[Radiotherapy of prostatic cancer]

In most cases, surgery and radiotherapy are used for primary local treatment of prostate carcinoma. The treatment decision depends to varying extents on the involvement of the two clinical fields urology and radio-oncology. Radiotherapy seems to have more weight in the treatment of prostate carcinoma in the USA than in Germany, albeit with local differences. For the early stages prospective observation of the tumour is recommended. Surgery, as far as possible nerve conserving procedures, is indicated for localized tumours with no infiltration of the capsule or seminal vesicles. This does not mean that the clinical results after radiotherapy are worse in these patients. With both treatment modalities the survival data are comparable with those in a healthy population. Surgery is limited to the exploration of the pelvic lymph nodes in the stages C and D1. Radiotherapy has been shown to be effective in these tumours, but is still not satisfactory, with a relapse rate of ca. 30% for stage C after 10 years. This means new research and developments are necessary in conformation radiotherapy, neutron therapy, brachytherapy and hyperthermia. Side-effects after radiotherapy are rare, with late complications in only a low percentage of patients. Recurrences after radical prostatectomy can be followed for at least 5 years without evidence of disease. Radiotherapy has a good palliative effect in bone and brain metastases.