Skip to main content
SpringerLink
Log in

Radiotherapy for Prostate Cancer

  • Chapter
  • First Online:
Chemotherapy and Immunotherapy in Urologic Oncology

Abstract

Radiation therapy works by generating free radicals that result in DNA damage, cell death, and tumor regression. Waves that are produced during therapeutic radiotherapy, most often X-ray or gamma-ray photons, act as sources of energy that disrupt orbital electrons to cause the formation of free radicals, which lead to damage to the cells (Jameson et al., Principles of cancer treatment. In: Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill, 2018. Available from http://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=192014984). The dose of radiation therapy, or gray (Gy), is the amount of measured radiation that is absorbed by the tissues of the body (Jameson et al., Principles of cancer treatment. In: Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill, 2018. Available from http://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=192014984). Cells that are not in the process of division when the radiotherapy is delivered are not as vulnerable to the effect of the radiation (Jameson et al., Principles of cancer treatment. In: Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill, 2018. Available from http://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=192014984). Therefore, giving smaller doses of radiotherapy over periods of time allows for more cells to be exposed to the effects of the radiation and also allows for recovery of normal tissues around the area of the tumor (Jameson et al., Principles of cancer treatment. In: Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill, 2018. Available from http://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=192014984).

Radiation therapy is a mainstay in the treatment of prostate cancer and techniques have evolved over time. Radiotherapy can be delivered in three different methods: external beam radiotherapy, brachytherapy, and intravenous radioisotope therapy. This chapter discusses radiation therapy techniques as well as expected side effects related to radiotherapy for prostate cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Principles of cancer treatment. In: Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill; 2018. Available from http://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=192014984.

    Google Scholar 

  2. Bhojani N, Capitanio U, Saurdi N, Jeldres C, Isbam H, Shariat SF, et al. The rate of secondary malignancies after radical prostatectomy versus external beam radiation therapy for localized prostate cancer: a population-based study on 17,845 patients [internet]. Int J Radiat Oncol Biol Phys. 2010;76(2):342–8; [cited 27 Oct 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20117287. https://doi.org/10.1016/j.ijrobp.2009.02.011.

    Article  PubMed  Google Scholar 

  3. National Comprehensive Cancer Network (NCCN). NCCN guidelines version 4.2018 prostate cancer. 2018. Available from https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed 8 Nov 2018.

  4. American Urological Association (AUA). Clinically localized prostate cancer: AUA/ASTRO/SUO guideline [internet]. 2017. Available from https://www.auanet.org/guidelines/prostate-cancer-clinically-localized-guideline.

  5. Morgan SC, Hoffman K, Loblaw DA, Buyyounouski MK, Patton C, Barocas D, et al. Hypofractionated radiation therapy for localized prostate cancer: an ASTRO, ASCO, and AUA evidence-based guideline. J Urol. [internet] 2018 (cited 13 Jan 2019). Available from https://www.jurology.com/doi/abs/10.1016/j.juro.2018.10.001. https://doi.org/10.1016/j.juro.2018.10.001.

  6. Swanson GP, Thompson IM, Tangen C, Paradelo J, Canby-Hagino E, Crawford ED, et al. Update of SWOG 8794: adjuvant radiotherapy for pT3 prostate cancer improves metastasis free survival [internet]. Int J Radiat Oncol Biol Phys. 2008;72(1 suppl):S31; [cited 13 Jan 2019]. Available from https://www.redjournal.org/article/S0360-3016(08)01051-1/fulltext. https://doi.org/10.1016/j.ijrobp.2008.06.835.

    Article  Google Scholar 

  7. DiBiase SJ, Roach M. External beam radiation therapy for localized prostate cancer. 2019 January 8 [cited 3 Feb 2019]. In UptoDate [internet]. UptoDate, Inc. Available from https://www.uptodate.com/contents/external-beam-radiation-therapy-for-localized-prostate-cancer?source=history_widget#H20.

