Recent London improvements in curative radiation therapy for relevant early prostate cancer.
Since the advent of PSA screening, the detection of early (organ confined) prostate cancer has improved. Although some indolent cancers in the elderly may be safely watched, the early diagnosis in younger men requires curative treatment. Two exciting modernized radiation therapy methods provide alternatives to major surgery and lead to cure rates equivalent to surgery. Modern intensity modulated external beam radiotherapy (IMRT) allows high-dose treatment to the prostate (+/- seminal vesicles) while maximally sparing the rectum (due to the extraordinary capability of creating a concavity in a high-dose radiation therapy volume). This has allowed escalation in the therapy dose to the prostate and improved cure rates. We have recently compared two different IMRT methods. Our introduction of "axial limits" rectal definition allows more accurate quantitation of relevant rectal sparing. Prostate radiation seed brachytherapy (Seattle 125-iodine method) provides a sophisticated, single-session radiation therapy method that has become the most popular curative method by busy men who want minimum interruption to their lives. The implant is "tailored" for the individual's gland size and shape, and in the London adaptation of the method there is interoperative monitoring of seed implantation, such that if any seed is slightly misplaced the information of deposition site is relayed back to a computer, which reconfigures the deposition of all subsequent seeds such that an ideal plan is achieved-dynamic, iterative, computer assisted implantation. The popularity of these two radiation techniques is largely due to the lesser rate of morbidity compared to surgery and the usual fast return to everyday life.
Department of Clinical Oncology, St. Bartholomew's Hospital, London, United Kingdom. Nick.Plowman@bartsandthelondon.nhs.uk
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D006801:Humans; D008131:London; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted