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Journal articles on the topic 'Prostate – Cancer – Radiotherapy'

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Author: Grafiati

Published: 4 June 2021

Last updated: 10 March 2023

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1

Catton, Charles N., Himu Lukka, and Jarad Martin. "Prostate Cancer Radiotherapy: An Evolving Paradigm." Journal of Clinical Oncology 36, no. 29 (October 10, 2018): 2909–13. http://dx.doi.org/10.1200/jco.2018.79.3257.

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The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A urologist referred a 69-year-old man for a radiotherapy opinion regarding a recently diagnosed adenocarcinoma of the prostate. Annual serum prostate-specific antigen (PSA) testing over 7 years demonstrated a rise in PSA from 1.36 ng/mL to 5.8 ng/mL, prompting a transrectal ultrasound that revealed a heterogeneous 37-mL gland containing no visualized hypoechoic nodules. Biopsy disclosed a Gleason score 3+4 (grade group 2) adenocarcinoma of the prostate. The synoptic report stated that six of 14 cores and 17% of the tissue were involved, with the greatest core involvement being 80% at the right apex. Perineural invasion was present without lymphovascular invasion. Disease was present bilaterally at the base, midgland, and apex.His medical history was significant only for treated peptic ulcer disease and he was taking no medication. His International Prostate Symptom Score was six of 35, and he reported being sexually active with good erectile function. There was no family history of prostate cancer. He is retired. Digital rectal examination revealed moderate benign prostatic hypertrophy with no suspicious nodules. A staging computerized tomography (CT) scan of the abdomen and pelvis and a whole-body bone scan ordered by his referring urologist reported no evidence of metastatic disease. The patient had discussed surgical options with his urologist and now wished to consider radiotherapy approaches.

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2

Park, Won. "Radiotherapy for prostate cancer." Journal of the Korean Medical Association 58, no. 1 (2015): 21. http://dx.doi.org/10.5124/jkma.2015.58.1.21.

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3

Khoo, V. "Radiotherapy of prostate cancer." European Journal of Cancer 47 (September 2011): S298—S301. http://dx.doi.org/10.1016/s0959-8049(11)70178-2.

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4

Nash, GF, KJ Turner, T. Hickish, J. Smith, M. Chand, and BJ Moran. "Interactions in the aetiology, presentation and management of synchronous and metachronous adenocarcinoma of the prostate and rectum." Annals of The Royal College of Surgeons of England 94, no. 7 (October 2012): 456–62. http://dx.doi.org/10.1308/003588412x13373405384611.

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Adenocarcinoma of the prostate and rectum are common male pelvic cancers and may present synchronously or metachronously and, due to their anatomic proximity. The treatment of rectal or prostate cancer (in particular surgery and/or radiotherapy) may alter the presentation, incidence and management should a metachronous tumour develop. This review focuses on the interaction between prostatic and rectal cancer diagnosis and management. We have restricted the scope of this large topic to general considerations, management of rectal cancer after prostate cancer treatment and vice versa, management of synchronous disease and cancer follow-up issues.

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5

Stanić, Jelena, Vesna Stanković, and Marina Nikitović. "Radiation toxicity in prostate cancer patients." Medicinski podmladak 72, no. 2 (2021): 26–33. http://dx.doi.org/10.5937/mp72-32377.

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Prostate cancer (PC) is the most frequent male tumor, accounting for about one-third of all cancers in men. Since survival is often favorable regardless of therapy, treatment decisions may depend on therapy-specific health outcomes. The majority of men initially diagnosed with localized PC ultimately die with, rather than of, their disease. As a result, men who are diagnosed will live many years with the treatment's sequelae. The major therapeutic strategies include radical prostatectomy or external beam radiotherapy. Radiotherapy is one of the curative treatment options. The tumor dose-response relationship has been studied and is widely accepted. The unsatisfactory local control with doses < 70 Gy led to dose escalation using highly precise radiotherapy techniques - three-dimensional conformal radiotherapy and intensity-modulated radiotherapy enabling the delivery of high radiation doses up to 74 - 78 Gy. Bowel, rectal and urinary toxicities are the principal limiting factors in delivering a high dose. Acute symptoms include a change in bowel habits, urgency, and fecal incontinence. The most commonly reported late toxicities were chronic diarrhea, proctitis, or rectal bleeding. Several factors have been associated with increased gastrointestinal toxicity such as larger bowel volume receiving high doses, the patient's age, diabetes, and concomitant use of androgen deprivation therapy. Bladder damage resulting from acute radiation toxicity is manifested as radiation cystitis (frequent urination and dysuric disorders). Smoking, previous abdominopelvic surgeries and the use of diuretics significantly affect the occurrence of acute genitourinary toxicity grade ≥ 2. Risk factors for the development of late genitourinary complications are higher radiation dose, previous urinary problems, transurethral interventions, and acute genitourinary complications. It is essential to strike a balance between the therapeutic benefits and radiotherapy side effects. Severe late complications significantly reduce the quality of life (QOL) of PC survivors. Early detection and proper evaluation of complications are especially important in increasing the patient's QOL.

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6

Ulys, Albertas, Alvydas Vėželis, Andrius Ivanauskas, and Marius Snicorius. "Treatment methods of prostate cancer recurrence after radiotherapy. Current treatment alternatives and our clinical experience." Lietuvos chirurgija 12, no. 3 (January 1, 2013): 138–43. http://dx.doi.org/10.15388/lietchirur.2013.3.1840.

