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Cancers
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New Insights into Prostate Cancer Radiotherapy
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New Insights into Prostate Cancer Radiotherapy

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 1 July 2025 | Viewed by 7466

Special Issue Editor

Prof. Dr. Grace Lu-Yao

E-Mail Website
Guest Editor
Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, USA
Interests: cancer surveillance, screening, and treatment for prostate cancer; outcomes research and cancer epidemiology; host factors and immunotherapy outcomes
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Prostate cancer is one of the most common types of cancer. Over the past few decades, radiotherapy has played a major role in the treatment of this disease. With the development of technology and long-term clinical experience, radiotherapy is widely applied in all clinical stages of the disease and has made significant advances in treatment. Ongoing research into radiotherapy could further improve cancer control and survival outcomes for patients with this cancer.

This Special Issue focuses on the latest topics in radiotherapy for prostate malignancies, including the treatment of patients, basic research, clinical applications, etc., and will, hopefully, contribute to the advancement of current clinical and laboratory research on prostate cancer radiotherapy.

Dr. Grace Lu-Yao
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prostate cancer
  • radiotherapy
  • radiation therapy

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Published Papers (5 papers)

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Research

17 pages, 3950 KiB  
Article
Can the Dose Constraints Be Trusted? Actual Dose Exposure of Bladder and Rectum During Prostate Cancer Radiotherapy
by Marc Petrikowski, Kai Kröger, Julian Roers, Dominik Hering, Sebastian Lohmann, Sergiu Scobioala, Uwe Haverkamp and Hans Theodor Eich
Cancers 2025, 17(7), 1194; https://doi.org/10.3390/cancers17071194 - 31 Mar 2025
Viewed by 429
Abstract
Background/Objectives: The actual daily dose distribution during image-guided radiotherapy (IGRT) for prostate cancer (PCa) deviates from the planned due to positional and volumetric changes in the patient’s body and organs at risk (OAR). This study investigates the difference between planned and delivered [...] Read more.
Background/Objectives: The actual daily dose distribution during image-guided radiotherapy (IGRT) for prostate cancer (PCa) deviates from the planned due to positional and volumetric changes in the patient’s body and organs at risk (OAR). This study investigates the difference between planned and delivered dose, by calculating the actual daily dose to bladder and rectum for each radiotherapy fraction. The impact of OAR volumes on dose distribution and the correlation with treatment-related toxicities will be evaluated. Methods: A cone-beam computed tomography (CBCT) based daily dose calculation was performed for a total of 821 CBCT scans of 20 patients with localized PCa treated with IGRT. Each fraction’s dose-volume histogram was analyzed, and toxicities were correlated with OAR dose exposures. Results: Daily dosimetric evaluation showed a significant increase in bladder V65–V70 and rectum V50–V70 compared to planned values (p ≤ 0.003 each). In contrast to bladder Dmean, the rectum Dmean was significantly increased (0.47 vs. 0.55; p < 0.001). For the bladder an exponential dose-volume relationship was demonstrated, while no dose-volume relationship was found for the rectum. On average, patients with increased genitourinary toxicities received significantly increased bladder Dmean (0.44 vs. 0.63, p = 0.014). Conclusions: Conventional dose evaluation via a summation plan rather underestimates daily dosimetric parameters. For adaptive radiotherapy of PCa, volumetric parameters rather than mean doses should be used for daily treatment planning constraints. Because established dose constraints cannot be reduced to a single fraction, reasonable dose constraints should consider daily positional and volumetric changes, rather than relying on a single planning CT. Full article
(This article belongs to the Special Issue New Insights into Prostate Cancer Radiotherapy)
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16 pages, 3470 KiB  
Article
Clinical Outcomes and Genomic Alterations in Gleason Score 10 Prostate Cancer
by Luke W. Chen, Yetkin Tuac, Sophia Li, Jonathan E. Leeman, Martin T. King, Peter F. Orio, Paul L. Nguyen, Anthony V. D’Amico, Cagdas Aktan and Mutlay Sayan
Cancers 2025, 17(7), 1055; https://doi.org/10.3390/cancers17071055 - 21 Mar 2025
Viewed by 551
Abstract
