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Radiation therapy for clinically localized prostate cancer: General principles

INTRODUCTION

The most effective therapy for clinically localized prostate cancer is controversial. Management options include radical prostatectomy, radiation therapy (external beam and/or brachytherapy, with or without androgen deprivation therapy [ADT]), or active surveillance (also termed watchful waiting) in carefully selected patients.

There are no randomized trials that directly compare radiation therapy (RT) with radical prostatectomy that have resolved the question of what constitutes the best treatment for men with localized prostate cancer. Ultimately, the choice of treatment is determined by a variety of factors including patient preference, physician judgment, and resource availability.

Modern prostate specific antigen (PSA)-based series suggest that outcomes with either external beam RT (EBRT) or brachytherapy using contemporary dosing schedules are similar to radical prostatectomy when men with clinically localized prostate cancer are stratified for pretreatment serum PSA, clinical tumor (T) stage, and Gleason score.

General principles underlying the use of RT for clinically localized prostate cancer will be reviewed here. Detailed discussions of external beam RT and brachytherapy for localized prostate cancer are presented separately, as is an overview comparing options for the initial treatment of localized prostate cancer. (See "External beam radiation therapy for localized prostate cancer" and "Brachytherapy for localized prostate cancer" and "Overview of treatment for clinically localized prostate cancer".)

ANATOMIC CONSIDERATIONS

The goal of RT for men with localized prostate cancer is the delivery of the planned dose of radiation to the tumor while minimizing radiation to surrounding normal tissues [1].
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