Radiotherapy and Prostate Cancer: Quo Vadis?

Context: Radiotherapy (RT) is one of the curative treatment options for clinically localised prostate cancer. Technical developments over recent years have yielded better conformation to the target volume, thus increasing the therapeutic ratio and decreasing side-effects. Objective: Our aim was to summarise current controversies in prostate cancer RT. Evidence acquisition: This paper is based on a presentation given at the 7th Meeting of the European Association of Urology Section of Oncological Urology in Vienna, Austria. Data from reviews and original papers were compiled and interpreted. Evidence synthesis: Evidence from randomised trials has indicated that total doses >72 Gy are significantly better in cases of biochemical disease-free survival. Image-guided radiotherapy resulted in reduced safety margins around the prostate target volume and decreased acute and late side-effects. To date, data from two randomised controlled trials have indicated comparable results between hypofractionation and normofractionation without an increase of side-effects. Until now, no prospective data have been published to support the hypothesis that proton therapy decreases late side-effects with comparable results to three-dimensional conformal intensity-modulated RT. Adjuvant RT for positive margins after radical prostatectomy (RP) has proved to be an advantage. Three phase 3 trials achieved a significant better biochemical nonevidence of disease of 20% for 5 yr. In one of these trials, survival also improved significantly with adjuvant radiation. However, salvage radiotherapy (SRT) is a possible option for a persisting or increasing prostate-specific antigen after RP. To date, there are no published randomised trials to compare adjuvant RT with SRT. Conclusions: During the few last years, there have been tremendous technological improvements with a focus on boosting the cure rate by increasing dose delivery while maintaining a similar or improved side-effect profile. Currently, efforts are also focused on shortening treatment times and improving efficacy through new technology. (C) 2010 Published by Elsevier B. V. on behalf of European Association of Urology.