Fundamentals of Radiation Treatment for Prostate Carcinoma – Techniques, Radiation Biology, and Evidence Base

Introduction

Radiation therapy was used to fight cancer within a few years of the discovery of X-rays in 1895. By 1902, Emil Grubbe had published an article outlining the conclusions from his own experience and that of dozens of writers for the treatment of cancer with radiation therapy. His conclusions were that the X-ray is a most remarkable therapeutic agent, in properly selected cases of so-called incurable conditions. The relief from pain is one of the most prominent features of the treatment. The X-ray has a pronounced effect upon internal cancers, the greatest value of the X-ray is obtained in treating postoperative cases to prevent recurrences, and it has a selective influence upon cells of the body; abnormal cells being effected more readily than the normal. Over a hundred years later, these principles still hold true in the treatment of prostate cancer. Radiation therapy remains ideally suited for curative treatment of localized disease as well as for palliation. Treatment techniques have evolved and the field has benefited from rapid advances in technology. At the same time surgical and other techniques have also improved making the selection of the optimal management of localized prostate carcinoma difficult for patients and clinicians. There are no conclusive prospective randomized studies demonstrating significant differences in overall survival and biochemical-free relapse between surgery and radiation therapy. In this chapter, we will provide fundamentals of radiation therapy, an overview of radiation biology and different treatment options in standard care, which will include both definitive and palliative radiation therapy in prostate carcinoma.