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Mitchell Terk, MD

Mitchell Terk, MD
Radiation Oncologist
Gold Star
2015 Castle Connolly Top Doctor's Award
2015 Jacksonville Magazine's Top Doctor's Award
2014 Castle Connolly Top Doctor's Award
2014 Jacksonville Magazine's Top Doctor's Award
2014 Vitals' Compassionate Doctor Award
2014 Vitals' On Time Award
2014 Top 10 Doctors Award


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Jamie Cesaretti, MD

Jamie Cesaretti, MD
Radiation Oncologist
Gold Star
2014 Best Doctor Award
2014 Orlando Style Magazine's Elite Doctor's Award
2012 Patient's Choice Award
2012 Top Doctors Award


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The Journal of the American Medical Association

 

Couple Riding Bikes Couple African American
                                       Couple Family Picture Dr. Looking in Microscope

Welcome to Jacksonville's Florida Proton Therapy for Prostate Cancer Resource Center

Every year 240,000 men will be diagnosed with prostate cancer, making it one of the most common cancers in the United States.

With improvements in early detection and recent advances in non-surgical treatment, men can now be cured of this disease and still maintain an excellent quality of life.

Our recent long-term studies have shown that more than 98% of men with early stage prostate cancer can be cured with a simple one-time out-patient prostate seed implant (brachytherapy), results far superior to proton beam radiation and other treatment modalities.

What is Proton Therapy?

Proton beam radiation is an older technology that has actually been in use since the 1950s. Rather than treating cancer with photons, as occurs with IGRT, men are simply treated with a different type of radioactive particle, called protons. Because it is new to north Florida, some men have been interested in comparing proton beam to newer and more precise forms of treatment, such as prostate Seed Implants and IMRT-IGRT.

In April 2012, one of the largest studies of prostate cancer outcomes in the US was published in the prestigious Journal of the American Medical Association. The researchers looked at 12,000 men treated with radiation for prostate cancer in the US and found that IMRT was associated with the BEST outcomes. Proton therapy had 31% higher gastrointestinal toxicity than IMRT and no discernible benefit when compared to other modalities (JAMA 2012).

The safety and effectiveness of seed implants and IGRT has been thoroughly studied in hundreds of scientific papers, with excellent long-term 15 year outcomes. In contrast, after 50 years of proton use, there is still remarkably very little published data on its cure rates and complications. There are no studies reporting outcomes beyond 5 years after treatment with proton beam. There are no studies showing long-term potency or incontinence rates. This data is critical for men with a long life expectancy. A review of every published study on proton beam radiation shows that patients suffer 20-40% higher cancer recurrence rates, are more likely to develop long term complications, and may be at a greater risk of developing new cancers than those treated with seed implants. In addition, proton beam therapy is time consuming (9 weeks of daily treatment are required), costly (more than $120,000), and not covered by many insurance plans.

One of the oldest and most experienced proton centers in the world is located at Harvard's Massachusetts General Hospital. A recent analysis there showed proton treatment actually delivered higher doses of radiation to the normal tissues around the prostate than treatment with IMRT (Trofimov et al IJROBP 2007). As a result, their institution now favors treating prostate cancer with seed implants or IMRT, instead of protons.

For the above reasons, most major cancer centers throughout the world have decided not to pursue the less effective proton beam technology and instead have focused their attentions on more innovative and successful seed implant and IMRT-IGRT programs for the optimal treatment of prostate cancer.

 

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Proton Radiation - Increased Recurrence Rate

Will seed implants improve my likelihood of being cured?

YES! Our cure rates with seed implants are 20 to 40% better than the best results ever published with proton beam therapy. Seed implants have the unique advantage of having the radiation placed directly into the cancer. The radiation is concentrated where it needs to be, without the unnecessary high dose radiation of areas outside the prostate, as occurs with proton therapy. (see chart below)

A recent study from the largest proton center in the country at Loma Linda, California reported that for 1,225 men with prostate cancer, the 5-year success rate with proton therapy was only 73%. For those with high risk disease, the success rate was only 43% (Slater, 2004). Unfortunately, there have not been any studies looking at outcomes more than 5 years following proton beam treatment. This is in comparison to our own recently reported long term study showing at 10 years, a 95% success rate with seed implants for intermediate risk disease, and 83% success rate for high risk disease (Terk 2009).

With the seeds being placed directly in the prostate, higher doses of radiation can be given to the cancer, resulting in a much higher BED (biologically effective dose). The 20-50% higher BED seen with seed implants results in much greater cancer killing. Seed implants allow the ultimate concentration of radiation directly in the prostate, while still keeping surrounding areas at the lowest dose possible.

Proton Beam vs. Seed Implant Success Chart

Biological Effective Dose Chart for Proton Beam, Seed Implant & Implant + IGRT


 

Proton Radiation - Increased Side Effects

Will I have fewer long term side effects with a seed implant?

YES - because high dose proton beam radiation is delivered externally from a machine, the radiation still must enter the body from the outside and pass through organs like the bladder and rectum and hips to reach the prostate, causing much greater side effects than seed implants. A study from a leading proton facility showed that following proton radiation, 41% of men had long-term rectal bleeding and 47% had long-term bleeding with urination (Gardner, 2002). Long-term incontinence rates after proton radiation still remain unknown.

