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September 14, 2005

Radiation Dose Escalation as Treatment for Clinically Localized Prostate CancerIs More Really Better?

Author Affiliations

Author Affiliations: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Md.

JAMA. 2005;294(10):1274-1276. doi:10.1001/jama.294.10.1274

Contemporary management of clinically localized adenocarcinoma of the prostate is based on the concept that destruction of prostate cancer cells by radiation therapy or removal of the prostate by radical prostatectomy will render the patient free of disease. Unfortunately, a number of men with clinically localized prostate cancer have only a temporary decrement in serum levels of prostate-specific antigen (PSA) following radiation or surgery, highlighting the need for more accurate staging and improved treatment.1,2 Several studies have correlated clinical stage, histological tumor grade, and pretreatment PSA levels with risk of disease recurrence following therapy, and contemporary risk stratification of prostate cancer uses a combination of these measures.3 This stratification schema is critical to the rationale for aggressive local treatment by allowing for selection of patients who are most likely to have localized disease and who will therefore potentially benefit by aggressive unimodal therapies, such as dose-escalated radiation.

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