protron therapy as a treatment option.

Respectfully,

I have a Ph.D. in Nuclear Engineering/Physics and
feel that I should comment on the therapeutic use
of protons for a variety of cancers including
prostate. I have no special knowledge of details
of cancer itself, or the cellular biology
involved. However, I do understand the physics of
the energy loss of charged particles and
radiation in matter. The desirability of using
protons over using x-rays(IMRT), is really quite
easy to understand.

First let’s follow what an x-ray beam does:
Imagine that we have a lump of cancerous tissue
to be targeted and that it lies inside the body.
An x-ray beam needs to first traverse body
tissue to get to the target, producing unwanted
damage to this beam entrance material. Next, the
residual beam hits the target, and finally the
residual beam damages the remaining tissue before
the beam can exit the body. So we have both
entrance and exit unwanted damage. X-ray beams
have another undesirable characteristic. They
tend to produce unlocalized radiation which
results whenever an x-ray interacts. This
radiation in turn contributes to damaging good
tissue that is not in the desired target area.

Next, for comparison, let’s follow a proton
through the same situation of target tissue
embedded within other healthy tissue. Protons
have a unique range depending upon their energy.
Another interesting property of protons is that
the slower they go, the more damage they produce
around their track. As they finally stop, they
deliver an extra burst of energy loss, and hence
damage, in the immediate location of the stopped
proton. So, proton treatment involves tuning the
beam energy to be sure that the protons are
stopped within the target tissue. As the beam
enters the patient, damage along the track is
relatively low, until the beam starts to slow.
The proton then enters the target and delivers
its maximum damage. And finally there is no exit
beam resulting in no damage in the region where x-
rays continued to produce damage. Finally there
is less spreading of secondary radiation around
the beam than was present with x-rays.

I think it is safe to say that the physics
indicates that there are definite advantages to
using a proton beam over IMRT as far as the
fraction of energy expended in the target, and
producing less unwanted side effects. I apologize
for this simple exposition, and I am well aware
that there are many other factors to consider,
but I hope it will help to clarify the important
and preferred role of proton therapy. Physics
demonstrates the clear advantage of protons over
x-rays. There is little question about that. The
only remaining question is whether our society is
willing to pay for it. I, for one, hope so.

Paul R. Klein Ph.D.
spklein2003@yahoo.com
.

With regards to the CMS proposal to stop coverage for Proton Treatment for Prostate Cancer I respectfully request that you DO NOT stop this very important coverage. [PHI Redacted] was treated with this procedure and when [PHI Redacted] was admitted to the facility PSA was 9.8 with a gleason score of 9. [PHI Redacted] had twelve biopsy samples that were all cancer. [PHI Redacted] just recently had second PSA check up after treatment and for both check up's the results show 0.0 This along with hundred's of friends that have experianced the same results should prove that it is the best treatments. I have one friend that had implants and spent 2 months with a catheter in him and recently told me that his PSA is climbing again.[PHI Redacted] had his removed at age 69. He is now 83 and is still wearing diapers. Immediatly after receiving Proton treatments each day [PHI Redacted] went and played racket ball, basketball, and some days participated in areobics. I have certainly never found anyone who had any of the options doing that. Again, PLEASE do not stop this important coverage. Thank you for taking my comments into consideration and pray that you will decide in favor of continuing this very important coverage.

[PHI Redacted] I wish to make this confirming notice that [PHI Redacted] treatment was PROTON THERAPY. Course of treatment was completed in [PHI Redacted]. [PHI Redacted] monitor PSA and it remains below .90. An indication of cure. [PHI Redacted] enjoyed no side affects or debilitating bodily function as a result of this treatment protocal. Had [PHI Redacted] not received medical health coverage could not have afforded this excellent treatment and cure.I know I speak for 100's of patients when I make the above statement. Proton is the least invasive procedure and should be available to all suffering from this killer disease!

Any radiation is harmful to healthy tissue.
Proton treatment minimizes the entry radiation
dose, maximizes the dose to the tumor and has
negligible exit dose. Beacause the radiation
dose to healthy tissues is less with protons, the
dose to the tumor can be greater leading to
higher cure rates and fewer side effects. Proton
treatments should be available to all prostate
patients.

David Collins, very satisfied patient

The idea to remove medicare coverage for proton treatment of prostate cancer would be a major step backward. As a scientifically trained person, [PHI Redacted] made the decision to get this treatment six years ago because it was the only method that could accurately treat cancer deep in the body without destruction of the outer tissues. Proton beam radiation penetrates outer tissue without damage before destroying the inner targeted area, whereas conventional photon radiation destroys any tissue on contact and loses its strength as it travels deeper. This accurate targeting of deep tissue is what makes the elimination of side effects possible.

This is the reason that many new proton centers are being built. Most treatments for prostate cancer are effective, but only proton therapy achieves highly effective results without any side effects. The cure of [PHI Redacted] prostate cancer without any side effects made cancer a minor issue instead of a life altering problem. Without Medicare coverage, this wouldn't have been possible. The total cost to medicare for [PHI Redacted] treatment was about $26,000, which seems to be reasonable compared to other methods.

Please keep in mind that physicians that treat prostate cancer with the old methods and do not have access to these high tech facilities have a lot to lose due to the competition of this scientific advancement.

I want to comment on Proton Beam Radiation Treatment for Prostate Cancer. [PHI Redacted] was diagnosed with Prostate Cancer at the Veterans Administration in late [PHI Redacted]. [PHI Redacted] consultation was with a lady doctor, in charge of the surgery treatment area for the VA. Their treatment at the VA was limited to either surgery or traditional radiation, and they required a patient consult with both heads of each department, and come to their own decision as to which type of treatment to accept. [PHI Redacted] went back to lady doctor surgeon to tell her [PHI Redacted] was ready to accept the surgery as soon as possible. That very, very wise lady suggested that [PHI Redacted] attend some of The American Cancer Society, Cancer Survivor Meetings that were being held at multiple locations here in the metroplex. [PHI Redacted] attended 3 of the different meetings at different locations. [PHI Redacted] found that the large majority of the "survivors" were mostly pleased to survive, but also observed that most of the "survivors" suffered a wide variety of side effects and problems. [PHI Redacted] also observed not only were there many problems, but very good odds that the cancer could return or was not totally removed or destroyed. After a few meetings [PHI Redacted] discovered a small group of guys that had been to California to a Proton Beam Radiation medical center. They without a doubt way exceeded the results of all the varied procedures that were available. At that time ([PHI Redacted]) there were not any other choices for this procedure, with their years of success and experience. There was another place using another form of Proton Beam treatment in combination with a confusing mix of other stuff, but I could not find success or experience at that facility. [PHI Redacted] made decision for treatment at the medical center in California. [PHI Redacted] talked to lady surgeon doctor at the VA, who congratulated [PHI Redacted] for what she thought was a wise decision. [PHI Redacted] and all of my Cancer Survivor friends all believe Proton Beam Radiation treatment for Prostate Cancer is far better and in the long run "Less Expensive" than alternate procedures. If your operation is trying to save budget money by eliminating Proton treatment, I strongly believe you are on the wrong track. [PHI Redacted] "BOB" (Brotherhood of The Balloon) represents thousands of Cancer Survivors that have experienced Proton Beam Radiation Treatment. I have yet to ever find or run into a Prostate Cancer patient from that facility and method of Proton Beam Radiation that was not very pleased with their loving and through care and healing.

I am puzzled as to why no comparative studies have been conducted between proton and photon raidation treatment. [PHI Redacted], I researched all availalble therapies and believe the best case for effective treatment of [PHI Redacted] condition is proton therapy. Killing the cancer with protons is as effective with fewer side effects for the individual, which is often overlooked in this debate.

It is foolish to stop Medicare payments for proton beam radiation treatments. [PHI Redacted] was treated in [PHI Redacted] at Loma Linda Hospital with proton beam radiation for prostate cancer. To this date, there is no clinical evidence of any recurrence of cancer[PHI Redacted]. This technology was most definitely the best available at the time of my treatment and it proved itself to be very effective. I believe, from followup studies, that proton beam radiation is the most effective and precise radiation treatment available that also protects, more effectively, healthy tissues and prevents some of the more unpleasant side effects of that treatment to cure cancer. Even the most modern photon radiation (IMRT) is not as accurate and side effect minimizing as modern proton beam radiation treatment. [PHI Redacted] I would also encourage any other person that I know to check out proton beam radiation treatment before choosing any other treatment. Medicare should continue to support this wonderful medical technology and the elderly patients that are stricken by cancer and need that treatment to save their lives.

[PHI Redacted] received Proton Beam treatment in [PHI Redacted]. [PHI Redacted] PSA was 11.2,Gleason was 4 and Staging was T1C. [PHI Redacted] PSA today is .6. [PHI Redacted] never had any incontinence, sexual dysfuntion or side effects. [PHI Redacted] urologist said that Surgery was the only cure. How wrong these Doctors are. The same happened to many friends of mine who followed [PHI Redacted]. Please do not take away the hope of others who would benefit from this incredible Medical Advancement. You or someone you love might need it some day.

