Current Prostate Reports

, Volume 7, Issue 3, pp 95–101

Radiation therapy approaches to the treatment of high-risk prostate cancer

  • Soroush Rais-Bahrami
  • Manish A. Vira
  • Louis Potters


Radiation therapy modalities have been shown to offer patients a nonoperative option for definitive treatment of localized prostate cancer as well as options for adjuvant or salvage therapy in high-risk prostate cancer patients. In patients with high-risk, localized disease, radiation therapy with or without adjuvant hormonal therapy is considered an excellent treatment option because of its efficacy within the prostate and among local periprostatic structures, addressing micrometastatic disease. Following radical prostatectomy in patients with high-risk or recurrent disease, radiotherapy can increase oncologic efficacy in both the adjuvant and salvage setting. Continued studies are underway to address ongoing concerns of sparing surrounding tissues unnecessary radiation while administering high-dose radiation to the prostate and targeted periprostatic structures. Newer technologies are using real-time imaging and computer-simulated motion calculation to adjust for physiological organ motion with respect to bony landmarks classically used to map areas of radiation administration.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Scher HI, Leidel SA, Fuks Z, et al.: Cancer of the prostate. In Cancer: Principles and Practice of Oncology edn 7. Edited by Devita VT Jr, Hellman S, Rosenberg SA. Philadelphia: Lippincott Williams & Wilkins; 2005:1192–1295.Google Scholar
  2. 2.
    D’Amico AV, Whittington R, Malkowicz SB, et al.: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998, 280:969–974.PubMedCrossRefGoogle Scholar
  3. 3.
    Zelefsky MJ, Chan H, Hunt M, et al.: Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urol 2006, 176:1415–1419.PubMedCrossRefGoogle Scholar
  4. 4.
    D’Amico AV, Moul JW, Carroll PR, et al.: Surrogate end point for prostate cancer-specific mortality after radical prostatectomy or radiation therapy. J Natl Cancer Inst 2003, 95:1376–1383.PubMedCrossRefGoogle Scholar
  5. 5.
    Stephenson AJ, Scardino PT, Eastham JA, et al.: Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst 2006, 98:715–717.PubMedCrossRefGoogle Scholar
  6. 6.
    Mitchell RE, Chang SS: Current controversies in the treatment of high-risk prostate cancer. Curr Opin Urol 2008, 18:263–268.PubMedCrossRefGoogle Scholar
  7. 7.
    Loeb S, Kettermann A, Ferrucci L, et al.: PSA doubling time and PSA velocity to predict high-risk prostate cancer: data from the Baltimore Longitudinal Study of Aging. Eur Urol 2008, 54:1073–1080.PubMedCrossRefGoogle Scholar
  8. 8.
    Pasteau O: Traitment du cancer de la prostate par le Radium. Rev Mal Nutr 1911, 363–367.Google Scholar
  9. 9.
    Young HH: Technique of radium treatment of cancer of the prostate in seminal vesicles. Surg Gynecol Obstet 1922, 34:93–98.Google Scholar
  10. 10.
    Denning CL: Carcinoma of the prostate seminal vesicles treated with radium. Surg Gynecol Obstet 1922, 34:99–118.Google Scholar
  11. 11.
    Whitmore WF Jr, Hilaris B, Grabstald H: Retropubic implantation of iodine 125 in the treatment of prostatic cancer. J Urol 1972, 108:918–920.PubMedGoogle Scholar
  12. 12.
    Holm HH, Juul N, Pedersen JF, et al.: Transperineal I-125 seed implantation in prostatic cancer guided by transrectal ultrasonography. J Urol 1983, 130:283–286.PubMedGoogle Scholar
  13. 13.
    Bagshaw MA, Kaplan HS, Sageiman RH: Linear accelerator supervoltage radiotherapy: carcinoma of the prostate. Radiology 1965, 85:121–129.PubMedGoogle Scholar
  14. 14.
    Bagshaw MA, Ray RR, Pistenma DA, et al.: External beam radiation therapy: primary carcinoma of the prostate. Cancer 1975, 36:723–728.PubMedCrossRefGoogle Scholar