Background: Gleason score (GS) 10 prostate cancer (PC) is a highly aggressive localized disease. Despite advances in treating high-risk PC, the clinical outcomes and molecular underpinnings of GS 10 remain unclear. This study aimed to determine whether GS 10 PC has distinct [...] Read more.
Background: Gleason score (GS) 10 prostate cancer (PC) is a highly aggressive localized disease. Despite advances in treating high-risk PC, the clinical outcomes and molecular underpinnings of GS 10 remain unclear. This study aimed to determine whether GS 10 PC has distinct clinical outcomes from other “high-risk” cancers (i.e., Gleason 8–9) and identify genomic alterations driving its aggressive phenotype. Methods: A retrospective review of The Cancer Genome Atlas database identified patients with GS 8–10 PC who underwent radical prostatectomy. Clinical factors were compared between GS 10 and GS 8–9 cohorts. Time to biochemical recurrence (BCR) was analyzed using Kaplan–Meier and Cox regression. RNA sequencing identified differentially expressed genes, and protein–protein interaction networks identified hub genes. Results: Of 192 patients, 13 (6.8%) had GS 10 PC. After median follow-up of 37.87 months, GS 10 status was associated with significantly lower time to BCR (AHR, 2.67; 95% CI, 1.18–6.02; p = 0.018) compared to GS 8–9. Multiple genes (e.g., RAD54L, FAAH, AATK, MAST2) showed higher alteration frequencies, and high expression of RAD54L, MAST2, and CCHCR1 correlated with shorter disease-free survival. Six overlapping hub genes (CD8A, CDC20, E2F1, IL10, TNF, VCAM1) were overexpressed in GS 10 tumors, reflecting key pathways in tumor progression. Conclusions: GS 10 PC confers inferior time to BCR and displays a distinct genomic landscape compared to GS 8–9 disease, highlighting the need for biomarker-driven therapeutic strategies. Further studies are needed to validate these genomic targets and improve management for this very high-risk population. Full article
(This article belongs to the Special Issue New Insights into Prostate Cancer Radiotherapy)
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16 pages, 2292 KiB  
Article
The Impact of Radiotherapy on the Primary Tumor in Patients with Metastatic High-Volume Castration-Sensitive Prostate Cancer: A Propensity Score Matching Analysis
by Antoni Skripai, Philip Blumenfeld, Aaron Krakow, Robert Den, Aron Popovtzer, Marc Wygoda and Tal Falick Michaeli
Cancers 2025, 17(2), 297; https://doi.org/10.3390/cancers17020297 - 17 Jan 2025
Viewed by 942
Abstract
Background: Retrospective studies suggest that local radiotherapy on the prostate improves overall survival in the metastatic setting, but its benefit in patients with high-burden metastatic disease is still uncertain. Methods: We conducted a retrospective study of 100 high-metastatic-burden prostate cancer patients at Hadassah [...] Read more.
Background: Retrospective studies suggest that local radiotherapy on the prostate improves overall survival in the metastatic setting, but its benefit in patients with high-burden metastatic disease is still uncertain. Methods: We conducted a retrospective study of 100 high-metastatic-burden prostate cancer patients at Hadassah Ein Karem Medical Center from 2004 to 2021. Patients receiving local RT alongside standard treatment were compared to those receiving standard treatment alone. Prostate RT involved EBRT to the prostate/seminal vesicles with/without pelvic lymph nodes, delivering 54–60 Gy in up to 3 Gy fractions. The standard treatment used was ADT including or excluding chemotherapy. Subsequently, we performed 1:1 propensity score matching on 50 patients for further analysis. Results: The cohort had 100 patients split evenly between the RT and NRT groups. The RT group had higher Overall Survival than NRT (p < 0.046), remaining significant after Propensity Score Matching (PSM) (p < 0.034). Biochemical progression-free survival was also higher in RT vs. NRT (p < 0.033), maintaining significance after PSM (p < 0.042). RT patients reported longer symptom-free time vs. NRT (p < 0.017), though this difference did not persist post-PSM (p < 0.249). Post-PSM analysis showed higher loco-regional progression-free survival in the RT group vs. NRT (p < 0.049). Conclusions: Our study shows improved overall survival in the high-metastatic-burden group when adding RT to the standard treatment of choice, which persists after propensity score matching. The RT group in the entire cohort also demonstrated a reduction in progressing urinary symptoms and biochemical progression-free survival. These findings highlight radiotherapy’s potential as a viable treatment in these patients. However, prospective studies with comprehensive data collection are needed to fully address this topic. Full article
(This article belongs to the Special Issue New Insights into Prostate Cancer Radiotherapy)
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Figure 1

