Therapeutic options for clinically localized carcinoma of the prostate

Four-week arc radiotherapy for B2-C prostate cancer: the need for prospective evaluation of short fractionation schemes

A retrospective review of 173 men with clinical stage B2-C prostate cancer treated by small-volume arc radiotherapy to 5200 cGy in 16 fractions over 4 weeks was undertaken. At 5 years, clinical local failure rates were 14% for stage B2 and 18% for stage C. Five-year survival rates were 81 and 61%, respectively. No discernible differences were detected between a policy of encompassing the planning target volume by the 90% or 95% isodose. The limitations of this retrospective evidence and that of the literature are discussed. In the context of resource limitations affecting radiation oncology, prospective assessment of this technique is required to determine the true outcome.

[The conformal radiotherapy of localized prostatic carcinoma: acute tolerance and early efficacy]

AIM

In a prospective trial early effectiveness and acute toxicity of conformal 3D-planned radiotherapy for localized prostate cancer was quantified using dose-volume-histogramms and evaluated with respect of treatment technique.

PATIENTS AND METHOD

Thirty-two men (44 to 80 years old) with locally advanced carcinoma of the prostate (stage B2 or C) have been treated by 3D-planned conformal radiotherapy using high energy photons. In 28/32 men treatment technique was a monoaxial bisegmental rotation with irregular fields. With single doses of 2.0 Gy a mean total dose of 63.9 +/- 4.9 Gy according to ICRU was applied within 46 +/- 4 days. Maximum dose was in the mean 105.1% +/- 3.8%. 3D treatment volume was 274.1 +/- 113.4 cm3. Median follow-up is 1.8 years (15 to 34 months). Toxicity was evaluated according to RTOG-EORTC by patient interview and physical examination on a weekly basis during radiotherapy and by regular follow-up.

RESULTS

Eleven patients had none, 15 mild (RTOG grade 1) and 6 moderate symptoms (RTOG grade 2, mainly diarrhoea, dysuria and polyuria). Acute complications leading to treatment interruption did not occur. In 16 patients symptoms disappeared within 6 weeks after radiotherapy. Only 2 men had symptoms which lasted longer than 3 months and were endoscopically examined. Up to now no late complications were detected. Incidence and severity of toxicity was significantly (p < 0.05) related to the size of treatment volume. Acute toxicity was found to depend statistically significant (p < 0.05) on the proportional volume of bladder and rectum, irradiated with more than 35 Gy. In 81% of the patients with pretherapeutic elevated PSA levels normalisation of PSA was observed. Overall mean PSA levels of 15.7 +/- 22.6 micrograms/l at the beginning of radiotherapy fell to 2.1 +/- 3.7 micrograms/l 6 weeks after irradiation. Only 1 Patient relapsed locally 22 months after radiation therapy.

CONCLUSION

We conclude that due to modern 3D-planned conformal techniques with optimization of treatment dose and improved protection of critical organs such as urinary bladder and rectum, radiotherapy allows an effective and well tolerated therapy of localized prostatic carcinoma.

Treatment of localized prostate cancer. Choosing the best alternative

Thousands of men will be faced with a diagnosis of prostate cancer this year and will turn to their primary care physician for advice about which treatment is best. Unfortunately, there are no easy answers, and multiple factors, including the patient's age, must be weighed in decision making. In this article, Drs Williams and Love sift through the pros and cons of the available treatment options for various profiles of organ-confined disease.