ENA man with localised prostate cancer is choosing between surgery and radiotherapy and hears that proton therapy in Germany is “more precise and has no after-effects”. Proton therapy for prostate cancer is available, but radiotherapy for prostate cancer in Germany takes several forms, and protons are one of them, not a separate miracle cure.
Below: how protons differ from conventional radiotherapy, who they suit, what research shows, how a course runs and how to decide. For the centres and other tumours, see proton therapy in Germany.
How proton radiotherapy differs from conventional radiotherapy
Protons and photons release their energy differently. Conventional radiotherapy uses photons, high-energy radiation like X-rays, which pass through the body, leaving a dose before and behind the tumour. Protons are charged particles that slow down in tissue and release most of their energy at the end of their path, at a depth set by the beam’s energy: the Bragg peak. Beyond it, the dose drops almost to nothing.
This matters for the prostate because the rectum and bladder lie right next to it. A lower dose to them is the main argument for protons: in theory, less bowel irritation and fewer urinary problems.
Proton radiotherapy in Germany is given at a small number of specialised centres, listed on the page on proton therapy in Germany. But the comparison is not with the radiotherapy of decades ago: modern intensity-modulated photon therapy (IMRT) fits both field and beam strength to the prostate, and imaging before each session (IGRT) checks its position. Photons are very precise too.
Who radiotherapy suits and when protons are chosen
Radiotherapy suits mainly men with a localised tumour and no distant spread; protons come into question once radiotherapy has been chosen. The urologist and radiation oncologist decide together, based on biopsy, MRI and PSA results, which are explained on the page on prostate cancer diagnosis.
Protons offer no advantage, or are inappropriate, when irradiating the gland is not the main step: if the disease has spread, systemic treatment becomes the mainstay. Some men are better served by surgery, and for low-risk tumours the German guideline advises active surveillance, not immediate treatment. The options are compared on the page on prostate cancer treatment in Germany.
The plan often includes more than radiotherapy. For higher-risk tumours, hormone therapy is added to deprive the tumour of testosterone; it may start before the first session and outlasts the course. Sometimes a hydrogel spacer is placed between prostate and rectum: a gel that holds the bowel away from the gland during treatment, so it gets less radiation, and is later absorbed. Both are the doctor’s decision.
What research shows
Large comparative studies have not yet shown that protons control prostate cancer more reliably or cause noticeably fewer side effects than modern photon therapy. Individual studies conflict: where protons cause fewer of some complications, they may cause more of others.
The German S3 guideline on prostate cancer is clear: for localised intermediate- and high-risk tumours there is no indication that protons benefit patients more than photon IMRT with image guidance, and for locally advanced tumours they should be offered only in clinical trials. For patients, this means: the guideline’s standard is photon technique, not protons, and insurance cover for protons must be clarified beforehand.
Any prostate radiotherapy can cause side effects. During and shortly after the course, urination may become more frequent and an irritated rectum can make bowel movements painful or loose; later, over the years, erections may weaken. The radiation oncologist explains the likelihood beforehand. The NCI patient summary on prostate cancer treatment notes that radiotherapy can cause erection and urinary problems.
How a course runs and how to decide
A course starts with planning scans, followed by weeks of outpatient sessions. On a planning CT and an MRI the doctor outlines the prostate and the organs to spare; sometimes tiny markers, such as gold ones, are placed in the gland to check its position before each session. Sessions run on weekdays for several weeks; the centre sets the schedule.
Decide only after talking to both a urologist and a radiation oncologist. Urologists to consult include Prof. Jürgen Gschwend, director of urology at Klinikum rechts der Isar and head of its ProstaTUM prostate centre. At München Klinik Bogenhausen, PD Dr Atiqullah Aziz heads urology and the prostate cancer centre. In Hamburg, Prof. Michael Rink heads urology at the Catholic Marienkrankenhaus, focusing on uro-oncological surgery.
If proton therapy is not suitable, photons are used, for example at Strahlentherapie Pasing in Munich or the radiotherapy and radiation oncology departments of Ulm University Hospital and University Hospital Bonn. The cost of a proton course is broken down on the page on proton therapy costs.
Frequently asked questions
Do I need to stay in hospital during prostate radiotherapy?
No. Prostate radiotherapy is outpatient treatment: you attend a session on weekdays and leave afterwards. Because the course lasts several weeks, a patient from abroad needs accommodation near the centre for the whole period. Sessions are almost daily and tiredness can build up towards the end, so a short journey helps.
Why is hormone therapy given with prostate radiotherapy?
Because for higher-risk tumours radiotherapy works more reliably with it: hormone therapy deprives the tumour of the testosterone that fuels its growth. The German guideline recommends it for intermediate- and high-risk tumours, for much longer at high risk. Its own side effects include hot flushes and fatigue, so doctor and patient decide together whether it is needed.
Can I insist on protons instead of photons?
You can ask, but the proton centre’s radiation oncologists decide whether protons would help in your case. If not, they offer photon radiotherapy, which is not a refusal to treat. Note that the German guideline sees no proven benefit of protons for localised intermediate- and high-risk tumours, and payment must be agreed in advance.
How AlenMed arranges proton therapy for prostate cancer
AlenMed starts with your documents: histology with the Gleason score, prostate MRI, PSA history and any PET-CT. We translate them and send a request to a proton therapy centre and, in parallel, to a urologist, so the options can be compared.
The centre replies on suitability and start date and sends a cost estimate. We then prepare the visa invitation, find accommodation for the weeks of outpatient treatment and arrange an interpreter for consultations. AlenMed’s office is in Munich; partner hospitals are all over Germany.
This material is for reference only and is not an offer. The type of radiotherapy and its appropriateness are decided by a doctor after an in-person assessment.
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