Patient Selection for Robotic Radiosurgery for Clinically Localized Prostate Cancer: Come One, Come All

Optimal treatment of prostate cancer patients is ­provided by a multidisciplinary team comprised of urologists, radiation oncologists, and medical oncologists, working together to stratify patients based upon their life expectancy, extent of disease, acceptance of risks and benefits, and consideration of potential changes in quality of life. Available treatment options range from radical prostatectomy to various forms of radiation therapy including ­intensity-modulated radiation therapy (IMRT), low dose rate (LDR) brachytherapy, high dose rate (HDR) brachytherapy, proton beam therapy, and robotic radiosurgery. Robotic radiosurgery is the most recent addition to the treatment arsenal for clinically localized prostate cancer that builds upon developments in enhanced precision of radiation delivery and the use of imaging guidance throughout treatment. Given the variety of available treatment options, the clinical considerations and patient selection criteria for each of these treatment options will be reviewed with a focus on applications of robotic radiosurgery for patients with disease confined to the prostate and adjacent tissues.