With the advent of modern radiation techniques, we have been able to deliver a higher prescribed
radiotherapy dose for localized
prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam
radiation therapy (EBRT) from the literature. Late rectal
bleeding is the main adverse effect, and an incidence of >20% of Grade ≥2 adverse events was reported for 2D conventional
radiotherapy of up to 70 Gy. 3D conformal
radiation therapy (3D-CRT) was found to reduce the incidence to ∼10%. Furthermore, intensity-modulated
radiation therapy (IMRT) reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external
radiotherapy. We should pay more attention to detailed quality of life (QOL) analysis, not only with respect to rectal
bleeding but also other specific symptoms (such as
urinary incontinence and
impotence), for two reasons: (i) because of the increasing number of patients aged >80 years, and (ii) because of improved survival with elevated doses of
radiotherapy and/or hormonal
therapy; age is an important prognostic factor not only for
prostate-specific antigen (PSA) control but also for adverse reactions. Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after
radiotherapy for
prostate cancer patients is changing from rectal
bleeding to total elaborate quality of life assessment.