ASCO and Cancer Care Ontario Update Guideline on Radiation Therapy for Prostate Cancer

The American Society of Clinical Oncology (ASCO) and Cancer Care Ontario today issued a joint clinical practice guideline update on brachytherapy for patients with prostate cancer. The update provides evidence-based recommendations for different patient risk groups and specifies the most effective forms of brachytherapy. The joint guideline was published in the Journal of Clinical Oncology. 

"This guideline provides very clear direction about what is now the nonsurgical standard of care for the majority of patients with prostate cancer—brachytherapy either by itself or as part of a combination approach," said Andrew Loblaw, MD, FRCPC, MSc, Co-Chair of the Expert Panel that developed the guideline update, representing ASCO. "Brachytherapy is also more convenient than external-beam radiation and has a much higher chance of curing the disease. However, not every patient should have brachytherapy, and not all treatment centers are experienced in delivering high-quality brachytherapy."

The guideline recommendations pertain to men newly diagnosed with prostate cancer who require or choose active treatment and are not considering, or are not suitable, for active surveillance. Patients may be ineligible for brachytherapy if they have moderate to severe urinary symptoms, an enlarged prostate, prior prostate surgery, and contraindications to radiation treatment, or are in poor physical health.

"For the urologists, who are most often the gatekeepers in terms of first contact with men with prostate cancer, this guideline update provides new information that they can incorporate into patient counseling and treatment decision-making," said Joseph Chin, MD, FRCSC, Co-Chair of the Expert Panel that developed the guideline update, representing Cancer Care Ontario. "By optimizing treatment selection, which may or may not be brachytherapy for a particular patient, outcomes should ultimately be improved."

Key recommendations of the guideline update include:

  • For eligible patients with low-risk prostate cancer either low–dose rate brachytherapy alone, external-beam radiotherapy alone, or radical prostatectomy should be offered.
  • For eligible patients with low-intermediate–risk prostate cancer (Gleason 7, prostate-specific antigen [PSA] < 10 ng/mL or Gleason 6, PSA 10–20 ng/mL), low–dose rate brachytherapy alone may be offered.
  • For eligible patients with intermediate-risk prostate cancer who choose to receive external-beam radiotherapy with or without androgen-deprivation therapy, addition of a low–dose rate or high–dose rate brachytherapy boost should be offered.
  • For eligible patients with high-risk prostate cancer receiving external-beam radiotherapy and androgen-deprivation therapy, brachytherapy boost (low–dose rate or high–dose rate) should be offered.
  • Iodine-125 and palladium-103 are each reasonable isotope options for patients receiving low–dose rate brachytherapy; no recommendation can be made for or against using cesium-131 or high–dose rate monotherapy. 
  • Patients should be counseled about all their care options (surgery, external-beam radiotherapy, brachytherapy, active surveillance, as applicable) in a balanced, objective manner preferably from multiple disciplines.
  • If choosing brachytherapy, a patient should go to a treatment center following strict quality assurance standards.

To develop this guideline update, an Expert Panel reviewed relevant literature published between 2011 and December 2016. Five randomized controlled clinical trials provided the evidence base for this guideline update.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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