PROTON THERAPY: I write to urge continuation of Medicare reimbursement for Proton Beam Ratiation Therapy (PBRT). [PHI Redacted] diagnosed with prostate cancer in [PHI Redacted], and discussed case with several top urologists in Southern Calif. All of them wanted to immediately perform surgery. None even suggested reading about PBRT. After [PHI Redacted] read voluminous information about the various treatments possible to treat prostate cancer [PHI Redacted] chose PBRT at Loma Linda University Medical Center. [PHI Redacted] chose it because it was non-invasive, had minimal side effects (particularly when compared to the other possible treatments), and was all out-patient. [PHI Redacted] PSA has been under 0.7 since completion of PBRT in [PHI Redacted]. It would appear that all of the medical people writing to oppose Medicare reimbursement for PBRT have a monetary interest in opposing; they are losing money when persons such as [PHI Redacted] chose PBRT over expensive surgery/hospital/etc.etc. treatments.[PHI Redacted]

I was fortunate enough to learn of proton therapy from a friend [PHI Redacted]. [PHI Redacted] underwent ten weeks of proton therapy four years ago without any side effects whatsoever, during treatment or since. [PHI Redacted] most recent PSA was 0.34 in April 2008. All of [PHI Redacted] plumbing operates as originally intended. For all practical purposes, it is as though [PHI Redacted] never had the disease. [PHI Redacted] belong to a local Prostate Cancer Support Group and strongly encourage all newly diagnosed members to investigate proton therapy, and to read the book You Can Beat Prostate Cancer by R.J. Marckini before choosing a course of therapy for themselves. I have freinds who have had Brachytherapy and surgery and they have resulting quality of life issues that [PHI Redacted] other proton graduates who belong to Prostate Cancer Support Group have never had to deal with. I believe that if urologists were truly impartial, and not trained surgeons, they would all recommend proton therapy because it is non- invasive, does minimal damage to surrounding tissue, and typically does not cause any reduction in quality of life. Medicare and Medicaide should continue to fund proton therapy for prostate cancer.

Proton beam therapy for prostate cancer appears in your 7/30/2008 document as a potential topic for discussion in the third quarter of 2008. In the paragraph devoted to this topic you state, “no current comparative trials comparing (it) to usual therapy”. I presume you are referring to randomized clinical trials (RCTs), since it is my understanding that even those requesting RCTs (e.g. Brada et al. Journal of Clinical Oncology 25:965-970. 2007) do not contest the various arguments that favor protons over x-rays. Even if those studies showed no difference among the treatments, it would be “the lack of equipoise in the arms of any trial” that would fail to meet the central requirement for performing an RCT.

Any discussion on proton beam therapy must include consideration of the quality of life issue. During and after treatment those receiving radiation via a proton beam are usually able to lead a normal, productive life. [PHI Redacted] had about four uncomfortable nights during nine weeks of treatment. Other than that, it was business as usual. In my current book, Faith and Proton Therapy vs. Prostate Cancer (ISBN: 978-1-934666-29-6), I document how [PHI Redacted] actually gained strength while being exposed to radiation, in stark contrast to what can take place when x-rays rather than a proton beam delivers it.

I believe it is extreamly important that Medicare continues to cover Proton therapy for prostate cancer. Side effects and cure rate are very important considerations when selecting a medical procedure.[PHI Redacted]

CMS Consideration in No Longer Providing Reimbursement for Proton Beam RX for Prostate Cancer.

[PHI Redacted] received proton beam therapy for prostate cancer paid for by Medicare and I am a proponent of Medicare continuing to pay for this treatment. I was fortunate to know someone in the southern California area who brought to my attention the proton beam radiation therapy being offered by Loma Linda University Medical Center in [PHI Redacted]. After considerable research into the modalities of treatment for this disease I concluded that, [PHI Redacted], it was the best treatment available. [PHI Redacted] medical history was one that very strongly discouraged surgery as a good choice. I personally found those who had undertaken other modalities and were suffering many long term side effects. Additionally, when [PHI Redacted] asked urologist about this treatment, because of his having been previously located near Loma Linda, he knew about the proton beam therapy and recommended that [PHI Redacted] pursue this type of therapy. [PHI Redacted]

After about a 9 month to one year period following treatment [PHI Redacted] PSAs fluctuated some (but overall had a downward course; [PHI Redacted] PSAs now for over six years have been below 1.0 and most of those were below 0.1. [PHI Redacted] felt good during treatment and no side effects from it. I think that CMS should give careful consideration to the lack of side effects. Treating undesirable side effects for years can also become very expensive. Certainly consideration should be given to the improved quality of life that the absence of these side effects allows the patient. My vote is for CMS to continue to pay for proton beam readiation for prostate cancer. I hope tha CMS will have at least one or two men on the board making the decision who have had severe and/or chronic side effects of other types of therapy for this disease.

I'm not going to pull any punches here but the detractors of Proton Beam treatment specifically in regard to Prostate Cancer treatment are usually specialists in other treatments. Hardly an unbiased segment of the medical ''profession''. [PHI Redacted] ran into the same bias when weighing the options [PHI Redacted] discovered that had Prostate Cancer. Every Dr. [PHI Redacted] spoke with decried all other treatments as barbaric, and their methods as the only way to treat it. I've seen better behavior from used car salesmen. The University of Utah Huntsman Cancer Center professed to have never heard of the treatment! Talk about not keeping up with the happenings in your field of supposed expertise. As for the advantages of Proton treatment, well they are many.

1. no invasive surgery and it's possible problems.
2. side effects limited to a sunburn on your hips and a slight burning when urinating during treatment.
3. NO IMPOTENCE. if that's not reason enough, well then go ahead with other treatments.THEY cannot claim this but will utter vague statements about ''nerve saving techniques'' all of which are total B.S.
4. 2 years later, with a recent biopsy, [PHI Redacted] NEGATIVE for cancer.
5. [PHI Redacted] continue a career as an airline pilot virtually unhindered by Proton Beam Radiation Treatment.

If I was 60 years old, fat and comfy in my field of practice as a prostate cancer surgeon or trained in other methodologies, wouldn't I decry Proton Beam Treatment as it totally obsoleted my procedure and devastated my bottom line?

Wouldn't I try and stop Medicare coverage of this procedure that renders me obsolete?

Re: PSA Testing and proton beam treatment for prostate cancer.

I have read news reports that a discontinuance of coverage for these items is being considered. I believe this is a huge mistake. The reasons cited in the news reports were alleged were economic and "quality of life" issues.

Several of my friends have had surgery or cryotherapy for prostate cancer, with or without hormone therapy, and most do have serious quality of life issues. [PHI Redacted] chose proton beam therapy and had NO side effects and 5 years of constantly low PSA. [PHI Redacted] had NO discomfort at the time of treatment. I have also had several aquaintances who did not have screening, and because of delayed diagnosis have since died, or are dying a painful death from metastatized prostate cancer.

The evidence is overwhelming that in the majority of cases, proton beam therapy is superior to every other therapy for this condition. It is safe, medicaly effective and cost effective. It should be retained on the covered options list as should PSA screening.

Re: PROTON RADIATION THERAPY FOR PROSTATE CANCER My comments for the continuing reimbursement by Medicare for proton radiation treatment for prostate cancer are heartfelt and are based on my own personal experience.

[PHI Redacted] was diagnosed with prostate cancer 2.5 years ago. As an engineer by trade, I made a concerted and extensive study of all the treatments available for this type of cancer. [PHI Redacted] concluded after research, going through the treatment and post treatment testing and side effects that Proton Radiation is the finest treatment currently available throughout the various facilities in the United States. After talking with various physicians during my researach, I concluded that Proton Radiation was not only state-of-the-art treatment, but chances of having any lingering after effects in comparison to other treatments was much, much better.

It would be a tragedy for people currently covered by Medicare and needing treatment to be denied this option. It is unfortunate that many physicians are not even aware of the treatment, or choose not to mention it in favor of their own methodology. The existing facilities, and those currently in the planning stages, require considerable investment; but the treatment gives a larger number patients a quality of life during and post treatment that many other types of treatment do not seem to offer.

Medicare offers "older" people the best health insurance coverage in the world. Please do not diminish this expectation; continue to offer coverage for Proton Radiation as an option for treating forty (40) different forms of cancer!

[PHI Redacted] would not have been able to avail [PHI Redacted] of this treatment if I had to pay for it on. Thanks for covering this fine program!

I am commenting on the potential removal from Medicare Coverage of proton radiation for prostate cancer.

[PHI Redacted] was diagnosed with prostate cancer in [PHI Redacted]. [PHI Redacted] [PHI Redacted] had died at 95, [PHI Redacted] died two years later at 93. [PHI Redacted]

[PHI Redacted] began attending a prostate cancer support group to learn as much from their experiences. I had discussions with Urologists, Radiation Oncologists and Surgeons. Since most of the men in the prostate support group had surgery for their treatment and claimed to be happy with the results, [PHI Redacted] scheduled surgery. At the next meeting, prior to surgery, [PHI Redacted] heard from a man that was totally incontinent after his surgery. Even though the men in the support group claimed to have an acceptable sexual life after surgery (I’ve since learned that is very subjective), [PHI Redacted] had accepted that [PHI Redacted] might have a reduced sexual capability, but [PHI Redacted] was not willing to accept a life of incontinence. I later learned of two other men in the immediate “network” of patients that were totally incontinent after their surgery.

