Radiation Medicine Rounds RMR RMR Radiation Medicine Rounds Editor-in-Chief: Charles R. Thomas. Jr. RMR Radiation Medicine Rounds Editor-in-Chief: Charles R. Thomas. Jr. P C rostate anCer Volume 2 • Issue 1 • 2011 P Allen M. Chen, MD, Guest Editor P r Srinivasan Vijayakumar, MD, DMRT, FACR, Guest Editor o rostate s Radiation Medicine Rounds is a trinary, hard cover, periodical designed to t provide an up-to-date review of a dedicated radiation medicine topic of interest to a clinicians and scientists who are involved in the care of patients receiving C radiotherapy. It serves as both a reference and instructional tool for students, t housestaff, fellows, practicing clinicians, medical physicists, cancer biologists, e anCer radiobiologists, and interdisciplinary colleagues throughout the oncology spectrum. This issue of Radiation Medicine Rounds includes reviews of all major recent C advances in treatment of favorable, intermediate and high-risk prostate cancer as well as newer modalities such as brachytherapy, stereotactic body radiation a therapy, and proton beam radiotherapy. Articles also review current knowledge in n the areas of new biomarkers, risk stratification, and prevention and quality of life. Allen M. Chen C Included in Prostate Cancer Srinivasan Vijayakumar e n New Biomarkers in Prostate Cancer: A Radiation Oncology Perspective r n Risk Stratification in Nonmetastatic Prostate Cancer: Implications for Treatment n Treatment of Favorable-Risk Prostate Cancer G U E S T E D I T O R S n Intermediate-Risk Prostate Cancer: Role of Androgen Deprivation C n High-Risk Prostate Cancer H E n Duration and Timing of Neoadjuvant/Adjuvant Androgen Deprivation in Nonmetastatic N Prostate Cancer n Current Role of Salvage and Adjuvant Radiotherapy for Prostate Cancer • n Prostate Brachytherapy V I n Stereotactic Body Radiation Therapy for Prostate Cancer J A n Image-Guided Strategies for Prostate Cancer Y A n Treatment of Intermediate-Risk Prostate Cancer k n Chemoprevention in Prostate Cancer: Current Clinical Evidence u n Quality-of-Life Issues in the Radiotherapeutic Management of Localized Prostate Cancer M A R Recommended Shelving Category: 2011 Oncology 2:1 11 W. 42nd Street New York, NY 10036 www.demosmedpub.com Cover design by Joe Tenerelli Radiation Medicine Rounds Charles R. Thomas, Jr., MD Editor-in-Chief Professor and Chair Department of Radiation Medicine Professor, Division of Hematology/Oncology Department of Medicine Knight Cancer Institute Oregon Health & Science University Cancer Institute Portland, Oregon PPrroossttaatteeCCaanncceerr__8877333388__PPTTRR__CCHH 0000__2222--0033--1111__ii--xxiivv..iinndddd ii 33//2222//22001111 1122::1144::1188 PPMM Editorial Board Indrin J. Chetty, PhD Dwight E. Heron, MD Detroit, Michigan Pittsburgh, Pennsylvania T.J. Fitzgerald, MD Robert S. Lavey, MD, MPH Worcester, Massachusetts Tampa, Florida C. David Fuller, MD A.J. Mundt, MD San Antonio, Texas San Diego, California Iris Gibbs, MD Ramesh Rengan, MD, PhD Stanford, California Philadelphia, Pennsylvania Karyn A. Goodman, MD Sharon A. Spencer, MD New York, New York Birmingham, Alabama Chandan Guha, MD, PhD Oscar Streeter, Jr., MD Bronx, New York Washington, DC Michele Y. Halyard, MD Charles R. Th omas, Jr., MD Scottsdale, Arizona Portland, Oregon Forthcoming Issues Head and Neck Cancer Dwight E. Heron, MD, and Roy Tishler, MD, PhD Guest Editors Gynecologic Cancer A. J. Mundt, Catheryn Yashar, and Loren Mell Guest Editors PPrroossttaatteeCCaanncceerr__8877333388__PPTTRR__CCHH 0000__2222--0033--1111__ii--xxiivv..iinndddd iiii 33//2222//22001111 1122::1144::1199 PPMM Radiation Medicine Rounds VOLUME 2, ISSUE 1 Prostate Cancer Guest Editors Allen M. Chen, MD Assistant Professor Department of Radiation Oncology Davis Cancer Center University of California Sacramento, California Srinivasan Vijayakumar, MD, DMRT, FACR Professor and Chair Department of Radiation Oncology University of