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Background / objectiveProstate cancer is the most common cancer among men of Lithuania. Every year about 3000 new cases of prostate cancer are diagnosed in our country. Many patients receive radiotherapy as primary treatment. Unfortunately, after several years some of the patients are diagnosed with prostate cancer recurrence. These cases are more challenging and require to apply salvage treatment methods. The aim of this article is to present our clinical experience and discuss the main features, advantages and disadvantages of the treatment methods.Patients and methodsRetrospective analysis of 10 salvage prostate cancer recurrence treatment cases was completed. All patients previously received radiotherapy as primary treatment. 5 patients received salvage high- dose brachiterapy (group 1) and other 5- salvage cryotherapy (group 2). Prostate cancer recurrences were diagnosed by multiparametric MRI and ultrasound guided transrectal or transperineal biopsies.ResultsAverage patient age was 64,2±7,9 years in group 1 and 68±3,1 years in group 2. None of the patients had prostate cancer progression to lymph nodes (N) or metastases (M) on initial diagnosis or before salvage treatment. No intraoperative complications were observed. Average time between radiotherapy and salvage therapy in both groups was 88,9±30,1 months. In both groups 1 patient suffered from salvage treatment failure- prostate cancer progression was observed.ConclusionsCurrently there is no perfect treatment method for recurrent prostate cancer. Every situation requires universal aproach. Our initial experience shows that salvage cryotherapy and brachiterapy can be a viable alternative for patients with disease progression after radiotherapy.Key words: prostate cancer, prostate cancer recurrence, salvage treatment.Prostatos vėžio recidyvų po spindulinės terapijos gydymo metodaiŠiuolaikinėje medicinoje naudojami metodai ir mūsų klinikinė patirtis Įvadas / tikslasLietuvoje kasmet nustatoma apie 3000 naujų prostatos vėžio atvejų. Daugeliui pacientų taikomas spindulinis gydymas. Deja, praėjus keletui metų, kai kuriems pacientams diagnozuojamas prostatos vėžio recidyvavimas. Šiuo metu yra daug gydymometodų, bet dažnai iškyla problemų pasirenkant optimalų. Šio straipsnio tikslas – pasidalinti mūsų klinikine patirtimi bei apžvelgti prostatos vėžio recidyvų po spindulinės terapijos gydymo alternatyvas.Pacientai ir metodaiRetrospektyviai buvo išanalizuota dešimt pacientų, kuriems po pirminio gydymo radioterapija buvo diagnozuotas prostatos vėžio recidyvavimas. 5 pacientai buvo gydomi didelių dozių brachiterapija (1 grupė), o likusiems 5 buvo skirta krioterapija(2 grupė). Prostatos vėžio recidyvai diagnozuoti multiparametriniu kontroliuojant MRT ir ultragarsu atliktomis transrektalinėmis ir transperinealinėmis prostatos biopsijomis.RezultataiPirmoje grupėje vidutinis pacientų amžius buvo 64,2±7,9 metų, o antroje grupėje 68±3,1. Nė vienam pacientui nebuvo nustatytas prostatos vėžio išplitimas į limfmazgius (N) ar metastazavimas (M). Intraoperacinių komplikacijų nepasitaikė. Vidutiniškaitarp pirminės radioterapijos ir gelbstinčio prostatos vėžio recidyvavimo gydymo praėjo 88,9±30,1 mėnesio. Gelbstintis prostatos vėžio recidyvavimo gydymas buvo nesėkmingas dviem atvejais – po vieną atvejį abiejose grupėse.IšvadosŠiuo metu nėra tobulo gydymo tų pacientų, kuriems prostatos vėžys recidyvavo po spindulinio gydymo. Tokiais atvejais reikalingi unikalūs sprendimai. Mūsų nedidelė pirmoji patirtis rodo, jog gelbstinčioji krioterapija ir brachiterapija – tinkami metodaigydyti pacientams, kuriems recidyvavo prostatos vėžys po spindulinės terapijos.Reikšminiai žodžiai: prostatos vėžys, prostatos vėžio recidyvai, gelbstintis gydymas.

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7

Chua, Melvin, Erle Holgersen, Veronica Sabelnykova, Adriana Salcedo, Alice Meng, Michael Fraser, Theodorus Van Der Kwast, Paul Christopher Boutros, and Robert G. Bristow. "Genomic architecture of radioresistant prostate cancer." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 26. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.26.

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26 Background: Spatial intra-tumoral heterogeneity of prostate cancer is secondary to genomic diversity and multi-clonality. These unique features potentially promote resistance to treatment. Here, we investigated if clonal selection or adaptation of new clones dominates in prostate cancer at the time of recurrence following radiotherapy. Methods: We identified 11 patients with biopsy-proven multifocal recurrent prostate cancer following radiotherapy. Copy number aberration (CNA) profiling was performed on 33 anatomically distinct tumor foci with 11 matched-normals. 4 cases had matched pre-radiotherapy tumors for CNA profiling to assess for clonality. We evaluated for recurrent gene amplifications and deletions, and determined genomic instability by percent genome aberration (PGA). We also compared these genomic indices against 373 sporadic prostate cancers from the Canadian Prostate Cancer Gene Network. Results: We observed large intra- and inter-patient variation (p <0.001, one-way ANOVA) in PGA scores among the radioresistant tumors. Interestingly, although total CNA counts did not differ between the radioresistant and sporadic cohorts (median = 40, radioresistant vs 33, sporadic, p = 0.20], there was a trend for increased genomic instability in the radioresistant cohort (median PGA = 8.8 vs 4.9, p = 0.059). Spatial resolution of gene-level CNAs revealed the acquisition of CNAs that were both common and non-recurrent in the multi-focal radioresistant tumors, thus suggesting a common clonal origin, with subsequent divergent evolution. Importantly, we observed a mixture of CNAs, including known prognostic genes in prostate cancer, namely NKX3-1, PTEN, TP53, CDKN1B, and CDH1,that was shared between pre-treatment and radioresistant tumors, favoring clonal selection. We also discovered a novel deleted region on Chr3p, consisting of RAD18 and FANCD2, which was uniquely present in the radioresistant tumors. Conclusions: Our novel observations in a small cohort of radioresistant prostate cancers favor the model of clonal selection, as opposed to new-onset tumors. These results support the discovery of biomarkers a priori, and targeted treatment of these radioresistant clones to improve the therapeutic ratio of precision radiotherapy.

