Strahlentherapie und Onkologie

, Volume 186, Issue 10, pp 531–534

The German S3 Guideline Prostate Cancer

Aspects for the Radiation Oncologist
  • Frederik Wenz
  • Thomas Martin
  • Dirk Böhmer
  • Stefan Martens
  • Felix Sedlmayer
  • Manfred Wirth
  • Kurt Miller
  • Axel Heidenreich
  • Mark Schrader
  • Wolfgang Hinkelbein
  • Thomas Wiegel
Current Discussion


This report summarizes the relevant aspects of the S3 guideline prostate cancer for the radiation oncologist. Treatment decision and dose prescription are discussed, as well as technical performance of external beam radiotherapy and brachytherapy. The relevant literature is cited to allow an overview of the current recommendations.

Key Words

Prostate cancer Radiation oncology German S3 guideline 

Die deutsche S3-Leitlinie Prostatakarzinom. Radioonkologische Aspekte


Dieser Bericht fasst die relevanten Aspekte der S3-Leitlinie Prostatakarzinom für den Strahlentherapeuten zusammen. Indikationsstellung und Dosisverschreibung werden ebenso diskutiert wie die technische Durchführung der perkutanen Bestrahlung und die Brachytherapie. Die relevante Literatur gibt einen Überblick über die aktuellen Empfehlungen.


