Download PDF
CC BY 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2024; 07(03): 203-214
DOI: 10.1055/s-0044-1782203
Special Issue Articles
Review Article

The Role of Radiation Therapy in the Management of Prostate Cancer and Posttreatment Imaging Appearances

Soumyadeep Ghosh 
1   Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Daniel B. Rosen 
2   Harvard Radiation Oncology Residency Program, Boston, Massachusetts, United States
,
Ankur Pandey
1   Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Nabih Nakrour 
1   Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Priyanka Prajapati
1   Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Mukesh Harisinghani
1   Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Sophia C. Kamran 
3   Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, United States
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Prostate cancer remains a significant global health concern, necessitating continuous research and innovation in treatment modalities. This review explores the currently employed techniques in radiation dose planning and tumor irradiation in the context of prostate cancer management. In addition, we delve into the nuances of expected posttreatment magnetic resonance imaging (MRI) appearances within the gland or in the prostate bed, postradiation tumor recurrence, and its mimics.

Radiation therapy (RT) has evolved as a cornerstone in prostate cancer treatment, offering both curative and palliative solutions. Recent developments have seen the emergence of advanced techniques such as intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), allowing for precise targeting of cancer cells while minimizing damage to surrounding healthy tissue.

The avoidance of normal tissue dose through more conformal dose distribution as in IMRT or proton therapy, improved imaging modalities as in multiparametric magnetic resonance imaging (mpMRI) and prostate positron emission tomography (PET), interventional separation of critical structures from the prostate target, and many other techniques can greatly reduce the side effects of RT. These advancements enhance treatment efficacy and reduce the risk of side effects, promoting improved patient outcomes.

Keywords

prostate cancer - external beam radiation therapy - brachytherapy - proton beam therapy - posttreatment imaging appearances - post radiation complications