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8

Ghadjar, Pirus, Stefan Höcht, and Thomas Wiegel. "Postoperative radiotherapy in prostate cancer." Lancet 397, no. 10285 (May 2021): 1623. http://dx.doi.org/10.1016/s0140-6736(21)00273-7.

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9

Ohri, Nitin, Xinglei Shen, Robert B. Den, Adam P. Dicker, Edouard J. Trabulsi, and Timothy N. Showalter. "Salvage radiotherapy for prostate cancer." Cancer Biology & Therapy 13, no. 14 (December 6, 2012): 1449–53. http://dx.doi.org/10.4161/cbt.22006.

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10

Brenner, David J., and Eric J. Hall. "Hypofractionation in prostate cancer radiotherapy." Translational Cancer Research 7, S6 (July 2018): S632—S639. http://dx.doi.org/10.21037/tcr.2018.01.30.

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11

Vavassis, Peter, David HA Nguyen, Jean-Paul Bahary, and Michael Yassa. "Hypofractionated radiotherapy in prostate cancer." Expert Review of Anticancer Therapy 12, no. 7 (July 2012): 965–72. http://dx.doi.org/10.1586/era.12.70.

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12

Shaikh, Talha, and Eric M. Horwitz. "Hypofractionated Radiotherapy for Prostate Cancer." Oncology Times 38, no. 17 (September 2016): 13–14. http://dx.doi.org/10.1097/01.cot.0000499606.90328.d8.

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13

Mendenhall, William M., Randal H. Henderson, and Nancy P. Mendenhall. "Definitive Radiotherapy for Prostate Cancer." American Journal of Clinical Oncology 31, no. 5 (October 2008): 496–503. http://dx.doi.org/10.1097/coc.0b013e31816d1ca6.

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14

Mendenhall, William M., Randal H. Henderson, R. Charles Nichols, Sameer R. Keole, and Nancy P. Mendenhall. "Postprostatectomy Radiotherapy for Prostate Cancer." American Journal of Clinical Oncology 32, no. 5 (October 2009): 529–34. http://dx.doi.org/10.1097/coc.0b013e31817e6ef9.

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15

Fuks, Z. "Conformal radiotherapy for prostate cancer." European Journal of Cancer 35 (September 1999): S384. http://dx.doi.org/10.1016/s0959-8049(99)81975-3.

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16

Parker, C. C., and D. P. Dearnaley. "Radical radiotherapy for prostate cancer." Cancer Treatment Reviews 29, no. 3 (June 2003): 161–69. http://dx.doi.org/10.1016/s0305-7372(03)00070-7.

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17

Teh, Bin S., and Hiromichi Ishiyama. "Hypofractionated radiotherapy for prostate cancer." Lancet Oncology 13, no. 1 (January 2012): 5–6. http://dx.doi.org/10.1016/s1470-2045(11)70347-3.

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18

Gouda, Mohamed Alaa. "Radiotherapy for metastatic prostate cancer." Lancet 394, no. 10201 (September 2019): 829. http://dx.doi.org/10.1016/s0140-6736(19)31782-9.

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19

Aparicio, Ana, Peter Thall, and Christopher Logothetis. "Radiotherapy for metastatic prostate cancer." Lancet 394, no. 10201 (September 2019): 829–30. http://dx.doi.org/10.1016/s0140-6736(19)31783-0.

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20

Höcht, Stefan, and Wolfgang Hinkelbein. "Postoperative radiotherapy for prostate cancer." Lancet 366, no. 9485 (August 2005): 524–25. http://dx.doi.org/10.1016/s0140-6736(05)67075-4.

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21

Dearnaley, David P. "Hypofractionated radiotherapy in prostate cancer." Lancet Oncology 16, no. 3 (March 2015): 237–38. http://dx.doi.org/10.1016/s1470-2045(15)70021-5.

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22

Motwani, Sabin B., and Rahul D. Tendulkar. "Hypofractionated radiotherapy for prostate cancer." Lancet Oncology 17, no. 12 (December 2016): e517. http://dx.doi.org/10.1016/s1470-2045(16)30588-5.

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23

Gastelblum, Pauline, Martine Roelandts, and Paul Van Houtte. "External Radiotherapy and Prostate Cancer." European Urology Supplements 5, no. 6 (April 2006): 487–90. http://dx.doi.org/10.1016/j.eursup.2006.02.015.

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24

Waldstein, Cora, Wolfgang Dörr, Richard Pötter, Joachim Widder, and Gregor Goldner. "Postoperative radiotherapy for prostate cancer." Strahlentherapie und Onkologie 194, no. 1 (September 19, 2017): 23–30. http://dx.doi.org/10.1007/s00066-017-1215-9.

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25

Lebesque, J. V. "Conformal radiotherapy of prostate cancer." European Journal of Cancer 33 (September 1997): S68. http://dx.doi.org/10.1016/s0959-8049(97)84683-7.

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26

Shioyama, Yoshiyuki, Hiroshi Tsuji, Hiroaki Suefuji, Makoto Sinoto, Akira Matsunobu, Shingo Toyama, Katsumasa Nakamura, and Sho Kudo. "Particle radiotherapy for prostate cancer." International Journal of Urology 22, no. 1 (October 12, 2014): 33–39. http://dx.doi.org/10.1111/iju.12640.

