DOI: https://doi.org/10.36347/sjmcr.2025.v13i12.028

Pages: 3001-3006

Background: Prostate cancer is the most commonly diagnosed malignancy among men in developed countries. Radiotherapy is a cornerstone of curative treatment, but proximity to organs at risk (OARs) such as the rectum and bladder remains a major challenge. Objective: To provide an updated narrative review of the main technological advances that have improved OAR sparing in external beam radiotherapy (EBRT) for prostate cancer. Methods: A literature review was conducted using PubMed and Scopus (2005–2024), focusing on studies related to conformal radiotherapy, intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), image-guided radiotherapy (IGRT), rectal spacers, proton therapy, and adaptive radiotherapy. Results: IMRT and VMAT significantly improve dose conformity and reduce exposure to the rectum and bladder. IGRT and fiducial tracking enhance daily targeting precision, allowing tighter margins. Hydrogel rectal spacers reduce rectal dose by up to 70% and improve patient-reported outcomes. Proton therapy offers theoretical dosimetric advantages, though without clear clinical superiority. Adaptive radiotherapy and AI-based tools represent emerging solutions for further OAR sparing. Conclusions: Technological progress has led to a substantial reduction in radiation-induced toxicity in prostate cancer radiotherapy. Future directions include personalised treatment through daily plan adaptation and automated planning driven by artificial intelligence.