Mississippi Medical Center Jackson, Mississippi New York PPrroossttaatteeCCaanncceerr__8877333388__PPTTRR__CCHH 0000__2222--0033--1111__ii--xxiivv..iinndddd iiiiii 33//2222//22001111 1122::1144::1199 PPMM Acquisitions Editor: Richard Winters Cover Design: Joe Tenerelli Compositor: Newgen Imaging Printer: Hamilton Printing Visit our website at www.demosmedpub.com Radiation Medicine Rounds is published three times a year by Demos Medical Publishing. Business Offi ce. All business correspondence including subscriptions, renewals, and address changes should be sent to Demos Medical Publishing, 11 West 42nd Street, 15th Floor, New York, NY, 10036. Copyright © 2011 Demos Medical Publishing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Demos Medical Publishing, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the web at www.copyright.com Th e ideas and opinions expressed in Radiation Medicine Rounds do not necessarily refl ect those of the Publisher. Th e Publisher does not assume any responsibility for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this periodical. Th e reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other health care professional relying on independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. Mention of any product in this issue should not be construed as endorsement by the contributors, editors, or the Publisher of the product or manufacturer’s claims. ISSN: 2151-4208 ISBN: 978-1-936287-33-8 Library of Congress Cataloging-in-Publication Data Prostate cancer / guest editors, Srinivasan Vijayakumar, Allen Chen. p. ; cm. — (Radiation medicine rounds; v. 2, issue 1) Includes bibliographical references and index. ISBN 978-1-936287-33-8 1. Prostate—Cancer—Radiotherapy. I. Vijayakumar, Srinivasan. II. Chen, Allen. III. Series: Radiation medicine rounds ; v. 2, issue 1. [DNLM: 1. Prostatic Neoplasms—radiotherapy. 2. Disease Progression. 3. Tumor Markers, Biological—therapeutic use. W1 RA162HD v. 2 issue 1 2011 /WJ 762] RC280.P7P742224 2011 616.999463—dc22 2011004858 Reprints. For copies of 100 or more of articles in this publication, please contact Reina Santana, Special Sales Manager. Special discounts on bulk quantities of Demos Medical Publishing books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. For details, please contact: Reina Santana, Special Sales Manager Demos Medical Publishing 11 W. 42nd Street New York, NY 10036 Phone: 800–532–8663 or 212–683–0072 Fax: 212–941–7842 E-mail: [email protected] Made in the United States of America 11 12 13 14 15 5 4 3 2 1 PPrroossttaatteeCCaanncceerr__8877333388__PPTTRR__CCHH 0000__2222--0033--1111__ii--xxiivv..iinndddd iivv 33//2222//22001111 1122::1144::1199 PPMM Contents Foreword vii Preface ix Contributors xi New Biomarkers in Prostate Cancer: A Radiation Oncology Perspective 1 Javier F. Torres-Roca Risk Stratifi cation in Nonmetastatic Prostate Cancer: Implications for Treatment 11 Richard E. Peschel Treatment of Favorable-Risk Prostate Cancer 17 Patrick Kupelian Intermediate-Risk Prostate Cancer: Role of Androgen Deprivation 27 Sravana K. Chennupati and Arthur Y. Hung High-Risk Prostate Cancer 35 Chirag Shah, Nasiruddin Mohammed, Michel Ghilezan, and Alvaro Martinez Duration and Timing of Neoadjuvant/Adjuvant Androgen Deprivation in Nonmetastatic Prostate Cancer 43 Ronald C. Chen, Jordan A. Holmes, and Anthony V. D’Amico Current Role of Salvage and Adjuvant Radiotherapy for Prostate Cancer 59 Peter J. Rossi, Mariam Korah, Brandon Mancini, Anees H. Dhabaan, and Ashesh B. Jani Prostate Brachytherapy 81 Sean M. McBride and Irving D. Kaplan Stereotactic Body Radiation Th erapy for Prostate Cancer 95 Th omas P. Boike and Robert D. Timmerman Proton Th erapy for the Treatment of Prostate Cancer 103 Quynh-Nhu Nguyen, Seungtaek Choi, and Andrew K. Lee Image-Guided Strategies for Prostate Cancer 113 Matthew H. Stenmark and Daniel A. Hamstra Treatment of Intermediate-Risk Prostate Cancer 131 