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27

Hanks, Gerald E. "Conformal radiotherapy for prostate cancer." Annals of Medicine 32, no. 1 (January 2000): 57–63. http://dx.doi.org/10.3109/07853890008995911.

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28

Wilkins, Anna, and Chris Parker. "Treating prostate cancer with radiotherapy." Nature Reviews Clinical Oncology 7, no. 10 (August 17, 2010): 583–89. http://dx.doi.org/10.1038/nrclinonc.2010.135.

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29

Bayley, Andrew, and Mary K. Gospodarowicz. "Radiotherapy for T3 prostate cancer." Current Urology Reports 4, no. 3 (May 2003): 205–10. http://dx.doi.org/10.1007/s11934-003-0070-7.

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30

Pinkawa, Michael, Jaroslav Siluschek, Bernd Gagel, Marc D. Piroth, Cengiz Demirel, Branka Asadpour, and Michael J. Eble. "Postoperative Radiotherapy for Prostate Cancer." Strahlentherapie und Onkologie 183, no. 1 (January 2007): 23–29. http://dx.doi.org/10.1007/s00066-007-1588-2.

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31

Goldner, Gregor, Samir Sljivic, Renee Oismueller, Johanna Salinger, Michael Mittermüller, Tanja Langsenlehner, Walter Harder, Gerhard Kametriser, Helmut Eiter, and Elisabeth Nechvile. "Prostate Cancer Radiotherapy in Austria." Strahlentherapie und Onkologie 187, no. 5 (April 26, 2011): 279–83. http://dx.doi.org/10.1007/s00066-011-2268-9.

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32

Rans, K., C. Berghen, S. Joniau, and G. De Meerleer. "Salvage Radiotherapy for Prostate Cancer." Clinical Oncology 32, no. 3 (March 2020): 156–62. http://dx.doi.org/10.1016/j.clon.2020.01.003.

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33

Nakamura, Katsumasa, Hitoshi Ishikawa, Tetsuo Akimoto, Manabu Aoki, Shinji Kariya, Hidemasa Kawamura, Tomoyasu Kumano, et al. "National survey of radiation oncologists’ practice patterns regarding hormone-naïve prostate cancer with bone metastases." Japanese Journal of Clinical Oncology 50, no. 10 (July 6, 2020): 1188–94. http://dx.doi.org/10.1093/jjco/hyaa111.

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Abstract Objective To explore radiation oncologists’ attitudes and practice patterns of radiotherapy for hormone-naïve prostate cancer with bone metastases in Japan. Methods An internet-based survey was distributed to board-certified radiation oncologists of the Japanese Society of Radiation Oncology. Three hypothetical cases were assumed: hormone-naïve prostate cancer with single, three or multiple non-symptomatic bone metastases. The respondents described their attitude regarding such cases, treatment methods and the radiotherapy dose fractionation that they would recommend. Results Among the 1013 board-certified radiation oncologists in Japan, 373 (36.8%) responded to the questionnaire. Most of the respondents (85.0%) believed that radiotherapy may be applicable as a primary treatment for hormone-naïve prostate cancer with bone metastases in some circumstances. For Case 1 (single bone metastasis), 55.0% of the respondents recommended radiotherapy for the prostate and bone metastasis. For Case 2 (three bone metastases), only 24.4% recommended radiotherapy for all lesions, and 31.4% recommended radiotherapy for the prostate only. For Case 3 (multiple bone metastases), 49.1% of the respondents stated that there was no indication for radiotherapy. However, 34% of the respondents still preferred to administer radiotherapy for the prostate. The radiotherapy techniques and dose fractionations varied widely among the respondents. Conclusion Most of the respondent radiation oncologists believed that radiotherapy may be beneficial for hormone-naïve prostate cancer with bone metastases.

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34

Parikh, Neil R., and Amar U. Kishan. "Stereotactic Body Radiotherapy for Prostate Cancer." American Journal of Men's Health 14, no. 3 (May 2020): 155798832092724. http://dx.doi.org/10.1177/1557988320927241.

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Prostate cancer remains the most common and second most deadly cancer diagnosed amongst U.S. men. External beam radiotherapy is a standard-of-care definitive treatment option for localized prostate cancer and historically constituted an 8–9-week treatment course comprised of 39–45 doses of 1.8–2.0 Gy each (conventional fractionation, CF). Based on the notion that prostate cancer may respond favorably to a higher dose per day, considerable research efforts have been focused on characterizing the safety and efficacy profile of shorter and shorter radiation courses. Ultrahypofractionation (UHF) involves condensing the radiation course into just 5–7 treatments of 6–8 Gy each. When utilizing modern techniques that allow the precise sculpting of a dose distribution that delivers high doses to the prostate and lower doses to surrounding normal tissues over five or fewer treatments, this treatment is called stereotactic body radiotherapy (SBRT). Two randomized trials (HYPO-RT-PC and PACE-B) have compared UHF to longer radiation courses. The former demonstrated that UHF and CF have similar long-term toxicity and efficacy, while the latter demonstrated that modern SBRT has equivalent short-term toxicity as well. A separate report from a consortium of studies data provides prospective, albeit nonrandomized, data supporting the longer-term safety and efficacy of SBRT specifically. Thus, mounting high-level evidence suggests that SBRT is an acceptable standard care of option for men with localized prostate cancer.

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35

Minamitani, Masanari, Tomoya Mukai, Hideomi Yamashita, Atsuto Katano, and Keiichi Nakagawa. "Effects on annual income changes after radical radiotherapy versus after prostatectomy in patients with localized prostate cancer with a specific employment status: A web-based pilot study." PLOS ONE 16, no. 9 (September 30, 2021): e0258116. http://dx.doi.org/10.1371/journal.pone.0258116.

