Image-guided, Tumor-focused Radiotherapy Treatment in Intermediate and High-risk Prostate Cancer

Definitive radiation therapy for prostate cancer with dose intensification and/or focal boosting has excellent oncologic outcomes. However, many patients experience long-term toxicity in particular to the genitourinary and gastrointestinal organs, impacting their quality of life. Given the excellent survivorship after definitive prostate cancer treatment, there is interest in identifying strategies that can improve the therapeutic ratio and minimize toxicity while maintaining excellent oncologic outcomes. Intraprostatic recurrence after definitive radiation therapy occurs at the site of the primary tumor and the dose to the site of the primary tumor is an important predictor of future treatment failure. This leads to the hypothesis that, if accurate discrimination between tumor(s) and benign prostate tissue can be achieved, radiation oncologists can devise tumor-focused radiation therapy plans that deliver ablative dose radiation therapy to the tumor(s) and de-escalated dose to the remainder of the electively irradiated prostate. This strategy is now possible thanks to advanced imaging technologies that can accurately identify the primary clinically significant tumor(s) to be targeted. De-escalated dose to the remainder of the prostate may lead to low dose also to neighboring organs, such as rectum and bladder, potentially leading to lower rates of acute and late toxicity and minimizing the impact of prostate cancer treatment on quality of life. A randomized trial is required to compare the efficacy and toxicity of tumor-focused radiation therapy to that of standard radiation therapy for definitive treatment of localized prostate cancer.