Strahlentherapie des prostatakarzinoms

As well as radical prostatectomy external body radiotherapy (EBRT) offers the chance of cure in non-metastasized prostate cancer. With total doses of 70 Gy or more, conventional fractionated RT can achieve 2-years biological no-evidence of disease (bNED) of more than 90% and about 50% in tumor stages with low and medium risk of metastases respectively. In early stages (T 1-2 Nx) recurrence free survival is after ten years 43-76%, in T1b-T2 pNO stages it is about 90% and comparable to those after radical prostatectomy. In T3-tumors recurrence free survival is from 32-42%. In randomized studies an advantage of conformal to conventional planned EBRT could be impressively demonstrated. Severe sequelae of the intestinal and urogenital tract could be seen in less than 5% of treated patients. The value of combined hormonal and radiation therapy is not yet cleared. In early stages results by pure EBRT are convincing so that hormonal therapy might be superfluous. In locally advanced stages a preceding hormonal therapy might decrease the tumor volume by reducing the tumor cell load and, therefore, reduce the conformally irradiated volume. The irradiation of the pelvic or abdominal lymphatic drainage did not improve overall survival in published studies so far though improving the locoregional tumor control rates. Due to the large irradiated volume and simple radiation techniques sequelae were impressively increased. A participation in running national or international studies to clarify the value of postoperative EBRT, RT of pelvic lymph nodes, dose escalation and combined hormonal and radiation therapy will be reasonable.