  8. Friedman LS. Clinical manifestations, diagnosis, and treatment of radiation proctitis. 2018 May 22 [cited 3 Feb 2019]. In UptoDate [internet]. UptoDate, Inc. Available from https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-radiation-proctitis?topicRef=6946&source=see_link#H520853351.

  9. Chao HH, Doucette A, Raizen D, Vapiwala N. Factors associated with fatigue in prostate cancer (PC) patients undergoing external beam radiation therapy (EBRT) [internet]. Pract Radiat Oncol. 2018;8(3):e139–48; [cited 31 Jan 2019]. Available from https://www.sciencedirect.com/science/article/pii/S187985001730259X?via%3Dihub. https://doi.org/10.1016/j.prro.2017.09.002.

    Article  PubMed  Google Scholar 

  10. Windsor PM, Nicol K, Potter J. A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma [internet]. Cancer. 2004;101(3):550–7; [cited 31 Jan 2019]. Available from https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.20378. https://doi.org/10.1002/cncr.20378.

    Article  PubMed  Google Scholar 

  11. Segal RJ, Reid RD, Courney KS, Sigal RJ, Kenny GP, Prud’Homme DG, et al. Randomized controlled trial of resistance or aerobic exercise in med receiving radiation therapy for prostate cancer [internet]. J Clin Oncol. 2009;27(3):344–51; [cited 31 Jan 2019]. Available from http://ascopubs.org/doi/full/10.1200/JCO.2007.15.4963?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed63.

    Article  Google Scholar 

  12. Igdem S, Alco G, Ercan T, Barlan M, Ganiyusufoclu K, Unalan B, et al. Insufficiency fractures after pelvic radiotherapy in patients with prostate cancer [internet]. Int J Radiat Oncol Biol Phys. 2010;77(3):818–23; [cited 2 Feb 2019]. Available from https://www.sciencedirect.com/science/article/pii/S0360301609009067?via%3Dihub. https://doi.org/10.1016/j/ijrobp.2009.05.059.

    Article  PubMed  Google Scholar 

  13. Alemozaffar M, Regan MM, Cooperberg MR, Wei JT, Michalski JM, Sandler HM, et al. Prediction of erectile function following treatment for prostate cancer [internet]. JAMA. 2011;306(11):1205–14; [cited 2 Feb 2019]. Available from https://jamanetwork.com/journals/jama/fullarticle/1104401. https://doi.org/10.1001/jama.2011.1333.

    Article  CAS  PubMed  Google Scholar 

  14. Hamilton AS, Stanford JL, Filliland FD, Albertsen PC, Stephenson RA, Hoffman RM, et al. Health outcomes after external-beam radiation therapy for clinically localized prostate cancer: results from the prostate center outcomes study [internet]. J Clin Oncol. 2001;19(9):2517–26; [cited 2 Feb 2019]. Available from http://ascopubs.org/doi/pdf/10.1200/JCO.2001.19.9.2517. https://doi.org/10.1200/JCO.2001.19.9.2517.

    Article  CAS  PubMed  Google Scholar 

  15. Incrocci L, Koper PCM, Hop WCJ, Slob AK. Sildenafil citrate (Viagra) and erectile dysfunction following external beam radiotherapy for prostate cancer: a randomized, double-blind, placebo-controlled, cross-over study [internet]. Int J Radiat Oncol Biol Phys. 2001;51(5):1190–5; [cited 3 Feb 2019]. Available from https://www.sciencedirect.com/science/article/pii/S0360301601017679?via%3Dihub. https://doi.org/10.1016/S0360-3016(01)01767-9.

    Article  CAS  PubMed  Google Scholar 

  16. Incrocci L, Slagter C, Slob AK, WCJ H. A randomized, double-blind, placebo-controlled, cross-over study to assess the efficacy of tadalafil (Cialis) in the treatment of erectile dysfunction following three-dimensional conformal external-beam radiotherapy for prostatic carcinoma [internet]. Int J Radiat Oncol Biol Phys. 2006;66(2):439–44; [cited 3 Feb 2019]. Available from https://www.sciencedirect.com/science/article/pii/S0360301606009448?via%3Dihub. https://doi.org/10.1016/j.ijrobp.2006.04.047.

