Update on the treatment of prostate cancer with external beam irradiation

We review the recent changes in the radiotherapeutic management of clinically localized prostate cancer, including the implementation of three-dimensional (3-D) conformal radiation therapy (3DCRT), biochemical disease-free survival (bNED control) using conventional and 3DCRT techniques, and the morbidity of these treatment strategies.

The components of 3DCRT are discussed, including patient immobilization, 3-D treatment planning, multileaf collimation, and electronic portal imaging. bNED control rates from institutions using conventional and 3DCRT techniques are compared. The gastrointestinal (GI) and genitourinary (GU) morbidity from prospective trials using conventional doses of radiation are compared to data from 3DCRT series. bNED control rates stratified by pretreatment prostate-specific antigen (PSA) are compared between surgical and radiation series.

bNED control rates (3-5 years) for patients treated with conventional and 3DCRT techniques ranged from 44-70% and 30-72% with pretreatment PSA levels 4-10 and 10-20, respectively. Although direct comparisons are difficult between treatment modalities, no difference in bNED control stratified by pretreatment PSA was observed between surgical and radiation patients.

Patients with clinically localized prostate cancer treated with 3DCRT demonstrate durable bNED control at 5 years. Conformal radiation techniques, multileaf collimation, electronic portal imaging, and patient immobilization have reduced acute and chronic GI and GU morbidity while allowing safe dose escalation in an effort to further improve local control and overall survival.