Advertisement

Prostate Cancer

  • Cordula Petersen
  • Rudolf Schwarz
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

The knowledge in the field of prostate cancer is rapidly changing. The majority of diagnoses relate to the use of screening prostate-specific antigen (PSA), which remains controversial. A combination of PSA level at diagnosis, clinical stage, and Gleason score is used to stratify patients into prognostic groups, with risk-adapted treatment assignment. The evaluation of treatment options for low-, intermediate- and high-risk prostate cancer has remained difficult primarily because of the lack of randomized trials. Most patients present with curative disease stage. Validated first-line treatment options include radical prostatectomy and radiation therapy, via either interstitial seed implants or external-beam radiation (EBRT). Radiation therapy for localized prostate cancer leads to equivalent oncologic outcomes as compared with radical prostatectomy. Interstitial seed implants and EBRT appear clinically equivalent. Modality-specific toxicity profile and logistics should be incorporated into the decision-making process of the individual patient. Results from randomized studies have established the value of dose-escalated radiotherapy alone in the unimodality setting versus standard-dose irradiation in combination with neoadjuvant and concurrent hormonal treatment. The timing and optimal duration of endocrine therapy in the era of dose escalation remain investigational. Adjuvant radiation therapy improves clinical outcome for pT3 prostate cancer or positive surgical margins.

Keywords

Gleason Score Androgen Deprivation Therapy National Comprehensive Cancer Network Localize Prostate Cancer Positive Surgical Margin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