13 pages, 2961 KiB  
Article
Effect of Prior Transurethral Prostate Resection (TURP) or Laser Enucleation (ThuLEP) on Radiotherapy-Induced Toxicity and Quality of Life in Prostate Cancer Patients Undergoing Definitive Radiotherapy
by David Rene Steike, Fabian Martin Troschel, Julian Roers, Jan Jakob Siats, Christopher Kittel, Niklas Benedikt Pepper, Stefan Gravemeyer, Philipp Papavassilis, Andres Jan Schrader, Hans Theodor Eich and Sergiu Scobioala
Cancers 2024, 16(19), 3403; https://doi.org/10.3390/cancers16193403 - 6 Oct 2024
Viewed by 1777
Abstract
In our study, the post-radiotherapy quality of life of prostate cancer patients who previously underwent transurethral resection of the prostate (TURP) is compared to those who had thulium laser enucleation of the prostate (ThuLEP) and those who had no prior surgery. It also [...] Read more.
In our study, the post-radiotherapy quality of life of prostate cancer patients who previously underwent transurethral resection of the prostate (TURP) is compared to those who had thulium laser enucleation of the prostate (ThuLEP) and those who had no prior surgery. It also aims to identify and assess risk factors affecting therapy tolerance in this patient group. We analyzed 132 patients with localized prostate cancer treated with definitive radiotherapy (RT), including 23 who had prior TURP and 19 who previously underwent ThuLEP. A total of 62% of patients underwent irradiation within 12 months after surgery. We included only patients treated with radiotherapy using the IMRT technique. Changes in patient-reported urinary toxicity were evaluated using the International Prostate Syndrome Score (IPSS) and the quality of life index of the World Health Organization (QoL/WHO-PSS) over a three-year post-radiotherapy period. Patients with prior TURP experienced significant deterioration in QoL and IPSS immediately after irradiation (p < 0.001), whereas those without previous surgery showed both less significant differences in IPSS and QoL scores. In conclusion, patients with previous TURP/ThuLEP differ from those without previous surgery in urinary quality of life and acute and chronic urinary symptom profiles after RT. The surgical technique (ThuLEP vs. TURP) and the time interval to irradiation are crucial factors affecting RT tolerance in acute and late settings. The previously operated patient group reported a significantly longer period of increased symptom burden. Full article
(This article belongs to the Special Issue New Insights into Prostate Cancer Radiotherapy)
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Graphical abstract

13 pages, 271 KiB  
Article
A Contemporary Report of Low-Dose-Rate Brachytherapy for Prostate Cancer Using MRI for Risk Stratification: Disease Outcomes and Patient-Reported Quality of Life
by Mira Patel, William Tyler Turchan, Christopher G. Morris, Dana Augustine, Tianming Wu, Aytek Oto, Gregory P. Zagaja and Stanley L. Liauw
Cancers 2023, 15(4), 1336; https://doi.org/10.3390/cancers15041336 - 20 Feb 2023
Cited by 4 | Viewed by 2918
Abstract
Purpose: We examined a prospective consecutive cohort of low dose rate (LDR) brachytherapy for prostate cancer to evaluate the efficacy of monotherapy for unfavorable-intermediate risk (UIR) disease, and explore factors associated with toxicity and quality of life (QOL). Methods: 149 men with prostate [...] Read more.
Purpose: We examined a prospective consecutive cohort of low dose rate (LDR) brachytherapy for prostate cancer to evaluate the efficacy of monotherapy for unfavorable-intermediate risk (UIR) disease, and explore factors associated with toxicity and quality of life (QOL). Methods: 149 men with prostate cancer, including 114 staged with MRI, received Iodine-125 brachytherapy alone (144–145 Gy) or following external beam radiation therapy (110 Gy; EBRT). Patient-reported QOL was assessed by the Expanded Prostate Index Composite (EPIC) survey, and genitourinary (GU) and gastrointestinal (GI) toxicity were prospectively recorded (CTC v4.0). Global QOL scores were assessed for decline greater than the minimum clinically important difference (MCID). Univariate analysis (UVA) was performed, with 30-day post-implant dosimetry covariates stratified into quartiles. Median follow-up was 63 mo. Results: Men with NCCN low (n = 42) or favorable-intermediate risk (n = 37) disease were treated with brachytherapy alone, while most with high-risk disease had combined EBRT (n = 17 of 18). Men with UIR disease (n = 52) were selected for monotherapy (n = 42) based on clinical factors and MRI findings. Freedom from biochemical failure-7 yr was 98%. Of 37 men with MRI treated with monotherapy for UIR disease, all 36 men without extraprostatic extension were controlled. Late Grade 2+/3+ toxicity occurred in 55/3% for GU and 8/2% for GI, respectively. Fifty men were sexually active at baseline and had 2 yr sexual data; 37 (74%) remained active at 2 yr. Global scores for urinary incontinence (UC), urinary irritation/obstruction (UIO), bowel function, and sexual function (SF) showed decreases greater than the MCID (p < 0.05) in UC at 2 mo, UIO at 2 and 6 mo, and SF at 2–24 mo, and >5 yr. Analysis did not reveal any significant associations with any examined rectal or urethral dosimetry for late toxicity or QOL. Conclusion: Disease outcomes and patient-reported QOL support LDR brachytherapy, including monotherapy for UIR disease. Full article
(This article belongs to the Special Issue New Insights into Prostate Cancer Radiotherapy)
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