ACR and ASTRO issue new guideline on brachytherapy

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.

4 Responses

  1. Note no mention of men who value maintaining their quality of life and avoiding the approximately 60 percent odds of permanent ED.

  2. For a significant percentage of those men, active surveillance would, in any case, be a much better option than any form of treatment.

  3. Certainly there are men who both require treatment more invasive than AS and value maintaining their quality of life. Simply expecting them to just “get over it” is, hopefully, not the long-term attitude of radiation oncologists and radiation therapists.

    It’s pretty disheartening to see the professional organizations of practitioners of a primary form of prostate cancer treatment release joint updated guidelines that includes the term “risk” a single time and never mentions incontinence, impotence, quality of life, or side effects at all.

    Clearly, they won’t be getting any better at avoiding negative side effects of the treatment if they refuse to acknowledge that these negative outcomes exist.

  4. Well this certainly ought to improve the statistics for brachytherapy. About the only thing they left out, that would improve them further, would be to treat only men without prostate cancer.

    ; -) (aka) az4peaks

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