Fundamentals of Radiation Treatment for Prostate Carcinoma - Techniques, Radiation Biology, and Evidence Base

Radiation therapy remains ideally suited for the curative treatment of localized prostate cancer and palliation of metastatic disease. New treatment techniques have been developed and the field has had rapid advances in technology. Brachytherapy (radioactive implants) has undergone changes with the increased use of high dose rate temporary implants. These have resulted in shorter treatment courses for favorable prostate cancer. Combined modality treatment with hormonal therapy has become standard for locally advanced definitive treatment. At the same time surgical and other techniques have also improved making the selection of the optimal management of localized prostate carcinoma difficult for patients and clinicians. There are no conclusive prospective randomized studies demonstrating significant differences in overall survival and freedom from biochemical relapse between surgery and radiation therapy. In this chapter, we provide an overview of radiation biology, different radiation treatment techniques, and the current standard of care for definitive and palliative radiation therapy in prostate cancer.