    Article  CAS  PubMed  Google Scholar 

  17. Vernia P, Fracasso PL, Casale V, Villotti G, Marcheggiano A, Stigliano V, et al. Topical butyrate for acute radiation proctitis: randomized crossover trial [internet]. Lancet. 2000;356(9237):1232–5; [cited 3 Feb 2019]. Available from https://www.sciencedirect.com/science/article/pii/S0140673600027872?via%3Dihub. https://doi.org/10.1016/S0140-6736(00)02787-2.

    Article  CAS  PubMed  Google Scholar 

  18. Hanson B, MacDonald R, Shaukat A. Endoscopic and medical therapy for chronic radiation proctopathy: a systematic review [internet]. Dis Colon Rectum. 2012;55(10):1081–95; [cited 3 Feb 2019]. Available from https://insights.ovid.com/pubmed?pmid=22965408. https://doi.org/10.1097/DCR.0b013e3182587aef.

    Article  PubMed  Google Scholar 

  19. Kennedy GD, Heise CP. Radiation colitis and proctitis [internet]. Clin Colon Rectal Surg. 2007;20(1):64–72; [cited 3 Feb 2019]. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780150/#r20064-54. https://doi.org/10.1055/s-2007-970202.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Do NL, Nagle D, Poylin VY. Radiation proctitis: current strategies in management [internet]. Gastroenterol Res Pract. 2011; [cited 3 Feb 2019]. Published online 17 Nov 2011. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226317/#B31; https://doi.org/10.1155/2011/917941.

  21. Elliott SP, Meng MV, Elkin EP, McAninch JW, Duchane J, Carroll PR. Incidence of urethral stricture after primary treatment for prostate cancer: data from CaPSURE [internet]. J Urol. 2007;178(2):529–34; [cited 3 Feb 2019]. Available from https://www.sciencedirect.com/science/article/pii/S0022534707007744#bib5. https://doi.org/10.1016/j.juro.2007.03.126.

    Article  PubMed  Google Scholar 

  22. Halpern JA, Sedrakyan A, Hsu WC, Mao J, Daskivich TJ, Nguyen PL, et al. Utilization, complications, and costs of stereotactic body radiation therapy (SBRT) for localized prostate cancer [internet]. Cancer. 2016;122(16):2496–504; [cited 3 Feb 2019]. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974119/. https://doi.org/10.1002/cncr.30101.

    Article  PubMed  PubMed Central  Google Scholar 

  23. American Society for Radiation Oncology. ASTRO model policies: proton beam therapy (PRT) [internet]. Arlington. [2017 June; cited 3 Feb 2019]. Available from https://www.astro.org/uploadedFiles/_MAIN_SITE/Daily_Practice/Reimbursement/Model_Policies/Content_Pieces/ASTROPBTModelPolicy.pdf.

  24. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors [internet]. N Engl J Med. 2008;358:1250–61; [cited 3 Feb 2019]. Available from https://www.nejm.org/doi/10.1056/NEJMoa074311?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov. https://doi.org/10.1056/NEJMoa074311.

    Article  CAS  PubMed  Google Scholar 

  25. Eade TN, Horwitz EM, Ruth K, Buyyounouski MK, D’Ambrosio DJ, Feigenberg SJ, et al. A comparison of acute and chronic toxicity for men with low-risk prostate cancer treated with intensity-modulated radiation therapy or 125I permanent implant [internet]. Int J Radiat Oncol Biol Phys. 2008;71(2):338–45; [cited 3 Feb 2019].