  15. 15.
    Roehl KA, Han M, Ramos CG, et al.: Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 2004, 172:910–914.PubMedCrossRefGoogle Scholar
  16. 16.
    Han M, Partin AW, Zahurak M, et al.: Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 2003, 169:517–523.PubMedCrossRefGoogle Scholar
  17. 17.
    Sylvester JE, Grimm PD, Blasko JC, et al.: 15-year biochemical relapse free survival in clinical stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat Oncol Biol Phys 2007, 67:57–64.PubMedCrossRefGoogle Scholar
  18. 18.
    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, 58:1048–1055.PubMedCrossRefGoogle Scholar
  19. 19.
    Nieder AM, Porter MP, Soloway MS: Radiation therapy for prostate cancer increases subsequent risk of bladder and rectal cancer: a population based cohort study. J Urol 2008, 180:2005–2009.PubMedCrossRefGoogle Scholar
  20. 20.
    Potters L, Morgenstern C, Calugaru E, et al.: 12-year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urol 2005, 173:1562–1566.PubMedCrossRefGoogle Scholar
  21. 21.
    Roach M 3rd, Hanks G, Thames HJ, et al.: Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006, 65:965–974.PubMedCrossRefGoogle Scholar
  22. 22.
    Pollack A, Zagars GK, Smith LG, et al.: Preliminary results of a randomized radiotherapy dose-escalation study comparing 70 Gy with 78 Gy for prostate cancer. J Clin Oncol 2000, 18:3904–3911.PubMedGoogle Scholar
  23. 23.
    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, 294:1233–1239.PubMedCrossRefGoogle Scholar
  24. 24.
    Boehmer D, Maingon P, Poortmans P, et al.: Guidelines for primary radiotherapy of patients with prostate cancer. Radiother Oncol 2006, 79:259–269.PubMedCrossRefGoogle Scholar
  25. 25.
    Chao KK, Goldstein NS, Yan D, et al.: Clinicopathologic analysis of extracapsular extension in prostate cancer: should the clinical target volume be expanded posterolaterally to account for microscopic extension? Int J Radiat Oncol Biol Phys 2006, 65:999–1007.PubMedCrossRefGoogle Scholar
  26. 26.
    Kestin L, Goldstein N, Vicini F, et al.: Treatment of prostate cancer with radiotherapy: should the entire seminal vesicles be included in the clinical target volume? Int J Radiat Oncol Biol Phys 2002, 54:686–697.PubMedCrossRefGoogle Scholar
  27. 27.
    Ling CC: Permanent implants using Au-198, Pd-103 and I-125: radiobiological considerations based on the linear quadratic model. Int J Radiat Oncol Biol Phys 1992, 23:81–87.PubMedCrossRefGoogle Scholar
  28. 28.
    Cha CM, Potters L, Ashley R, et al.: Isotope selection for patients undergoing prostate brachytherapy. Int J Radiat Oncol Biol Phys 1999, 45:391–395.PubMedCrossRefGoogle Scholar
  29. 29.
    Kupelian PA, Willoughby TR, Reddy CA, et al.: Hypofractionated intensity-modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: Cleveland Clinic experience. Int J Radiat Oncol Biol Phys 2007, 68:1424–1430.PubMedCrossRefGoogle Scholar
  30. 30.
    Merrick GS, Butler WM, Wallner KE, et al.: Impact of supplemental external beam radiotherapy and/or androgen deprivation therapy on biochemical outcome after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2005, 61:32–43.PubMedCrossRefGoogle Scholar
  31. 31.
    Blasko JC, Grimm PD, Sylvester JE, et al.: Palladium-103 brachytherapy for prostate carcinoma. Int J Radiat Oncol Biol Phys 2000, 46:839–850.PubMedCrossRefGoogle Scholar
  32. 32.
    Bolla M, Collette L, Blank L, et al.: Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 2002, 360:103–106.PubMedCrossRefGoogle Scholar
  33. 33.
    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, 61:1285–1290.PubMedCrossRefGoogle Scholar
  34. 34.
    Granfors T, Modig H, Damber JE, et al.: Long-term followup of a randomized study of locally advanced prostate cancer treated with combined orchiectomy and external radiotherapy versus radiotherapy alone. J Urol 2006, 176:544–547.PubMedCrossRefGoogle Scholar
