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radiation therapy for prostate cancer

Indications: - prostate cancer Management: - radiation therapy [2] a) preferred modality for stage T3 (C) b) impotence is less frequent than with surgery c) men with positive surgical margins benefit most [3,4] d) a 6 month course of androgen-deprivation therapy prior to radiation therapy improves mortality by 50% in men with locally-advanced prostate cancer [5] **** [1]) e) does not improve survival or distant metastases after radical prostatectomy in patients with T3 disease or positive surgical margins [6] f) external beam radiotherapy for localized painful bone metastasis [1,7] - not needed in the absence of neurologic deficits or pain [1] i) IV radium-223 for multiple painful bone metastases (see bone metastases) - bone-targeted alpha-emitting radiation may improve survival in metastatic castrate-resistant prostate cancer [9] - beta-emitting radiation not as helpful j) radiation therapy for prostate cancer results in small increase in risk for bladder cancer & colorectal cancer [8]

General

radiation therapy (XRT)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15 16, 17, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018.
  2. Thompson IM JR et al, Adjuvant radiotherapy for pathologically advanced prostate cancer. A randomized clinical trial. JAMA 2006, 296:2329 PMID: 17105795
  3. Van der Kwast TH et al, Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911 J Clin Oncol 2007, 25:4178
  4. Wiegel T et al Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol 2009 Jun 20; 27:2924. PMID: 19433689
  5. Denham JW Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial The Lancet Oncology, 25 March 2011 PMID: 21440505 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70063-8/fulltext - Parker C Androgen deprivation before prostate radiotherapy: how long is long enough? The Lancet Oncology, 25 March 2011 PMID: 21440506 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70072-9/fulltext
  6. Bolla M et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: Long-term results of a randomised controlled trial (EORTC trial 22911). Lancet 2012 Oct 19; PMID: 23084481
  7. Basch E et al Systemic Therapy in Men With Metastatic Castration-Resistant Prostate Cancer: American Society of Clinical Oncology and Cancer Care Ontario Clinical Practice Guideline. J Clin Oncol. Sept 8, 2014 PMID: 25199761 http://jco.ascopubs.org/content/early/2014/09/03/JCO.2013.54.8404.full.pdf+html
  8. Wallis CJ et al Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis. BMJ 2016;352:i851 PMID: 26936410 http://www.bmj.com/content/352/bmj.i851 Eyler CE, Zietman AL A (relatively) risky business: the link between prostatic radiotherapy and second malignancies. BMJ 2016;352:i1073 PMID: 26935234 http://www.bmj.com/content/352/bmj.i1073
  9. Terrisse S, Karamouza E, Parker CC et al Overall Survival in Men With Bone Metastases From Castration-Resistant Prostate Cancer Treated With Bone-Targeting Radioisotopes. A Meta-analysis of Individual Patient Data From Randomized Clinical Trials. JAMA Oncol. Published online December 12, 2019. PMID: 31830233 https://jamanetwork.com/journals/jamaoncology/fullarticle/2757384