[PHI Redacted] canceled surgery and began research for other alternatives. [PHI Redacted] selected proton radiation because it was the only treatment for which could find a reasonable database of men who had the treatment and were willing to document and talk about their results. A year after treatment ended [PHI Redacted] cancer free, am totally continent[PHI Redacted].

(As a side note, the radition oncologist and the surgeon [PHI Redacted] had talked to were visible angry with [PHI Redacted] for choosing proton treatment.)

I can’t find any reliable information about the side effects from normal radiation treatment or surgery for prostate cancer. A recent NY Times article “August 27, 2008, 9:26 am Regrets After Prostate Surgery” indicated that nearly 20% of men who had surgery were later sorry they had the surgery.

What seems to be needed, rather than knocking proton radiation as a treatment, is a clear definition and measurement of the side effects for all prostate cancer treatments. I believe it is becoming more commonly accepted that there isn’t a question about whether there is incontinence after surgery, it is a matter of the degree of incontinence. The same is probably true about sexual performance.

As we all live longer and expect to have a good quality of life later in our lives, the quality of life issue should be considered very seriously before any cutting back on proton support is made.

There is a database of at least 3500 men that have had proton radiation treatment for prostate cancer. I don’t know that all of them are 100% satisfied with the treatment, but at least it gave me reliable first hand information about side effects that I could not find for any of the other prostate cancer treatments.

Please don't remove Medicare support for proton treatment of prostate cancer until there is reliable data that other treatments do not cause any more side effects than proton radiation.

[PHI Redacted] I too was troubled by lack of comparative trials between modalities. It seems that the best head-to-head study would involve a randomized test of treatments involuntarily assigning patients the modality of treatment. Clearly few would agree to that, if it were ethical. So we use multivariate analysis, holding some variables constant. To me the first problem is that the population of those undergoing surgery has to be fitter, and probably younger, and more likely to have organ contained disease than those undergoing radiation—just to withstand the rigors of and to justify the surgery. Controlling for age would be easy, but controlling for amount of disease is another problem. For example, [PHI Redacted] gleason score of six, ten years ago, would probably have been a five, according to a study by the University of Chicago. This grade inflation, the Will Rogers affect, makes it tough to control for a category that has changed in the last decade. Another problem is the changing protocols. For example, the proton radiation dose ten years ago was less than it is today. Surgery now has a robotic option. Data are not available for these newer methods. Lack of data, lack of comparative trials does not justify lack of funding. Prostate cancer patients are the majority at proton beam centers. [PHI Redacted] are treated more efficiently than other cancer patients and keep the gantries full, lowering the cost per treatment to all. Reducing funding of prostate cancer patients may have the adverse effect of reducing the treatment and research on other forms of cancer—head, neck, spine, and , possibly soon, breast cancer. Can you imagine adversely effecting breast cancer treatments? Encourage comparative trials, but please don’t cut the funding.

[PHI Redacted] a successful patient of Proton Radiation Treatment, and an aggressive and vocal proponent of that treatment option for the past five years. I was shocked to learn that Medicare coverage for this excellent treatment option may be discontinued.

Since [PHI Redacted] was only 58 years old when went through the 8 week proton treatment regimen, [PHI Redacted] did not qualify for Medicare coverage, but, instead, relied upon private medical coverage to cover the majority of the treatment costs. Since many of my friends with Prostate Cancer are covered by Medicare, I am always quick to point out to them that Medicare does cover Proton Radiation Treatment. That fact seems to help them to focus their study on treatment options, based on all the factors, not just cost/medical coverage.

[PHI Redacted], like many of fellow Proton Radiation Treatment patients, experienced no negative side effects during and post treatment.

I believe there are 5 and 10 year studies that show that Proton Radiation Treatment is at least as effective as standard radiation treatment and surgery (The Gold Standard). I, for one, am very glad that [PHI Redacted] elected Proton Radiation Treatment over the surgery previously scheduled.

For the thousands of men who are dianosed with Prostate Cancer each year, please do not discontinue Medicare funding for Proton Radiation Treatment.

[PHI Redacted] was treated for prostate cancer using protons. [PHI Redacted] not suffered from any of the common side affects of other treatments. I consider this a superior form of treatment. Clearly the increase in centers across the nation are proof this is a superior form of cancer cure.

[PHI Redacted] received proton beam therapy for prostate cancer and wish to comment that the treatment was effective, with very little side effect, and has reduced any need for folllow-up. Please continue to make it available to medi-care patients.
Skip Bell

Please do not cut medicare coverage for PROTON BEAM THERAPY to treat cancer it is the best, [PHI Redacted] received PBT [PHI Redacted] and doing fine PSA 0.01 Last four checkups.

Proton Beam Treatments for Prostate Cancer Patients

After being diagnosed with Prostate cancer in [PHI Redacted], [PHI Redacted] did a great deal of research to determine what treatment would best keep [PHI Redacted] alive. The research included; talking to Medical Doctors, researchers, patients of all current treatment methods (some of which were being re-treated as their choice did not remove all of the cancer), reading from various professional writings and visiting, with orientations wherever possible, the different treatment centers. The research also included patient results from the different treatments.

This research led [PHI Redacted] to one conclusion, if wanted the best results, with the fewest side effects, then the Proton Beam treatments was the only way to go.

In the long run, I am sure that [PHI Redacted] saved the insurance company a great deal of money since there have been no side effects that may have led to additional expenses.

Thank God discovered the Proton Beam.

I wish to comment on the proposals to not cover Medicaid coverage for Proton Beam Radiation for Prostate Cancer. [PHI Redacted] received Proton Beam Radiation for prostate cancer under Medicaid/supplement insurance coverage in February,March and April [PHI Redacted]. The treatment was very successful in eliminating the cancer with virtually no side effects. During treatments [PHI Redacted] was able to work 30 hours per week in a custom cabinet shop, which would have been impossible had [PHI Redacted] chosen surgery, regular radiation or other current accepted treatments. [PHI Redacted] quality of life remained virtually normal and has continued since treatment. Why should medicaid coverage be denied for Proton Beam Radiation treatment for prostate cancer, when there are numerous sites under construction or which have opened just because those sites may not be in the local proximity to where the individual lives? We who have become eligible for medicaid coverage should not be deprived of treatment benefits when we have worked for so many years to be eligible for its benefits just because other treatment modalities claim to be able to treat prostate cancer but cannot back up their claims of effectiveness, cost and above all maintain the quality of life cancer victims should expect. To eliminate medicaid coverage for Proton Beam Radiation for prostate cancer victims will be a tremendous step backward.

Only individuals who have not personally experienced prostate cancer could reasonably suggest that the cost comparison in this debate should begin and end with the fact that survival rates are equivalent.

Follow-on costs and quality of life are legitimate cost factors in the equation. Individuals and government alike pay enormous sums for improved quality of life in countless ways. Why would these sums be left out of equivalency calculations in this one issue? Not to be maudlin about it, but the absence of the classic side effects of surgery and photon radiation is priceless.

[PHI Redacted] a 72 year old chemical engineer two years post proton radiation treatment for prostate cancer. [PHI Redacted] had no side effects. PSA is holding below 1.0.

[PHI Redacted] chose proton radiation because of extensive data, widely available, showing minimal side effects from proton radiation compared to surgery, photon radiation in all its forms, and hormone deprivation therapy.

In fact, [PHI Redacted] employed hormone deprivation therapy for almost six years as a least-worst alternative to surgery and photon radiation. [PHI Redacted] Fortunately, about the time that the therapy was becoming less effective, [PHI Redacted] stumbled upon proton therapy on the internet. [PHI Redacted] immediately arranged for that treatment.

If Medicare really wants to save money long term, it should be subsidizing construction of proton treatment centers.

The post Proton prostrate cancer treatment support group that [PHI Redacted] joined enlightened to the extreme side effects of radical, DiVinchi surgery, and x-ray beam treatments which [PHI Redacted] had previously considered. None of the members had heard of Proton therapy. [PHI Redacted] was embarassed to describe treatment with its lack of side effects. Surely this treatment should remain a funded tool for medicare. A impartial statistical study will reveal the total value of Proton Therapy as compaired to old methods. [PHI Redacted] regained aviation medical and live a full and active life in every way, should this chance be denied my fellow citizens?

[PHI Redacted] Proton Beam was from Feb - 2 May [PHI Redacted]. [PHI Redacted] psa is still decreasing from 9.0 pretreatment currently 1.4. A slight ache in [PHI Redacted] hips which lasted 6-7 months was the only side effect. [PHI Redacted] treatment was about $63,000 plus out of pocket travel and rooming expenses of about $10,000.00 over the 3 months in California. Preferred care and Tricare covered 100% the $63k even though it was out of the coverage area. They recognize the value of absence of post treatment expense for side effects.

Dear Sirs,

When an [PHI Redacted] associate told me of his complete cure for his prostate cancer by Proton radiation, as a professional mechanical engineer and holder of seventy-nine United States patents, I am of course interested in anything technical.

Although my innovations are in the transportation field rather than the medical field, I was fascinated by my friend’s immediate and complete recovery, with absolutely no side effects. Years later [PHI Redacted] was told had prostate cancer, level Gleason 9. [PHI Redacted] urologist, who had seen [PHI Redacted] regularly every six months for the previous 20 years (but didn’t detect prostate cancer until it had progressed to Gleason 9) suggested radical surgery.