In contrast to proton beam radiation, long term side effects are very rare with seed implants. Using an intra-operative dosimetry technique, the likelihood of the seeds migrating outside the prostate is less than 0.4%. Urinary incontinence occurs in less than 1% of men following a seed implant. Other severe urinary problems are also very rare. (Zelefsky, 2007)

Will seed implants allow for improved preservation of my erectile function?

YES - The best erectile function preservation rates are obtained with seed implants. By pinpointing the seeds directly in the prostate, there is minimal effect on nerves that help control erections. Studies show that up to 90% of men maintain their erectile function after a seed implant (Cesaretti, 2007). Erectile function has never been evaluated after proton beam radiation. Because proton radiation needlessly treats outside the prostate where the nerves reside to a high dose, much greater impotency rates are expected.

Radiation Effect Chart for Proton Beam & Seed Implant Prostate Cancer Treatment

A. A dose map of a prostate being treated with protons shows the excess radiation deposited outside the prostate. This is what causes the higher side effects.

B. A similar dose map of a prostate being treated with a seed implant shows no excess radiation outside the prostate, as the seeds radiate the prostate from within.

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Proton Radiation - Dangers

Why is there a high risk of proton radiation causing a new cancer to develop?

Of great concern, the renowned radiation biologist Dr. Eric Hall reported that the physics of proton radiation delivery causes excessive neutron contamination in the patient’s body.

Neutrons are dangerous nuclear particles that can damage normal organs. They are known to increase the likelihood of developing potentially life-threatening secondary cancers. (Hall, 2007).

This risk of neutron contamination is much greater with proton radiation than with either IGRT or seed implants.

 

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Proton Radiation - Salvage Treatment

What are my treatment options if I have a recurrence of my cancer after proton beam radiation?

The Florida Center for Prostate Care has the largest published experience in the world using seed implants to treat patients with recurrent cancer after prior radiation treatment. Several simple tests and our review of your records help determine if you are a potential candidate for this highly specialized treatment.

 

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Questions to Ask Your Doctor if You Are Considering Proton Radiation

Men with prostate cancer deserve answers clearly supported by evidence published in medical journals. 4 questions you MUST ask your proton doctor if you are considering proton beam treatment:

1. Have you personally published your 10 year proton beam results in a medical journal or presented them at an international conference?

2. For my stage of prostate cancer, what is the published likelihood that I will be cancer free 10 years after proton beam radiation? (please show me the articles)

3. Why do experts report my risk for developing a new secondary cancer is greater after proton beam radiation than prostate seed implants?

4. What is the 10 year published likelihood of maintaining my erectile function and urinary control (continence) after proton beam radiation?

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About Us

World Class Prostate Cancer Experience

The Florida Center for Prostate Care has physicians dedicated to the treatment of all stages of prostate cancer, including recurrent cancer after proton beam radiation.

Our caring team has treated more than 10,000 men with prostate cancer, and has performed more than 5,000 prostate seed implants, making us one of the world's premier centers. We have patented medical devices and published extensive research in medical journals. Based on our experience and reputation, we have trained hundreds of doctors across the United States, Europe, Asia, and Africa on our Procision™ seed implant technique. All of our centers also offer image guided radiation therapy (IGRT), the newest technology for the most precise delivery of external radiation therapy. Our experience will allow you to feel confident that you have obtained the best possible care anywhere in the world.

Cancer Experts

We have board certified specialists on hand for all other types of cancer as well, including lung, breast, and colon-rectal. We have one of the largest, most comprehensive radiosurgery programs in the world. We have been continuously caring for cancer patients throughout the area since the 1950's.

Our Primary Goal

Our primary goal is to provide you with comprehensive and leading edge cancer care in a compassionate and friendly environment.

New York Times Dr. Terk & Dr. Cesaretti top cancer specialist 2016

Mitchell Terk, MD Awarded Castle Connolly's 2016 Top Doctors Metro Area Jacksonville Award
Mitchell Terk, MD Awarded Castle Connolly's 2016 Top Doctors Metro Area Jacksonville Award
Mitchell Terk, MD American Registry: America's Most Honored Professionals Top 1% 2016 Award
Mitchell Terk, MD American Registry: America's Most Honored Professionals Top 1% 2016 Award
Jamie Cesaretti, MD American Registry: America's Most Honored Professionals Top 5% Award</b>
Jamie Cesaretti, MD American Registry: America's Most Honored Professionals Top 5% 2016 Award
Jamie Cesaretti, MD Awarded Castle Connolly's 2016 Top Doctors Metro Area Jacksonville Award
Jamie Cesaretti, MD Awarded Castle Connolly's 2016 Top Doctors Metro Area Jacksonville Award

International Prostate Cancer Conference 2014
International Prostate Conference 2013
Free prostate cancer booklet request
Florida Center for Prostate care

 

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DISCLAIMER: This website is not affiliated with the city of Jacksonville, Florida or the University of Florida Proton Therapy Institute.