Open Access

ARTICLE

Changing management of localized prostate cancer: a comparison survey of Ontario radiation oncologists

Jarad Martin¹, George Rodrigues², Shawn Malone³, Gerard Morton⁴, Holly Campbell⁵, Juanita Crook¹

1 Division of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
2 Department of Radiation Oncology, London Regional Cancer Centre, London, Ontario, Canada
3 Department of Radiation Oncology, Ottawa Regional Cancer Centre, Ottawa, Ontario, Canada
4 Department of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada
5 Department of Radiation Oncology, Durham Regional Cancer Centre, Oshawa, Ontario, Canada
Address correspondence to Dr. Jarad Martin, Division of Radiation Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9 Canada

Canadian Journal of Urology 2006, 13(Suppl.2), 26-33.

Abstract

Background and purpose: Annual genitourinary radiation oncology meetings aim to assist in the dissemination of knowledge that may affect current practice. We aim to measure changes in practice approaches that have occurred while these meetings have been conducted.
Materials and methods: A previously published survey from 2002 was sent to all genitourinary radiation oncologists in Ontario. Six prostate cancer patient scenarios were used: three definitive (low risk, intermediate risk, high risk), and three post-operative (extracapsular extension, margin positive, slowly rising PSA). There were 21 responders from seven cancer centers.
Results: Using biological equivalent dose (BED), there is significant dose escalation in 2005, particularly for intermediate risk patients (mean BED 73.0 Gy2 in 2002 versus 76.1 Gy2 in 2005, p=0.0003). There has been a corresponding move away from the use of neoadjuvant hormones in these patients (2002: 62% versus 2005: 24%, p=0.0097). More accurate prostate localization using fiducials is more common, leading to less use of rectal barium and urethrograms in the simulation process. In the definitive settings there is more utilization of rigid immobilization and more complex treatment delivery including intensity modulated radiotherapy. There is also greater use of multileaf collimation, electronic portal imaging and dose volume histograms in 2005 compared with 2002.
Conclusions: There have been significant changes in the way that prostate cancer is managed with radiotherapy in Ontario between 2002 and 2005. Dose escalation and more complex treatment planning is widely evident.

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