External-Beam Radiotherapy in the Management of Carcinoma of the Prostate

Abstract

Background

External-beam radiotherapy (EBRT) has been used in the treatment of adenocarcinoma of the prostate gland for more than 30 years. Well-documented clinical series have demonstrated the effectiveness of EBRT in achieving both cause-specific survival and freedom from biochemical (prostate-specific antigen [PSA]) progression.

Methods

The indications and expected treatment results for treatment by EBRT in the management of adenocarcinoma of the prostate gland are reviewed. The treatment of early-stage disease definitively by EBRT alone or as complement to radioactive seed implant is emphasized. In the management of locally advanced disease, the use of EBRT with combined androgen ablation is discussed as definitive therapy and also as indicated in the postoperative adjuvant management of surgically identified pathologic stage T3 disease.

Results

The relative clinical benefit of EBRT compared with the mostly predictable and well-defined moderate side effects, which are manageable in most instances by conservative measures treatment, is well established. Advances in defining radiation-beam parameters have led to more effective and safer treatment for prostate cancer.

Conclusions

EBRT has historically been a mainstay in the management of prostate cancer. It remains a useful and indicated treatment modality in patients with early-stage, locally advanced, and metastatic disease.

References

Goffinet

D.R.

, Bagshaw

M.A.

. Radiation therapy of prostate carcinoma: thirty year experience at Stanford University. Prog Clin Biol Res. 1990; 359: 209–229.

AJCC Cancer Staging Manual. 5th ed. Philadelphia, Pa: Lippincott-Raven; 1997.

Partin

A.W.

, Kattan

M.W.

, Subong

E.N.

. Combination of prostate-specific antigen, clinical stage and Gleason score to predict pathological stage of localized prostate cancer: a multi-institutional update. JAMA. 1997; 277: 1445–1451.

Wallner

, Blasko

, Dattoli

M.S.

. Prostate Brachytherapy Made Complicated. Seattle, Wash: SmartMedicine Press; 1997.

Pollack

, Zagars

G.K.

. External beam radiotherapy dose response of prostate cancer. Int J Radiat Oncol Biol Phys. 1997; 39: 1011–1018.

Pollack

, Smith

L.G.

, von Eschenbach

A.C.

. External beam radiotherapy dose response characteristics of 1127 men with prostate cancer treated in the PSA era. Int J Radiat Oncol Biol Phys. 2000; 48: 507–512.

Hanks

G.E.

, Hanlon

A.L.

, Schultheiss

T.E.

. Dose escalation with 3D conformal treatment: five year outcomes, treatment optimization, and future directions. Int J Radiat Oncol Biol Phys. 1998; 41: 501–510.

Zelefsky

M.J.

, Leibel

S.A.

, Gaudin

P.B.

. Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys. 1998; 41: 491–500.

Lyons

J.A.

, Kupelian

P.A.

, Mohan

D.S.

. Importance of high radiation doses (72 Gy or greater) in the treatment of stage T1–T3 adenocarcinoma of the prostate. Urology. 2000; 55: 85–90.

10.

Shipley

W.U.

, Verhey

L.J.

, Munzenrider

J.E.

. Advanced prostate cancer: the results of a randomized comparative trial of high dose irradiation boosting with conformal protons compared with conventional dose irradiation using photons alone. Int J Radiat Oncol Biol Phys. 1995; 32: 3–12.

11.

Pollack

, Zagars

G.K.

, Smith

L.G.

. 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.

12.

Asbell

S.O.

, Schlager

B.A.

, Baker

A.S.

. Revision of treatment planning for carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1980; 6: 861–865.

13.

Pilepich

M.V.

, Prasad

S.C.

, Perez

C.A.

. Computed tomography in definitive radiotherapy of prostatic carcinoma, part 2: definition of target volume. Int J Radiat Oncol Biol Phys. 1982; 8: 235–239.

14.

Hanks

G.E.

, Martz

K.L.

, Diamond

J.J.

. The effect of dose on local control of prostate cancer. Int J Radiat Oncol Biol Phys. 1988; 15: 1299–1305.

15.

Fukunaga-Johnson

, Sandler

H.M.

, McLaughlin

P.W.

. Results of 3D conformal radiotherapy in the treatment of localized prostate cancer. Int J Radiat Oncol Biol Phys. 1997; 38: 311–317.

16.

Hanks

G.E.

, Krall

J.M.

, Hanlon

A.L.

. Patterns of care and RTOG studies in prostate cancer: long-term survival, hazard rate observations, and possibilities of cure. Int J Radiat Oncol Biol Phys. 1994; 28: 39–45.

17.

Bagshaw

M.A.

, Cox

R.S.

, Ray

G.R.

. Status of radiation treatment of prostate cancer at Stanford University. NCI Monogr. 1988; 47–60.

18.

Kuban

D.A.

, el-Mahdi

A.M.

, Schellhammer

P.F.

. Potential benefit of improved local tumor control in patients with prostate carcinoma. Cancer. 1995; 75: 2373–2382.

19.

Perez

C.A.

, Lee

H.K.

