BERKELEY, CA (UroToday.com) - Transperineal permanent brachytherapy is a commonly utilized and well-accepted treatment option for localized prostate cancer.
It has an excellent track record with respect to cure and local control rates with an acceptable morbidity profile. It is utilized as monotherapy for low-risk patients and can be used in combination with supplemental external beam radiation therapy and/or androgen suppression therapy for patients with intermediate and high-risk disease.
As with all treatment modalities, optimum results require adherence to guidelines with respect to patient selection, details of the procedure, and quality assurance measures. Recently, increased attention has been devoted to issues of radiation therapy safety and quality assurance in all areas of radiation oncology practice, including prostate brachytherapy. Professional organizations such as the American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) have worked together with the American Brachytherapy Society (ABS) to revise guidelines with respect to the performance of permanent prostate brachytherapy. These guidelines play an important role in summarizing recent developments in the literature and in educating practitioners as to appropriate procedures in the performance of prostate brachytherapy.
The permanent prostate brachytherapy guideline has been updated in 2010, after a review process involving the ACR and ASTRO. The guideline had last been revised five years ago and there have been advances in literature, science, and practice of prostate brachytherapy since that time. The document was developed after a systematic literature review, with input from radiation oncologists and physicists who are experienced with the performance of permanent prostate brachytherapy. The document addresses issues such as qualifications and responsibilities of personnel involved in the prostate brachytherapy procedure, patient selection criteria, treatment planning techniques, post implant dosimetry, as well as radiation safety and physics quality control issues. This document should provide valuable guidance for those interested in starting a prostate brachytherapy program at their hospital or facility. For experienced practitioners, it will provide a review of the procedures typically utilized in performance of prostate brachytherapy. Specifically, the document does emphasize the need for post implant dosimetry in patients treated with permanent prostate brachytherapy, and it recommends that post implant dosimetry be mandatory for patients treated with permanent transperineal prostate brachytherapy. Furthermore, the use of image-based planning such as CT or MRI is recommended in order to provide for more accurate dosimetry than had previously been possible with the use of orthogonal radiographs.
Review of this guideline would be instructive for practitioners who are involved in the practice of prostate brachytherapy. This is an area where patterns of practice have been continuously evolving since prostate brachytherapy has become more widely accepted as a treatment technique for prostate cancer. The document discusses appropriate practice guidelines and documentation which will help the practitioner in ensuring that quality and safety concerns have an important place in a successful prostate brachytherapy program.
Seth A. Rosenthal, MD, FAC as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.