Prostatakarzinom Strahlentherapie Deutsche S3-Leitlinie 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Al-Mamgani A, Heemsbergen WD, Peeters ST, Lebesque JV. Role of intensity- modulated radiotherapy in reducing toxicity in dose escalation for localized prostate cancer. Int J Radiat Oncol Biol Phys 2009;73:685–91CrossRefPubMedGoogle Scholar
  2. 2.
    Böhmer D, Wenz F, Martin T, et al. Strahlentherapie des Prostatakarzinoms in der neuen S3-Leitlinie Teil 1: Lokal begrenztes und lokal fortgeschrittenes Prostatakarzinom. Urologe A 2010;49:211–5CrossRefPubMedGoogle Scholar
  3. 3.
    Bohrer M, Schröder P, Welzel G, et al. Reduced rectal toxicity with ultrasound- based image guided radiotherapy using BAT (B-mode acquisition and targeting system) for prostate cancer. Strahlenther Onkol 2008;184:674–8CrossRefPubMedGoogle Scholar
  4. 4.
    Bolla M, van Poppel H, Collette L, et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 2006;366:572–8CrossRefGoogle Scholar
  5. 5.
    Bolla M, de Reijke TM, Van Tienhoven G, et al. Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med 2009;360:2516–27CrossRefPubMedGoogle Scholar
  6. 6.
    D’Amico A, Altschuler M, Whittington R, et al. The use of clinical parameters in an interactive statistical package to predict pathological features associated with local failure after radical prostatectomy for prostate cancer. Clin Perform Qual Health Care 1993;1:219–22PubMedGoogle Scholar
  7. 7.
    D’Amico AV, Chen MH, Renshaw AA, et al. Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. JAMA 2008;299:289–95CrossRefPubMedGoogle Scholar
  8. 8.
    Dearnaley DP, Sydes MR, Graham JD, et al., RT01 Collaborators. Escalated- dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol 2007;8:475–87CrossRefPubMedGoogle Scholar
  9. 9.
    Deger S, Boehmer D, Roigas J, et al. High dose rate (HDR) brachytherapy with conformal radiation therapy for localized prostate cancer. Eur Urol 2005;47:441–8CrossRefPubMedGoogle Scholar
  10. 10.
    Demanes DJ, Rodriguez RR, Schour L, et al. High-dose-rate intensity-modulated brachytherapy with external beam radiotherapy for prostate cancer: California endocurietherapy’s 10-year results. Int J Radiat Oncol Biol Phys 2005;61:1306–16CrossRefPubMedGoogle Scholar
  11. 11.
    Galalae RM, Martinez A, Mate T, et al. Long-term outcome by risk factors using conformal high-dose-rate brachytherapy (HDR-BT) boost with or without neoadjuvant androgen suppression for localized prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:1048–55CrossRefPubMedGoogle Scholar
  12. 12.
    Galalae RM, Martinez A, Nuernberg N, et al. Hypofractionated conformal HDR brachytherapy in hormone naive men with localized prostate cancer. Is escalation to very high biologically equivalent dose beneficial in all prognostic risk groups? Strahlenther Onkol 2006;182:135–41CrossRefPubMedGoogle Scholar
  13. 13.
    Hanks GE, Pajak TF, Porter A, et al. Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: the Radiation Therapy Oncology Group Protocol 92-02 [Erratum in: J Clin Oncol 2004;22:386]. J Clin Oncol 2003;21:3972–8CrossRefPubMedGoogle Scholar
  14. 14.
    Hermesse J, Biver S, Jansen N, et al. A dosimetric selectivity intercomparison of HDR brachytherapy, IMRT and helical tomotherapy in prostate cancer radiotherapy. Strahlenther Onkol 2009;185:736–42CrossRefPubMedGoogle Scholar
  15. 15.
    Hoskin PJ, Motohashi K, Bownes P, Bryant L, Ostler P. High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: initial results of a randomised phase three trial. Radiother Oncol 2007;84:114–20CrossRefPubMedGoogle Scholar
  16. 16. pdfGoogle Scholar
  17. 17.
    Köhler FM, Boda-Heggemann J, Küpper B, et al. Phantom measurements to quantify the accuracy of a commercially available cone-beam CT gray-value matching algorithm using multiple fiducials. Strahlenther Onkol 2009;185:49–55CrossRefPubMedGoogle Scholar
  18. 18.
    Kuban DA, Tucker SL, Dong L, et al. Long-term results of the M.D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008;70:67–74CrossRefPubMedGoogle Scholar
  19. 19.
    Kumar S, Shelley M, Harrison C, et al. Neo-adjuvant and adjuvant hormone therapy for localised and locally advanced prostate cancer. Cochrane Database Syst Rev 2006;4:CD006019PubMedGoogle Scholar
  20. 20.
    Kupelian PA, Potters L, Khuntia D, et al. Radical prostatectomy, external beam radiotherapy < 72 Gy, external beam radiotherapy > or = 72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1–T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:25–33CrossRefPubMedGoogle Scholar
  21. 21.
    Lohr F, Fuss M, Tiefenbacher U, et al. Optimierter Einsatz der Strahlentherapie durch IMRT und Präzisionslokalisationsverfahren bei der Behandlung des fortgeschrittenen Prostatakarzinoms. Urologe A 2004;43:43–51CrossRefPubMedGoogle Scholar
  22. 22.
    Martin T, Wenz F, Böhmer D, et al. Strahlentherapie des Prostatakarzinoms in der neuen S3-Leitlinie Teil 2: Postoperative Strahlentherapie und Brachytherapie. Urologe A 2010;49:216–20CrossRefPubMedGoogle Scholar
  23. 23.
    Peeters ST, Heemsbergen WD, Koper PC, et al. Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol 2006;24:1990–6CrossRefPubMedGoogle Scholar
  24. 24.
    Pilepich MV, Winter K, Lawton CA, et al. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma – long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys 2005;61:1285–90CrossRefPubMedGoogle Scholar
  25. 25.
    Pinkawa M, Piroth MD, Fischedick K, et al. Impact of the target volume (prostate alone vs. prostate with seminal vesicles) and fraction dose (1.8 Gy vs. 2.0 Gy) on quality of life changes after external-beam radiotherapy for prostate cancer. Strahlenther Onkol 2009;185:724–30CrossRefPubMedGoogle Scholar
  26. 26.
    Schaefer JW, Welzel G, Trojan L, et al. Long-term health-related quality- of-life outcomes after permanent prostate brachytherapy. Onkologie 2008;31:599–603CrossRefGoogle Scholar
  27. 27.
    Sharkey J, Cantor A, Solc Z, et al. 103Pd brachytherapy versus radical prostatectomy in patients with clinically localized prostate cancer: a 12-year experience from a single group practice. Brachytherapy 2005;4:34–44CrossRefPubMedGoogle Scholar
  28. 28.
    Shipley WU, Lu JD, Pilepich MV, et al. Effect of a short course of neoadjuvant hormonal therapy on the response to subsequent androgen suppression in prostate cancer patients with relapse after radiotherapy: a secondary analysis of the randomized protocol RTOG 86-10. Int J Radiat Oncol Biol Phys 2002;54:1302–10CrossRefPubMedGoogle Scholar
  29. 29.
    Stephenson CG, Catton CN, DeWeese TL, et al. Predicting the outcome of slavage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 2007;25:2035–4CrossRefPubMedGoogle Scholar
  30. 30.
    Sylvester JE, Blasko JC, Grimm PD, et al. Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: the Seattle experience. Int J Radiat Oncol Biol Phys 2003;57:944–52CrossRefPubMedGoogle Scholar
  31. 31.
    Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol 2009;181:956–62CrossRefPubMedGoogle Scholar
  32. 32.
    Van der Kwast TH, Bolla M, Van Poppel H, et al., EORTC 22911. Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911. J Clin Oncol 2007;25:4178–86CrossRefPubMedGoogle Scholar
  33. 33.
    Widmark A, Klepp O, Solberg A, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet 2009;373:301–8CrossRefPubMedGoogle Scholar
  34. 34.
    Wiegel T, Bottke D, Steiner U, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol 2009;27:2924–30CrossRefPubMedGoogle Scholar
  35. 35.
    Wiegel T, Lohm G, Bottke D, et al. Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome – results of a retrospective study. Int J Radiat Oncol Biol Phys 2009;73:1009–16CrossRefPubMedGoogle Scholar
  36. 36.
    Zelefsky MJ, Wallner KE, Ling CC, et al. Comparison of the 5-year outcome and morbidity of three-dimensional conformal radiotherapy versus transperineal permanent iodine-125 implantation for early-stage prostatic cancer. J Clin Oncol 1999;17:517–22PubMedGoogle Scholar
  37. 37.
    Zelefsky MJ, Yamada Y, Kollmeier MA, et al. Long-term outcome following three-dimensional conformal/intensity-modulated external-beam radiotherapy for clinical stage T3 prostate cancer. Eur Urol 2008;53:1172–9CrossRefPubMedGoogle Scholar
  38. 38.
    Zietman AL, Bae K, Slater JD, et al. Randomized trial comparing conventional- dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from Proton Radiation Oncology Group/American College of Radiology 95-09. J Clin Oncol 2010;28:1106–11CrossRefPubMedGoogle Scholar
  39. 39.
    Zietman AL, DeSilvio ML, Slater JD, et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA 2005;294:1233–9CrossRefPubMedGoogle Scholar

