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Optimizing Selection of Patients for Prostate SBRT: Overview of Toxicity and Efficacy in Low, Intermediate, and High-Risk Prostate Cancer

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Stereotactic Radiosurgery for Prostate Cancer

Abstract

The first patient to receive treatment with stereotactic body radiotherapy (SBRT) for prostate cancer (PCa) was treated in the year 2000. Since then, as the result of several single-institution and multi-institutional trials, over a decade-and-half’s worth of clinical experience has accrued to help guide indications for routine treatment with SBRT and identify promising areas for investigation in clinically localized PCa. In this introductory Chapter, we briefly review the standard risk stratification scheme for clinically localized PCa to contextualize the selection of patients for treatment with SBRT. We then provide a comprehensive synthesis of the medical literature to date, focusing on the tabulation of efficacy and toxicity rates as reported. While randomized clinical trials comparing SBRT with conventionally fractionated or moderately hypofractionated RT are underway, the current body of evidence supports the efficacy and safety of SBRT not only for low PCa, but also for intermediate risk disease. We also review some of the reports describing higher than anticipated toxicities, and provide likely explanations for these discrepancies. Potential contraindications to SBRT, such as large prostate size and prior transurethral resection of the prostate, are discussed. Finally, we discuss the emerging evidence examining the role of SBRT in high-risk PCa.

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  1. Department of Radiation Oncology, University of California, Los Angeles, CA, USA

    Amar U. Kishan & Christopher R. King

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  1. Amar U. Kishan
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Correspondence to Amar U. Kishan .

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    Michael J. Zelefsky

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Kishan, A.U., King, C.R. (2019). Optimizing Selection of Patients for Prostate SBRT: Overview of Toxicity and Efficacy in Low, Intermediate, and High-Risk Prostate Cancer. In: Zelefsky, M. (eds) Stereotactic Radiosurgery for Prostate Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-92453-3_1

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