Radiation therapy for locally advanced PCa continues to evolve. A current treatment recommendation for nonmetastatic, high-risk disease includes AS combined with RT. The precise duration and sequencing of AS has not been established but most frequently includes treatment in the neoadjuvant, concomitant and, occasionally, adjuvant periods. As technology allows higher doses without significant increases in morbidity and as clinical data provide proof of a radiation dose response, RT doses continue to escalate. The goal of therapy for metastatic disease continues to focus on the relief of pain and the improvement in quality of life. Multiple studies document the significant role RT plays in achieving these goals. Focal RT and systemic radioisotopes have become the mainstay of management in this patient group and the development of newer isotopes that cause less marrow toxicity will improve the therapeutic ratio and provide an opportunity for their use with systemic chemotherapy. As molecular and genomic technologies advance, directed targeting of critical cellular radiation-response pathways hold the promise of improved radiation response and individualized, tailored therapy.
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