Radiotherapy for the treatment of locally advanced and metastatic prostate cancer

Introduction The value of radiotherapy in the treatment of prostate cancer has been recognized for nearly a century. The use of transurethral radium was first described in 1911 by Pasteau and Degrais.1 In 1930, Smith and Pierson described the utility of high voltage X-ray therapy in the treatment of prostate cancer, and, in 1930, Widmann subsequently noted an improvement in survival for patients with advanced prostate cancer treated with kilovoltage X-rays.2,3 Prior to the advent of prostate-specific antigen (PSA), the majority of patients were diagnosed based on clinically evident disease, which was often more advanced than the presentations commonly seen today. The activity of radiation in prostate cancer was evident by its effect on large palpable tumors that resolved following treatment. Widespread screening for prostate cancer has led to an increasing frequency of the disease being detected in its early stages, but there remains a significant proportion of patients who are diagnosed with locally advanced or even metastatic disease.