External beam radiation therapy for prostate cancer

Abstract

Abstract6 During the past 35 years, external beam radiation therapy (RT) has been a mainstay in the management of prostate cancer and continues to be used in the treatment of almost one third of all patients receiving definitive therapy.7 Throughout the past decade, increasing numbers of patients receiving radiation have been treated with three-dimensional (3D) conformal rather than with conventional techniques. PROSTATE SPECIFIC ANTIGENThe development of the prostate specific antigen (PSA) test and its utilization as a screening tool, therapeutic measure, and prognostic indicator, have increased the number of patients diagnosed and subsequently treated for non-metastatic disease. More importantly, pretreatment PSA level has been shown to be the strongest independent predictor of treatment outcome (especially PSA control) after both surgery and radiation. [8][9][10][11] Biochemical disease-free survival [bNED-biochemical no evidence disease-control) is defined by a non-rising post-treatment PSA level, while a rising post-treatment PSA level now predicts failure many years before disease becomes clinically detectable.12-14 Appropriate use of pretreatment disease classification and serial post-treatment PSA levels allow accurate and meaningful assessments of various treatment modalities. 15Routine use of PSA measurement entered clinical practice in the late 1980s.C A C a n c e r J C l i n 2 0 0 0 ; 5 0 : 3 4 9 -3 7 5

Patient satisfaction with treatment decisions for clinically localized prostate carcinoma. Results from the Prostate Cancer Outcomes Study

“…If this trend continued, functional status and satisfaction ultimately may be higher. Additionally, treatment advances have occurred since our cohort was assembled in the mid‐1990s, particularly for radiation therapy 26. More recently treated patients may report fewer complications and greater satisfaction.…”

“…Additionally, treatment advances have occurred since our cohort was assembled in the mid-1990s, particularly for radiation therapy. 26 More recently treated patients may report fewer complications and greater satisfaction. We would expect the variables associated with satisfaction, though, to remain similar.…”

Targeting PI3K/Akt/mTOR signaling pathway in the treatment of prostate cancer radioresistance

“…However, further dose escalations to 82 Gy in a phase II trial for localized CaP yielded significant acute and late morbidity (Coen et al, 2011). Although three dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and image guide radiation therapy (IGRT) can increase dose to local CaP and improve control rate (Horwitz and Hanks, 2000), the clinical outcomes indicate these advanced approaches cannot completely overcome radioresistance in CaP (Vora et al, 2013). Radiosensitizers enhance tumor-specific DNA damage by inhibiting major signaling and repair pathways in tumor cells and thus facilitate tumor cell death (Mukherji et al, 2012).…”

Racial differences in initial treatment for clinically localized prostate cancer

“…Although these studies raised questions about racial differences in cancer treatment and outcomes, they also had important limitations. Much of the data were collected before the era of PSA screening and before widespread use of nerve‐sparing prostatectomy techniques, 14 or newer forms of external beam radiation and brachytherapy, 15 that can reduce treatment complications. Furthermore, cancer registries cannot readily identify men who presented with clinically localized cancer.…”