ADT

Androgen deprivation therapy

CTV

Clinical target volume

DVH

Dose volume histogram

EBRT

External beam radiotherapy

FFCF

Freedom from clinical failure

GTV

Gross tumor volume

IMRT

Intensity modulated radiotherapy

IPSS

International prostatic symptom score

OS

Overall survival

OAR

Organ at risk

PCa

Prostate cancer

PFS

Progression free survival

PLND

Pelvic Lymph Node Dissection

PSA

Prostate specific antigen

PTV

Planning target volume

RT

Radiotherapy

References

  1. Bolla M, Collette L, Blank L, Warde P, Dubois JB, Mirimanoff R-O et al (2002) 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 360:103–106PubMedCrossRefGoogle Scholar
  2. Bolla M, van Poppel H, Collette L, van Cangh P, Vekemans K, Da Pozzo L et al (2012) Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long term results of a randomised controlled trial (EORTC trial 22911). Lancet 380:2018–2027PubMedCrossRefGoogle Scholar
  3. Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff R-O, Storme G et al (2010) External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol 11:1066–1073PubMedCrossRefGoogle Scholar
  4. Botrel TEA, Clark O, Pompeo ECL, Bretas FFH, Sadi MV, Ferreira U et al (2013) Hypofractionated external-beam radiation (HEBRT) versus conventional external-beam radiation (CEBRT) in patients with localized prostate cancer: a systematic review and meta-analysis. Core Evid 8:1–13PubMedCentralPubMedCrossRefGoogle Scholar
  5. Brady L, Heilmann H-P, Molls M, Nieder C (2011) Foreword. In: Lu JJ, Brady LW (eds) Decision making in radiation oncology (Bd. 2). Springer, HeidelbergGoogle Scholar
  6. Buckstein M, Carpenter TJ, Stone N, Stock RG (2013) Long-term outcomes and toxicity in patients treated with brachytherapy for prostate adenocarcinoma younger than 60 years of age at treatment with minimum 10 years of follow-up. Urology 81:364–369PubMedCrossRefGoogle Scholar
  7. D’Amico AV, Chen M-H, Renshaw AA, Loffredo M, Kantoff PW (2008) Androgen suppression and radiation vs. radiation alone for prostate cancer: a randomized trial. JAMA 299:289–295PubMedGoogle Scholar
  8. D’Amico AV, Manola J, Loffredo M, Renshaw AA, DellaCroce A, Kantoff PW (2004) 6-month androgen suppression plus radiation therapy vs. radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA 292:821–827PubMedCrossRefGoogle Scholar
  9. Dearnaley DP, Syndikus I, Sumo G, Bidmead M, Bloomfield D, Clark C et al (2012) Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: preliminary safety results from the CHHiP randomized controlled trial. Lancet Oncol 13:43–54PubMedCrossRefGoogle Scholar
  10. Denham JW, Steigler A, Wilcox C, Lamb DS, Joseph D, Atkinson C et al (2008) Time to biochemical failure and prostate-specific antigen doubling time as surrogates for prostate cancer-specific mortality: evidence from the TROG 96.01 randomised controlled trial. Lancet Oncol 9:1058–1068PubMedCrossRefGoogle Scholar
  11. Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M et al (2013) An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int 111:22–29PubMedCrossRefGoogle Scholar
  12. Fiorino C, Rancati T, Fellin G, Vavassori V, Cagna E, Casanova-Borca V et al (2012) Late fecal incontinence after high-dose radiotherapy for prostate cancer: better prediction using longitudinal definitions. Int J Radiat Oncol Biol Phys 83:38–45PubMedCrossRefGoogle Scholar
  13. Grimm P, Billiet I, Boswick C, Dicker A, Frank S, Immerzeel J, Keyes M, Kupelian P, Lee W, Machtens S, Mayade J, Moran B, Merrick G, Millar J, Roach M, Stock R, Shinohara K, Scholz M, Weber E, Zietman A, Zelefsky M, Wong J, Wentworth S, Vera R, Langley S (2012) Comparative analysis of prostate-specific antigen free survival outcomes for patients with los, intermediate and high risk prostate cancer treatment by radical therapy. Results from the prostate cancer results study group. BJUI 109:22–29CrossRefGoogle Scholar
  14. Hanks GE, Hanlon AL, Schultheiss TE, Pinover WH, Movsas B, Epstein BE et al (1998) Dose escalation with 3D conformal treatment: five year outcomes, treatment optimization, and future directions. Int J Radiat Oncol Biol Phys 41:501–510PubMedCrossRefGoogle Scholar
  15. Heidenreich A, Bastian P, Bellmunt J, Bolla M, Joniau S, Van der Kwast T, Mason M, Matveev V, Mottet N, Wiegel T, Zattoni F (2012) Guidelines on prostate cancer. http://www.uroweb.org
  16. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, Mottet N, Schmid H, Van der Kwast T, Wiegel T, Zattoni F (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59:61–71PubMedCrossRefGoogle Scholar
  17. Kao J, Stone NN, Lavaf A, Dumane V, Cesaretti JA, Stock RG (2008) 125I Monotherapy using D90 implant doses of 180 Gy or greater. Int J Radiat Oncol Biol Phys 70:96–101PubMedCrossRefGoogle Scholar
  18. Kim SP, Karnes RJ, Nguyen PL, Ziegenfuss JY, Han LC, Thompson RH et al (2012) Clinical implementation of quality of life instruments and prediction tools for localized prostate cancer: results from a national survey of radiation oncologists and urologists. J Urol pii: S0022-5347(12)05806-5. doi:  10.1016/j.juro.2012.11.174
  19. Kuban DA, Tucker SL, Dong L, Starkschall G, Huang EH, Cheung MR et al (2008) Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 70:67–74PubMedCrossRefGoogle Scholar
  20. Kupelian PA, Potters L, Khuntia D, Ciezki JP, Reddy CA, Reuther AM et al (2004) 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 58:25–33PubMedCrossRefGoogle Scholar
  21. Lawton CA, Bae K, Pilepich M, Hanks G, Shipley W (2008) 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 70:437–441PubMedCentralPubMedCrossRefGoogle Scholar