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Men with localized prostate cancers are insured for undergoing radical radiotherapy or prostatectomy. However, limited information is available on the influence of cancer treatments on patients’ employment status in Japan. Therefore, in this web-based survey, we aimed to compare the effects of post-treatment changes on the annual income of patients with prostate cancer after undergoing radical radiotherapy and prostatectomy and to identify the risk factors associated with the decrease in annual income. We investigated the clinical characteristics and demographics including pre-treatment working status, self-employment, non-regular employment, working for wage or salary, and joblessness of patients with localized prostate cancer. Multivariable logistic regression was performed to analyze the effects of various factors on the change in the annual income of self-employed and non-regularly employed workers. Seventy-eight eligible patients with localized prostate cancer had undergone radiotherapy, and 128 patients had undergone prostatectomy. Among self-employed and non-regularly employed workers, post-treatment income decline rates in those who underwent radiotherapy were smaller but not significant (12% vs. 42%, P = 0.074). Multivariable logistic regression analysis revealed that initial treatment for prostate cancer was the only significant risk factor for the post-treatment income decline among self-employed and non-regularly employed workers. Radiotherapy was associated with a smaller decrease in income (odds ratio, 0.22; 95% confidence interval, 0.052–0.95; P = 0.042). Our novel results implied the effectiveness of radiotherapy in preventing post-treatment income decline among patients with prostate cancer based on specific employment status: self-employed or non-regularly employed.

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36

Rucinska, Monika, Marta Stefanczyk, Joanna Minczewska, and Sergiusz Nawrocki. "Stereotactic hypofracionated radiotherapy for prostate cancer patients." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e16097-e16097. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e16097.

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e16097 Background: 3D conformal radiotherapy (78Gy in 2Gy per fraction) is the standard treatment for prostate cancer patients. It is a very long treatment, not comfortable both for patients and radiotherapy departments. Stereotactic radiotherapy has recently been recognized as an alternative technique. Prostate cancer has probably a low α/β ratio (1.5Gy) and 33.5Gy in 5 fractions has the predicted efficacy of 78Gy in 39 fractions. The objective of the study was to investigate the effectiveness and safety of stereotactic radiotherapy for localized prostate cancer. Methods: This is a prospective one-center clinical study. The treatment was done with IMRT. PTV received 33.5Gy in 5 fractions twice a week. Three gold fiducial markers were placed in the prostate under transrectal ultrasound guidance for image-guided positioning and motion tracking. Treatment planning CT and MRI scans were performed. IMRT plans were done. Before each treatment MV Cone Beam CT and portal imagines for markers were performed. Results: In this analysis 32 patients were included (age 65-83 years, median 73 years) with localized low- and intermediate-risk (according to NCCN) adenocarcinoma of prostate T2-T3N0M0. Combined Gleason scores were 5 to 7, the prostate-specific antigen (PSA) was 4.7-20.0ng/ml (median 10.2ng/ml). The median prostate volume calculated during treatment planning (on CT and MR) was 40.5cc (15.8cc to 113.6cc). Acute genitourinary toxicity Grade 1–2 was observed in about 50% patients and only Grade 1 acute gastrointestinal toxicity in 25% patients. No Grade 3 or higher toxicity was reported. Only 3 patients reported rectal bleeding after radiotherapy (Grade 1 late toxicity). PSA level were systematically decreased to 1.08ng/ml 3 months, 0.91ng/ml 6 months and 0.56ng/ml 9 months after treatment end. Conclusions: Stereotactic hypofractionated radiotherapy for prostate cancer patients is an effective and safe treatment in short term analysis.

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37

Cho, L. Chinsoo, Robert Timmerman, and Brian Kavanagh. "Hypofractionated External-Beam Radiotherapy for Prostate Cancer." Prostate Cancer 2013 (2013): 1–11. http://dx.doi.org/10.1155/2013/103547.

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There are radiobiological rationales supporting hypofractionated radiotherapy for prostate cancer. The recent advancements in treatment planning and delivery allow sophisticated radiation treatments to take advantage of the differences in radiobiology of prostate cancer and the surrounding normal tissues. The preliminary results from clinical studies indicate that abbreviated fractionation programs can result in successful treatment of localized prostate cancer without escalation of late toxicity.

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38

Nakamura, Yuki, Takahiko Soma, Keita Izumi, Yasuyuki Sakai, Hiroki Ushijima, Shigehiro Kudo, Yoshihiro Saito, and Yukio Kageyama. "Screening of chronic radiation proctitis and colorectal cancer using periodic total colonoscopy after external beam radiation therapy for prostate cancer." Japanese Journal of Clinical Oncology 51, no. 8 (April 23, 2021): 1298–302. http://dx.doi.org/10.1093/jjco/hyab056.

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Abstract Objective To investigate the incidence of colorectal cancer and chronic radiation proctitis after prostate radiotherapy using periodic total colonoscopy screening. Methods From February 2013 to January 2018, 270 patients who underwent external beam radiation therapy for prostate cancer were advised to receive periodic total colonoscopy screening annually. We evaluated the incidence and characteristics of colorectal cancer and chronic radiation proctitis. Results First, second, third, fourth and fifth total colonoscopy were performed in 256 (95%), 151 (56%), 60 (22%), 23 (8.5%) and 7 (2.6%) patients at a median of 14, 31, 42, 54 and 72 months after radiotherapy, respectively. The prevalence proportion of colorectal cancer in the first colonoscopy since radiotherapy was 3.9%. Twelve (4.4%) patients were diagnosed with colorectal cancer, including four invasive cancers, during a follow-up period. Eight of these 12 patients had not experienced rectal bleeding. The median time to diagnosis of colorectal cancer was 21 months. Chronic radiation proctitis was observed in 136 (50%) patients, including 67 (25%) patients with symptomatic bleeding. Conclusions The high detection rate of asymptomatic radiation proctitis suggests the utility of total colonoscopy to screen for early-stage colorectal cancer prior to or following radiotherapy for prostate cancer. Considering the longevity after localized prostate cancer treatment, the awareness of chronic radiation-induced proctitis and the risk of colorectal cancer masked by bleeding is needed in treatment decision -making.

