Pavol Dubinský
PSA assessment has dramatically changed management of prostate cancer over the last fifteen years. Diagnostics based on PSA has shifted presentation of this disease towards early, localized stages, although it remains to show whether this practice, perhaps formalized in screening programme, would decrease prostate cancer specific mortality. Anyhow, as localized cancer is seen more often, a clinitian is regularly confronted with therapeutical dilemma. Clinical information can be used to select therapy with the least morbidity. Age, patient preference, comorbidity, PSA level, Gleason score, clinical T stage and in some occations percentage of positive biopsies and radiological studies are taken in account. Morever, preference of refering physitian plays important role too. External radiotherapy (RAT) represents possible option for a patient with localized prostate carcinoma. Modern radiotherapy is characterized by maximal shielding of normal tissue in view of reduction of late radiation damage. Technological development has shifted cost benefit ratio and it seems more improvements can be expected. The role of androgen suppression in locally advanced cancer treated by radiotherapy has been to some extent defined by several studies. Some patients with high risk localized cancer were included but this group was not evaluated separately. There is only one reported randomized study evaluating androgen suppression in localized disease and results of several others are awaited. Proper patient selection for treatment by the means of external radiotherapy is presented. Minimal prerequisites for delivery of this treatment are defined. Technological progress, combination with androgen suppression and toxicity of radiotherapy are summarised in this paper.