Recent advances in nonsurgical management of localized prostate cancer

Abstract

limited to clinical stage T1 or T2, oncological outcomes are believed to be comparable for most men undergoing RP, external-beam radiation, or brachytherapy. Therefore, the basis upon which patients select the primary therapy has shifted toward the consideration of treatment-related morbidity and health-related QOL. Although the probability of eradicating prostate cancer is increased by increasing the radiation dose, classic radiotherapy techniques at doses of more than 70 Gy result in high rates of severe rectal and bladder toxicity. Threedimensional (3D)-conformal radiotherapy and, more recently, IMRT have been shown to improve local control and signifi cantly decrease the side effects, thus improving patient health-related QOL. With recent advances in transrectal ultrasound image-guided and computer-based treatment planning systems, prostate brachytherapy has been widely accepted as a safe and effective treatment for localized prostate cancer. In Japan, the use of iodine-125 as a seed source was legally approved in 2003, and since then the number of these procedures has been increasing dramatically. A number of innovative local therapeutic approaches have been investigated for men with localized prostate cancer, including HIFU, cryotherapy, and thermal therapy. Most of these approaches have not yet suffi ciently matured to be considered as standard therapy for men with prostate cancer, but these investigational treatments appear promising. With continuing technological refi nements, some of these could become established methods of treatment in future. On the other hand, although classical hormonal treatment for men with localized prostate cancer is widely used in clinical practice, its particular role remains to be elucidated, and further study is warranted to establish its clinical signifi cance. In this issue of the International Journal of Clinical Oncology, leaders in the fi eld review the current status and future perspectives of recently developed nonsurgical treatment modalities for localized prostate cancer. I believe these review articles will be useful to aid in our understanding of recent progress in the management of prostate cancer. Received: July 27, 2007