title: Future directions from past experience: a century of prostate radiotherapy.
abstract: Prostate cancer is the most commonly diagnosed noncutaneous malignancy in men, yet 100 years ago it was considered a rare disease. Over the past century, radiation therapy has evolved from a radium source placed in the urethra to today's advanced proton therapy delivered by only a few specialized centers. As techniques in radiation have evolved, the treatment of localized prostate cancer has become one of the most debated topics in oncology. Today, patients with prostate cancer must often make a difficult decision between multiple treatment modalities, each with the risk of permanent sequelae, without robust randomized data to compare every treatment option. Meanwhile, opinions of urologists and radiation oncologists about the risks and benefits involved with each modality vary widely. Further complicating the issue is rapidly advancing technology which often outpaces clinical data. This article represents a complete description of the evolution of prostate cancer radiation therapy with the goal of illuminating the historical basis for current challenges facing oncologists and their patients.
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH. Electronic address: wardm3@ccf.org.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Ward
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Rahul D
authors.initials: RD
authors.lastname: Tendulkar
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
mesh_terms: D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D001918:Brachytherapy / Q000266:history / Q000379:methods; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology / Q000528:radiation effects*; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D061766:Proton Therapy / Q000266:history / Q000379:methods; D011868:Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant / Q000266:history / Q000379:methods; D011883:Radium / Q000627:therapeutic use; D016879:Salvage Therapy / Q000266:history / Q000379:methods
chemical_list: D011868:Radioisotopes; D011883:Radium
keywords: Brachytherapy; History of medicine; IMRT; Proton therapy; Treatment planning