The treatment of clinically localized prostate cancer is controversial. Options include radical prostatectomy, external-beam radiation therapy (EBRT), brachytherapy, cryotherapy, and watchful waiting.
Methods
The author reviews EBRT as treatment for clinically localized prostate cancer, with particular emphasis on the technological advances that have allowed dose escalation and fewer therapy-related side effects.
Results
Technological advances in the last two decades have significantly improved the delivery of EBRT to the prostate. This has resulted in an overall increase in the total dose that can be safely delivered to the prostate, which has led to modest improvements in biochemical outcome. An alternative approach of combining androgen suppression therapy and EBRT has also been successful in improving clinical outcomes. However, establishing the optimal therapy for prostate cancer remains controversial.
Conclusions
Recent progress has led to improvements in clinical outcomes in patients treated with EBRT for prostate cancer. It is hoped that the next decades will bring continued advances in the development of biologicals that will further improve current clinical outcomes.
References
1.
JemalA., SiegelE., WardE.Cancer statistics, 2006. CA Cancer J Clin.2006; 56: 103โ130.
2.
BucciM.K., BevanA., RoachMIII. Advances in radiation therapy: conventional to 3D, to IMRT, to 4D, and beyond. CA Cancer J Clin.2005; 55: 117โ134.
3.
Intensity Modulated Radiation Therapy Collaborative Working Group.Intensity-modulated radiotherapy: current status and issues of interest. Int J Radiat Oncol Biol Phys.2001; 51: 880โ914.
4.
Ten HakenR.K., FormanJ.D., HeimburgerD.K.Treatment planning issues related to prostate movement in response to differential filling of the rectum and bladder. Int J Radiat Oncol Biol Phys.1991; 20: 1317โ1324.
5.
PickettB., RoachMIII, VerheyL.The value of nonuniform margins for six-field conformal irradiation of localized prostate cancer. Int J Radiat Oncol Biol Phys.1995; 32: 211โ218.
6.
RoachMIII, Faillace-AkazawaP., MalfattiC.Prostate volumes and organ movement defined by serial computerized tomographic scans during three-dimensional conformal radiotherapy. Radiat Oncol Investig.1997; 5: 187โ194.
7.
LangenK.M., JonesD.T.Organ motion and its management. Int J Radiat Oncol Biol Phys.2001; 50: 265โ278.
8.
TrichterF., EnnisR.D.Prostate localization using transabdominal ultrasound imaging. Int J Radiat Oncol Biol Phys.2003; 56: 1225โ1233.
9.
LangenK.M., PouliotJ., AnezinosC.Evaluation of ultrasoundbased prostate localization for image-guided radiotherapy. Int J Radiat Oncol Biol Phys.2003; 57: 635โ644.
10.
HuangE., DongL., ChandraA.Intrafraction prostate motion during IMRT for prostate cancer. Int J Radiat Oncol Biol Phys.2002; 53: 261โ268.
11.
PouliotJ., AubinM., LangenK.M.(Non)-migration of radiopaque markers used for on-line localization of the prostate with an electronic portal imaging device. Int J Radiat Oncol Biol Phys.2003; 56: 862โ866.
12.
AubinS., BeaulieuL., PouliotS.Robustness and precision of an automatic marker detection algorithm for online prostate daily targeting using a standard V-EPID. Med Phys.2003; 30: 1825โ1832.
13.
WongJ.R., GrimmL., UematsuM.Image-guided radiotherapy for prostate cancer by CT-linear accelerator combination: prostate movements and dosimetric considerations. Int J Radiat Oncol Biol Phys.2005; 61: 561โ569.
14.
PouliotJ., Bani-HashemiA., ChenJ.Low-dose megavoltage cone-beam CT for radiation therapy. Int J Radiat Oncol Biol Phys.2005; 61: 552โ560.
15.
LetourneauD., MartinezA.A., LockmanD.Assessment of residual error for online cone-beam CT-guided treatment of prostate cancer patients. Int J Radiat Oncol Biol Phys.2005; 62: 1239โ1246.
OldhamM., LetourneauD., WattL.Cone-beam-CT guided radiation therapy: a model for on-line application. Radiother Oncol.2005; 75: 271โ278.
18.
SchellhammerP.F., el-MahdiA.M., HigginsE.M.Prostate biopsy after definitive treatment by interstitial 125iodine implant or external beam radiation therapy. J Urol.1987; 137: 897โ901.
19.
ScardinoP.T., WheelerT.M.Local control of prostate cancer with radiotherapy: frequency and prognostic significance of positive results of postirradiation prostate biopsy. NCI Monogr.1988: 95โ103.
20.
ScardinoP.T.The prognostic significance of biopsies after radiotherapy for prostatic cancer. Semin Urol.1983; 1: 243โ252.
21.
MillerE.B., LadagaL.E., el-MahdiA.M.Reevaluation of prostate biopsy after definitive radiation therapy. Urology.1993; 41: 311โ316.
22.
KubanD.A., el-MahdiA.M., SchellhammerP.The significance of postirradiation prostate biopsy with long-term follow-up. Int J Radiat Oncol Biol Phys.1992; 24: 409โ414.
23.
