Prostate cancer breakthrough that the NHS won't offer: It can spare men like Joe the side-effects of treatment. So why is it only available abroad?

Joe Tuftnell, 70, from Andover, Hants, was told to do nothing about cancer

Hee paid £16,000 for proton beam therapy in Prague clinic

Joe Tuftnell was not convinced when his doctors told him that the best course of treatment for his early-stage prostate cancer was to do nothing.

Instead, the retired IBM engineer went to Prague to have the tumour destroyed by proton beam therapy, a cutting-edge intervention not available on the NHS.

Joe, 70, a grandfather of three who lives with wife Vanessa, 67, in Andover, Hants, was diagnosed last April. A routine blood test by his GP revealed his level of prostate-specific antigen (PSA) had risen.

Joe Tuftnell, photographed at his home in Hampshire, Went abroad for prostate cancer treatment

PSA is produced by the prostate gland - raised levels can mean the gland has developed a cancerous growth.

A biopsy confirmed the diagnosis and Joe was told by his hospital consultant that the cancer could be managed with 'active surveillance'.

While this might sound like doing nothing, in fact it involves closely monitoring the tumour - usually with PSA tests and digital rectal examinations every three to six months, and repeat prostate biopsies every few years.

If tests show the cancer is growing, doctors may give treatment such as surgery, radiotherapy or chemotherapy.

'Active surveillance' is offered to men with less aggressive prostate cancer to avoid or put off unnecessary treatment that has potentially serious side-effects.

The prostate is a chestnut-size gland that sits below the bladder and around the urethra. Next to it are nerves and blood vessels that are essential for proper erectile and bladder function.

Pictured with his wife Vanessa. He paid £16,000 for the procedure

Radiation can damage these nerves and blood vessels - half of prostate cancer patients given conventional radiotherapy were impotent after two years, according to a study published in the Journal of the National Cancer Institute. About 4 per cent of men are left with serious urinary incontinence. Surgery can also damage the nerves and blood vessels.

Joe 'could not see the point of waiting for the condition to worsen' but the alternatives didn't appeal, either. 'They meant I faced a considerable risk of impotence and incontinence,' he says.

Then last year he was visiting a friend in Prague when he saw a newspaper article about the Prague Proton Therapy Centre, which offers proton beam therapy.

Unlike conventional radiotherapy, which relies on high-intensity X-rays, this bombards tumours with protons, the hearts of atoms. The millimetre-accurate treatment is claimed to be less destructive to surrounding tissue and so less likely to cause side-effects.

Furthermore, the physical characteristics of protons mean they are not absorbed into the tissue they pass through, so they don't damage it while killing the tumour.

'The success rates were the same as conventional treatments offered in the UK,' says Joe. 'While there was no guarantee I'd not suffer side-effects, the chances looked promising.'

They sent the beam in from one side of my body, then the other,' he remembers. There was no pain or discomfort - I left the hospital within an hour of arriving... My PSA has dropped from 7 to 1.8 and I'm living a normal life'

Doctors in Prague said the operation would cost £16,000. Had his cancer been at an advanced stage, it could have cost up to £29,000.

Joe raided his life savings and had the procedure last June.

After he had been given an MRI and CT scan, surgeons inserted three small gold grains into his prostate to enable the beam to target the tumour safely.

He lay in a body mould that held him absolutely straight, so his prostate did not move while the beam was targeted; then he was wheeled into the radiation room.

The procedure took only a minute and a half. 'They sent the beam in from one side of my body, then the other,' he remembers.

'There was no pain or discomfort - I left the hospital within an hour of arriving.'

This process was repeated four times, every second day.

'My NHS consultant was initially concerned about what I'd done,' Joe says. 'But the outcome has been brilliant. My PSA has dropped from 7 to 1.8 and I'm living a normal life.'

The Prague clinic claims it receives daily inquiries from British men about being treated for prostate cancer. So far, all the British patients it has treated have funded their care themselves.

This month it was reported that Peter Kysel, a retired British banker who went to Prague for proton therapy, was planning to send his £17,000 bill to the NHS in the hope of taking advantage of a law that gives patients the right to be treated anywhere in the European Union (if that treatment is considered appropriate). But why is this treatment not available in the UK?

All the British patients the Prague clinic has treated have funded their care themselves

art of the problem is the cost of proton therapy technology - about £125 million per machine. But doctors here also say there is a lack of robust clinical evidence to prove its worth conclusively over conventional radiotherapy.

Last August, the Government confirmed that £250 million would be made available to build two UK proton therapy centres - one at The Christie Hospital in Manchester, the other at University College Hospital in London. Both are due to open in 2018.

But Cancer Research UK says the centres will not be treating men with prostate cancer. 'They will be focusing their time and energy on childhood cancers and rare adult cancers,' says Kat Arney, the charity's science information manager.

Proton therapy has many benefits over conventional treatment for these cancers. Rare adult cancers, such as those at the base of the skull or spine, can be hard to tackle without damaging surrounding nerves, and conventional radiotherapy can be particularly harmful for children, whose bodies and brains are still developing.

The NHS sends 80 such patients a year abroad to have proton therapy, and treating them in the UK should save money in the long term, says Kat Arney.

But in prostate cancer, the evidence so far for proton therapy's increased benefits is considered too marginal to justify the cost.

The Proton Therapy Centre claims the treatment dramatically cuts the risk of life-changing side-effects, such as impotence.

'As far as we can tell, the incidence of impotence is about 30 per cent for people who have proton beam therapy, compared with about 60 per cent for conventional treatment,' says Mike Cullen, the UK representative for the centre. These results have not been independently verified.

But the good news is that a British firm is developing new, cheaper proton-therapy equipment.



London-based Advanced Oncotherapy is working with physicists at the European Centre for Nuclear Research (Cern), the scientists who developed the Large Hadron Collider. It says its new machines will fit into one room rather than occupying a whole purpose-built facility.

They cost around £26 million per machine, less than a quarter of the price of the two competitors.

Advanced Oncotherapy is proposing to install proton beam therapy units in ten UK hospitals and clinics in the next five years.

Christopher Nutting, professor of radiotherapy at the Royal Marsden Hospital and Institute of Cancer Research, and a non-executive director of Advanced Oncotherapy, says: 'We should be cautious about the claims being made for proton therapy.

'In the U.S., private care providers are making all sorts of spurious claims for it.'

However, he is quietly hopeful.

'Any form of radiation therapy where you can be more accurate is potentially a beneficial advance.

