[Prostate cancer].
The incidence of prostate cancer has been increasing gradually in Japan, and the optimal use of radiation therapy is important to improve therapeutic outcome and quality of life. The clinical trials conducted by RTOG and EORTC have made it clear that dose escalation results in improvement of the local control rate in early stage localized prostate cancer and androgen ablation in combination with radiation therapy improves biochemical control and the progression-free survival rate in locoregionally advanced prostate cancer. To select optimal patients for dose escalation study and to determine the optimal use of androgen ablation, it has become clear that the Gleason score and pretreatment PSA value provide valuable information in addition to clinical stage. In terms of prophylactic irradiation to pelvic lymph nodes, there has been no definitive evidence that prophylactic irradiation of clinically or pathologically uninvolved pelvic lymph nodes improves the overall survival rate. Brachytherapy including 125-I or 103-Pd permanent implants and high-dose-rate brachytherapy is now widely used in the treatment of prostate cancer, but clear indications have not yet been determined because of the lack of clinical trials. In this paper, we summarize evidence concerning the role of radiation therapy in the treatment of prostate cancer and also describe the biological basis of prostate cancer, which influences the optimal selection of treatment modalities.
Akimoto
Tetsuo
T
Department of Radiology and Radiation Oncology, Gunma University School of Medicine.
D001918:Brachytherapy; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*