Prostate Cancer

Prostate cancer has surpassed lung cancer as the most common cancer in men.

The different treatment modalities of localized prostate cancer are:

  • Radical Prostatectomy
  • Radical Radiotherapy

Radical radiotherapy
EBRT, or Radical Radiotherapy, is a non-surgical treatment for prostate cancer using high-energy X-rays

Who is it suitable for?
Most often used in older, less fit men or as a second-line treatment, when cancer is found to have spread beyond the gland.

How to Improve RT outcome?

  • Dose Escalation
  • Improved Biochemical Free Survival
  • Over All Survival
  • ADT with EBRT
  • Improved Overall Survival

How can we Escalate The Dose up to 80-90 Gy?
Proper fixation: Knee and Ankle Support devices

High Technology: IMRT or ARC Therapy

Very accurate daily setup:

  • Daily reproducible bladder and rectal filling
  • Daily on Board imaging with online matching (IGRT)

The first Priority in dose escalation is the Rectum

Rectal Constrains

  • V40 Gy < 60%, Ideally <35%
  • V65 Gy < 40%
  • V70 Gy 30%
  • V75 Gy 10%

Advantages of RT of Localized Prostate Cancer

  • Avoid surgical complications like bleeding, infection, infarction, pulmonary embolism.
  • Low risk of urinary incontinence and stricture.
  • Short term preservation of erectile function.

Disadvantages

  • course 8-9 weeks.
  • Temporary bladder , bowel symptoms
  • Probable Late erectile dysfunction.
  • Salvage prostatectomy is extremely morbid.

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