Variant 3.
A 60-y-old man, asymptomatic in PSA screening program∗
| Treatment | Rating | Comments |
|---|---|---|
| Continue planning using current CT simulation | 7 | Definitive EBRT for large prostates without ADT is associated with low rates of GU or GI toxicity.122 |
| Use ADT for downsizing of gland | 4 | Consider this option if dosimetric criteria are not met on initial plan due to large prostate volume. |
| Recommend for surgery rather than RT | 5 | This option is recommended if obstructive symptoms are present. |
| RT fractionation | ||
| CFRT | 8 | |
| HFRT | 5 | |
| SBRT | 4 | The toxicities of SBRT in large prostate glands have not been fully characterized. |
| Simulation | ||
| CT simulation (kV CT) | 8 | |
| MRI simulation and fusion to CT | 8 | Volume on MRI is noted to be smaller than that on CT.41 |
Rating scale: 1, 2, 3 = usually not appropriate; 4, 5, 6 = may be appropriate; 7, 8, 9 = usually appropriate.
ADT, androgen deprivation therapy; EBRT, external beam radiation therapy; GI, gastrointestinal; GU, genitourinary; HFRT, hypofractionated radiation therapy; MRI, magnetic resonance imaging; SBRT, stereotactic body radiation therapy. Other abbreviations as in Variant 1.
∗
PSA 5.2 ng/mL, prostate within normal limits, no palpable lesions. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. CT simulation reveals very large-volume prostate (100 mL).