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  • Review Article
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Treating prostate cancer with radiotherapy

Nature Reviews Clinical Oncology volume 7, pages 583–589 (2010)Cite this article

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Abstract

This Review focuses on the adverse effects of radical radiotherapy for localized prostate cancer. The adverse effects are described in the context of alternative treatment modalities. First, we consider the methodological issues that make comparison between the different treatment modalities problematic. Such issues include differences in baseline levels of urinary, bowel and sexual dysfunction, the importance of using patient-reported outcomes and the distinction between actuarial and prevalence rates of treatment-related toxic effects. Second, we describe the pattern of adverse effects that occur over time after radiotherapy. Here, we focus on evidence for a beneficial effect of radiotherapy on some urinary symptoms, and the controversy regarding the risk of secondary malignancy. Third, predictors of radiation toxicity are discussed. Accurate prediction of radiotherapy toxicity would be an invaluable tool for treatment individualization. It is noteworthy that the data on the adverse effects of prostate radiotherapy necessarily relate to treatment as it was delivered in the past. It is likely that recent technical advances, such as intensity modulation and image guidance, will further improve the toxicity profile of prostate radiotherapy.

Key Points

  • Studies of treatment-related toxic effects should include analysis of pretreatment functional status, patient-reported outcomes and the use of prevalence, rather than cumulative, rates of toxicity

  • Data from the SPCG7 trial show that the addition of prostate radiotherapy has only a modest impact on mean urinary, bowel and sexual bother in men receiving hormone treatment

  • Pretreatment bowel function and prior abdomino-pelvic surgery are important predictors of late rectal toxicity after prostate radiotherapy

  • Obstructive lower urinary tract symptoms typically improve after prostate radiotherapy

  • Any additional risk of rectal cancer after prostate radiotherapy remains uncertain

  • Intensity modulated radiotherapy and image-guided radiotherapy have the potential to further improve the therapeutic index of prostate radiotherapy

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Figure 1: Changes in reported symptoms in urinary, bowel, sexual and global health domains.7
Figure 2: Smoothed probability plots of the interval likelihood of returning to baseline health-related quality of life as measured by various instruments.
Figure 3: IMRT plans for prostate cancer treatment.
Figure 4: Antero-posterior and lateral electronic portal imaging device (EPID) and digitally reconstructed radiographs (DRR) showing gold fiducial markers within the prostate gland.

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Authors and Affiliations

  1. Academic Urology Unit, Institute of Cancer Research, Royal Marsden Hospital, Sutton, SM2 5PT, Surrey, UK

    Anna Wilkins & Chris Parker

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  1. Anna Wilkins
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Contributions

A. Wilkins contributed to the data research, writing, and reviewing/editing of the manuscript. C. Parker contributed to the data research, discussion, and reviewing/editing of the manuscript.

Corresponding author

Correspondence to Anna Wilkins.

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The authors declare no competing financial interests.

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Wilkins, A., Parker, C. Treating prostate cancer with radiotherapy. Nat Rev Clin Oncol 7, 583–589 (2010). https://doi.org/10.1038/nrclinonc.2010.135

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