Advances in the treatment of prostate cancer with radiotherapy

• Review of advances in localized prostate cancer treated with radiotherapy.
• Radiotherapy intensification may increase the therapeutic ratio of prostate cancer.
• New biomarkers will improve prognostic stratification to test these strategies.

IntroductionPrognosis of prostate cancer has improved as a result of the combination with androgen deprivation therapy and the increase of radiation dose. However, a high number of prostate cancer patients will develop biochemical recurrence; therefore a research effort to increase the control of the tumour in these patients is necessary.MethodsTo increase the therapeutic ratio (the index between cytotoxic effects and normal tissue complications with a certain dose of radiation), different new strategies described in the literature have been reviewed.ResultsThere are several strategies that may increase the efficacy of radiotherapy to treat prostate cancer. First is based on physics and technology, and second based on biology.DiscussionTechnical advances in radiotherapy allow intensification of radiation through escalation of the dose or in combination with chemotherapy. Furthermore, targeting specific molecular dysregulated pathways in the tumour will increase the effects of radiation specifically in tumour cells. Hopefully, these strategies will result in increased rates of tumour control in all prognostic groups, especially in high risk tumours and a subgroup of patients with intermediate risk tumours, minimizing treatment morbidity and increasing the therapeutic ratio of radiotherapy.