While waiting admission for Proton radiation, [PHI Redacted] checked with the group in Seattle who are supposed to be the leaders in the implantation of radioactive “seeds” in the prostate gland. Because [PHI Redacted] cancer had progressed to Gleason 9, the Seattle group advised that was beyond the stage of prostate cancer that was treatable by their seed technique.

As you can imagine, I recommend Proton treatment to anyone I meet who has prostate cancer.

Many come up with stories they learn from practitioners of other corrective measures. Most recently a lifelong friend told me he wouldn’t consider Proton radiation because he “wouldn’t want a catheter inserted for months in his urinary canal”, and that he feared the “incontinence rendered by Proton radiation”.

Re: Proton Therapy for prostate cancer [PHI Redacted] received proton therapy from [PHI Redacted]. The treatment was painless, quick, and effective. There were NEVER any side effects. [PHI Redacted] was able to continue a comfortable life-style. [PHI Redacted] last PSA was 0.08 and the DRE revealed healing with no rough scar tissue. [PHI Redacted] couldn't have afforded this treatment without the help of Medicare and supplemental insurance. [PHI Redacted] feeling wonderful knowing that this cancer has been eliminated with no lingering health problems. Life is great again!! What a terrific feeling it is to know that you longer need to worry about this cancer. [PHI Redacted] Proton therapy is a great treatment for many reasons, and should not be denied to those who cannot afford to pay for it themselves.

Please not remove CMS approval for Proton Beam therapy under Medicare. [PHI Redacted] was sucessfully treated with Proton Beam Therapy at UFPTI the fall of [PHI Redacted]. [PHI Redacted] had a very aggressive form of Prostate Cancer with a PSA of 10.7 and a Gleason score of 9..[PHI Redacted] had virtually no side effects of any kind. You only need to see who,s ox is being gored to determine the opposition to this funding. Not many urologists know or want their patients to find about PROTON. mEDICINE IS A BUSINESS.

Three years ago [PHI Redacted] was diagnosed with prostate cancer. [PHI Redacted] reviewed the various choices available and selected proton beam therapy. [PHI Redacted] [PHI Redacted] no side effects and the cancer is gone. I have heard from otherswho have had the proton therapy and tey have no side effects. Many people I know in my area have had other treatments (seeds, x-ray radiation, etc.) and they have side effects sexual and urinary. Many are wearing diapers for the rest of theit lives. Some have had treatments that cost additional money.

Regarding bisphosphonate treatment for
osteoporosis and osteonecrosis of the jaw, there
is no reason to believe that the route of
administration is a risk factor. Dose (i.e.,
higher doses given IV for cancer) increase the
likelihood of ONJ, but the osteoporosis IV dose is
approximately 1/10 of the dose given for cancer.
This is addressed in the ASBMR task force report.
Khosla S, et al. Bisphosphonate-associated
osteonecrosis of the jaw: report of a task force
of the American Society for Bone and Mineral
Research. J Bone Miner Res 2007;22:1479-1491.

I am a [PHI Redacted] retired academic Pathologist who taught at the University of California San Diego, Loyola University Medical School, and the University of California at Irvine. I had a long time affiliation with the Department of Veterans Affairs and held the position of Chief of Staff at Long Beach VA Hospital from 1990-2001. I have been retired for about five years. When [PHI Redacted] was diagnosed with early stage prostate cancer in December of [PHI Redacted], very carefully look at all of the various treastment possibilities for early stage prostate cancer. [PHI Redacted] chose Proton Therapy at Loma Linda University for several clear reasons. The first reasons is that the way protons deliver their energy is through the phenomenon of the Bragg Peak that causes 90% of the energy to be released when the protons stop. This means that there is minimal side effect scatter to adjacent soft tissue and adjacent structures. IMRT delivers approximately 60-70% of the energy from gamma particles to the prostatic bed. The second reason [PHI Redacted] chose proton therapy was that there was very precise targeting to the prostate, to 1.2 cm beyond the prostate capsule and to the adjacent seminal vesicles. The tumors arise in the periphery of the gland and recurrence is in the adjacent soft tissue and in the adjacent seminal vesicles. The third reason why [PHI Redacted] chose proton therapy is that they had a very low sideeffect profile including no incontinence, minimal effect on potency and minimal rectal bleeding from neovascularization. The fourth reason why [PHI Redacted] chose proton therapy was that they had excellent outcomes which were clearly as good as any other treatments. [PHI Redacted] rejected brachytherapy because could now be assured of the dosage of irradiation that was delivered to the periphery of the prostate gland and very little to no irradiation was delivered to the seminal vesicles. Because I had done academic tumor biology research for over 30 plus years, I was highly qualified to review all of the appropriate medical literature. [PHI Redacted] made the right conclusion and [PHI Redacted] been free of prostate cancer for over five years with no sideeffects

The current controversary around proton therapy vs brachytherapy appears to be focused on the associated costs of each therapy. The physics involved and the precise targeting associated with proton therapy certainly caused me to select proton therapy. I strongly feel that this should continue to be a clinical option that is reimbursed through Medicare as it is a very effective treatment with minimal to no sideeffects.

[PHI Redacted] a cancer survivor thanks to Proton radiation. [PHI Redacted] completed radiation in [PHI Redacted] with absolutely no side effects what so ever..[PHI Redacted] enjoying a great lifestyle..I have encouraged other males to at least look into proton radiation before selecting other methods of treatment..Please all forms of treament are great but let us not get into a war of words and do what is best for the patient..

[PHI Redacted] was treated with proton radiation three years ago and very distressed that Medicare is considering removing coverage of this vital cancer treatment. When [PHI Redacted] was diagnosed and began research on treatment options it became obvious that there were grim choices for long term quality of life among the traditional surgical and photon radiation treatments. I did extensive research which including many discussions with men who had been treated with the traditional methods. Almost without exception they would, after initially saying it went OK, begin to tell me about the various problems with incontinence and impotence that they lived with. It was very depressing and caused a great deal of anxiety[PHI Redacted].

[PHI Redacted] I talked with and corresponded with many who had experienced this treatment and they reported minimal if any long term deterioration of their quality of life. My conclusion is that true all of the treatments have similarity in outcomes as far as treating the disease; but the potential long term side effects are a very real concern. Many practitioners of the ‘standard’ treatments focus on the cure and pass over or minimize side effects. [PHI Redacted] urologist was very hostile to proton treatment with insinuations that it was some kind of voodoo. My sense, and it may only be perception, is that many radiologists and urologists feel that proton treatment threatens their practice in some way.

It seems to be very dismissive to focus on the cure and ignore the long term side effects as if we were lucky to be cured and just live with them. Before you come to any conclusion I urge you to survey the opinions of the men who have had the various treatments to really understand the extent of deterioration of quality of life in each.

[PHI Redacted]received 8 weeks of Proton & 3D therapy for Prostate Cancer - No complications! [PHI Redacted] had a prostatectomy - spent 10 days in the hospital, he suffered from incontinence & erectile dysfunction. His medical costs as a in-patient for 10 days exceeded charges for 8 weeks treatment as a out-patient. [PHI Redacted] -ERNIE GALL-

I am a neurosurgeon certified by the American
Board of Neurological Surgery in May 1979. I was
Chairman of Neurosurgery and residency program
director for 10 years at the National Naval
Medical Center, Bethesda, MD. I have been in
private practice in Warren and Youngstown Ohio for
the past 9 years.

In the past 6-7 years I have preformed well over
500 kyphoplastys. Before that I had performed
several vertebroplastys. I have treated vertebral
compression fractures in patients with
osteoporosis and metastatic disease. Before
adopting vertebroplasty and kyphoplasty, I had
treated such patients with very unsatisfactory
medical modalities with analgesics and bracing.
Bracing in particular was a waste of time and
money in that very few of the people that I
ordered braces for ever wore them for more than a
few days and most patients continued suffer
unremitting pain for months with frequent
exacerbations as fractured vertebrae continued to
collapse further and further.

I feel strongly that patients with vertebral
compression fractures in osteoporsis or metastases
should be treated with kyphoplasty ACUTELY. This
allows rapid return to premorbid levels of
functional activity but, importantly, prevents not
infrequent additional vertebral collapse with
increased pain and reaching a degree of severe
collapse wherein kyphoplasty (or vertebroplasty)
are rendered impossible.

In my experience with 500 plus kyphoplastys I have
achieved 90 percent or more pain relief in 85 to
90 percent of patients. I have had no deaths,
infections, neurological or cardiopulmonary
complications. Leakage rates have been less than 3
percent. 97 percent of patients have been
discharged to premorbid living arrangements in
less than 24 hours of performance of the
kyphoplasty. Over 85 percent are discharged on
nothing stronger than acetomenophen or ibuprofen
for pain.

This experience clearly demonstrates the health
benefits of kyphoplasty for pain relief and
restoration of a high level of functional
activity. This applies to both tumor and
osteoporosis patients.

I am convinced that the partial restoration of
vertebral height achieve by kyphoplasty (more than
seen in vertebroplasty) reduces spinal imbalance
and muscular strain which is part of the reason
for the excellent level of pain relief achieved
with kyphoplasty.