CrookJ., RobertsonS., CollinG.Clinical relevance of transrectal ultrasound, biopsy, and serum prostate-specific antigen following external beam radiotherapy for carcinoma of the prostate. Int J Radiat Oncol Biol Phys.1993; 27: 31โ37.
24.
BabaianR.J., KojimaM., SaitohM.Detection of residual prostate cancer after external radiotherapy: role of prostate specific antigen and transrectal ultrasonography. Cancer.1995; 75: 2153โ2158.
25.
PollackA., ZagarsG.K., SmithL.G.Preliminary results of a randomized radiotherapy dose-escalation study comparing 70 Gy with 78 Gy for prostate cancer. J Clin Oncol.2000; 18: 3904โ3911.
26.
PollackA., ZagarsG.K., StarkschallG.Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys.2002; 53: 1097โ1105.
27.
ZietmanA.L., DeSilvioM.L., SlaterJ.D.Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA.2005; 294: 1233โ1239.
28.
SathyaJ.R., DavisI.R., JulianJ.A.Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol.2005; 23: 1192โ1199.
29.
RagdeH., GradoG.L., NadirB.Modern prostate brachytherapy. CA Cancer J Clin.2000; 50: 380โ393.
30.
AshD.Advances in radiotherapy for prostate cancer. Br J Radiol.2005; 78(spec no 2): S112โS116.
31.
HolmH.H., JuulN., PedersenJ.F.Transperineal 125iodine seed implantation in prostatic cancer guided by transrectal ultrasonography. J Urol.1983; 130: 283โ286.
32.
D'AmicoA.V., WhittingtonR., MalkowiczS.B.Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA.1998; 280: 969โ974.
33.
KupelianP.A., PottersL., KhuntiaD.Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy > or = 72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys.2004; 58: 25โ33.
34.
BrachmanD.G., ThomasT., HilbeJ.Failure-free survival following brachytherapy alone or external beam irradiation alone for T1-2 prostate tumors in 2222 patients: results from a single practice. Int J Radiat Oncol Biol Phys.2000; 48: 111โ117.
35.
PeschelR.E., ColbergJ.W.Surgery, brachytherapy, and external-beam radiotherapy for early prostate cancer. Lancet Oncol.2003; 4: 233โ241.
36.
MerrickG.S., ButlerW.M., WallnerK.E.Impact of supplemental external beam radiotherapy and/or androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys.2005; 61: 32โ43.
37.
DattoliM., WallnerK., TrueL.Long-term outcomes after treatment with external beam radiation therapy and palladium 103 for patients with higher risk prostate carcinoma: influence of prostatic acid phosphatase. Cancer.2003; 97: 979โ983.
38.
SylvesterJ.E., BlaskoJ.C., GrimmP.D.Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: the Seattle experience. Int J Radiat Oncol Biol Phys.2003; 57: 944โ952.
39.
PickettB., KurhanewiczJ., PouliotJ.Three-dimensional conformal external beam radiotherapy compared with permanent prostate implantation in low-risk prostate cancer based on endorectal magnetic resonance spectroscopy imaging and prostate-specific antigen level. Int J Radiat Oncol Biol Phys.2006; 65: 65โ72. Epub 2006 Mar 6.
PilepichM.V., WinterK., LawtonC.A.Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma: long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys.2005; 61: 1285โ1290.
42.
PilepichM.V., WinterK., JohnM.J.Phase III Radiation Therapy Oncology Group (RTOG) trial 86-10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys.2001; 50: 1243โ1252.
43.
LawtonC.A., WinterK., GrignonD.Androgen suppression plus radiation versus radiation alone for patients with stage D1/pathologic nodepositive adenocarcinoma of the prostate: updated results based on national prospective randomized trial Radiation Therapy Oncology Group 85-31. J Clin Oncol.2005; 23: 800โ807.
44.
BollaM., GonzalezD., WardeP.Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med.1997; 337: 295โ300.
45.
BollaM., ColletteL., BlankL.Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet.2002; 360: 103โ106.
46.
HanksG.E., PajakT.F., PorterA.Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: the Radiation Therapy Oncology Group Protocol 92-02. J Clin Oncol.2003; 21: 3972โ3978. Erratum in: J Clin Oncol. 2004; 22: 386.
47.
D'AmicoA.V., ManolaJ., LoffredoM.6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA.2004; 292: 821โ827.
48.
LaverdiereJ., GomezJ.L., CusanL.Beneficial effect of combination hormonal therapy administered prior and following external beam radiation therapy in localized prostate cancer. Int J Radiat Oncol Biol Phys.1997; 37: 247โ252.
49.
LaverdiereJ., NabidA., De BedoyaL.D.The efficacy and sequencing of a short course of androgen suppression on freedom from biochemical failure when administered with radiation therapy for T2-T3 prostate cancer. J Urol.2004; 171: 1137โ1140.
50.
CrookJ., LudgateC., MaloneS.Report of a multicenter Canadian phase III randomized trial of 3 months vs 8 months neoadjuvant androgen deprivation before standard-dose radiotherapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys.2004; 60: 15โ23.
51.
RoachMIII, DeSilvioM., LawtonC.Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: Radiation Therapy Oncology Group 9413. J Clin Oncol.2003; 21: 1904โ1911.
