Treatment of early stage prostate cancer: radiotherapy

PATIENTS with T1/T2 prostate cancer are well served by external beam radiation. 1. T1/T2, N0, M0 PATIENTS: The 10-year outcome of N0 patients is equal to that obtained by radical prostatectomy in similar patients without the operative mortality or incontinence that accompanies the latter procedure. Ten-year cure has been confirmed by PSA studies in irradiated patients, while this has not yet been demonstrated in surgical patients. 2. T1, NX, M0 PATIENTS: After radiation therapy these patients show no excess mortality as long as 15 years after treatment, an outcome confirming a strict criteria of cure. 3. T2, NX PATIENTS: After radiation therapy, these patients show continuing excess mortality to 15 years, but most 15-year survivors are NED, again supporting the concept of long-term cure. 4. T1/T2 N+, M0 PATIENTS: We must have clinical trials in these patients that study the roles of radiation, androgen deprivation, and surgery. 5. Conformal treatment technology is improving the technical delivery and dose administered by radiation therapy and decreasing both the acute and late side effects of treatment. It remains to be proved whether the increased dose and accuracy will improve local control and cure as hoped.