The American College of Radiology (ACR) and the American Society for Radiation Oncology (ASTRO) have jointly issued a new guidance document on the treatment of prostate cancer with permanent radioactive “seed” implants inserted through the perineum.
The full text of the document is available on the ACR web site and has also been published in the International Journal of Radiation Oncology Biology Physics.
The new guidance explicitly identifies six types of patients who are potentially not appropriate candidates for permanent implant brachytherapy:
- Men with a life expectancy of less than 5 years
- Men with an unacceptable level of operative risk
- Men with”poor anatomy” which could result in a suboptimal implant (e.g., a large or poorly healed transurethral resection of the prostate [TURP] defect, a large median lobe, or just a large gland size)
- Men with pathologically positive lymph nodes
- Men with distant metastases
The guideline gives recommendations for radiation dosing and some comment on the potential need for combining brachytherapy with external beam radiation therapy and androgen deprivation in men with intermediate- or high-risk disease. It does not make any comment on the relative value of different types of radioactive seed.