Objective: To summarize the major new findings in prostate cancer in radiation oncology in the last year.
Methods: A review of the 2007 annual meetings of the ASCO, ASTRO, EAU, AUA annual congresses and bibliographic review.
Results: Incidence of prostate carcinoma is increasing in France (62 000 cases in 2005), but its mortality rate is stable (9202 deaths). This finding justified the active surveillance option for selected patients. For the initial staging or in case of biochemical relapse after surgery, the 11-C-choline PET/CT has not today proven any meaningful clinical benefit. Dose escalation in exclusive external beam radiotherapy has now proven its potential interest in several randomized trials and also in some retrospective data: biochemical control is regularly increased in case of higher dose. Even if this dose escalation increased also toxicity, this is always acceptable. Some unconfirmed data suggested that this benefit in biochemical control is translated in a better clinical disease-free survival. The role of prophylactic nodal irradiation is still debated. On the other hand, in the unfavorable group, a long-term androgen deprivation (3 years at least) is more efficient than a short-term androgen deprivation in an EORTC randomized trial. In more advanced disease, discussion between imediate and deferred hormonal treatment is also a matter of debate; but it seems that patients with a PSA higher than 50 ng/ml or a PSA doubling time lower than 12 months must received immediate hormonal manipulation. However, late effects of the hormonal treatment are now recognized: metabolic syndrom is often diagnosed after androgen deprivation and seems to increase cardio-vascular mortality. All local treatments had deleterious effects on quality of life and the initial conditions of the patients must be incorporated in the treatment choice.
Conclusion: Last year has seen many publications on prostate cancer, some of them could impact on our clinical practice.