Chicago Prostate Cancer Center, Westmont, IL.University of Texas Southwestern Medical Center, Dallas, TX; MD Anderson Cancer Center, Houston, TX; University of California San Francisco, San Francisco, CA; Radiological Associates of Sacramento, Sacramento; Loma Linda University Medical Center, Loma Linda, CA; University of Miami, Miami, FL; Karmanos-Crittenton Cancer Center, Rochester Hills, MI; Cleveland Clinic Foundation, Cleveland, OH; Roswell Park Cancer Institute, Buffalo, New York, American Urological Association, NY; Memorial Sloan Kettering Cancer Center, New York, NY; Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV.
External beam radiation therapy is a standard of care treatment for men who present with clinically localized (T1-T2) prostate cancer. The purpose of this review was to provide clarification on the appropriateness criteria and management considerations for the treatment of prostate cancer with external beam radiation therapy.
A panel consisting of physicians with expertise on prostate cancer was assembled and provided with a number of clinical scenarios for consensus treatment and management guidelines. Prostate cancer patient vignettes were presented along with specific management recommendations based on an extensive review of the modern external beam radiotherapy literature. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances, where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Modern external beam radiation therapy series demonstrate favorable biochemical control rates for patients with localized prostate cancer. Morbidity profiles are also favorable and it is clear that this is enhanced by modern techniques like 3-dimensional conformal radiation therapy and intensity-modulated radiation therapy. An active area of investigation is evaluating the use of hypofractionated dosing.
Continued investigation to refine patient selection, external beam radiation technology application, and alternative dosing schedules should result in further improvements in biochemical outcome and decreased morbidity with external beam radiation treatment for localized prostate cancer.
Moran BJ, Derose P, Hsu IC, Abdel-Wahab M, Arterbery VE, Ciezki JP, Frank SJ, Mohler JL, Rosenthal SA, Rossi CJ Jr, Yamada Y, Merrick GS. Are you the author?
Reference: Am J Clin Oncol. 2011 Dec;34(6):636-647.