The long-term efficacy of prostate cancer treatment has been questioned, whether considering the results of prostatectomy or radiation therapy.<sup>1 Chodak G.W., Thisted R.A., Gerber G.S. , e al. Results of conservative management of clinically localized prostate cancer N Engl J Med 1994 ;  330 : 242-248  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Discussed elsewhere in this issue of Urologic Clinics of North America is the evidence supporting long-term control by prostatectomy and it is the purpose of this article to present data supporting long-term cure with radiation. These contributions emphasize the positives obtained from both specialties, which are the most likely means of furthering progress with this difficult disease. In this article I present data related to three points pertinent to the radiation treatment of prostate cancer and include some prospects for improvement.

First, there is unquestioned evidence that radiation therapy eliminates prostate cancer for 15 or more years. That concept is not open to rational discussion, although the fraction controlled is open to discussion. Second, when similar patient populations (in terms of independent prognostic variables) are compared, the 5-, 10-, and 15-year results are similar with radiation therapy or prostatectomy. In our recent studies, multivariate analysis has shown that pretreatment prostate-specific antigen (PSA), palpation stage, Gleason score, and pretreatment PSA doubling time are independent variables in determining biochemical freedom from disease for patients treated with radiation (Hanks GE, Hanlon AL, Lee WR, et al, unpublished data, 1995).<sup>18 Lee W.R., Hanks G.E., Schultheiss T.E. , e al. Localized prostate cancer treated by external beam radiotherapy alone: Serum PSA driven outcome analysis J Clin Oncol 1995 ;  13 : 464-469

Cliccare qui per andare alla sezione Riferimenti</sup> In an ideal comparison of surgery and radiation, these factors should all be balanced. Third, conformal radiation therapy is a major advance that not only improves the quality of a patient's life by reducing morbidity, but offers better cancer control by more accurately irradiating the target.<sup>12 Hanks G.E., Lee W.R., Schultheiss T.E. Clinical and biochemical evidence of control of prostate cancer at five years after external beam radiation J Urol 1995 ;  154 : 456-459  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 14 Hanks G.E., Schultheiss T.E., Hunt M.A. , e al. Factors influencing incidence of acute grade 2 morbidity in conformal and standard radiation treatment of prostate cancer Int J Radiat Oncol Biol Phys 1995 ;  31 : 25-29  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 26 Schultheiss T.E., Hanks G.E., Hunt M.A. , e al. Incidence of and factors related to late complications in conformal and conventional radiation treatment of cancer of the prostate Int J Radiat Oncol Biol Phys 1995 ;  32 : 643-650  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 28 Soffen E.M., Hanks G.E., Hunt M.A. , e al. Conformal static field radiation therapy treatment of early prostate cancer versus non-conformal techniques: A reduction in acute morbidity Int J Radiat Oncol Biol Phys 1992 ;  24 : 485-488  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 33 Zelefsky M.J., Leibel S.A., Kutcher G.J. , e al. The feasibility of dose escalation with three-dimensional conformal radiotherapy in patients with prostatic carcinoma The Cancer Journal from Scientific American 1995 ;  1 : 142-150

Cliccare qui per andare alla sezione Riferimenti</sup>

Data is presented from several selected single institutions' retrospective reviews, the national patterns of care surveys of radiation outcome representing US national averages, prospective clinical trials conducted by the Radiation Therapy Oncology Group (RTOG), and from the conformal treatment program in use since 1989 at Fox Chase Cancer Center (FCCC).