  22. Lawton CA, Michalski J, El-Naqa I (2009) RTOG GU radiation oncology specialists reach consensus on pelvic lymph node volumes for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 74:383–387PubMedCentralPubMedCrossRefGoogle Scholar
  23. Lawton CA, Winter K, Murra K, Machtay M, Mesic J, Hanks G, Coughlin C, Pilepich MV (2001) Updated results of the phase III radiation therapy oncology group (RTOG) trial 85–31 evaluating the potential benefit of androgen suppression following standard radiation therapy for unfavorable prognosis carcinoma of the prostate. Int J Radiat Oncol Biol Phys 49:937–946PubMedCrossRefGoogle Scholar
  24. Michalski JM, Lawton C, El-Naqa I (2010) Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 76:361–368PubMedCentralPubMedCrossRefGoogle Scholar
  25. Mottet N, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, Schmid H, Van der Kwast T, Wiegel T, Zattoni F, Heidenreich A (2011) EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol 59:572–583PubMedCrossRefGoogle Scholar
  26. Mottet N, Peneau M, Mazeron J, Molinie V, Richaud P (2012) Addition of radiotherapy to long term androgen deprivation in locally advanced prostate cancer: an open randomized phase 3 trial. Eur Urol 62:213–219PubMedCrossRefGoogle Scholar
  27. Nag S, Beyer D, Friedland J, Grimm P, Nath R (1999) American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 44:789–799PubMedCrossRefGoogle Scholar
  28. NCCN (2010) NCCN clinical practice guidelines in oncology: prostate cancer v. 1.2010. Available at www.nccn.org/professionals/physicians_gls/pdf/prostate.pdf
  29. Partin AW, Kattan MW, Subong ENP, Walsh PC, Wojno KJ, Oesterling JE (1997) Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. JAMA 277:1445–1451PubMedCrossRefGoogle Scholar
  30. Peeters ST, Heemsbergen WD, Koper PC, van Putten WL, Slot A, Dielwart MF et al (2006) 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 24:1990–1996PubMedCrossRefGoogle Scholar
  31. Pilepich MV, Caplan R, Byhardt RW, Lawton CA, Gallagher MJ, Mesic JB et al (1997) Phase III trial of androgen suppression using goserelin in unfavorable-prognosis carcinoma of the prostate treated with definitive radiotherapy: report of Radiation Therapy Oncology Group Protocol 85–31. J Clin Oncol 15:1013–1021PubMedGoogle Scholar
  32. Pilepich MV, Winter K, John MJ, Mesic JB, Sause W, Rubin P et al (2001) Phase III radiation therapy oncology group (RTOG) trial 86–10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys 50:1243–1252PubMedCrossRefGoogle Scholar
  33. Pilepich MV, Winter K, Lawton CA, Krisch RE, Wolkov HB, Movsas B et al (2005) Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma—long-term results of phase III RTOG 85–31. Int J Radiat Oncol Biol Phys 61:1285–1290PubMedCrossRefGoogle Scholar
  34. Pommier P, Chabaud S, Lagrange JL, Richaud P, Lesaunier F, Le Prise E et al (2007) Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol 25:5366–5373PubMedCrossRefGoogle Scholar
  35. Roach M III, DeSilvio M, Lawton C, Uhl V, Machtay M, Seider MJ et al (2003) Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: Radiation Therapy Oncology Group 9413. J Clin Oncol 21:1904–1911PubMedCrossRefGoogle Scholar
  36. Roach M, Marquez C, You HS et al (1994) Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 28:33–37PubMedCrossRefGoogle Scholar
  37. Roeloffzen EM, Crook J, Monninkhof EM, McLean M, van Vulpen M, Saibishkumar EP (2012) External validation of the pretreatment nomogram to predict acute urinary retention after (125)I prostate brachytherapy. Brachytherapy 11:256–264PubMedCrossRefGoogle Scholar
  38. Taira AV, Merrick GS, Galbreath RW, Wallner KE, Butler W (2010) Natural history of clinically staged low- and intermediate risk prostate cancer treated with monotherapeutic permanent interstitial brachytherapy. Int J Radiat Oncol Biol Phys 76:349–354PubMedCrossRefGoogle Scholar
  39. Thompson IM, Tangen CM, Paradelo J, Lucia MS, Miller G, Troyer D et al (2009) 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 181:956–962PubMedCentralPubMedCrossRefGoogle Scholar
  40. Valdagni R, Kattan MW, Rancati T, Yu C, Vavassori V, Fellin G et al (2012) Is it time to tailor the prediction of radio-induced toxicity in prostate cancer patients? Building the first set of nomograms for late rectal syndrome. Int J Radiat Oncol Biol Phys 82:1957–1966PubMedCrossRefGoogle Scholar
  41. Warde P, Mason M, Ding K (2011) Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomized phase 3 trial. Lancet 378:2104–2111PubMedCentralPubMedCrossRefGoogle Scholar
  42. Widmark A, Klepp O, Solberg A (2009) Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomized phase III trial. Lancet 373:301–308PubMedCrossRefGoogle Scholar
  43. Wiegel T, Bottke D, Steiner U, Siegmann A, Golz R, Störkel S et al (2009) 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 27:2924–2930PubMedCrossRefGoogle Scholar
  44. Zelefsky MJ, Kuban D, Levy LB, Potters L, Beyer DC, Blasko JC et al (2007) Multi-institutional analysis of long-term outcome for stages T1–T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys 67:327–333PubMedCrossRefGoogle Scholar
  45. Zietman AL, Bae K, Slater JD, Shipley WU, Efstathiou JA, Coen JJ et al (2010) 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 28:1106–1111PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Radiotherapy and RadiooncologyUniversity Medical Center Hamburg-EppendorfHamburgGermany

Personalised recommendations