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PROSTATE CANCER

Prostate cancer is the cancer that occurs in the male's prostate.

It is the most common cancer in men >50 years of age.

Signs and symptoms include weak urinary stream, polyuria, nocturia, hematuria, erectile dysfunction, pelvic pain, back pain, chest pain, lower extremity weakness or numbness and loss of bowel or bladder control.

Radiotherapy

Interstitial Prostate Brachytherapy

  • Implantation of small radioactive sources into the prostate gland
  • Recommended initial therapeutic strategy for patients with low-risk prostate cancer
    • Difficult to perform in patients with very small or very large prostates, bladder outlet obstruction symptoms, or previous transurethral resection of the prostate (TURP)
  • Recommended doses:
    • 120 Gy (palladium)
    • 140 Gy (125I) with postoperative dosimetry

Low Dose-Rate Brachytherapy

  • Uses permanent low-energy seeds (Iodine-125, Palladium-103) for implantation that delivers adequate doses
  • Recommended for patients with low-risk disease
  • May be given to patients with intermediate risk together with external beam radiation therapy (EBRT)
  • Recommended dose:
    • Iodine-125: 145 Gy [110 Gy with 40-50 Gy external beam radiation therapy (EBRT)]
    • Palladium-103: 125 Gy [90-100 Gy with 40-50 Gy external beam radiation therapy (EBRT)]

High Dose-Rate Brachytherapy

  • Uses temporary radioactive sources (eg Iridium-192) inserted into different locations in the prostate gland
  • Recommended for patients with intermediate- to high-risk localized or locally advanced prostate cancer
  • Usually given together with external beam radiation therapy (EBRT) [40-50 Gy]
  • Recommended dose:
    • Monotherapy: 13.5 Gy x 2 fractions
    • With external beam radiation therapy (EBRT): 9.5-11.5 Gy x 2 fractions; 5.5-7.5 Gy x 3 fractions; 4-6 Gy x 4 fractions

External Beam Radiation Therapy (EBRT)

  • Recommended initial therapeutic strategy for patients with low-high risk prostate cancer
  • Should be reconsidered in patients with very low-risk prostate cancer with life expectancy of >10-20 years
  • Limited radiation fields are preferred over extended field radiotherapy for localized and locally advanced prostate cancer
  • Localization of prostate with image-guided radiation therapy (IGRT) is necessary with either 3-dimensional conformal radiation therapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) for reducing target margin and ensuring treatment accuracy
  • Recommended dose for patients with low-risk prostate cancer is 75.6-79.2 Gy; intermediate- to high-risk and metastatic prostate cancer is 81.0 Gy

Radiopharmaceutical Therapy

  • Eg Radium-223 dichloride, ß-emitting agents (Strontium-89, Samarium-153)
  • Option for palliative treatment of patients with metastatic disease

Beta-Emitting Radioactive Agents

  • Eg Strontium-89 (Sr-89, 89Sr), Samarium-153 (Sm-153, 153Sm)
  • Used for treatment of painful bone metastases

Radium-223 dichloride

  • An alpha particle-emitting radioactive agent used for metastatic castration-resistant prostate cancer (CRPC) with symptomatic bone metastases but without visceral involvement
    • Studies have shown that patients given Radium-223 had better overall survival and time to appearance of symptomatic bone events than those given placebo

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