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Masson, Susan, Raj Persad, and Amit Bahl. "HDR Brachytherapy in the Management of High-Risk Prostate Cancer." Advances in Urology 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/980841.

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High-dose-rate (HDR) brachytherapy is used with increasing frequency for the treatment of prostate cancer. It is a technique which allows delivery of large individual fractions to the prostate without exposing adjacent normal tissues to unacceptable toxicity. This approach is particularly favourable in prostate cancer where tumours are highly sensitive to dose escalation and to increases in radiotherapy fraction size, due to the unique radiobiological behaviour of prostate cancers in contrast with other malignancies. In this paper we discuss the rationale and the increasing body of clinical evidence for the use of this technique in patients with high-risk prostate cancer, where it is combined with external beam radiotherapy. We highlight practical aspects of delivering treatment and discuss toxicity and limitations, with particular reference to current practice in the United Kingdom.

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Irabor, Omoruyi Credit, William Swanson, Fiza Shaukat, Johanna Wirtz, Abba Aji Mallum, Twalib Ngoma, Ahmed Elzawawy, Paul Nguyen, Luca Incrocci, and Wilfred Ngwa. "Can the Adoption of Hypofractionation Guidelines Expand Global Radiotherapy Access? An Analysis for Breast and Prostate Radiotherapy." JCO Global Oncology, no. 6 (September 2020): 667–78. http://dx.doi.org/10.1200/jgo.19.00261.

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PURPOSE The limited radiotherapy resources for global cancer control have resulted in increased interest in developing time- and cost-saving innovations to expand access to those resources. Hypofractionated regimens could minimize cost and increase access for limited-resource countries. In this investigation, we estimated the percentage cost-savings per radiotherapy course and increased radiotherapy access in African countries after adopting hypofractionation for breast and prostate radiotherapy. For perspective, results were compared with high-income countries. METHODS The cost and course of breast and prostate radiotherapy for conventional and hypofractionated regimens in low-resource facilities were calculated using the Radiotherapy Cost Estimator tool developed by the International Atomic Energy Agency (IAEA) and then compared with another activity-based costing model. The potential maximum cost savings in each country over 7 years for breast and prostate radiotherapy were then estimated using cancer incidence data from the Global Cancer Observatory database with use rates applied. The increase in radiotherapy access was estimated by current national capacities from the IAEA directory. RESULTS The estimated cost per course of conventional and hypofractionated regimens were US$2,232 and $1,339 for breast treatment, and $3,389 and $1,699 for prostate treatment, respectively. The projected potential maximum cost savings with full hypofractionation implementation were $1.1 billion and $606 million for breast and prostate treatment, respectively. The projected increase of radiotherapy access due to implementing hypofractionation varied between +0.3% to 25% and +0.4% to 36.0% for breast and prostate treatments, respectively. CONCLUSION This investigation demonstrates that adopting hypofractionated regimens as standard treatment of breast and prostate cancers can result in substantial savings and increase radiotherapy access in developing countries. Given reduced delivery cost and treatment times, we anticipate a substantial increase in radiotherapy access with additional innovations that will allow progressive hypofractionation without compromising quality.

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Zhang, Hong, Hongmei Yang, Sanjukta Bandyopadhyay, Michael T. Milano, Chunkit Fung, Edward M. Messing, and Yuhchyau Chen. "Increased risk of high-grade prostate cancer among testicular cancer survivors." PLOS ONE 17, no. 2 (February 14, 2022): e0263573. http://dx.doi.org/10.1371/journal.pone.0263573.

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Introduction Testicular cancer survivors (TCS) have an increased risk of additional cancers, including prostate cancer. Our understanding of the natural history of prostate cancer in testicular cancer survivors is very limited due to its rare incidence. Methods Using the Surveillance, Epidemiology, and End Results (SEER) Registry from 1978 to 2011, we identified 282 TCS with subsequent prostate cancer and examined the tumor grade and clinical outcomes in contrast to men with primary prostate cancer in the general population. Results TCS with a subsequent prostate cancer diagnosis were more likely to be diagnosed at a younger age than men with primary prostate cancer (65.2% vs. 37.6% for age ≤65, 34.8% vs. 62.4% for age >65, p<0.001) and were more likely to have grade III/IV tumors (46.2% vs. 37.0%, p<0.002). Longer latency between testicular and prostate cancer diagnoses was associated with a higher risk of grade III/IV (p<0.001) cancer. Despite the increased risk for high-grade tumors, 10-year prostate cancer-specific survival and overall survival were not significantly different between TCS and men with primary prostate cancer. Based on the available information in SEER, we found that prior history of radiotherapy for testicular cancer had no impact on tumor grade or survival outcomes. Conclusions Prostate cancer in TCS was more likely to be diagnosed at a younger age and with higher grades. Risks of grade III/IV disease increased with longer latency between testicular and prostate cancer diagnoses. Radiotherapy for testicular cancer did not appear to have a significant impact on the outcome of subsequent prostate cancer.

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Din, Omar S., Narottam Thanvi, Catherine J. Ferguson, and Peter Kirkbride. "Palliative prostate radiotherapy for symptomatic advanced prostate cancer." Radiotherapy and Oncology 93, no. 2 (November 2009): 192–96. http://dx.doi.org/10.1016/j.radonc.2009.04.017.

