• Cryosurgery
• Hormonal Ablation Therapy
• Management of Prostate Cancer
• Metastatic Prostate Cancer and Chemotherapy
• Observation (Expectant Management)
• Radiation Therapy
• Radical Prostatectomy

Radiotherapy, the use of ionizing radiation to destroy cancer cells, has been proven to be effective in the treatment of many cancers. Its role in the treatment of prostate cancer is somewhat limited by the relative radiation insensitivity of prostate cancer (Zelefsky et al., 1997). Radiation can be delivered by two modalities. It can be deilviered either as external beam radiotherapy in which an external tube delivers radiation directly to the prostate with little effect on surrounding tissues. A second approach to the treatment of localized prostate cancer is the administration of permanent implants such as 125iodine or 103palladium, known as brachytherapy. Brachytherapy with 125iodine has the potential advantage of delivering very high doses of local radiation therapy with a minimum of scatter and subsequent injury to surrounding structures such as bowel, bladder, and urethral sphincter/urethra. However, accurate placement of the implants is critical to delivery of radiation therapy.

Combinations of external-beam radiation therapy and brachytherapy have also been applied. Both external-beam radiation as well as brachytherapy have been enhanced in their effectiveness by the use of imaging modalities such as CT scans and transrectal ultrasound

Rapid evolution of prostate radiation therapy techniques has occurred over the past several years. Given the very long natural history and follow-up that is required to evaluate patients with localized prostate cancer for treatment effectiveness, very few patients have been treated with contemporary radiation techniques and had adequate follow-up

Hormonal therapy with radiation
One approach to optimizing the effectiveness of radiation therapy is to decrease the amount of tumor present using pretreatment hormone therapy for three to six months prior to radiation treatment. Several large studies have looked at this issue and have found that pretreatment hormonal therapy prior to radiation therapy is more effective than radiation alone.