Anyone having observed patients undergoing medical
management (anlagesics and bracing) and
kyphoplasty would consider use of medical
management as cruel and unusual punishment.

CMS should seek less patient abusing means of cost
control than the dollars that might be saved by
placing unwarranted restrictions, financial or
otherwise, on performance of kyphoplasty.

Thank you for your consideration of the above.

Proton Beam Radiation Treatment for Prostate Cancer.

[PHI Redacted] finished treatment, [PHI Redacted], at Loma Linda, Ca. for Prostate Cancer. There has been zero side effects and he feels wonderful, At his 4 month checkup, his PSA dropped from 12.4 to 2.o.

It is expensive, but in the long run, it is cheaper because there are no side effects afterwards. therefore,there is no other costs involved except his regular check up and PSA tests.

It is disheartening to read postings
from 'medical professionals' that only consider
the technical and first appearance cost aspects
of cancer treatment and not the final outcome.
At first glance it appears these 'professionals'
are concerned from a competitive outlook about a
completely proven treatment that might cut into
their profit centers. I didn't read in a single
posting about the care or side effects of
the 'customers' they serve.
I have several friends that have each gone
through the therapies listed in the postings and
each of them have had severe and awful long term
problems - I know of no such problems with any of
the proton treatment customers I have met and
talked with!
It is also interesting to note that many of the
patients I met at Loma Linda going through
treatment had gone through some of these other
treatments and now had to come to the Proton
Center to clean up what these 'medical
professionals' had missed or screwed up - so now
what is the real cost to Medicare to pay twice
for these treatments when the first treatment
would have cured the problem?
My opinion is that the proton treatment should be
the only option Medicare should consider for the
treatment of prostate cancer!

[PHI Redacted] had the proton treatment,it is the best procedure and worth all the money and time doing it. No problems after seven years. [PHI Redacted] had this done at 80 after Dr. said we do not operate on men of your age.

Both Kyphoplasty and Vertebroplasty have worked
extremely well in my practice. I have experience
with over 500 cases, and the results are nearly
miraculous. People who come into my suite barely
able to ambulate, leave one hour later pain-free.
These procedures work well for Any kind of painful
fracture whethr osteoporotic, traumatic , or
neoplastic in nature. I Strongly urge you to
remove Kyphoplasty and Vertebroplasty from any NCD
policy.

[PHI Redacted] received Proton Radiation treatment for prostate cancer which was covered by Medicare because of age (71).Being a retired chemical engineer, I carefully studied the cure rates and side effects of the various treatment options.[PHI Redacted] selected Proton radiation because the cure rares were the same as for surgery and conventional radiation but the side effects were much less.[PHI Redacted] Proton treatment has proven choise to be the correct one as [PHI Redacted] have no sign of cancer reoccuring after 4 years and absolutely no side effects from Proton radiation treatment.

I believe that Medicare should continue to cover this procedure in the future.When I first started to explore proton thearpy, only two sites were available.Now there are several around the country and more seem to be on the horizon. I believe this is happening because of the minimual side effects from proton radiation.

When considering costs, the additional costs associated with side effects should be included in the other treatment oprions.

Proton treatment for prostate cancer

[PHI Redacted] I cannot express strongly enough my belief that it should continue to be covered.

[PHI Redacted] had zero side-effects from the treatment (unlike many of my associates who have suffered from incontinence and impotence after both surgery and seed implant treatments). Quality of life is something that is impossible to measure. Since treatment [PHI Redacted] PSA has remained at 0.1 and follow-up exams show no evidence of any problems.

In fact, my Family Doctor has stated that he will absolutely have the same treatment should he develop prostate cancer.

As a side note - [PHI Redacted] decision to have Proton Treatment was not made due to financial considerations but due to word-of-mouth research [PHI Redacted] did with others who had had all types of treatment and Protons were the overwhelming winner for both lack of side effects and long- term prognosis.

[PHI Redacted] a survivor of prostate cancer, and I attribute the cure to the proton beam treatment [PHI Redacted]. [PHI Redacted] PSA level is now 0.1. Medicare approved the procedure and without Medicare's help, [PHI Redacted] would not have been able to receive this treatment which I believe was much better than radical surgery. [PHI Redacted] urologist strongly recommended radical surgery but 2 yrs after received the proton beam treatment, he told [PHI Redacted] that made the right decision. [PHI Redacted] I strongly recommend that Medicare continue to help pay for the proton beam treatment.

[PHI Redacted] former prostate cancer patient who was treated with proton therapy under Medicare approximately six years ago. [PHI Redacted] suffered no side effects from the therapy, and PSA has hovered near zero since the therapy was completed. Some of my acquintances had far less successful results from other therapies. I urge you not to discontinue Medicare payment for proton therapy.

[PHI Redacted] a recovering prostate cancer patient who received proton treatment. [PHI Redacted] experience-and that of the hundreds of other proton patients with whom I have had contact-was outstanding. The tumor was controlled, and the side-effects were minimal-or none. In contrast, of the many people who I know that have had other treatments, the vast majority have had problems-even including death(either from recurrence or surgery-related). Many have had to endure additional treatment, and many have had to live out their lives with some kind of impairment of their normal functions. It is inconceivable that you would restrict access to proton treatment for prostate cancer because cheaper treatments are available-they are also less successful.

My comment is with respect to the following proposal; Proton beam therapy for prostate cancer: Proposed as means to concentrate radiation therapy and reduce side effects. Very high upfront cost to build these facilities and thus only at very few facilities. For prostate cancer treatment, no current comparative trials comparing to usual therapy.

[PHI Redacted] had succesful treatment for prostate cancer by proton beam radiation. [PHI Redacted] was treated six years ago, PSA prior to treatment was 23. Since treatment, PSA is steady at 0.7. [PHI Redacted] little or no side effects from the treatment. In the meantime, two friends had conventional radical prostitectomy, both endured incontinence and impotence after the surgery. One of them died later still wearing his depends. Another aquaintance was treated with cyrotherapy and still sufferes from the effect of the treatment on the surounding tissues. I convinced yet another person to seak treatment by Proton beam radiation. He [PHI Redacted], as I am, very satisfied with his treatment and recovery.

The upfront costs are higher because of the costs of building the facility. However, the benefits must be well documneted because, since [PHI Redacted] treatment, three more facitities have opened and more are currently under construction. Construction costs will continue to fall as more are built.

There was sufficient documented evidence, when [PHI Redacted] was trying to decide on treatment, of the benefits of the treatment by proton beam radiation, less side effects and reduced damage to surrounding tissue. [PHI Redacted] had to arrange follow up coverage with a local oncologist after treatment. Before treatment he said he thought traditional radiation therapy would do as good a job. Subsequent to treatment he said "You really made the right choice".

I think the statement in the proposal saying that there are no current studies that show benefits of proton beam radiation for the treatment prostate cancer is misleading. The evidence was clearly there when [PHI Redacted] made decision. I think it should be the responsibility of "conventional" therapies to prove that they are as good as Proton Beam Radiation.

Between [PHI Redacted], [PHI Redacted] was treated for prostate cancer at Loma Linda Medical Center. [PHI Redacted] was treated with Proton Therapy. [PHI Redacted] made this decision because of the successful record of treatment with NO side effects.

As of this date, [PHI Redacted] had NO side effects, PSA continues to go down and the quality of life is as good as it ever was.

I firmly believe that this form of treatment offers the best chance that the cancer victim will not suffer the side effects of incontenance and/or impotence and gives a good quality of life during and after treatment.

After much research, I am very happy with this choice and I encourage others to investigate Proton therapy.

I feel it would be a tragedy to deny payment for Proton therapy based on the cost. You cannot put a price on QUALITY OF LIFE after treatment.

Thank you, Eugene H. Armstrong

[PHI Redacted] underwent Proton therapy treatment for Prostate Cancer in 2005. I learned of this cancer treatment thru my dentist whose father-in-law had the treatment 16 years earlier( & is still cancer- free). After being approved for the treatment and insurance coverage, [PHI Redacted] began treatment with no side effects. It is amazing and I have recommended this to some co-workers who have been diagnosed and know of 2 who have done this treatment with great success. [PHI Redacted] PSA has gone down to 1.0 with no sign of cancer returning. There were no side effects during or after treatment. I feel it is very important to keep proton treatment as a treatment for Medicare patients. It is very effective with less side effects than other treatments and should be made available thru Medicare for those who take the time to research treatments and discover this method. It would be very sad to think that if [PHI Redacted] cancer returns at a later date that Medicare would not cover this treatment as I KNOW that it WORKS! Please consider the mental well being of cancer patients along with the physical. I feel, as do former proton treatment patients, that Proton should be available to any person in the US who would choose it as it is effective!

SUBJECT: Response to The Possibility of CMS Eliminating Payment for Proton Beam Radiation Therapy for Prostate Cancer

[PHI Redacted] received proton beam radiation therapy Gy 18 months ago to cure prostate cancer. [PHI Redacted] had daily treatments providing in total about 80 Gy to prostate. If given on whole body at one time, this would be about 10 times a lethal dose. The radiation to good tissue was so low that [PHI Redacted] had no significant negative side effects. Treatment was painless and there were no restrictions on physical activity. [PHI Redacted] PSA before treatment was 11 ng/ml and has continued going down. Today it is 1.5 ng/ml. About 100 other prostate cancer patients being treated at the same time had similar results.

