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Prostate Cancer

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Decision Tools for Radiation Oncology

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

The knowledge in the field of prostate cancer is rapidly changing. The majority of diagnoses relate to the use of screening prostate-specific antigen (PSA), which remains controversial. A combination of PSA level at diagnosis, clinical stage, and Gleason score is used to stratify patients into prognostic groups, with risk-adapted treatment assignment. The evaluation of treatment options for low-, intermediate- and high-risk prostate cancer has remained difficult primarily because of the lack of randomized trials. Most patients present with curative disease stage. Validated first-line treatment options include radical prostatectomy and radiation therapy, via either interstitial seed implants or external-beam radiation (EBRT). Radiation therapy for localized prostate cancer leads to equivalent oncologic outcomes as compared with radical prostatectomy. Interstitial seed implants and EBRT appear clinically equivalent. Modality-specific toxicity profile and logistics should be incorporated into the decision-making process of the individual patient. Results from randomized studies have established the value of dose-escalated radiotherapy alone in the unimodality setting versus standard-dose irradiation in combination with neoadjuvant and concurrent hormonal treatment. The timing and optimal duration of endocrine therapy in the era of dose escalation remain investigational. Adjuvant radiation therapy improves clinical outcome for pT3 prostate cancer or positive surgical margins.

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Abbreviations

ADT:

Androgen deprivation therapy

CTV:

Clinical target volume

DVH:

Dose volume histogram

EBRT:

External beam radiotherapy

FFCF:

Freedom from clinical failure

GTV:

Gross tumor volume

IMRT:

Intensity modulated radiotherapy

IPSS:

International prostatic symptom score

OS:

Overall survival

OAR:

Organ at risk

PCa:

Prostate cancer

PFS:

Progression free survival

PLND:

Pelvic Lymph Node Dissection

PSA:

Prostate specific antigen

PTV:

Planning target volume

RT:

Radiotherapy

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Authors and Affiliations

  1. Department of Radiotherapy and Radiooncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany

    Cordula Petersen & Rudolf Schwarz

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  1. Cordula Petersen
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  2. Rudolf Schwarz
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Corresponding author

Correspondence to Cordula Petersen .

Editor information

Editors and Affiliations

  1. Department of Oncology, Nordland Hospital Trust Bodø University of Tromsø, Bodø, Norway

    Carsten Nieder

  2. Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA

    Laurie E. Gaspar

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© 2013 Springer-Verlag Berlin Heidelberg

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Petersen, C., Schwarz, R. (2013). Prostate Cancer. In: Nieder, C., Gaspar, L. (eds) Decision Tools for Radiation Oncology. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2013_855

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  • DOI: https://doi.org/10.1007/174_2013_855

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-37101-1

  • Online ISBN: 978-3-642-37102-8

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