    Article  Google Scholar 

  26. Grills IS, Martinez AA, Hollander M, Huang R, Goldman K, Chen PY, et al. High dose rate brachytherapy as prostate monotherapy reduces toxicity compared to low dose rate palladium seed [internet]. J Urol. 2004;171(3):1098–104; [cited 3 Feb 2019]. Available from https://www.sciencedirect.com/science/article/pii/S0022534705624226?via%3Dihub. https://doi.org/10.1097/01.ju.0000113299.34404.22.

    Article  PubMed  Google Scholar 

  27. Bolla M, Maingon P, Carrie C, Villa S, Kistios P, Phillip MP, et al. Short acting androgen suppression and radiation dose escalation for intermediate and high risk localized prostate cancer: results of EORTC trial 2291 [internet]. J Clin Oncol. 2016;34(15):1748–56; [cited 3 Feb 2019]. Available from http://ascopubs.org/doi/full/10.1200/JCO.2015.64.8055?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&. https://doi.org/10.1200/JCO.2015.64.8055.

    Article  CAS  PubMed  Google Scholar 

  28. Radiation Therapy Oncology Group. RTOG/EORTC late radiation morbidity scoring schema. 2019. Available from https://www.rtog.org/researchassociates/adverseeventreporting/rtogeortclateradiationmorbidityscoringschema.aspx.

  29. Denham JW, Steigler A, Lamb DS, Joseph D, Turner S, Matthews J, et al. Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial [internet]. Lancet. 2011;12(5):451–9; [cited 17 Feb 2019]. Available from https://www.sciencedirect.com/science/article/pii/S1470204511700638?via%3Dihub. https://doi.org/10.1016/S1470-2045(11)70063-8.

    Article  CAS  PubMed  Google Scholar 

  30. Pisansky TM, Hung D, Gomella L, Amin MB, Balogh AG, Chinn DM, et al. Duration of androgen suppression before radiotherapy for localized prostate cancer: Radiation Therapy Oncology Group randomized clinical trial 9910 [internet]. J Clin Oncol. 2015;33(4):332–9. Available from http://ascopubs.org/doi/pdf/10.1200/JCO.2014.58.0662. https://doi.org/10.1200/JCO.2014.58.0662.

    Article  PubMed  Google Scholar 

  31. Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff RO, Storme G, et al. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study [internet]. Lancet Oncol. 2010;11(11):1066–73; [cited 17 Feb 2019]. Available from https://www.sciencedirect.com/science/article/pii/S1470204510702230?via%3Dihub. https://doi.org/10.1016/S1470-2045(10)70223-0.

    Article  CAS  PubMed  Google Scholar 

  32. Pilepich MV, Winter K, Lawton CA, Krisch RE, Wolkov HB, Movsas B, et al. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma – long term results of phase III RTOG 85-31 [internet]. Int J Radiat Oncol Biol Phys. 2005;61(5):1285–90; [cited 17 Feb 2019]. Available from https://www.sciencedirect.com/science/article/pii/S036030160402468X?via%3Dihub. https://doi.org/10.1016/j.irobp.2004.08.047.

    Article  CAS  PubMed  Google Scholar 

  33. Horwitz EM, Bae K, Hanks GE, Porter A, Grignon DJ, Brereton HD, et al. Ten-year follow-up of radiation therapy oncology group protocol 92-02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer [internet]. J Clin Oncol. 2008;26(15):2497–504; [cited 17 Feb 2019]. Available from: http://ascopubs.org/doi/pdf/10.1200/JCO.2007.14.9021. https://doi.org/10.1200/JCO.2007.14.9021.

    Article  CAS  PubMed  Google Scholar 

  34. Smith MR. Side effects of androgen deprivation therapy. 2018 February 13 [cited 2019 February 17]. In UptoDate [internet]. UptoDate, Inc. Available from https://www.uptodate.com/contents/side-effects-of-androgen-deprivation-therapy?search=adt%20and%20radiation%20therapy%20prostate%20cancer&topicRef=6947&source=see_link#H22.

