The role of external-beam radiation therapy in the treatment of clinically localized prostate cancer.

BACKGROUND The treatment of clinically localized prostate cancer is controversial. Options include radical prostatectomy, external-beam radiation therapy (EBRT), brachytherapy, cryotherapy, and watchful waiting. METHODS The author reviews EBRT as treatment for clinically localized prostate cancer, with particular emphasis on the technological advances that have allowed dose escalation and fewer therapy-related side effects. RESULTS Technological advances in the last two decades have significantly improved the delivery of EBRT to the prostate. This has resulted in an overall increase in the total dose that can be safely delivered to the prostate, which has led to modest improvements in biochemical outcome. An alternative approach of combining androgen suppression therapy and EBRT has also been successful in improving clinical outcomes. However, establishing the optimal therapy for prostate cancer remains controversial. CONCLUSIONS Recent progress has led to improvements in clinical outcomes in patients treated with EBRT for prostate cancer. It is hoped that the next decades will bring continued advances in the development of biologicals that will further improve current clinical outcomes.