Prevalence And Determinants Of Acute Adverse Effects Of External Beam Radiation Therapy Among Patients On Treatment For High Risk Prostate Cancer

Abstract

Prostate cancer is a malignancy of marked importance and causes significant mortality and morbidity in the male population. It is commonly diagnosed in the 7th decade after 65yrs. It is rarely diagnosed in men younger than 50 years old, accounting for only 2% of all cases(1) . Global incidence rates have shown that it is the 5th common malignancy worldwide in men, though the incidence and mortality rates vary significantly between countries regions and races, 19% in developed countries, and 5.3% in developing countries. Studies have also shown that 60-70% of CAp originates in the gland’s peripheral zone, 10–20% in the transition zone, and 5–10% in the central zone. CAp contributes 11.7% of new cancer cases overall (2). The important variables considered for risk stratification before determining treatment are; age, PSA, Gleason score and measure of tumor volume by clinical tumor (T) stage and/or extent of biopsy core involvement. This risk stratification avoids under-treatment of high risk disease and over-treatment of low risk disease(2). Among the available treatment modalities, radiotherapy contributes an important alternative to radical surgery alone to achieve cure in high risk prostate cancer management and it has been shown that external beam radiotherapy treatment offers similar survival benefits as surgery(3). In this respect, Intensity-modulated radiotherapy (IMRT) with/without IGRT, is currently the gold standard for external beam radiotherapy(4), though currently not available within the local set-up. Of note is that other modalities e.g. 2 dimensional and 3 dimensional conformal radiotherapy currently applied in limited resource setting. In as much as the treatment is geared towards beneficial outcomes, this modality is not without significant morbidity to the patient. This includes both short and long term adverse effects on skin and subcutaneous tissues, urinary system, gastro-intestinal system and musculo-skeletal system, which may in severe cases necessitate cessation of treatment(5). Most cases of prostate cancer present late in our set-up thus making radiotherapy a very important modality to be utilized in management of these cases which may not be amenable to surgery. The study seeks to determine prevalence and determinants of acute adverse effects of ERBT for the high risk CAp.