Intensity-modulated radiotherapy for adenocarcinoma of the prostate: a point of view

Adenocarcinoma of the prostate (CaP) is treated by surgery or irradiation, or both, with the type of treatment determined largely by local resources and referral patterns. Although the techniques employed by surgeons and radiation oncologists have improved and the morbidities associated with each have declined, for neither are they negligible. Epidemiologic data suggest that between 81% and 85% of men with CaP die of other causes, and a recent survey of untreated men arrived at a similar figure of 83%. Clinical reports, based upon postoperative tumor volume and grade, show that at least 5% of prostatectomies are unnecessary but the extent to which the other 95% benefit from this procedure is unclear. Some sense of these benefits is provided by a randomized, prospective clinical trial that compared prostatectomy with watchful waiting, and found only a 6% gain in overall survival after 8 years. These data call into question the promotion of highly complex and expensive radiation therapy equipment for the treatment of CaP when the prospects for increased life expectancies are at best small and unlikely to be distinguishable from results achieved by surgery, conventional external beam, or radioactive-seed implants.