  35. 35.
    Lawton CA, Bae K, Pilepich M, et al.: Long-term treatment sequelae after external beam irradiation with or without hormonal manipulation for adenocarcinoma of the prostate: analysis of radiation therapy oncology group studies 85-31, 86-10, and 92-02. Int J Radiat Oncol Biol Phys 2008, 70:437–441.PubMedCrossRefGoogle Scholar
  36. 36.
    Shapiro EY, Rais-Bahrami S, Morgenstern C, et al.: Long-term outcomes in younger men following permanent prostate brachytherapy. J Urol 2009 (in press).Google Scholar
  37. 37.
    Magheli A, Rais-Bahrami S, Humphreys EB, et al.: Impact of patient age on biochemical recurrence rates following radical prostatectomy. J Urol 2007, 178:1933–1937.PubMedCrossRefGoogle Scholar
  38. 38.
    Haese A, Epstein JI, Huland H, et al.: Validation of a biopsy-based pathologic algorithm for predicting lymph node metastases in patients with clinically localized prostate carcinoma. Cancer 2002, 95:1016–1021.PubMedCrossRefGoogle Scholar
  39. 39.
    Allaf ME, Palapattu GS, Trock BJ, et al.: Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol 2004, 172:1840–1844.PubMedCrossRefGoogle Scholar
  40. 40.
    Lawton CA, DeSilvio M, Roach M 3rd, et al.: An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys 2007, 69:646–655.PubMedCrossRefGoogle Scholar
  41. 41.
    Stone NN, Potters L, Davis BJ, et al.: Multicenter analysis of effect of high biologic effective dose on biochemical failure and survival outcomes in patients with Gleason score 7–10 prostate cancer treated with permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys (in press).Google Scholar
  42. 42.
    Thompson IM Jr, Tangen CM, Paradelo J, et al.: Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. JAMA 2006, 296:2329–2335.PubMedCrossRefGoogle Scholar
  43. 43.
    Bolla M, van Poppel H, Collette L, et al.: Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet 2005, 366:572–578.PubMedCrossRefGoogle Scholar
  44. 44.
    Trabulsi EJ, Valicenti RK, Hanlon AL, et al.: A multiinstitutional matched-control analysis of adjuvant and salvage postoperative radiation therapy for pT3-4N0 prostate cancer. Urology 2009 (in press).Google Scholar
  45. 45.
    Trock BJ, Han M, Freedland SJ, et al.: Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 2008, 299:2760–2769.PubMedCrossRefGoogle Scholar
  46. 46.
    Litwin MS, Gore JL, Kwan L, et al.: Quality of life after surgery, external beam irradiation, or brachytherapy for early-stage prostate cancer. Cancer 2007, 109:2239–2247.PubMedCrossRefGoogle Scholar
  47. 47.
    Namiki S, Satoh T, Baba S, et al.: Quality of life after brachytherapy or radical prostatectomy for localized prostate cancer: a prospective longitudinal study. Urology 2006, 68:1230–1236.PubMedCrossRefGoogle Scholar
  48. 48.
    Sanda MG, Dunn RL, Michalski J, et al.: Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 2008, 358:1250–1261.PubMedCrossRefGoogle Scholar
  49. 49.
    Moinpour CM, Hayden KA, Unger JM, et al.: Health-related quality of life results in pathologic stage C prostate cancer from a Southwest Oncology Group Trial comparing radical prostatectomy alone with radical prostatectomy plus radiation therapy. J Clin Onc 2008, 26:112–120.CrossRefGoogle Scholar
  50. 50.
    Abdel-Wahab M, Reis IM, Hamilton K: Second primary cancer after radiotherapy for prostate cancer: a seer analysis of brachytherapy versus external beam radiotherapy. Int J Radiat Oncol Biol Phys 2008, 72:58–68.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  • Soroush Rais-Bahrami
  • Manish A. Vira
  • Louis Potters
    • 1
  1. 1.North Shore-Long Island Jewish Health SystemNew Hyde ParkUSA

Personalised recommendations