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Radiotherapy in the Management of Clinically Localized Prostate Cancer: Evolving Standards, Consensus, Controversies and New Directions

Joycelyn L. Speight, Mack Roach, III

From the Departments of Radiation Oncology and Urology, UCSF/Mt. Zion Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California

Address reprint requests to Joycelyn L. Speight, MD, PhD, Department of Radiation Oncology, UCSF/Mt. Zion Comprehensive Cancer Center, 1600 Divisadero St H1031, Box 1708, San Francisco, CA 94143-1708; e-mail: speight{at}radonc17.ucsf.edu.

Major advances have been made in the definitive use of various forms of radiotherapy (RT) in the management of clinically localized prostate cancer (PCa). Despite tremendous gains, the radiation oncology community continues to struggle with several key questions. In general, the areas of controversy pertain to how to improve the therapeutic ratio of RT. Specifically, key issues include dose escalation; the relative benefit of alternative forms of RT (ie, brachytherapy and protons); target localization; the use, timing, and duration of androgen deprivation; and the need for pelvic nodal irradiation. Multiple efforts have been made to address each of these issues; however, there is no consensus on how to resolve them. This review is an evidence-based critique of the available treatment approaches considered for the optimal use of radiotherapy as definitive management of clinically localized PCa.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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