The dose distribution with protons to the prostate is significantly better than treatment with neutrons or x-rays, permitting more radiation to the cancer and a better cure rate with no major adverse side effects in most cases. James Metz, MD at the Abramson Cancer Center of the University of Pennsylvania, compares the acute and long term side effects of protons, photons (x-rays), and prostatectomy in a report, dated June 29, 2006. His comparison is summarized below.

The acute complications of proton versus photon therapy are:
Grade 2 GU toxicity - Protons 0%, Photons 28%
Grade 2 GI toxicity - Protons 0%, Photons 35%
Either GU or GI morbidity - Protons 0%, Photons 53%

Acute complications of a prostatectomy are:
Hospitalization - 5 to 7 Days
Absence from work - 4 to 6 Weeks
Death - 0.3%
Pulmonary embolism/ DVT - 2.6%
Myocardial infarction or arrhythmia's - 1.4%
Wound Complications - 1.3%
Lymphocele - 0.6%
Surgical Rectal Injury - 1.5%

Long term complications for protons, photons and prostatectomy are:
Impotence - Protons 30%, Photons 60%, prostatectomy 60%
Incontinence requiring a pad - Protons prostatectomy 32%
Bladder Neck contracture - Protons 0%, Photons 3%, prostatectomy 8%
Chronic Cystitis - Protons 0.4%, Photons 5%, prostatectomy n/a
Grade 3 GU toxicity severe frequency - Protons 0.3%, Photons 2%, prostatectomy 36%
Grade 3 GI toxicity rectal bleeding requiring transfusion severe pain - Protons 0%, Photons 7%, prostatectomy n/a
Rectal Stricture - Protons 0%, Photons 0.5%, prostatectomy n/a.

In addition to the above, the AMA in 2005 published a report stating that those patients having a prostatectomy will have a reoccurrence of cancer within 10 years.

Also, protons may treat tumors within 0.4 inches of nerves or vital organs without damage to these items. This is not possible when treatment is done with x-rays. This fact helps to confirm that proton beam therapy reduces radiation to good tissue for prostate treatment.

Yes, treating prostate cancer is more expensive with protons than treatment with x-rays. Conversely, cost for treatment of acute and long term complications with standard treatment are substantial. This may involve treatment with chemotherapy, radiation, hormones and more, plus a negative effect upon the patient’s quality of life, lost time, hospitalization and other complications. I do not know the cost of a prostatectomy, but based upon the cost of [PHI Redacted] one day in the hospital to place a stent in an artery ($40,000), the cost of a prostatectomy is probably at least as high as proton therapy.

Some claim that proton therapy is experimental. Over 55,000 cancer patients have been treated with protons. 25 facilities in the world now treat prostate cancer and about 50 other cancers with protons in a clinical environment, and at least 15 more are building or planned. About 200 insurance companies support proton therapy for cancer including prostate cancer.

Some claim that the 5 hospitals in the USA providing proton therapy are enough. Again, wrong. These facilities can treat, at most, 12,000 patients per year. As estimate for today indicates that about 300,000 cancer patients per year could benefit from proton therapy. An oncologist at a large hospital stated to me that due to the aging population, this number could reach 1,000,000 within 10 to 15 years.

Robert J. Marckini ([PHI Redacted]) published a book in 2006 entitled, “You Can Beat Prostate Cancer and You Don’t Need Surgery To Do It.” This book was written after studying proton and standard treatments and discussion with many doctors and patients. His book is now one of the best selling medical books on amazon.com. He also established a prostate cancer support group, now numbering over 3,500 patients.

In all due respect, if Medicare should eliminate payment for proton therapy for prostate cancer, it would be a disservice to patients, negatively effect their lives and in the long run, increase Medicare cost. With further technology improvements planned for existing and planned proton treatment facilities, its cost will decrease.

Sincerely,

Proton beam therapy for prostate cancer: Proposed as means to concentrate radiation therapy and reduce side effects. Very high upfront cost to build these facilities and thus only at very few facilities. For prostate cancer treatment, no current comparative trials comparing to usual therapy.

My response to this issue:

[PHI Redacted] was treated for prostate cancer at the Loma Linda University Medical Center in January to March 2004. [PHI Redacted] had a PSA of 5 and a Gleason Score of 3+2 for a total of (5). [PHI Redacted] biopsy showed cancer was a stage T1C. [PHI Redacted] prostate was enlarged to about 80 grams.

[PHI Redacted] had 40 proton treatments and PSA has continued to decline and is now 0.2 after 4 and a half years. Following Proton therapy treatment [PHI Redacted] no side affects from the treatment. [PHI Redacted] take Flomax and Finasteride (Proscar) to offset the normal issues of an enlarged prostate.

Proton therapy has cured [PHI Redacted] prostate cancer and allowed to have a normal life without urinary or sexual side affects. [PHI Redacted] very thankful that was able to have this proton therapy versus other options that usually have life changing negative side affects.

My Perspective [PHI Redacted] Concerning Medicare Funding of Proton Beam Therapy

[PHI Redacted] I submit the following for your consideration.

Prior to selecting PBT, [PHI Redacted] researched, read books on different modalities, and talked with many former PBT patients. Some of them can be contacted by phone or e-mail here: http://www.protonbob.com

After treatment, [PHI Redacted] had one minor side affect which resolved in two days (blood in urine … checked by cystoscopy.) The opinion of the radiation oncologist is that it was the normal process of blood cells renewing themselves.

[PHI Redacted] feel well and able to maintain the level of energy and good general health that [PHI Redacted] had before the Proton Beam Therapy.

I have read with dismay of the side effects suffered by those who had surgery. A patient my family knows had brachytherapy. Due to a seed moving where it was not supposed to go, this man nearly lost his life. Instances like this reinforced [PHI Redacted] decision to choose PBT.

[PHI Redacted] incurred considerable personal expense traveling 6000 miles round trip to the PBT facility. Why did [PHI Redacted] choose to do that when a world renowned IMRT center was only 100 miles from home? It was because of the excellent results, with few side effects, expressed in many testimonials for PBT and because of research.

Further, it was because [PHI Redacted] had a right nephrectomy in [PHI Redacted] and nephrologist recommended that [PHI Redacted] not choose IMRT because of side effects.

The cost of [PHI Redacted] treatment to Medicare was not the total of the charges submitted by the Proton Center. It was 80% of the Medicare “approved charges”. The difference was significant.

Medicare has been at the forefront of providing medical care for seniors. Regardless of a man’s age, it is imperative that he be given a chance at a full and healthy life.

If you were to be a candidate for treatment of prostate cancer, what would you recommend that Medicare do?

Please consider the material I have included here – when making a decision on continuing Medicare funding of Proton Beam Therapy.

Thank you.

In [PHI Redacted] developed prostate cancer and researched all the different treatments and decided, without a doubt, on Proton Therapy. [PHI Redacted] now cancer free and so thankful that Medicare and Blue Cross covered the cost. It is an absolutely marvelous treatment. No Hospital stay, no discomfort and no side effects. I have many friends who did other treatments and almost every one suffered from side effects such as incontinence and impotency, which creates more expense and follow-up treatment and surgery. Please continue funding the Proton Therapy cure for cancer. Thank you.
Charles Cory

[PHI Redacted] a Prostate Cancer Survivor. [PHI Redacted] had Proton Beam Radiation on Prostate and writing to encourage you to continue financial support for this type of treatment that I would say is superior to all others. [PHI Redacted] Family Physician suggested that [PHI Redacted] investigate Proton Beam Radiation when it was proven that [PHI Redacted] had aggressive cancer of the Prostate through biopsies by Urologist. [PHI Redacted] purposely did not chose Surgery due to a disastrous, near death, encounter with surgery on a poisonous, infected Gall Bladder. [PHI Redacted] was aware of radiation burns from X-Ray Radiation. I talked with men having had Proton Beam Radiation and they all related positive experiences. I have had 35 years experience as a Research Engineer in Major Electronic Instrumentation Companies so I applied good research methods to find the best solution for [PHI Redacted] need. [PHI Redacted] was grateful to travel 500 miles and be a short term resident for 8 weeks of treatment. [PHI Redacted] not experienced any side effects after 5 years from treatment. [PHI Redacted] PSA has been near zero for over 4 years. I am very grateful that Proton Beam Radiation was recognized for its quality treatment and covered by Medicare. I encourage you to continue that coverage.

Ablation for atrial fibrillation: If medication is not effective or not tolerated for atrial fibrillation, a nonsurgical procedure called catheter ablation may be chosen. Focal and circumferential catheter ablation for atrial fibrillation is still being studied in investigational trials but may be done in selected patients to try to cure atrial fibrillation. Is the evidence adequate to demonstrate health benefits in the patients who receive the procedure?

My response to this issue:

[PHI Redacted] was treated for atrial fibrillation by Dr. [PHI Redacted] at the Cleveland Clinic in April, [PHI Redacted] by the use of focal and circumferential catheter ablation. [PHI Redacted] was 66 years old at the time, and was otherwise in health

[PHI Redacted] had recurring and chronic atrial fibrillation for about 5 years preceding the ablation. [PHI Redacted] took a number of different drugs to control the Afib, but all of them made [PHI Redacted] sick and prevented from living a normal and active life. [PHI Redacted] could not easily walk up stairs or play any favorite sports such as tennis, hiking, camping, etc.

