Initial management of high risk early stage prostate cancer: Radiation

Because there are many treatment options for nonmetastatic prostate cancer, it is vitally important to define risk and determine a patient’s prognosis to aid in the treatment design. Risk is defined many ways, although the single most important prognostic variable is a person’s pretreatment PSA level.1 Other important variables include Gleason score, T stage, and radiation dose.2 At Fox Chase Cancer Center (FCCC) and elsewhere, these variables are used to categorize men into multiple risk groups.3-5 Patients with low-risk disease include those with PSA (10 ng/mL, Gleason score 2 to 6 and T1c/T2a disease. The high-risk group consists of patients having one of the following highrisk features: Gleason score 8 to 10, PSA greater than 20 ng/mL, or T3/T4 disease. Intermediate-risk patients do not fit into either of the above risk groups. Treatment options for low-and high-risk disease are discussed elsewhere. The focus of this chapter is on radiation treatment options for men with intermediate risk prostate cancer.