, Georgiou

. Technical and tumor-related factors affecting outcome of definitive irradiation for localized carcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1993; 26: 581–591.

20.

Shipley

W.U.

, Prout

Jr , Coachman

N.M.

. Radiation therapy for localized prostate carcinoma: experience at the Massachusetts General Hospital (1973-1981). NCI Monogr. 1988; 67–73.

21.

Dattoli

M.J.

, Wasserman

S.G.

, Koval

J.M.

. Conformal brachytherapy boost to external beam irradiation for localized high risk prostate cancer. Int J Radiat Oncol Biol Phys. 1995; 25: 1056. Abstract.

22.

Zietman

A.L.

, Coen

J.J.

, Shipley

W.U.

. Radical radiation therapy in the management of prostatic adenocarcinoma: the initial prostate-specific antigen value as a predictor of treatment outcome. J Urol. 1994; 151: 640–645.

23.

Pisansky

T.M.

, Cha

S.S.

, Earle

J.D.

. Prostate-specific antigen as a pretherapy prognostic factor in patients treated with radiation therapy for clinically localized prostate cancer. J Clin Oncol. 1993; 11: 2158–2166.

24.

Kuban

D.A.

, el-Mahdi

A.M.

, Schellhammer

P.F.

. Prostate-specific antigen for pretreatment prediction and post treatment evaluation of outcome after definitive irradiation for prostate cancer. Int J Radiat Oncol Biol Phys. 1995; 32: 307–316.

25.

American Society For Therapeutic Radiology and Oncology Consensus Panel.

Consensus statement: guidelines for PSA following radiation therapy.

Int J Radiat Oncol Biol Phys. 1997; 37: 1035–1041.

26.

Grimm

P.D.

, Blasko

J.C.

, Ragde

. Ultrasound-guided transperineal implantation of iodine-125 and palladium-103 for the treatment of early-stage prostate cancer: technical concepts in planning, operative technique, and evaluation. In: Shellhammer

P.F.

, ed. New Techniques in Prostate Surgery. Vol 2. Philadelphia, Pa: WB Saunders; 1994.

27.

Stromberg

J.S.

, Martinez

A.A.

, Horwitz

E.M.

. Conformal high dose rate iridium-192 boost brachytherapy in locally advanced prostate cancer: superior prostate-specific antigen response compared with external beam treatment. Cancer J Sci Am. 1997; 3: 346–352.

28.

Critz

F.A.

, Tarlton

R.S.

, Holladay

D.A.

. Prostate specific antigen monitored combination radiotherapy for patents with prostate cancer. Cancer. 1995; 75: 2383–2391.

29.

Grado

G.L.

, Larson

T.R.

, Balch

C.S.

. Actuarial disease-free survival after prostate cancer brachytherapy using interactive techniques with biplane ultrasound and fluoroscopic guidance. Int J Radiat Oncol Biol Phys. 1998; 42: 289–298.

30.

Ragde

, Blasko

J.C.

, Grimm

P.D.

. Brachytherapy for clinically localized prostate cancer: results at 7- and 8-year follow up. Semin Surg Oncol. 1997; 13: 438–443.

31.

Wallner

, Roy

, Harrison

. Tumor control and morbidity following transperineal iodine 125 implantation for stage T1/T2 prostatic carcinoma. J Clin Oncol. 1996; 14: 449–453.

32.

Beyer

D.C.

, Priestly

Jr . Biochemical disease-free survival following 125I prostate implantation. Int J Radiat Oncol Biol Phys. 1997; 37: 559–563.

33.

Stock

R.G.

, Stone

N.N.

. The effect of prognostic factors on therapeutic outcome following transperineal prostate brachytherapy. Semin Surg Oncol. 1997; 13: 454–460.

34.

Zagars

G.K.

, von Eschenbach

A.C.

, Johnson

D.E.

. The role of radiation therapy in stages A2 and B adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1988; 14: 701–709

35.

Bagshaw

M.A.

, Kaplan

I.D.

, Cox

R.C.

. Prostate cancer: radiation therapy for localized disease. Cancer. 1993; 71: 939–952.

36.

Zagars

G.K.

, von Eschenbach

A.C.

, Ayala

A.G.

. Prognostic factors in prostate cancer: analysis of 874 patients treated with radiation therapy. Cancer. 1993; 72: 1709–1725.

37.

Zietman

A.L.

, Coen

J.J.

, Dallow

K.C.

. The treatment of prostate cancer by conventional radiation therapy: an analysis of long-term outcome. Int J Radiat Oncol Biol Phys. 1995; 32: 287–292.

38.

Pilepich

M.V.

, Caplan

, Byhardt

R.W.

. 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. 1997; 15: 1013–1021.

39.

Pilepich

M.V.

, Winter

, Roach

. Phase III Radiation Therapy Oncology Group (RTOG) trial 86-10 of androgen deprivation before and during radiotherapy in locally advanced carcinoma of the prostate. Proc Annu Meet Am Soc Clin Oncol. 1998: 17; 1185A. Abstract.

40.

Bolla

, Gonzalez

, Warde

. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med. 1997; 337: 295–300.