Radiothérapie stéréotaxique du cancer de la prostate localisé : modalités, indications et rôle de l’urologue

Abstract

Introduction: The aim was to report the modalities/indications of stereotactic body radiotherapy (SBRT) in localized prostate cancer (PCa) and to explain the role of the urologist in preparing for irradiation.Methods: A PubMed database search and narrative review of articles was performed in December 2023 to provide a comprehensive review of the literature on the subject. Only articles in French or English were examined.Results: SBRT generally delivers 35-40 Gy over 5 sessions, image-guided and intensity-modulated. In the primary treatment of localized CaP, SBRT is indicated in patients at low or favorable intermediate risk, without combination with androgen deprivation therapy, in selected patients and in expert centers, based on efficacy data from the HYPO-RT-PC trial, and safety data from the PACE-B trial. Stereotactic (re)irradiation would appear to provide similar oncological results to other treatment modalities, in the case of salvage treatment after primary non-surgical treatment. The results of the GETUG-31 trial are encouraging, but larger comparative studies are still needed to clarify the place of SBRT in this indication. The role of the urologist is paramount prior to SBRT, and a description of the preparation consisting in the placement of gold markers and Spacer is proposed (https://www.urofrance.org/formation/pose-de-fiduciaires-et-spacer-par-voie-transperineale/)Conclusion: SBRT in localized CaP is a therapy with growing indications, where urologist-radiotherapist collaboration is crucial.