John A. Kalapurakal PPrroossttaatteeCCaanncceerr__8877333388__PPTTRR__CCHH 0000__2222--0033--1111__ii--xxiivv..iinndddd vv 33//2222//22001111 1122::1144::1199 PPMM vi Contents Chemoprevention in Prostate Cancer: Current Clinical Evidence 145 Jason M. Phillips and Al Barqawi Quality-of-Life Issues in the Radiotherapeutic Management of Localized Prostate Cancer 153 Th omas J. Pugh and Steven J. Frank Index 163 PPrroossttaatteeCCaanncceerr__8877333388__PPTTRR__CCHH 0000__2222--0033--1111__ii--xxiivv..iinndddd vvii 33//2222//22001111 1122::1144::1199 PPMM Foreword ■ FROM THE EDITOR-IN-CHIEF Radiation Medicine Rounds is a quarterly, hard cover, periodical series that is designed to provide an up-to- date review of a dedicated radiation medicine topic of interest to clinicians and scientists who are involved in the care of patients receiving radiotherapy. It is intended to serve as both a reference and instructional tool by students, housestaff , fellows, practicing clinicians, medical physicists, cancer/radiobiologists, and interdisci- plinary colleagues throughout the oncology spectrum. Th e current issue, Prostate Cancer, is a successful attempt to concisely summarize one of the diseases that has served as a paradigm for implementation of emerging technology and understanding of cancer biol- ogy over the past two decades. Our volume editors, Drs. Allen M. Chen and Srinivasan Vijayakumar, have assembled a dedicated group of investigators who have authored a compilation of succinct and timely reviews addressing high-priority aspects of radiotherapy for this very common tumor in men. On behalf of the edi- torial board, I congratulate Allen and Vijay for putting together a state-of-the-art, easy-to-read, and valuable resource in the fi eld of prostate cancer radiation medicine. Dr. Charles R. Thomas, Jr. Series Editor-in-Chief Radiation Medicine Rounds Portland, Oregon PPrroossttaatteeCCaanncceerr__8877333388__PPTTRR__CCHH 0000__2222--0033--1111__ii--xxiivv..iinndddd vviiii 33//2222//22001111 1122::1144::1199 PPMM This page intentionally left blank Preface Clinical treatment decisions for prostate cancer are more complicated than ever, and technological advances in the fi eld of radiation oncology continue to revolutionize the management of this disease at a breathtaking pace. Th is volume of Radiation Medicine Rounds was designed with the intention of providing the practicing radiation oncologist with a broad and well-balanced synopsis of many of the relevant issues surrounding the management of prostate cancer with radiation therapy. Particular attention is focused not only on many of the current controversies, but also on future strategies, which may play an increasingly signifi cant role in the future. Th e opening articles consider the principles of the sciences underlying the presentation of prostate cancer. Accordingly, controversies regarding diagnostic stratifi cation and how they may aff ect treatment are empha- sized. Along these lines, specialized clinical scenarios detailing the utility of postoperative radiation therapy, brachytherapy, and androgen deprivation are illustrated given the widespread utilization of these modalities. Th e middle articles focus heavily on the emergence of advanced technologies such as stereotactic body radio- therapy, proton beam radiotherapy, and image-guided radiotherapy, and how they may potentially aff ect the therapeutic ratio. Lastly, articles surrounding the all-important issues of prevention and quality of life bring this volume to a close. We hope this volume serves as an instructive reference for the radiation oncology community and thank the many contributors for their time and expertise in helping to bring this project to fruition. Allen M. Chen, MD Srinivasan Vijayakumar, MD, DMRT, FACR PPrroossttaatteeCCaanncceerr__8877333388__PPTTRR__CCHH 0000__2222--0033--1111__ii--xxiivv..iinndddd iixx 33//2222//22001111 1122::1144::1199 PPMM