An oncologist's view: advances in radiotherapy for prostate cancer and how they are improving treatment outcomes

Within prostate cancer, radiotherapy has come a long way. We are entering a new era of personalised treatment, driven by innovations in imaging, precision targeting and adaptive treatment planning. The difference between what we could offer 10 to 15 years ago to now is remarkable. 

As these advanced radiotherapy techniques become standard practice, prostate cancer treatment is becoming more targeted, effective, and tailored to individual patient needs.

Consultant Clinical Oncologist, Vinod Mullassery, shares his expert insights on the latest advancements in radiotherapy treatment options for prostate cancer.

What is radiotherapy and how is it used to treat prostate cancer?

Radiotherapy is the use of high energy X-rays to target and destroy cancer cells. It is a common treatment for prostate cancer and used either on its own or in combination with hormones. Radiotherapy can also be used if the cancer returns after surgery or after various focal treatments for prostate cancer.

What is a radiotherapy technique vs a radiotherapy technology?

Effective radiotherapy relies on both treatment techniques and technology. A technique is the method used to plan and deliver the treatment, such as shaping radiation beams or tracking movement, while the technology is the machine or software used to deliver that technique. 

How has radiotherapy treatment progressed?

Today’s radiotherapy is more precise and personalised than ever before. In the early days oncologists would use very basic X-ray images to guide treatment. This meant that nearby healthy tissue or organs could also be affected by the treatment, resulting in more side effects for patients. But we’ve come a long way since then. Today, oncologists like me can use advanced imaging and, along with physicists and dosimetrists we can create more detailed treatment plans. This means we can deliver treatment with far greater accuracy, reducing side effects and improving outcomes. 

What is IMRT and why is it important in prostate cancer treatment? 

Intensity Modulated Radiotherapy (IMRT) is a treatment technique that allows us to shape and control radiation beams. This means we can deliver high dose treatment directly to the prostate with minimum impact on nearby organs including the rectum and bladder. Although relatively modern, IMRT is now considered a standard therapy. This means it’s widely recognised and used as an effective treatment option.

What is Image-guided radiotherapy (IGRT)?

All radiotherapy planning uses imaging to guide treatment. Image-guided radiotherapy (IGRT) means that we take images just before or during a treatment session to make sure the prostate is in the right position. The prostate is not a fixed organ, it is prone to move slightly from day to day, depending on bladder filling or bowel activity, so this additional imaging helps us to ensure treatment is delivered as accurately as possible.

What is SABR and how is it different?

Stereotactic ablative body radiotherapy (SABR) is a modern treatment technique and is an advanced form of radiotherapy. SABR uses smaller, focussed beams of radiation from different angles that meet at the tumour. This technique combined with advanced imaging and motion management tracking technology allows us to target with greater accuracy and deliver a higher dose each day. SABR is particularly beneficial in treating prostate cancer as these cells are more sensitive to larger doses of radiotherapy. 

A key advantage of SABR is that we can deliver a higher dose per session, allowing treatment to be completed in fewer visits over a shorter period. Its accuracy also helps minimise side effects.
Patients often ask if SABR is as effective as conventional radiotherapy, and in the right cases, evidence shows it can deliver excellent outcomes with low risks of side effects. 

What is MR-Linac technology and why is it considered a breakthrough?

The MR-Linac is one of the most exciting developments in radiotherapy. It combines an MRI scanner with a radiotherapy treatment machine, called a linear accelerator. It’s a real breakthrough in radiotherapy treatment because for the first time we can scan patients at the same time as treating them, giving us a real time view of the tumours we are targeting. This is referred to as adaptive radiotherapy because we can pause and adapt treatment in the moment, this “see as you treat” approach means we can make slight adjustments on the spot if the prostate moves, helping the radiation stay perfectly targeted.

This technology coupled with the SABR treatment technique means prostate cancer patients can benefit from higher doses of treatment in fewer treatment sessions with less side effects.

This is particularly helpful in treating the prostate which can move during a treatment session, based on the body’s normal functions, such as bladder or bowel fullness. It is also very effective at treating locally recurring prostate cancer, as the additional level of real time accuracy means we can target with the highest precision, avoiding nearby healthy tissue or organs. 

Is MR-Linac treatment available in the UK?

Yes, we’re really pleased to be launching this treatment option at The Harley Street Clinic. The UK has also played a major role in developing and testing MR-Linac treatment approaches, helping to shape how prostate cancer is treated worldwide.

What is the future of radiotherapy for prostate cancer?

Radiotherapy treatment for prostate cancer has evolved into a highly precise and advanced treatment option. Innovations including SABR and MR-Linac mean that our patients have access to faster, safer, and more effective radiotherapy treatment than ever before. 

We’ve moved into a more personalised era of radiotherapy and that is very exciting for us as clinicians because it means we can optimise treatment for each individual patient. In the future there is a potential that AI and advanced imaging could play a role in further personalisation, which could lead to even better outcomes and improved quality of life.

The goal is simple: treat cancer effectively, whilst helping patients maintain their quality of life.

Final thoughts: Radiotherapy may not always make the headlines, but for prostate cancer it remains one of the most effective and most rapidly improving treatments we have. As an oncologist, I’ve seen how these advances can make a real difference, helping men live longer and healthier with fewer side effects, and that ultimately is what matters most.