  35. Ward JF, Vogelzang N, Davis BJ. Initial management of regionally localized intermediate-, high-, and very high – risk prostate cancer and those with clinical lymph node involvement. 2019 February 11 [cited 17 Feb 2019]. In UptoDate [internet]. UptoDate, Inc. Available from https://www.uptodate.com/contents/initial-management-of-regionally-localized-intermediate-high-and-very-high-risk-prostate-cancer-and-those-with-clinical-lymph-node-involvement?search=adt%20and%20radiation%20therapy%20prostate%20cancer&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2956464.

  36. Moy B, Linder BJ, Chao NJ, Gounder MM. Hemorrhagic cystitis in cancer patients. 2018 [cited 4 Mar 2019]. In UptoDate [internet]. UptoDate, Inc. Available from https://www.uptodate.com/contents/hemorrhagic-cystitis-in-cancer-patients?source=history_widget#H1760164724.

  37. Inokuchi H, Mizowaki T, Norihisa Y, Takayama K, Ikeda I, Nakamura K, et al. Correlation between urinary dose and delayed radiation cystitis after 78 Gy intensity-modulated radiotherapy for high-risk prostate cancer: a 10-year follow-up study of genitourinary toxicity in clinical practice [internet]. Clin Transl Radiat Oncol. 2017 6:31–36; [cited 3 Mar 2019]. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862643/. https://doi.org/10.1016/j.ctro.2017.09.005.

  38. Chapter 29 – Prostate. In: Radiation oncology: management decisions. Philadelphia: Lippincott Williams & Wilkins; 2019. Available from http://ovidsp.tx.ovid.com/sp-3.32.2a/ovidweb.cgi?QS2=434f4e1a73d37e8c4c7d6b65ba1a76f10a5f0eeeb99837e07ca68deaddb0a4b0cd2925ebbbcf384b7dca20bf0c0be6a2c11e50864caec7a3a6905907355151f83559bac33189355c15f613aa0c5c4bc695b0712cb5be03f6e75da3efa37e15de05ef9ff00ff8edfdaad11b48e66bb81abe196e04da6dbc37a27d3371db5421f95f3a65aaff7455c7ce0a8aac7eef55c9455ae740464cbfd95c597c4515565370da52469f485779d6a22988d6d5688441aa384cdca6d673fba30369ecd1a6f62e2dc66094e535b427a2569c021d2837af9161979d31ef93174b74895b892efb6f.

  39. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction [internet]. Urology. 1997;49(6):822–30; [cited 2019 March 12]. Available from https://www.sciencedirect.com/science/article/pii/S0090429597002380?via%3Dihub. https://doi.org/10.1016/S0090-4295(97)00238-0.

    Article  CAS  PubMed  Google Scholar 

  40. Moul JW, Lee WR. Rising serum PSA following local therapy for prostate cancer: definition, natural history, and risk stratification. 2019 [cited 12 Mar 2019]. In UptoDate [internet]. UptoDate, Inc. Available from https://www.uptodate.com/contents/rising-serum-psa-following-local-therapy-for-prostate-cancer-definition-natural-history-and-risk-stratification#H6.

  41. Roach M, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference [internet]. Int J Radiat Oncol Bio Phys. 2006;65(4):965–74; [cited 11 Mar 2019]. Available from https://www.sciencedirect.com/science/article/pii/S0360301606006638?via%3Dihub. https://doi.org/10.1016/j.ijrobp.2006.04.029.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Ann E. Donnelly

  2. Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Robert Den

Authors
  1. Ann E. Donnelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Den
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ann E. Donnelly .

Editor information

Editors and Affiliations

  1. Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Edouard J. Trabulsi

  2. Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Costas D. Lallas

  3. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Anne E. Lizardi-Calvaresi

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Donnelly, A.E., Den, R. (2021). Radiotherapy for Prostate Cancer. In: Trabulsi, E.J., Lallas, C.D., Lizardi-Calvaresi, A.E. (eds) Chemotherapy and Immunotherapy in Urologic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-52021-2_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-52021-2_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-52020-5

  • Online ISBN: 978-3-030-52021-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation