Prostate Cancer: Current Status, New Developments and Applications in Radiotherapy

Abstract

Over the last few years, the management of prostate cancer has undergone many changes and due to substantial developments in the understanding of prostate cancer biology, functional imaging, technological radiotherapy and new systemic agents. There is an ever-growing spectrum of treatment strategies aimed at improving patient selection, treatment outcomes and disease evaluation. This special issue will explore some of these exciting and emerging new management schemes to understand the rationale and their methodology, evaluate the current data underpinning the basis of its development and future directions. The topics selected for this special issue on prostate cancer range from functional imaging to the use of new targeted therapies in the setting of non-metastatic prostate cancer. This issue begins with the use of functional and molecular imaging from Turkbey et al. [1]. Standard magnetic resonance imaging (MRI) sequences have been the recognised gold standard for pelvic imaging, particularly for appropriate T staging in prostate cancer. The development of MRI sequences such as diffusion-weighted MRI, dynamic contrast-enhanced MRI and MRI spectroscopy has provided greater assessment and functionality. Used together with standard MRI sequences, this multi-parametric MRI combination can greatly improve both the identification and the staging of prostate cancer to enable better patient selection for strategies that include focal therapy, dose escalation with simultaneous integrated boosting for the whole gland or treatment of the dominant intra-prostatic nodule, as well as the evaluation of treatment responses. The availability of higher strength MRI imagers and multi-channel phased array surface coils may provide equivalent imaging to endorectal coil probes and can have advantages for both patient comfort and image co-registration when used for radiotherapy treatment planning. In addition, there are many new positron emission tomography (PET) tracers that have been shown to provide greater sensitivity and specificity compared with the fluorine-18 labelled glucose analogue (FDG-PET) for prostate cancer imaging. These PET tracers include 11 C-acetate and 11 C-choline or 11 F-choline with newer tracers that target the amino acid transport, such as 11 C-methionine and 11 F-FACBC (synthetic L-leucine amino-acid analogue). These scans may provide useful information in recurrent local disease or the detection of early nodal involvement. There is renewed interest in the prostate-specific membrane antigen as an imaging biomarker. The opportunities that these new functional and molecular imaging modalities can offer are many, but there must be appropriate and careful clinical correlation in