Role of Radiotherapy in Localized Prostate Cancer

2018 ◽  
Author(s):  
Joelle Helou ◽  
Andrew Loblaw
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Dose Escalation ◽  
Low Risk ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Beam Radiation ◽  
Pathologic Features ◽  
Risk Patients ◽  
Postoperative Setting

Radiation is a standard treatment approach in the treatment of prostate cancer, in either a definitive or postoperative setting. There is mounting evidence of improved cancer outcomes with higher doses of radiation in all risk categories, including low-risk prostate cancer patients. Technical advances with the emergence of inverse planning intensity-modulated techniques combined with image guidance have allowed for dose escalation using external-beam radiation therapy (EBRT). However, despite more accurate treatment delivery, dose-escalated radiation has consistently translated into increased toxicity. Stereotactic body radiotherapy and brachytherapy offer great means of dose escalation to the prostate without increasing the dose to the surrounding organs. Radiation options for low-risk patients include hypofractionated EBRT and brachytherapy monotherapy. Intermediate-risk patients can be divided into favorable and unfavorable groups. For favorable-risk disease, monotherapeutic approaches could be considered, whereas for unfavorable intermediate-risk and high-risk disease, a combination of therapies must be considered. In the postoperative setting, adjuvant radiation improves biochemical outcomes in patients with adverse pathologic features (pT3 and/or positive margins).   This review contains 2 figures, 5 tables, 1 video and 135 refereces Key words: prostate cancer, radiation therapy, brachytherapy, stereotactic ablative body radiation, hypofractionation, hormonal therapy

Role of Radiotherapy in Localized Prostate Cancer

2018 ◽  
Author(s):  
Joelle Helou ◽  
Andrew Loblaw
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Dose Escalation ◽  
Low Risk ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Beam Radiation ◽  
Pathologic Features ◽  
Risk Patients ◽  
Postoperative Setting

Radiation is a standard treatment approach in the treatment of prostate cancer, in either a definitive or postoperative setting. There is mounting evidence of improved cancer outcomes with higher doses of radiation in all risk categories, including low-risk prostate cancer patients. Technical advances with the emergence of inverse planning intensity-modulated techniques combined with image guidance have allowed for dose escalation using external-beam radiation therapy (EBRT). However, despite more accurate treatment delivery, dose-escalated radiation has consistently translated into increased toxicity. Stereotactic body radiotherapy and brachytherapy offer great means of dose escalation to the prostate without increasing the dose to the surrounding organs. Radiation options for low-risk patients include hypofractionated EBRT and brachytherapy monotherapy. Intermediate-risk patients can be divided into favorable and unfavorable groups. For favorable-risk disease, monotherapeutic approaches could be considered, whereas for unfavorable intermediate-risk and high-risk disease, a combination of therapies must be considered. In the postoperative setting, adjuvant radiation improves biochemical outcomes in patients with adverse pathologic features (pT3 and/or positive margins).   This review contains 2 figures, 5 tables, 1 video and 135 refereces Key words: prostate cancer, radiation therapy, brachytherapy, stereotactic ablative body radiation, hypofractionation, hormonal therapy

Predictors of prostate cancer-specific mortality in elderly men with intermediate-risk prostate cancer treated with radiation therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9543-9543
Author(s):  
A. Nanda ◽  
M. Chen ◽  
B. J. Moran ◽  
M. H. Braccioforte ◽  
D. Dosoretz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Elderly Men ◽  
Beam Radiation ◽  
Increased Risk ◽  
Specific Mortality ◽  
Risk Prostate Cancer ◽  
Cancer Specific Mortality