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Sanguineti, G., M. Marcenaro, P. Franzone, M. Orsatti, F. Foppiano, and V. Vitale. "Radiotherapy for prostate-confined hormone refractory prostate cancer." International Journal of Radiation Oncology*Biology*Physics 51, no. 3 (November 2001): 280. http://dx.doi.org/10.1016/s0360-3016(01)02337-9.

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Kabalin, John N. "Prostate needle biopsy following radiotherapy for prostate cancer." Urology 46, no. 4 (October 1995): 603–4. http://dx.doi.org/10.1016/s0090-4295(99)80284-2.

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Ali, Adnan, Christopher C. Parker, and Noel W. Clarke. "Prostate radiotherapy in newly diagnosed metastatic prostate cancer." Current Opinion in Urology 29, no. 6 (November 2019): 620–28. http://dx.doi.org/10.1097/mou.0000000000000675.

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Pinkawa, M., K. Fischedick, B. Asadpour, M. D. Piroth, B. Gagel, B. Krenkel, J. Klotz, and M. J. Eble. "Do patients with larger prostates have greater toxicity after external beam radiotherapy for localized prostate cancer?" Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 15577. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.15577.

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15577 Background: To aim of the study was to assess the impact of prostate volume (PV) on health-related quality of life (HRQOL) before and at different points in time after conformal radiotherapy for prostate cancer. Methods: A group of 180 patients has been surveyed prospectively before (time A), at the last day (B), two months after (C) and sixteen months (median) after (D) radiotherapy (70.2- 72Gy) using a validated questionnaire (Expanded Prostate Cancer Index Composite). Patients in this analysis (n=165) met the prerequisite of responding to the first and last questionnaire. The multi-item scale scores were transformed lineary to a 0–100 scale, with higher scores representing better HRQOL. The group has been divided into a subgroup with a small PV (median 32cc; range 11–45; 83 patients) and a subgroup with a large PV (median 59cc; range 46–151; 82 patients). Results: Treatment plans for large prostates implied a larger planning target volume (averagely 396 vs. 305cc; p<0.01) with a significantly larger dose to the bladder and rectum at all volume levels. Patients with large prostates presented with lower urinary bother (averagely 76 vs. 83; p=0.04), but higher bowel bother scores (averagely 95 vs. 90; p<0.01) before the beginning of treatment. At time B, urinary bother scores decreased stronger for patients with large prostates (averagely 22 vs. 16 points). Comparing posttreatment scores to baseline scores, no significant decrease resulted for urinary function or bother scores for both groups at time C and D. At time D, urinary function scores even increased significantly for patients with large prostates (averagely 4 points). Bowel function and bother scores were still significantly lower for both groups at time C and D (averagely 3–8 points). HRQOL scores did not differ significantly between both patient groups at time D. Conclusions: In spite of a higher dose-load to the organs at risk, lower urinary bother scores before treatment and a higher decrease of urinary scores at the end of radiotherapy for patients with larger prostates, long-term HRQOL scores did not differ significantly between patients with large and small prostates. An improvement of urinary function suggests a regression of hyperplastic prostatic tissue. No significant financial relationships to disclose.

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Chuang, Jen-Pin, Yen-Chien Lee, Jenq-Chang Lee, Chin-Li Lu, and Chung-Yi Li. "A Population-Based Study of Secondary Prostate Cancer Risk after Radiotherapy in Male Patients with Rectal Cancer: A Retrospective Cohort Study." Medicina 55, no. 4 (April 14, 2019): 104. http://dx.doi.org/10.3390/medicina55040104.

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Background and objective: Risk of secondary prostate cancer after radiation therapy among patients with rectal cancer remains undetermined. Given an increased incidence of rectal cancer in younger people and improved survival for rectal cancer patients who received radiation therapy, the potential risk of secondary prostate cancer needs to be further investigated. Materials and Methods: Male patients (n = 11,367) newly diagnosed rectal cancer and who underwent abdominoperineal resection (APR) or low anterior resection (LAR) from 1 January, 1998 to 31 December, 2010 were identified from Taiwan National Health Insurance Research Database. The incidence and relative risk of secondary prostate cancer in study patients with (n = 1586) and without (n = 9781) radiotherapy within one year after rectal cancer diagnosis were compared using a competing-risks analysis. Results: Rectal cancer patients with radiotherapy were at a significantly decreased risk of developing prostate cancer, with a hazard ratio (HR) of 0.41 (95% confidence interval = 0.20–0.83) after adjustment for age. Analysis of the risk estimated for various follow-up lengths suggested that a decreasing HR was seen through the period followed-up and that there was a trend of decreasing prostate cancer risk with time after radiotherapy. Conclusions: Radiotherapy was significantly associated with decreased risk of secondary prostate cancer among rectal cancer patients, by a magnitude of 59%.

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Kodzo-Grey Venyo, Anthony. "Cryotherapy As Treatment of Curative Intent for Localized Adenocarcinoma of The Prostate Gland with A Focus on Low-risk and Medium – (Intermediate-) Risk Localized Adenocarcinoma of The Prostate Gland: A Review and Update." Clinical Research and Clinical Trials 5, no. 5 (April 27, 2022): 01–25. http://dx.doi.org/10.31579/2693-4779/083.

