Prostate cancer is the most frequent malignancy in the U.S. with the annual number of new cases exceeding 185,000 and 35,000 deaths. This big difference between incidence and mortality suggests that many patients diagnosed with prostate cancer survive.
Indeed, due to dramatic improvements in screening and diagnosis the majority of cases are diagnosed in earlier stages; and new treatment technologies account for an impressive cure rate of 90% in patients with earlier stages. It was estimated that there were more than 2,000,000 survivors of prostate cancer in the U.S. in 2007.
The treatment options for prostate patients are based on a detailed assessment of all characteristics of the cancer (stage, grade, PSA, number of positive cores at biopsy, prostate size, and some others), patient’s functionality (life expectancy, performance status, presence of other medical conditions, such as chronic urinary issues, diabetes, etc.), as well as personal preference in treatment technique. The menu of available options includes watchful waiting, surgery, external beam radiation, brachytherapy, hormonal therapy, selectively or in different combinations.
Due to the complexity of decision making and the risk of potential complications associated with any treatment choice, the patients are always encouraged to see a urologist and a radiation oncologist, and, if any questions remain – seek second opinion.   
Along with manual and robotic radical prostatectomy, radiation therapy has gained a prominent role as an equally effective treatment option. The treatment is done on a linear accelerator daily over a period of 8-9 weeks with dynamic shaping and intensity modulating of multidirectional beams (IMRT) allowing maximal spearing of normal tissue. For delineation of the target radiation, oncology centers utilize fused CT/MRI images. For accuracy of the treatment delivery, real-time imaging devices (such as the cone beam CT integrated with a treatment machine, ultrasound, or megavoltage x-ray electronic films) are used in combination with metallic feducial markers implanted into the prostate before the course of therapy.
Cone beam CT is one of the newest technical developments. In simple terms it is a hybrid of an x-ray treatment machine and CT. The obvious advantage of an integrated system is the ability to obtain 3D CT images of the prostate right before each treatment and make appropriate adjustments with accuracy within a few milimeters. With such technology the dose of radiation is safely escalated and results equalize from surgery.
Another well established and highly effective treatment technique is the brachytherapy, which is Greek for “treatment from short distance.” The shortest distance imaginable is the placement of radioactive seeds directly into the prostate gland. The procedure is done under general anesthesia with real-time ultrasound guidance and the patient is discharged the same day. The seeds contained rapidly decaying radioactive isotopes Pd-103 or I-131. While the seeds are active (5-6 months for Pd-103) they produce low KV x-rays. As the seeds reside inside the prostate, the prostate cancer cells absorb a very high dose of radiation, while normal tissues get much less. Seeds implants and similar forms of high dose rate brachytherapy (HDR BT) have the same rate of success as surgery or external beam radiation.
The stereotactic radiosurgery (SRS – such as the cyber knife) concept of external beam radiation of prostate cancer is undergoing evaluation in several centers at the present. With that option the whole treatment is done in five days, which is an attractive perspective. However, this therapy remains controversial and is highly experimental. There are some theoretical issues with fraction dose size, and definition of the margin around the prostate. In addition, there is no long-term data on the clinical outcomes.  Time will show how effective the treatment is. And it is quite possible that SRS of the prostate will gain recognition and will be added to the list of standard options.