Table of Contents Author Guidelines Submit a Manuscript
Prostate Cancer
Volume 2016, Article ID 4897515, 10 pages
http://dx.doi.org/10.1155/2016/4897515
Review Article

Prostate Radiotherapy in the Era of Advanced Imaging and Precision Medicine

1Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35249-6832, USA
2Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
3Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA

Received 20 November 2015; Accepted 20 January 2016

Academic Editor: Robert Gardiner

Copyright © 2016 Caleb R. Dulaney et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tremendous technological advancements in prostate radiotherapy have decreased treatment toxicity and improved clinical outcomes for men with prostate cancer. While these advances have allowed for significant treatment volume reduction and whole-organ dose escalation, further improvement in prostate radiotherapy has been limited by classic techniques for diagnosis and risk stratification. Developments in prostate imaging, image-guided targeted biopsy, next-generation gene expression profiling, and targeted molecular therapies now provide information to stratify patients and select treatments based on tumor biology. Image-guided targeted biopsy improves detection of clinically significant cases of prostate cancer and provides important information about the biological behavior of intraprostatic lesions which can further guide treatment decisions. We review the evolution of prostate magnetic resonance imaging (MRI) and MRI-ultrasound fusion-guided prostate biopsy. Recent advancements in radiation therapy including dose escalation, moderate and extreme hypofractionation, partial prostate radiation therapy, and finally dose escalation by simultaneous integrated boost are discussed. We also review next-generation sequencing and discuss developments in targeted molecular therapies. Last, we review ongoing clinical trials and future treatment paradigms that integrate targeted biopsy, molecular profiling and therapy, and prostate radiotherapy.