Prostate Cancer Radiotherapy: Current Status, Clinical Challenges, and Future Strategies

Abstract

The radiation therapy for prostate cancer plays a central role in the overall management of the disease, covering a wide range of applications, including radical treatment for localized tumors, postoperative adjuvant/rescue radiotherapy, and palliative treatment for advanced metastatic lesions. With the advancement of radiotherapy technologies and optimization of combined treatment strategies, the precision and safety of prostate cancer radiotherapy have significantly improved. However, key clinical challenges remain: how to determine the suitability of radical surgery or radiotherapy, balance the increase in radiation dose with toxicity control, the choice between adjuvant or salvage radiotherapy for postoperative recurrence, and the synergistic mechanisms and applicable populations for radiotherapy combined with novel endocrine drugs or immunotherapy. This article systematically reviews the current status and recent advances in prostate cancer radiotherapy, explores the management of radical radiotherapy, postoperative adjuvant radiotherapy (ART), and salvage radiotherapy (SRT), the management of radiotherapy toxicity, and individualized treatment strategies in the context of new technologies. It further investigates cutting-edge technologies such as AI-guided radiotherapy planning and Flash ultra-high-speed radiotherapy, with the aim of providing evidence-based support for clinical decision-making and research translation.