PROSTATE-CANCER

This synthesis of the literature on radiotherapy for prostate cancer i s based on 53 scientific articles, including 4 randomized studies, 3 p rospective studies, and 44 retrospective studies. These studies involv e 52005 patients. The literature provides no apparent evidence to moti vate radiotherapy, or any treatment, for highly differentiated TO tumo rs. Some findings suggest that radiotherapy or surgery may be indicate d for poorly differentiated tumors. The literature however shows no di fferences in tumor effects between these two methods for treating TO t umors. Radiotherapy is milder and less mutilating. Conclusions cannot be drawn from the literature concerning whether surgery (radical prost atectomy) or external radiotherapy is preferable for T1 and T2 tumors. Most probably, some patients are more suitable for surgery, others fo r radiotherapy. More patients are, nevertheless, candidates for radiot herapy. The value of external radiotherapy for T3 tumors is documented . Radiotherapy is valuable as palliative treatment for T4 tumors. Radi otherapy may be valuable as localized, symptom-relieving treatment for generalized prostate cancer. Treatment given via a few high fractions saves patients' time, hospitalization, and resources. Concerning indi vidualized treatment: the differentiation grade is important for the c hoice of treatment method, mainly in early, but even in late clinical stages. This may involve choosing between radiotherapy and endocrine t herapy, or even choosing between radiotherapy and surgery. The value o f external radiotherapy increases as the differentiation grade of the tumor decreases. It is essential to treat patients at facilities that have the diagnostic potential to establish the differentiation grade o f tumors. The value of postoperative radiotherapy has not yet been dem onstrated at any clinical stage of prostate cancer. Treatment results from interstitial brachytherapy alone appear to be clearly inferior to the results from other methods. The value of combining interstitial/e xternal radiotherapy should be studied further.