Copyright information

© Urban &amp; Vogel, Muenchen 2010

Authors and Affiliations

  • Frederik Wenz
    • 1
    • 12
  • Thomas Martin
    • 2
  • Dirk Böhmer
    • 3
  • Stefan Martens
    • 4
  • Felix Sedlmayer
    • 5
  • Manfred Wirth
    • 6
  • Kurt Miller
    • 7
  • Axel Heidenreich
    • 8
  • Mark Schrader
    • 9
  • Wolfgang Hinkelbein
    • 10
  • Thomas Wiegel
    • 11
  1. 1.Department of Radiotherapy and RadiooncologyUniversity Medicine Mannheim, University of HeidelbergHeidelbergGermany
  2. 2.Group Practice for Radiotherapy and RadiooncologyBremenGermany
  3. 3.Department of RadiotherapyCharité – University Medicine Berlin, Campus Virchow ClinicBerlinGermany
  4. 4.Department of UrologyMarien-Krankenhaus BergischGladbachGermany
  5. 5.Department of Radiotherapy and RadiooncologySalzburger LandesklinikenSalzburgAustria
  6. 6.Department of UrologyUniversity Hospital Carl Gustav CarusDresdenGermany
  7. 7.Department of UrologyCharité – University MedicineBerlinGermany
  8. 8.Department of UrologyUniversity Hospital AachenAachenGermany
  9. 9.Department of UrologyUniversity Hospital UlmUlmGermany
  10. 10.Department of RadiotherapyCharité – University Medicine Berlin, Campus Benjamin FranklinBerlinGermany
  11. 11.Department of Radiotherapy and RadiooncologyUniversity Hospital UlmUlmGermany
  12. 12.Klinik für Strahlentherapie und RadioonkologieUniversitätsmedizin MannheimMannheimGermany

Personalised recommendations