Today, the arsenal of “high-precision” or “targeted” radiotherapy includes a variety of techniques and approaches that, like the pieces of a puzzle, need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of these innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.

Part I Imaging, Delineation and Immobilization

MR Imaging and MR Spectroscopy in Prostate Cancer 3

PET/CT Imaging in Prostate Cancer: Indications and Perspectives for Radiation Therapy 15

Target Volume Definition in Primary Prostate Cancer Radiotherapy 33

Value of Patient Immobilization in External Beam Radiotherapy for Prostate Cancer 41

Internal Immobilization: From Rectal Balloon to Hyaluronic Acid 45

Part II Clinical Endpoints

Biochemical Recurrence: A Valuable Endpoint? 55

Overall- and Disease-Specific Survival in Prostata Cancer: Too Long to Wait? 65

Late Toxicity and Quality of Life 75

Part III Dose Escalation and New Radiation Techniques

Dose Escalation: An Update on Randomised Clinical Trials 89

Intensity-Modulated Radiation Therapy for Clinically Localized Prostate Cancer 95

IGRT: How and When 103

Part IV Locally Advanced Diseaes

Techniques of Pelvic Irradiation 111

Prophylactic Treatment of the Pelvic Lymphatics in Patients with High-Risk Prostate Cancer: Pro Radiation 123

Prophylactic Treatment of the Pelvic Lymphatics: Contra 131

Hormonal Therapy and Radiation Therapy: Randomized and Prospective Trials 137

Treatment of Clinically Involved Lymph Nodes 149

Part V Hypofractionation

Hypo-fractionation in Prostate Cancer: Biological Aspects 155

Hypofractionation and Stereotactic Treatment: Clinical Data 163

Focal Therapy and the Index Lesion Hypothesis in Prostate Cancer 173

Part VI Brachytherapy

Permanent Seed Implantation 187

High-Dose-Rate Brachytherapy in the Treatment of Clinically Localized Prostate Cancer 211

Part VII Adjuvant Treatment and Salvage Treatment

Target Volume Definition in Postoperative Radiotherapy 227

Randomized Trials for Adjuvant Radiotherapy 231

Salvage Radiotherapy After Radical Prostatectomy 243

Salvage Prostatectomy After Radiotherapy 253

Part VIII Use of Protons and Heavy Ions

Proton Therapy for Prostate Cancer: Technological and Clinical Aspects 263

There is Evidence for the Superiority of Protons and Heavy Ions, Pro 277

There is Evidence for the Superiority of Protons or Heavy Ions, Contra 291

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