Prostate Cancer

Abstract

This synthesis of the literature on radiotherapy for prostate cancer is based on 53 scientific articles, including 4 randomized studies, 3 prospective studies, and 44 retrospective studies. These studies involve 52 005 patients.

The literature provides no apparent evidence to motivate radiotherapy, or any treatment, for highly differentiated TO tumors. Some findings suggest that radiotherapy or surgery may be indicated for poorly differentiated tumors. The literature however shows no differences in tumor effects between these two methods for treating TO tumors. Radiotherapy is milder and less mutilating.

Conclusions cannot be drawn from the literature concerning whether surgery (radical prostatectomy) or external radiotherapy is preferable for Tl and T2 tumors. Most probably, some patients are more suitable for surgery, others for radiotherapy. More patients are, nevertheless, candidates for radiotherapy.

The value of external radiotherapy for T3 tumors is documented.

Radiotherapy is valuable as palliative treatment for T4 tumors.

Radiotherapy may be valuable as localized, symptom-relieving treatment for generalized prostate cancer. Treatment given via a few high fractions saves patients' time, hospitalization, and resources.

Concerning individualized treatment, the differentiation grade is important for the choice of treatment method, mainly in early, but even in late clinical stages. This may involve choosing between radiotherapy and endocrine therapy, or even choosing between radiotherapy and surgery. The value of external radiotherapy increases as the differentiation grade of the tumor decreases. It is essential to treat patients at facilities that have the diagnostic potential to establish the differentiation grade of tumors.

The value of postoperative radiotherapy has not yet been demonstrated at any clinical stage of prostate cancer.

Treatment results from interstitial brachytherapy alone appear to be clearly inferior to the results from other methods. The value of combining interstitial/external radiotherapy should be studied further.