9543 Background: To identify clinical factors associated with prostate cancer-specific mortality (PCSM), adjusting for co-morbidity, in elderly men with intermediate-risk prostate cancer treated with brachytherapy alone or in conjunction with external beam radiation therapy (EBRT). Methods: The study cohort comprised 1,978 men of median age 71 (interquartile range [IQR], 66–75) years with intermediate-risk prostate cancer (Gleason score 7 with PSA 20 ng/mL or less and tumor category T2c or less). Fine and Gray's multivariable competing risks regression was used to assess whether presence of cardiovascular disease (CVD), age, treatment, year of brachytherapy, PSA level, or tumor category were associated with the risk of PCSM. Results: After a median follow up of 3.2 (IQR, 1.7 - 5.4) years, 15 men were observed to experience PCSM. The presence of CVD was significantly associated with a decreased risk of PCSM (AHR 0.20, 95% CI 0.04 - 0.99, P = 0.05), whereas an increasing PSA level was significantly associated with an increased risk of PCSM (AHR 1.14, 95% CI 1.02 - 1.27, P = 0.02). In the absence of CVD, cumulative incidence estimates of PCSM were higher (P = 0.03) in men with PSA levels above as compared to the median PSA level (7.3 ng/mL) or less; however, in the setting of CVD there was no difference (P = 0.27) in these estimates stratified by the median PSA level (6.9 ng/mL). Conclusions: Detection of intermediate-risk prostate cancer in elderly men without CVD at lower PSA levels is associated with a lower risk of PCSM; this risk reduction is not observed in men with known CVD. [Table: see text] No significant financial relationships to disclose.

Treatment results of brachytherapy versus external beam radiation therapy for intermediate risk prostate cancer.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e16041-e16041
Author(s):  
Barry W. Goy ◽  
Margaret S. Soper ◽  
Tangel Chang ◽  
Harry A. Cosmatos ◽  
Jeff M. Slezak ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Intermediate Risk ◽  
Treatment Results ◽  
Beam Radiation ◽  
Risk Prostate Cancer

External beam radiation therapy improves survival in high- and intermediate-risk non-metastatic octogenarian prostate cancer patients

2019 ◽  
Vol 52 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Sophie Knipper ◽  
Cristina Dzyuba-Negrean ◽  
Carlotta Palumbo ◽  
Angela Pecoraro ◽  
Giuseppe Rosiello ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Intermediate Risk ◽  
Beam Radiation

INTREPId (INTermediate Risk Erection PreservatIon Trial): A randomized trial of radiation therapy and darolutamide for prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. TPS384-TPS384
Author(s):  
Martin T. King ◽  
David R. Wise ◽  
Lawrence M. Scala ◽  
Neil M. Mariados ◽  
Amanda Whitbeck ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Controlled Trial ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Open Label ◽  
Eligibility Criteria ◽  
Fixed Sequence ◽  
Beam Radiation ◽  
Risk Prostate Cancer

TPS384 Background: Men with intermediate risk prostate cancer are often recommended external beam radiation therapy (EBRT) with or without 4-6 months of androgen deprivation therapy (ADT). However, ADT can be associated with prolonged erectile dysfunction due to delayed testosterone recovery. Darolutamide is a second-generation androgen receptor with low blood-brain barrier penetration. We hypothesize that men who receive Darolutamide with RT rather than ADT with RT are able to achieve surrogate PSA endpoints indicative of long-term disease control while preserving erectile function. Methods: This is an open label, phase 2B, multi-center, randomized controlled trial. Eligibility criteria include intermediate risk prostate cancer, good erectile quality per the EPIC-26 questionnaire, and archival tissue suitable for submission to Decipher Biosciences (San Diego, CA). Men will be stratified by Decipher score (low/intermediate vs high), RT modality (EBRT vs Brachytherapy/stereotactic body radiation therapy/combination RT), and age (>65 vs <65). Men with a Decipher high score will be strongly encouraged to undergo extreme RT dose-escalation. The primary endpoint is PSA nadir ≤ 0.5 within 6 months from end of treatment (EOT). The hierarchical endpoint is maintenance of good erectile quality at 3 months from EOT. The key secondary endpoint is interval to PSA failure at 3 years from EOT. Endpoints will be analyzed in a fixed-sequence hierarchical method. 220 patients will be accrued over 3 years. Non-inferiority margins for the primary and key secondary endpoints are 9% (90% power) and 4.9% (80% power), respectively. Men will be randomized to 6 months of GnRH agonist plus bicalutamide 50 mg daily with RT or 6 months of darolutamide 600 mg twice daily with RT. Assessments will occur at baseline, during treatment, EOT, and at regularly scheduled intervals up to 36 months from EOT. Correlative endpoints include discovering transcriptomic and radiomic predictors of response. Clinical trial information: NCT04025372.

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