The circumferential catheter ablation immediately returned [PHI Redacted] to normal sinus rhythm and been in normal sinus rhythm for over 5 years since the ablation. The ablation basically gave [PHI Redacted] life back. The drugs were not able to do that[PHI Redacted]. For [PHI Redacted] circumferential catheter ablation was a life saver.

[PHI Redacted] 71 now, and about a month ago [PHI Redacted] was under considerable stress. For the first time since the ablation [PHI Redacted] had a short bout of Afib. It was treated with Propafenone HCL (Rythmol) and immediately returned to normal sinus rhythm again. [PHI Redacted] cardiologist believes it is likely will able to stop taking Rythmol in month or so. It is very important to [PHI Redacted] to maintain sinus rhythm without taking heart rhythm drugs as they all have serious and harmful side affects.

[PHI Redacted] very thankful that was able to have circumferential catheter ablation so could return to normal sinus rhythm and enjoy an active and healthy life style.

[PHI Redacted] was diagnosed with prostate cancer in [PHI Redacted]. [PHI Redacted] doctor recommended proton therapy treatment. [PHI Redacted] accepted that advice. [PHI Redacted] received the 8-week treatment and feel that it is by far the best there is available today. [PHI Redacted] PSA is checked every 6 months by Urologist and it has remained under 1.0. [PHI Redacted] was completely satisfied with every aspect of treatment and would not hesitate to recommend proton treatment to anyone diagnosed with prostate cancer.

I have been a practicing Orthopedic Surgeon performing total hip arthoplasty for over 21 years. The BHR resurfacing arthoplasty represents a dramatic improvement in this proceedure. The BHR is a total hip in that both the acetabulum and femoral head are resurfaced and therefore it does represent a "stop gap" type proceedure. In actually the longevity of this operation is almost identical to convential total hip replacement. However, the BHR patients have less bone removed, recover faster, have less pain, a lower dislocation rate, and higher overall patient satifaction. It is clearly the superior operation and I perform this proceedure on all patients who are candidates for it because of its superiority. It would be a travesty not to have this proceedure available to our Medicare and Medicaid population

Sincerely, Arthur F.Lee M.D. FACS

Proton Beam Therapy is the most effective method for treatment of prostate cancer. It has the best statistics for complete recovery without the serious side effects that are characteristic of 'seeds, surgery, and x-rays'. [PHI Redacted] a walking, completely functioning testament to the success of proton beam therapy treatment. It would be a tragedy if future generations of prostate cancer victims were denied this form of treatment. In essence such denial sentences future prostate cancer suffers to a life of misery and pain. I know this for a fact because my friends and neighbors who chose other methods of treatment currently suffer from their sides effects, they feel embarrassed in public and suffer from continuous pain. As the agent amd gardian of health care for the aged medicare and its minions OWE it to the men of this nation to continue to support proton beam therapy as a treatment option for prostate cancer.

Proton Treatment for Prostate Cancer

[PHI Redacted] recently completed 45 proton treatments for prostate cancer. [PHI Redacted] cannot express the gratitude for being able to receive this treatment. [PHI Redacted] NO side effects from this treatment. NONE. I talked to friends that had surgury for prostate cancer and and still wearing diapers 3 years later. I talked to men who have incontient problems and are impotent. [PHI Redacted] NONE of this problems. Without Medicare many of us could not have this treatment. I urge whomever is voting on this not to discontinue this coverage.

Eliminating Medicare coverage for the treatment of prostate cancer with proton beam therapy is very ill-advised. Attention instead should be to bring down the cost of treatment in the years ahead.

After months of careful investigation in [PHI Redacted], [PHI Redacted] chose to have prostate cancer treated with protons at Loma Linda University Medical Center. Why? [PHI Redacted] lead a very active life and wanted to avoid debilitating side effects that not only would affect life going forward but that of wife. [PHI Redacted] made the right choice. Except for some slowing of urination, which possibly is due to aging anyway, [PHI Redacted] side effect free.

Cancer has been on my agenda for many years at no small cost to myself. I was a director of the broadcast industry's Radio and Television Codes heavily involved in the self-regulation of TV advertising. In 1969, I blew the whistle on cigarette advertising before Congress leading to the legislation banning cigarette commercials from radio and TV. As a result, the broadcast industry lost countless of millions of dollars and I lost my broadcast career but many lives were saved.

Why do I mention this? Because money is not the sole determing factor when decisiona on health issues are involved. Medical coverage and the treatment method impact one's health and lifestyle for years to come. Decisions have to be made based upon the quality of treatment, its outcome and minimal side effects - not just the cost. In that regard. proton beam therapy for prostate cancer ranks at or near the top. [PHI Redacted]

I am not medical never have been nor will I ever be but what I do know from experience. [PHI Redacted] was diagnosed with prostate cancer over two years ago. He weighed many options but the only one that made sense to him was Proton therapy. He had proton and photon treatments. He is doing great. I would hate for Medicare to discontinue the coverage of proton therapy. [PHI Redacted] has no side effects never any incontinence, no pain. Feels great. We have/had friends who used other methods of treatments and [PHI Redacted] has not experienced any of their side effects. They have had problems with incontinence and their sex life wasn't all that great after treatment. Please let the person with the prostate cancer make the decision as to what kind of treatment is best for them. Just knowing that they have cancer is a hard pill to sollow and then be told they can't have the treatment they want.

There is an error in my comment
The paragraph "In addition to the above, the AMA in 2005
published a report stating that over one third of those patients
having a prostatectomy will have a reoccuranceof cancer within
10 years."

' over one third" was not included in the submittal. Sorry for the
error.
PCW

I am a retired USDA Veterinary Medical Officer (Foreign Programs Officer) [PHI Redacted]. [PHI Redacted] was treated succesfully by proton beam radiation with practically no untoward effects or complications. [PHI Redacted] In contrast, [PHI Redacted] had radical operation(removal of prostrate) at Sloane- Kettering Memorial Hospital. He had so many complications and after effects and worst of all, he became impotent. He had to undergo further expensive surgeries and treatments at Cornell Medical Hospital in New York so he could be intimate with his wife again. His quality of life was severely affected by the surgical removal of his prostrate. Two years later, his prostrate cancer showed up again and was successfully treated by proton beam radiation at Loma Linda. [PHI Redacted] proton beam treatment was over four years ago and psa is now 0.6 and prostrate shrunk considerably that urine flows easily and normally. [PHI Redacted] Your plan to stop reimbursing proton beam treatment expenses will be a great mistake and will be a step backward to more humane treatments of cancer. Quality of life must be considered in your decision. Thank you.

[PHI Redacted] was diagnosed with prostate cancer in July of [PHI Redacted] and spent six months analyzing all the treatment options (including surgery, IMRT, proton beam therapy and seeds), deciding on Proton Beam Therapy. [PHI Redacted] decision was heavily weighted by the probability of the side effects from the various modalities, possibly resulting negative effects on life style. [PHI Redacted] finished treatment at Loma Linda Medical Center in March of [PHI Redacted]. To date the treatment lived up to expectations - psa has continued to fall and there have been no side effects, ie, no incontinence, no erectile dysfunction and no rectal issues. Needless to say [PHI Redacted] quite happy with decision to use Proton Beam Therapy.

This is in regards to Medicare possibly dropping medicare recipients from receiving aid for Proton Radiation treatments for prostate cancer. [PHI Redacted] After witnessing [PHI Redacted] with prostate cancer at age 58; his surgery; and his very painful death 7 weeks later I knew I would never have surgery. [PHI Redacted] had surgery on his prostate 4 years ago. It is now a horror story and it has come back. His demise is in the near future. After much research, I discovered the proton treatment. [PHI Redacted] had 35 treatments with NO SIDE EFFECTS. The proton treatment seems to have a much higher success rate than surgery with a very minimum amount of side effects. And others that I have spoken to who has had this proton treatment has a very low PSA count many years later with a very good quality of life. My reason for writing to you is to please advise those requesting medicare to drop this treatment that this is a very successful treatment and should not be stopped. If you know anyone who has protate cancer, please have them check into proton treatments. This treatment is saving [PHI Redacted] life! Thank you for reading my letter.

Re: Proposal to stop Proton Medicare reimbursements:

[PHI Redacted] a Prostate Cancer survivor who owes life to having been able to receive Proton Therapy seven years ago. [PHI Redacted] cancer, Gleason 9, was sufficiently aggressive that precise pin-pointing of the radiation beam was required. This was possible with Proton Therapy, but not with conventional radiation. The result was not only an undetectable PSA, but, very importantly, reduction of major long-lasting side effects.

I am commenting on the proposal to discontinue reimbursement by Medicare for Proton Radiation Therapy. [PHI Redacted] had Proton Therapy for prostate cancer and the reason [PHI Redacted] selected Proton over all the other options was because of quality of life concerns. [PHI Redacted] experience is that [PHI Redacted] had zero issues related to sexual, urinary or intestinal or any other function during or since treatment.

