IMRT for prostate cancer

The increased frequency of PSA testing has led to an increased diagnosis of early organ confined prostate cancer. Diagnosis is primarily made by histology, via TRUS-guided sextant biopsy or template biopsy which can provide improved localisation of cancer within the prostate. Staging is from digital rectal examination, from imaging with multi-parametric MRI (TNM staging), from PSA levels, and from histology (Gleason score). Those with localised disease have radical treatment options, primarily surgery with radical prostatectomy +/lymph node clearance or radical radiotherapy, which can be delivered by external beam radiotherapy (EBRT) or by interstitial radiotherapy (brachytherapy). Most patients undergoing radiotherapy have EBRT. Those with minimal urinary symptoms and low risk disease may be eligible for low dose rate brachytherapy, and those with localised bulky tumour may be eligible for high dose rate brachytherapy in combination with EBRT. In the UK in 2014/15, 15,868 patients received radical prostate radiotherapy, of which 1,504 were brachytherapy.