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The review summarizes historical whole-gland dose approaches, then explains how prostate MRI and PET with prostate-specific tracers support localization and focal dose-escalation of high-risk subvolumes. It reviews evidence for improved biochemical control with focal dose escalation while addressing remaining uncertainties in clinical target volume definition and prescription strategy.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/target-volume-optimization-for-localized-prostate-cancer-review/340375/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/target-volume-optimization-for-localized-prostate-cancer-review/340375.png","ImageObject",300,407,{"name":92,"@type":93},"Eden","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the primary purpose of the review?","Question",{"text":113,"@type":114},"To provide a comprehensive review of how to optimize target volume definition for treatment planning in intact localized prostate cancer, with emphasis on focal boost volume definition.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How does focal dose escalation differ from whole-gland dose escalation historically?",{"text":118,"@type":114},"Whole-gland approaches delivered a uniform dose to the prostate (with or without seminal vesicle coverage), while focal dose escalation focuses higher doses on high-risk subvolumes enabled by advanced imaging.",{"name":120,"@type":111,"acceptedAnswer":121},"What key limitations or open questions remain after the evidence presented?",{"text":122,"@type":114},"Uncertainty remains about the optimal target volume definition and prescription strategy, including how pathological correlates and tumor spread patterns should inform clinical target volume delineation.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},340375,1790105944,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146},1374391974468,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Author Manuscript Author Manuscript Author Manuscript Author Manuscript  \n\n| | HHS Public Access\u003Cbr>Author manuscript\u003Cbr>Pract Radiat Oncol. Author manuscript; available in PMC 2024 November 03. |\n| --- | --- |\n\nPublished in final edited form as:  \nPract Radiat Oncol. 2024 ; 14(6): 522–540. doi:10.1016/j.prro.2024.06.006 .  \nTarget Volume Optimization for Localized Prostate Cancer  \nKrishnan R. Patel, MD, MHSa,* , Uulke A. van der Heide, PhDb, Linda G.W. Kerkmeijer, MD, PhDc, Ivo G. Schoots, MDb, Baris Turkbey, MDd, Deborah E. Citrin, MDa, William A. Hall, MDe  \na Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland  \nb Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands  \nc Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands dMolecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland  \neFroedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin  \nAbstract  \nPurpose: To provide a comprehensive review of the means by which to optimize target volume definition for the purposes of treatment planning for patients with intact prostate cancer with a specific emphasis on focal boost volume definition.  \nMethods: Here we conduct a narrative review of the available literature summarizing the current state of knowledge on optimizing target volume definition for the treatment of localized prostate cancer.  \nResults: Historically, the treatment of prostate cancer included a uniform prescription dose administered to the entire prostate with or without coverage of all or part of the seminal vesicles. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase 3 data has demonstrated that incorporating focal dose escalation to high-risk subvolumes ofthe prostate improves biochemical control without significantly increasing toxicity.  \nStill, several fundamental questions remain regarding the optimal target volume definition and prescription strategy to implement this technique. Given the remaining uncertainty, a knowledge of the pathological correlates of radiographic findings and the anatomic patterns of tumor spread may help inform clinical judgement for the definition of clinical target volumes.  \nThis is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/))  \n*Corresponding author: Krishnan R. Patel, MD, MHS; [Krishnan.Patel@nih.gov](Krishnan.Patel@nih.gov).  \nSupplementary materials  \nSupplementary material associated with this article can be found in the online version at doi:10.1016/j.prro.2024.06.006 . Data sharing is not applicable. No original data are presented in this review.  \nAuthor Manuscript Author Manuscript Author Manuscript Author Manuscript  \nPatel et al. Page 2  \nConclusion: Advanced imaging has the ability to improve outcomes for patients with prostate cancer in multiple ways, including by enabling focal dose escalation to high-risk subvolumes.  \nHowever, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice, and key knowledge gaps remain. A detailed understanding of the pathological correlates of radiographic findings and the patterns of local tumor spread may help inform clinical judgement for target volume definition given the current state of uncertainty.  \nSection I: Introduction  \nRadiation therapy for prostate cancer (PCA) has undergone several improvements over the past decades, including dose escalation. Several retrospective analyses 1,2 and prospective, randomized controlled trials3–6 have determined that whole-gland ","cbCaigKjkajZa7qC","https://ap.wps.com/l/cbCaigKjkajZa7qC","pdf",2488497,32,"English","# Abstract\n# Section I: Introduction\n# Section II: Imaging-Based Target Volume Delineation","[{\"question\":\"What is the primary purpose of the review?\",\"answer\":\"To provide a comprehensive review of how to optimize target volume definition for treatment planning in intact localized prostate cancer, with emphasis on focal boost volume definition.\"},{\"question\":\"How does focal dose escalation differ from whole-gland dose escalation historically?\",\"answer\":\"Whole-gland approaches delivered a uniform dose to the prostate (with or without seminal vesicle coverage), while focal dose escalation focuses higher doses on high-risk subvolumes enabled by advanced imaging.\"},{\"question\":\"What key limitations or open questions remain after the evidence presented?\",\"answer\":\"Uncertainty remains about the optimal target volume definition and prescription strategy, including how pathological correlates and tumor spread patterns should inform clinical target volume delineation.\"}]","Target Volume Optimization for Localized Prostate Cancer - review | PDF",1790036137,81]