What is the role of EBRT in the treatment of metastatic and advanced prostate cancer?

Updated: Dec 29, 2020
  • Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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For locally advanced prostate cancer (clinical stage T3), the accepted treatment recommendation is external beam radiotherapy (EBRT) as local treatment for cure. Brachytherapy may be added to EBRT. In addition, studies have suggested that the addition of androgen-deprivation therapy (ADT) yields improvement in progression-free survival in patients. [20]

The standard treatment consists of 2 months of ADT before and then EBRT throughout. Three-dimensional (3-D) conformal radiation therapy is available to increase the radiation delivered to the prostate while minimizing the exposure to the rest of the pelvis; namely, the bladder and rectum.

Zapatero et al found that using long-term androgen deprivation in conjunction with higher doses (> 78 Gy) of radiotherapy was associated with improved biochemical tumor control in high-risk patients. A Gleason sum of more than 7 and a pretreatment PSA level of more than 20ng/mL indicated a risk of PSA failure that was 6.8 times higher. [21]

In patients with metastatic prostate cancer, radiation is also applied for palliative purposes. It is used in patients with hormone-refractory disease with painful bone metastases and in patients with impending spinal cord compression.

Adverse effects of EBRT include cystitis, proctitis, enteritis, impotence, urinary retention, and incontinence.

In patients with oligometastatic recurrent prostate cancer, the phase II Observation Versus Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer (ORIOLE) study demonstrated a survival benefit from stereotactic ablative radiation (SABR) treatment. ORIOLE randomly assigned 54 men who had one to three metastatic lesions measuring ≤5 cm to either SABR or observation for 6 months. Median PFS was not reached for men treated with SABR but was 5.8 months for men who underwent observation (hazard ratio, 0.30; P = 0.002). [22]

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