Publication History

Article published online:
29 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Schaeffer EM, Srinivas S, Adra N. et al. Prostate cancer, version 4.2023. NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2023; 21 (10) 1067-1096
    CrossrefPubMedGoogle Scholar
  • 2 Kamran SC, Light JO, Efstathiou JA. Proton versus photon-based radiation therapy for prostate cancer: emerging evidence and considerations in the era of value-based cancer care. Prostate Cancer Prostatic Dis 2019; 22 (04) 509-521
    CrossrefPubMedGoogle Scholar
  • 3 Efstathiou JA, Kamran SC, Spratt DE. Protons versus photons for prostate cancer: an answer that is long overdue and coming. Int J Radiat Oncol Biol Phys 2021; 110 (04) 1098-1100
    CrossrefPubMedGoogle Scholar
  • 4 Combes AD, Palma CA, Calopedos R. et al. PSMA PET-CT in the diagnosis and staging of prostate cancer. Diagnostics (Basel) 2022; 12 (11) 2594
    CrossrefPubMedGoogle Scholar
  • 5 Hamstra DA, Mariados N, Sylvester J. et al. Continued benefit to rectal separation for prostate radiation therapy: final results of a phase III trial. Int J Radiat Oncol Biol Phys 2017; 97 (05) 976-985
    CrossrefPubMedGoogle Scholar
  • 6 Leeman JE, Cagney DN, Mak RH. et al. Magnetic resonance-guided prostate stereotactic body radiation therapy with daily online plan adaptation: results of a prospective phase 1 trial and supplemental cohort. Adv Radiat Oncol 2022; 7 (05) 100934
    CrossrefPubMedGoogle Scholar
  • 7 de Rooij M, Hamoen EHJ, Witjes JA, Barentsz JO, Rovers MM. Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol 2016; 70 (02) 233-245
    CrossrefPubMedGoogle Scholar
  • 8 Lebastchi AH, Gupta N, DiBianco JM. et al. Comparison of cross-sectional imaging techniques for the detection of prostate cancer lymph node metastasis: a critical review. Transl Androl Urol 2020; 9 (03) 1415-1427
    CrossrefPubMedGoogle Scholar
  • 9 Heesakkers RA, Hövels AM, Jager GJ. et al. MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study. Lancet Oncol 2008; 9 (09) 850-856
    CrossrefPubMedGoogle Scholar
  • 10 Hövels AM, Heesakkers RAM, Adang EM. et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 2008; 63 (04) 387-395
    CrossrefPubMedGoogle Scholar
  • 11 Vallini V, Ortori S, Boraschi P. et al. Staging of pelvic lymph nodes in patients with prostate cancer: Usefulness of multiple b value SE-EPI diffusion-weighted imaging on a 3.0 T MR system. Eur J Radiol Open 2015; 3: 16-21
    CrossrefPubMedGoogle Scholar
  • 12 Harisinghani MG, Barentsz J, Hahn PF. et al. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 2003; 348 (25) 2491-2499
    CrossrefPubMedGoogle Scholar
  • 13 Woo S, Suh CH, Kim SY, Cho JY, Kim SH. Diagnostic performance of magnetic resonance imaging for the detection of bone metastasis in prostate cancer: a systematic review and meta-analysis. Eur Urol 2018; 73 (01) 81-91
    CrossrefPubMedGoogle Scholar
  • 14 Allen SD, Thompson A, Sohaib SA. The normal post-surgical anatomy of the male pelvis following radical prostatectomy as assessed by magnetic resonance imaging. Eur Radiol 2008; 18 (06) 1281-1291
    CrossrefPubMedGoogle Scholar
  • 15 Lopes Dias J, Lucas R, Magalhães Pina J. et al. Post-treated prostate cancer: normal findings and signs of local relapse on multiparametric magnetic resonance imaging. Abdom Imaging 2015; 40 (07) 2814-2838
    CrossrefPubMedGoogle Scholar
  • 16 Grant K, Lindenberg ML, Shebel H. et al. Functional and molecular imaging of localized and recurrent prostate cancer. Eur J Nucl Med Mol Imaging 2013; 40 (Suppl. 01) S48-S59
    CrossrefPubMedGoogle Scholar
  • 17 Sella T, Schwartz LH, Swindle PW. et al. Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology 2004; 231 (02) 379-385
    CrossrefPubMedGoogle Scholar
  • 18 Casciani E, Polettini E, Carmenini E. et al. Endorectal and dynamic contrast-enhanced MRI for detection of local recurrence after radical prostatectomy. AJR Am J Roentgenol 2008; 190 (05) 1187-1192
    CrossrefPubMedGoogle Scholar
  • 19 Panebianco V, Barchetti F, Sciarra A. et al. Prostate cancer recurrence after radical prostatectomy: the role of 3-T diffusion imaging in multi-parametric magnetic resonance imaging. Eur Radiol 2013; 23 (06) 1745-1752
    CrossrefPubMedGoogle Scholar
  • 20 Kitajima K, Hartman RP, Froemming AT, Hagen CE, Takahashi N, Kawashima A. Detection of local recurrence of prostate cancer after radical prostatectomy using endorectal coil MRI at 3 T: addition of DWI and dynamic contrast enhancement to T2-weighted MRI. AJR Am J Roentgenol 2015; 205 (04) 807-816
    CrossrefPubMedGoogle Scholar
  • 21 Ali A, Hoyle A, Haran ÁM. et al. Association of bone metastatic burden with survival benefit from prostate radiotherapy in patients with newly diagnosed metastatic prostate cancer: a secondary analysis of a randomized clinical trial. JAMA Oncol 2021; 7 (04) 555-563
    CrossrefPubMedGoogle Scholar
  • 22 Zietman AL, Bae K, Slater JD. et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95-09. J Clin Oncol 2010; 28 (07) 1106-1111
    CrossrefPubMedGoogle Scholar
  • 23 Ritter M. Rationale, conduct, and outcome using hypofractionated radiotherapy in prostate cancer. Semin Radiat Oncol 2008; 18 (04) 249-256
    CrossrefPubMedGoogle Scholar
  • 24 Brand DH, Kirby AM, Yarnold JR, Somaiah N. How low can you go? The radiobiology of hypofractionation. Clin Oncol (R Coll Radiol) 2022; 34 (05) 280-287
    CrossrefPubMedGoogle Scholar
  • 25 Morgan SC, Hoffman K, Loblaw DA. et al. Hypofractionated radiation therapy for localized prostate cancer: executive summary of an ASTRO, ASCO and AUA evidence-based guideline. J Urol 2019; 201 (03) 528-534
    CrossrefPubMedGoogle Scholar
