Risk stratification in prostate cancer treated with radiation therapy: a window of opportunity for new clinical trials

Prostate cancer (PCa) is the most incident male cancer in USA and in Europe (1,2). Among malignant solid tumors that constantly require careful and specialized management planning, PCa is a multifaceted disease for which the decision making process has to precisely evaluate several variables concerning the tumor and its host. PCa may present a wide spectrum of clinical situations that require different interventional options. Due to the prostate specific antigen (PSA) “revolution”, in the past years, the health operators’ community has mainly focused on the identification of the indolent disease in order to avoid overtreatment; and active surveillance has been considered as a reasonable and primary choice for a substantial portion of patients. On the other hand, more recently, the definition of PCa subtypes with a clinical behavior more comparable to other aggressive solid tumors calls for different considerations about this kind of disease, especially in light of the new therapeutic agents’ availability. In particular, clinical studies aimed at defining the comparative validity of the current treatment approaches in high-risk localized disease and possibly exploring alternative therapeutic strategies, are urgently needed.