Radiation therapy for the treatment of locally advanced and metastatic prostate cancer.
Radiation therapy for locally advanced PCa continues to evolve. A current treatment recommendation for nonmetastatic, high-risk disease includes AS combined with RT. The precise duration and sequencing of AS has not been established but most frequently includes treatment in the neoadjuvant, concomitant and, occasionally, adjuvant periods. As technology allows higher doses without significant increases in morbidity and as clinical data provide proof of a radiation dose response, RT doses continue to escalate. The goal of therapy for metastatic disease continues to focus on the relief of pain and the improvement in quality of life. Multiple studies document the significant role RT plays in achieving these goals. Focal RT and systemic radioisotopes have become the mainstay of management in this patient group and the development of newer isotopes that cause less marrow toxicity will improve the therapeutic ratio and provide an opportunity for their use with systemic chemotherapy. As molecular and genomic technologies advance, directed targeting of critical cellular radiation-response pathways hold the promise of improved radiation response and individualized, tailored therapy.
Thurman
S A
SA
Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA.
Ramakrishna
N R
NR
DeWeese
T L
TL
D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D017353:Gene Deletion; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D017619:Hemibody Irradiation; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D009363:Neoplasm Proteins / Q000097:blood / Q000235:genetics; D009364:Neoplasm Recurrence, Local; D009502:Neutrons / Q000627:therapeutic use; D010166:Palliative Care; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D061766:Proton Therapy; D011836:Radiation Tolerance; D011867:Radioisotope Teletherapy; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D016032:Randomized Controlled Trials as Topic; D012493:Samarium / Q000627:therapeutic use; D013326:Strontium Radioisotopes / Q000627:therapeutic use; D015996:Survival Rate; D016896:Treatment Outcome; D014407:Tumor Cells, Cultured / Q000187:drug effects / Q000528:radiation effects
D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D006727:Hormone Antagonists; D009363:Neoplasm Proteins; D013326:Strontium Radioisotopes; D007987:Gonadotropin-Releasing Hormone; D012493:Samarium; D017430:Prostate-Specific Antigen