Modern External-Beam Radiation Therapy for Prostate Cancer: How and When?

ObjectivesThis paper reviews the latest technologic developments in the field of external-beam radiation therapy (RT) for prostate cancer (PCa) and their clinical applications in the postprostatectomy setting and in conjunction with hormonal manipulation.MethodsThis review is based on a presentation during the New Horizons in Urology 2007 meeting held in Monte Carlo, Monaco, and includes relevant data from recently published literature.ResultsModern computer imaging, for example, computer tomography or magnetic resonance imaging, allows three-dimensional treatment planning techniques and a better definition and delineation of the target (prostate with or without seminal vesicles) and of the organs at risk (rectum, bladder, and penile bulb). Intensity-modulated RT and image-guided RT approaches are now available for the RT of PCa. Several phase 3 randomized clinical trials have demonstrated that immediate adjuvant RT after radical prostatectomy (RP) for patients at high risk for local relapse is associated with improved biochemical-free survival and clinical progression-free survival, compared to salvage RT. Furthermore, for high-risk, locally advanced PCa, androgen-deprivation therapy (ADT) combined with RT has shown better overall survival, compared to RT alone and recent data have revealed that 3 yr of adjuvant ADT after RT is superior to 6 mo for this subgroup of patients.ConclusionsTechnologic progress has contributed to improved RT results in clinically localized and locally advanced PCa. Immediate, adjuvant RT should be considered for patients with high-risk pathologic features after RP. For patients with locally advanced PCa, ADT combined with RT yields better outcomes than RT alone.