I know other men who have had other treatments surgery and radiation seed implants, who have had significant and progressively worsening issues since their treatments.

Not only is their quality of life deteriorating, but their medical costs continue to mount as they try to correct or lessen the symptoms of their problems.

I believe it would be a mistake by Medicare to discontinue Proton treatment reimbursement because of the initial cost of the treatment. You need to include the after treatment costs of the other methods surgery, regular radiation and seed implants, as well as the potential deprivation of quality of life benefits for Proton patients. In addition, continuing improvements in Proton methods is bringing the costs down and the future costs will be much more competitive.

Proton Therapy Treatment for Prostate Cancer

Based on [PHI Redacted] experiance I strongly urge CMS to continue to cover Proton Therapy Treatment for prostate cancer. [PHI Redacted] PSA is down to .05 and never had issues with incontinence or impotence. [PHI Redacted] had no infection, bleeding or pain. This treatment is far superior, and safer than traditional surgery for the above reasons.

[PHI Redacted] did a lot of research and consulted several doctors before choosing proton therapy for treating [PHI Redacted] prostate cancer. I think proton therapy is best for many man due to the minimalizaiton of side effects, which must be taken into account in determining "cost", which must surely decrease as time goes on. Please do not take away this treatment choice

Dear Sir or Madam,

I cannot fathom the proposal to disallow Medicare reimbursement for Proton therapy treatment. This issue should not be about the cost of the treatment, but rather its effectiveness and lack of side effects, which results in a much better quality of life for the cancer patient. I watched [PHI Redacted] lose all of his quality of life after having prostate removal surgery no more fishing, golf, or anything he used to enjoy tremendously. When [PHI Redacted] was diagnosed decided upon proton therapy because of 1) it's overall effectiveness and 2) because of minimal side effects.

[PHI Redacted] received proton treatment at Massachusetts General Hospital for prostate cancer over three years ago. [PHI Redacted] PSA was 4.7 before treatment and as of last test had decreased to 1.2, with no side effects whatsoever.

The issue here should NOT be about cost, because if you remove that from the equation, the overall best and most effective option for the treatment of prostate cancer is proton therapy. The money saved via this poorly-thought-out proposal would be better spent going after doctors who convince unknowing, uneducated patients to undergo needless surgery, or surgery where it is quickly discovered that the patient needs some form of radiation treatment because the Medicare paid for surgery did not remove all the cancer. You should be ENCOURAGING patients to receive proton therapy rather than trying to remove this option from the acceptable Medicare treatments. This proposal is a giant step backwards.

George Jehn

RE: Medicare/Medicaid Coverage of Proton Therapy for Treatment of Prostate Cancer

There is no question in my mind that proton therapy offers the best available treatment option for men diagnosed with early- or intermediate-stage prostate cancer. Medicare and Medicaid should continue to grant full coverage to these treatments. This will also help ensure that most private insurance companies continue to cover this proven therapy – an important fact for those of us who have not yet reached retirement age. I hope HHS will take the educated patient’s perspective into account when making its decision on this matter.

[PHI Redacted] I learned about this option by chance and word-of-mouth. Specialists offering alternative treatments don’t like to talk about proton therapy or have done little to inform themselves about it. They leave it up to motivated patients interested in their own well-being to do the research. [PHI Redacted] urologist who diagnosed [PHI Redacted] was more objective than many I have heard about from my friends on the subject of proton therapy. He said he had heard of it but did not know a lot about it, encouraged research and was genuinely neutral in his recommendation of treatments.

I extensively researched proton therapy and compared it to the many alternatives[PHI Redacted]. I discovered there are lots of studies on surgical and traditional radiation options, but most are based on what most people would consider to be small patient sample sizes – 300 to less than 1,000 in most cases. Further, most of these studies were sponsored by medical institutions with a vested interest in the therapy being studied.

The long-term survival rates of patients in these studies were roughly the same for all of the analyzed treatments, but the frequency of undesirable side-effects was high, quite variable and affected significantly by the choice of physician who performed or managed the treatment. [PHI Redacted]

In contrast to photon therapy, proton therapy is performed at only a few facilities in the United States, is comparatively “new,” and not surprisingly has fewer published studies to document its growing success. There is a rather extensive study published by Loma Linda that should be closely reviewed. It documents that proton therapy for prostate cancer patients is producing results equivalent or somewhat better than those for IMRT and other more widely practiced radiation therapies.

In addition, I encourage CMS to carefully review the just-released Harvard study that is mentioned in one of the comments posted in this online comment section of the HHS website. That study covered 1,450 patients treated between 1974 and 2001 and controlled for age, year of treatment, site of treatment, and cancer histology.

The Harvard study found a remarkable 50 percent lower incidence in secondary malignancies in proton patients than in those who had received photon radiation treatments. Apart from the lower frequency and intensity of post-treatment side-effects, this is one of the important claimed benefits of proton therapy – which now has been documented in a solid, peer-reviewed study.

[PHI Redacted] recently completed therapy at the Florida Proton Therapy Institute with very positive results and an exceptional experience: no pain, quality care, accessible physicians and nurses, and professionals who were eager to explain proton therapy and its likely impacts. [PHI Redacted] was able to continue a very active telecommuting work routine throughout 8 weeks of proton therapy and maintain usual, active lifestyle throughout.

With average life expectancy rising and earlier diagnosis of prostate cancer occurring, the economics of proton therapy has become clear. This miraculous treatment option should be encouraged and fully funded. Proton therapy is good medicine and good public policy. HHS would not have placed this therapy on its covered list previously if it did not agree with this conclusion.

Proton therapy is both reasonable and necessary. Thousands of patients who have experienced it believe this is true and there are recent, valid studies that show the genuine immediate and long- term benefits of this therapy in comparison with other alternatives.

Thank you for considering these comments.

[PHI Redacted] After checking out several alternative treatments [PHI Redacted] decided on Proton. There are very few side effects with this treatment. Just a little red spot on one hip was the extent of [PHI Redacted] side effects. When compared with what [PHI Redacted] urologist was recommending (hormone shots and radiation) this was a breeze! Hormone shots were not necessary. At one time [PHI Redacted] PSA was 29 (after a biopsy) and now it is 2.9 and will continue to go down. [PHI Redacted] was a 7 Gleason Score. [PHI Redacted] 80 years old and am glad that did not do the "watch and wait" theory either. The treatment was great and so were the people at the Florida Proton Center. I would recommend Proton treatments for anyone with cancer.

I am concerned that CMS will remove proton therapy from coverage by medicare, based on the biased and uneducated responses of many oncologists and radiologists who favor IMRT. Many of the comments I have read so far demonstrate a lack of knowledge about the advanced proton procedures and a failure to take into account the reports of patients on the success of their treatment. Patient follow up has been done and is continuing to be done contrary to the opinions of several commentors and extensive documentation is available. Advances have been made in proton therapy and accurate beam modulation is done, specifically designed for each patient, and prostate location is also done with x-ray location by gold fudicial markers during each exposure and after exposure as well. As a scientist familiar with radiation effects in materials, selection of proton therapy based on Bragg effects was a fundamental in [PHI Redacted] selection of proton therapy. Costs of proton therapy are coming down, and research to provide advanced treatment with IMRT sized machines is underway. I believe strongly that to stop reimbursement for proton therapy is a serious mistake. Please do not stop coverage!

I am [PHI Redacted] and a retired air Force veteran. I strongly oppose the emlimina- tion of funding of Proton Therapy from Medicare.

[PHI Redacted] a one year survivor who had Proton Therapy. [PHI Redacted] experienced no significant side-effects during treatment nor after. [PHI Redacted] was able to continue a fairly active lifestyle including cycling. [PHI Redacted] rode bicycle almost 800 miles during treatment which [PHI Redacted] could not have done under any other treatment protocol I know of.

Please consider lifestyle and quality of life factors in your evaluation and keep funding Proton Therapy as it is the best overall package today in my view.

It is imperative that proton therapy be covered
by medicare! Opponents(all who seem to be
motivated by reduction in the income from their
specialties) state things like "brachytherapy
has equal result to proton therapy". No one has
had a seed migrate with protons!

Response to question of effectiveness of Proton Treatment: Proton treatment has Successfully treated prostate Cancer in 2004. [PHI Redacted] I am definitely a proponent of Proton Treatment. Thank You

Regarding the funding of proton radiation
treatment for prostate cancer:
Consideration should be given to the fact that
many of the patients were not acceptable for
other cancer treatments because of the higher
grades of their cancer or their complications
like organs out of place or a stroke candidate.
These higher risk patients could be accepted for
proton treatment. Other treatments could accept
only the low risk patients so the data must take
this into consideration, Then the efficiency of
proton radiation will be truly indicated.

[PHI Redacted] was diagnosed with Prostate Cancer and thought it was the end of the world. [PHI Redacted] doctors told [PHI Redacted] to "pick poison"; i.e. surgery, seeds, or radiation. All have lasting side effects especially incontinence and impotance. After careful study [PHI Redacted] found out about and chose Proton Beam Therapy. [PHI Redacted] Cancer cured and absolutely no lasting side effects. All treatments are not equal. Proton Beam Therapy is by far the best. Please do not deny Medicare coverage for this treatment.
Thank you,
Charles BlaneyI though