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Prostate cancer is the most common cancer in men in the Western world.

The significant increase in the disease after 1990 is due, on the one hand, to the increase in life expectancy and, on the other hand, to the development of diagnostic tools combined with the awareness of men about the prevention of the disease.

Every year, approximately 450,000 Europeans are diagnosed and approximately 100,000 end up with prostate cancer with the annual cost of healthcare exceeding 6 billion euros.

However, less than half of European men seem to be aware of the risk of prostate cancer and its effects.

Age, race and heredity are known causative factors, while the man’s diet and sexual life probably play an aggravating role. Usually in the early stages there are no symptoms and the disease is diagnosed by chance during a preventive check-up with PSA measurement.

The patient should then undergo a digital examination and if there is suspicion of malignancy, an imaging-guided biopsy is required to make the diagnosis. The disease is then staged, i.e. the control of the extent of the cancer with various imaging methods.

The choice of the optimal treatment for prostate cancer is generally based on the histological characteristics and stage of the disease, the age and general health of the patient as well as the weighing of the risks and benefits of each therapeutic method.

Parameters such as quality of life, functional outcome, expected oncological outcome, coexisting health problems and the individual’s priorities are decisive for making the decision. The categorization of the disease into risk groups based on PSA, biopsy and imaging studies significantly contributes to the planning of treatment individually for each patient.

The treatment of prostate cancer includes active surveillance, surgical treatment (laparoscopic / robotic-assisted radical prostatectomy), radiotherapy (external / brachytherapy) and hormone therapy.

In early-stage disease, the patient has the option of choosing between surgery and radiotherapy; in more extensive tumors, the combination of radiotherapy and hormone therapy is usually more effective, while in many cases radiotherapy is also required after prostatectomy when complete removal has not been performed or when the disease recurs.

The role of radiotherapy in prostate cancer

Radiotherapy is indicated in the treatment of early-stage prostate cancer with almost similar results to radical surgery. For patients with more extensive intermediate/high-risk tumors, the combination of radiotherapy and hormone therapy is usually more effective.

In many cases, radiotherapy is also required after prostatectomy when complete removal has not been performed or when the disease recurs. Finally, it is an irreplaceable treatment for the treatment and relief of symptoms in patients with metastatic disease.

Radiotherapy can be administered either as external radiotherapy using high-energy X-rays that are produced by a linear accelerator and precisely directed at the tumor, or as brachytherapy by placing radioactive implants inside the prostate.

Developments in the field of Radiotherapy in recent decades have led to the application of modern techniques that provide the ability to administer high doses of radiation with absolute precision focused on the target with the greatest possible avoidance of neighboring normal organs. Three-dimensional conformal radiotherapy (3D–Conformal Radiotherapy) and the latest generation of intensity-modulated radiotherapy (IMRT) as well as image-guided radiotherapy (IGRT) further reduce the toxicity of the treatment and increase its effectiveness.

The main contribution of these new techniques was the escalation of the radiotherapy dose resulting in improved local control of prostate cancer with a significant reduction in gastrointestinal and urinary side effects, avoidance of incontinence and preservation of erectile function in the majority of patients.

Survival rates for patients with prostate cancer are constantly increasing, as a result of public awareness, the widespread use of population screening and significant advances in prostate cancer treatments.