  • 26 Jackson WC, Silva J, Hartman HE. et al. Stereotactic body radiation therapy for localized prostate cancer: a systematic review and meta-analysis of over 6,000 patients treated on prospective studies. Int J Radiat Oncol Biol Phys 2019; 104 (04) 778-789
    CrossrefPubMedGoogle Scholar
  • 27 Gaur S, Turkbey B. Prostate MR imaging for posttreatment evaluation and recurrence. Radiol Clin North Am 2018; 56 (02) 263-275
    CrossrefPubMedGoogle Scholar
  • 28 Chan MF, Cohen GN, Deasy JO. Qualitative evaluation of fiducial markers for radiotherapy imaging. Technol Cancer Res Treat 2015; 14 (03) 298-304
    CrossrefPubMedGoogle Scholar
  • 29 Penson DF. Follow-up surveillance after definitive local treatment for prostate cancer - UpToDate. Accessed December 14, 2023 at: https://www.uptodate.com/contents/follow-up-surveillance-after-definitive-local-treatment-for-prostate-cancer
    Google Scholar
  • 30 Roach III M, Hanks G, Thames Jr H. et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus conference. Int J Radiat Oncol Biol Phys 2006; 65 (04) 965-974
    CrossrefPubMedGoogle Scholar
  • 31 Zumsteg ZS, Spratt DE, Romesser PB. et al. Anatomical patterns of recurrence following biochemical relapse in the dose escalation era of external beam radiotherapy for prostate cancer. J Urol 2015; 194 (06) 1624-1630
    CrossrefPubMedGoogle Scholar
  • 32 Mottet N, Bellmunt J, Bolla M. et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 2017; 71 (04) 618-629
    CrossrefPubMedGoogle Scholar
  • 33 Tan N, Bavadian N, Calais J. et al. Imaging of prostate specific membrane antigen targeted radiotracers for the detection of prostate cancer biochemical recurrence after definitive therapy: a systematic review and meta-analysis. J Urol 2019; 202 (02) 231-240
    CrossrefPubMedGoogle Scholar
  • 34 Perera M, Papa N, Roberts M. et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: a systematic review and meta-analysis. Eur Urol 2020; 77 (04) 403-417
    CrossrefPubMedGoogle Scholar
  • 35 Perera M, Papa N, Christidis D. et al. Sensitivity, specificity, and predictors of positive 68Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: a systematic review and meta-analysis. Eur Urol 2016; 70 (06) 926-937
    CrossrefPubMedGoogle Scholar
  • 36 Mohan R, Kneebone A, Eade T. et al. Long-term outcomes of SBRT for PSMA PET detected oligometastatic prostate cancer. Radiat Oncol 2023; 18 (01) 127
    CrossrefPubMedGoogle Scholar
  • 37 Seifert R, Telli T, Opitz M. et al. Unspecific 18F-PSMA-1007 bone uptake evaluated through PSMA-11 PET, bone scanning, and MRI triple validation in patients with biochemical recurrence of prostate cancer. J Nucl Med 2023; 64 (05) 738-743
    CrossrefPubMedGoogle Scholar
  • 38 de Galiza Barbosa F, Queiroz MA, Nunes RF. et al. Nonprostatic diseases on PSMA PET imaging: a spectrum of benign and malignant findings. Cancer Imaging 2020; 20 (01) 23
    CrossrefPubMedGoogle Scholar
  • 39 Krämer S, Görich J, Gottfried HW. et al. Sensitivity of computed tomography in detecting local recurrence of prostatic carcinoma following radical prostatectomy. Br J Radiol 1997; 70 (838) 995-999
    CrossrefPubMedGoogle Scholar
  • 40 Crawford ED, Koo PJ, Shore N. et al; RADAR III Group. A clinician's guide to next generation imaging in patients with advanced prostate cancer (RADAR III). J Urol 2019; 201 (04) 682-692
    CrossrefPubMedGoogle Scholar
  • 41 McCammack KC, Raman SS, Margolis DJA. Imaging of local recurrence in prostate cancer. Future Oncol 2016; 12 (21) 2401-2415
    CrossrefPubMedGoogle Scholar
  • 42 Kim CK, Park BK, Lee HM. Prediction of locally recurrent prostate cancer after radiation therapy: incremental value of 3T diffusion-weighted MRI. J Magn Reson Imaging 2009; 29 (02) 391-397
    CrossrefPubMedGoogle Scholar
  • 43 Kim CK, Park BK, Park W, Kim SS. Prostate MR imaging at 3T using a phased-arrayed coil in predicting locally recurrent prostate cancer after radiation therapy: preliminary experience. Abdom Imaging 2010; 35 (02) 246-252
    CrossrefPubMedGoogle Scholar
  • 44 Rouvière O, Vitry T, Lyonnet D. Imaging of prostate cancer local recurrences: why and how?. Eur Radiol 2010; 20 (05) 1254-1266
    CrossrefPubMedGoogle Scholar
  • 45 Dwyer M. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®) Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic. 2024. Accessed December 14, 2023 at: https://www.nccn.org/home/member-
    Google Scholar
  • 46 Hotta M, Nguyen K, Thin P. et al. Kinetics of PSMA PET uptake in prostate cancer lesions after radiation therapy: a single-center retrospective study. J Clin Oncol 2022; 40 (06) 36
    CrossrefGoogle Scholar
  • 47 Friedman LS, Hong TS. Radiation proctitis: clinical manifestations, diagnosis, and management. UpToDate. Accessed December 14, 2023 at: https://www.uptodate.com/contents/radiation-proctitis-clinical-manifestations-diagnosis-and-management
    Google Scholar
  • 48 Lips IM, Dehnad H, van Gils CH, Boeken Kruger AE, van der Heide UA, van Vulpen M. High-dose intensity-modulated radiotherapy for prostate cancer using daily fiducial marker-based position verification: acute and late toxicity in 331 patients. Radiat Oncol 2008; 3 (01) 15
    CrossrefPubMedGoogle Scholar
  • 49 Choe KS, Jani AB, Liauw SL. External beam radiotherapy for prostate cancer patients on anticoagulation therapy: how significant is the bleeding toxicity?. Int J Radiat Oncol Biol Phys 2010; 76 (03) 755-760
    CrossrefPubMedGoogle Scholar
  • 50 Kerkmeijer LGW, Groen VH, Pos FJ. et al. Focal boost to the intraprostatic tumor in external beam radiotherapy for patients with localized prostate cancer: results from the FLAME randomized phase III trial. J Clin Oncol 2021; 39 (07) 787-796
    CrossrefPubMedGoogle Scholar