Topic 17. Radiotherapy in the Treatment of Prostate Cancer
Prostate cancer is the most common malignant tumor in men and one of the leading causes of cancer-related death worldwide. It usually arises from the glandular epithelium (adenocarcinoma) of the prostate.
Radiotherapy is one of the main curative treatment modalities for localized and locally advanced prostate cancer. It may also be used after surgery, in recurrent disease, or for palliation of metastatic disease.
Treatment depends on:
- TNM stage
- PSA level
- Gleason score (Grade Group)
- Patient's age
- Life expectancy
- General health
3. Risk Classification
Treatment decisions are based on risk groups. Serum prostate-specific antigen(PSA) from blood test is used for screening,
Low Risk
- PSA <10 ng/mL
- Gleason score ≤6 ( ISUP Grade Group 1)
- Stage T1–T2a
Intermediate Risk
- PSA 10–20 ng/mL
- Gleason score 7 (Grade Group 2–3)
- Stage T2b–T2c
High Risk
- PSA >20 ng/mL
- Gleason score 8–10 (Grade Group 4–5)
- Stage ≥T3
4. Role of Radiotherapy According to Stage
A. Localized Disease (Stage I–II)
Curative treatment options include:
- Active surveillance (selected low- risk patients)
- Radical prostatectomy
- Definitive radiotherapy -
- Radical EBRT ± 6 months HT
- Brachytherapy - prostate I - 125
Radiotherapy offers cure rates comparable to surgery.
B. Locally Advanced Disease (Stage III), t3- t4
Standard treatment:
- External Beam Radiotherapy (EBRT)
- Long-term Androgen Deprivation Therapy (ADT)
Radiotherapy improves:
- Local control
- Disease- free survival
- Overall survival
C. High- Risk Disease
Treatment usually consists of:
EBRT
- Long- term ADT (2–3 years)
- Sometimes brachytherapy boost
D. Metastatic Disease (Stage IV)
Primary treatment:
- Systemic therapy (ADT ± chemotherapy or newer hormonal agents)
Radiotherapy is used for:
- Palliation of bone pain
- Spinal cord compression
- Symptomatic local disease
- Selected low- volume metastatic disease combined with systemic therapy