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Cryotherapy which is also referred to as cryosurgery or cryoablation refers to utilization of very cold temperatures to freeze various cells depending upon the pathology. Cryotherapy has tended to be utilized as treatment of curative intent for localized low-risk and intermediate risk carcinomas of the prostate gland. Cryotherapy has also been utilized for the treatment of post-cryotherapy failure prostate cancers with residual tumour or locally recurrent tumour that is confined to the prostate gland. Cryotherapy has also been utilized for the treatment of locally recurrent prostate cancers or localized prostate cancers that have remained following failure of radiotherapy to the prostate cancer of curative intent or radical prostatectomy of prostate for prostate at times. Because cryotherapy of prostate cancer is a minimally invasive treatment procedure, it can be utilized in the treatment of patients who have localized prostate cancer whose tumours could be treated by means of radical prostatectomy or radiotherapy (external beam radiotherapy or brachytherapy) who are considered not to be medically fit to undergo these procedures because of their co-morbidities. The most common treatment options for the management of localized adenocarcinomas of the prostate gland tend to involve radical prostatectomy or radical radiotherapy. Nevertheless, other treatment options for localized prostate cancer that have been undertaken sporadically include: Radiofrequency ablation of the prostate cancer, High intensity focussed ultrasound scan treatment of prostate cancer, irreversible electroporation of prostate cancer. Cryotherapy of prostate cancer as treatment of curative intent has tended to be published sporadically based upon case reports or case series and there has not been reports of an extensive clinical-trials on cryotherapy of localized adenocarcinoma of the prostate. Furthermore, there is no consensus opinion validated definition of biochemical failure pursuant to treatment of localized prostate cancer by cryotherapy. Nevertheless, one article has reported a prospective study with the undertaking of standardized follow-up protocol in which it a series of 108 patients who were diagnosed as having localized adenocarcinoma of prostate that was staged T1c to T2c were treated by primary cryoablation of curative intent and in which the median follow-up was 61 months. With regard to the results of this study, the criteria of biochemical recurrence had been unified based upon the American Society for Therapeutic Radiology and Oncology (ASTRO). The end points of the study included: biochemical progression-free survival (BPFS), cancer-specific survival, as well as overall survival. The complication rates were reported in the study. With regard to the results the biochemical progression-free survival rates were for low-, medium-, and high-risk prostate cancer patients 96.4%, 91.2%, and 62.2%, respectively. The Cancer-specific survival was 98.1%. The overall survival reached 94.4%. The complications that were encountered included incontinence in 5.6% of the patients, urinary tract obstruction in 1.9% of the patients, urethral sloughing in 5.6% of the patients, haematuria in 1.9% of the patients, perineal pain in 11.1% of the patients, and prostatorectal fistula in 0.9% of the patients. Erectile disfunction was found in 98.1% of the patients. The authors concluded that cryotherapy is an effective and minimally invasive treatment for primary carcinomas of the prostate gland in well-selected cases, and the treatment procedure is associated with low surgical risk and good results in terms of biochemical progression-free survival (BPFS), cancer-specific survival, and overall survival. Even though the results of this study had illustrated that the oncology outcome of high-risk prostate cancer was lower than the outcome of low-risk and intermediate-risk prostate cancer more than 60% of patients who had high-risk prostate cancer had biochemical progression-free survival after a median follow-up of 61 months. At the moment cryotherapy is being utilized as treatment of curative option for some low-risk and intermediate (medium) -risk prostate cancer. Cryotherapy of the primary prostate cancer has been utilized for the palliative treatment of some advanced / metastatic prostate cancer which had temporarily ameliorated the general health of few reported patients. In the scenario of persistence of localized low-risk or intermediate- (medium-) risk localized prostate cancer that have persisted following cryotherapy of the prostate cancer, the cancer can be treated by means of either further cryotherapy, radical prostatectomy, radical radiotherapy, HIFU treatment, Irreversible electroporation, and radiofrequency ablation of prostate gland. The complications of erectile / sexual dysfunction, and urinary incontinence / voiding dysfunction following cryotherapy for prostate cancer tends to be more transient in comparison with following radical prostatectomy or radical radiotherapy. It may be that cryotherapy of localized prostate cancer of low-risk, and medium-risk patients may have a slightly inferior long-term oncology outcome in comparison with radical prostatectomy, radical radiotherapy and other minimally invasive treatment options of curative intent but this needs to be further investigated through a large global multicentre treatment comparative study of various treatment options with a long-term follow-up. Nevertheless, cryotherapy of prostate cancer does represent a minimally invasive alternative treatment for localized prostate cancer as treatment of curative intent and it can also be used to treat persistent/locally recurrent prostate cancer following radical radiotherapy and radical prostatectomy. Cryotherapy as treatment option is a safe and effective treatment option for localized low-risk and medium-risk prostate cancer.

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Hernández, A., L. Pelari, G. Caddedu, I. Císcar, K. Ytuza, S. Sastre, E. Carrasco, et al. "PO-1168: Radiotherapy in high risk prostate cancer: Whole pelvic radiotherapy vs prostate only radiotherapy." Radiotherapy and Oncology 152 (November 2020): S614—S615. http://dx.doi.org/10.1016/s0167-8140(21)01186-5.

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Radosevic-Jelic, Ljiljana, Suzana Stojanovic, and I. Popov. "Radio therapy in prostate cancer treatment." Acta chirurgica Iugoslavica 52, no. 4 (2005): 93–102. http://dx.doi.org/10.2298/aci0504093r.

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Prostate cancer is a complex disease, with many controversial aspects of management in almost all stages of disease. The natural history of this tumor is variable and is influenced by multiple prognostic factors. Radical prostatectomy and radiotherapy are standard treatment options for disease limited to the prostate. The data in literature does not provide clear- cut evidence for the superiority of any treatment. Neo- adjuvant or adjuvant hormonal therapy improves local control and survival in locally advanced disease. The patients treated with radiotherapy would have a relatively long life expectancy, not great risk factors for radiation toxicity and a preference for radiotherapy. The advantages of radiotherapy are that it has a significant potential for cure, it is well tolerated in the majority of men especially when the modern techniques of conformal radiotherapy and intensity modulated therapy are used and it is non-invasive therapeutic options with no anesthesia risk. Expected complications like radiation cystitis, impotence and proctitis are registered in about 1% of patients.

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