Clinically Localized Prostate Cancer – Part III: Principles of Radiation and Future Directions

Patient Guideline Summary

Publication Date: May 9, 2022

Last Updated: April 29, 2023

Objective

This patient summary means to discuss key recommendations from the American Urological Association (AUA) and the American Society for Radiation Oncology (ASTRO) for Localized Prostate Cancer – Part III of three. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Prostate cancer is the most common non-cutaneous cancer among US men.

Fortunately, the vast majority of cases are diagnosed when they are clinically localized.

The early disease has no symptoms. It is diagnosed by physical examination and a blood test for prostate-specific antigen (PSA).

This patient summary focuses on radiation treatment.

Treatment

There are two types of radiation treatment for prostate cancer – external beam radiation therapy (EBRT) and brachytherapy.
- EBRT (which uses a radiation source outside your body.)
  - (Proton treatment is also available but, to date, has not proved to be better than current methods.)
- Brachytherapy (which uses “seeds” of radioactive iodine, cesium, or palladium implanted in the prostate. The procedure is similar to a biopsy of the prostate.)

One or both types can be used in various doses depending on the nature and extent of your cancer.
- EBRT requires a precise 3-dimensional rendering of your cancer so that normal tissue is least harmed by the radiation.

Hypofractionation (refers to fewer, higher doses of radiation, achieving the total recommended dose in less time.)

An additional variable that improves outcome is “dose-escalation,” rather than a fixed dose throughout the course of treatment.

Higher-risk patients may benefit from irradiation of nearby lymph nodes and hormone deprivation (ADT).
- ADT, like radiation, may be used in variations of agent, dose, duration, and combination with other treatments.

Abbreviations

ADT: Androgen Deprivation Therapy
ASTRO: American Society For Radiation Oncology
AUA: American Urologic Association
BERT: External Beam Radiation Therapy
PSA: Prostate-specific Antigen

Source Citation

Eastham JA, Auffenberg GB, Barocas DA, Chou R, Crispino T, Davis JW, Eggener S, Horwitz EM, Kane CJ, Kirkby E, Lin DW, McBride SM, Morgans AK, Pierorazio PM, Rodrigues G, Wong WW, Boorjian SA. Clinically Localized Prostate Cancer: AUA/ASTRO Guideline. Part III: Principles of Radiation and Future Directions. J Urol. 2022 May 10:101097JU0000000000002759. doi: 10.1097/JU.0000000000002759. Epub ahead of print. PMID: 35536141.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.