. 2016 Oct 20;2(1):62–84. doi: 10.1016/j.adro.2016.10.002

Variant 6.

A 60-y-old man, asymptomatic in PSA screening program^∗

Treatment	Rating	Comments
IGRT
Daily CT with soft-tissue alignment	7	There are no specific recommendations on RTOG 0534.⁷¹ CBCT with fiducial markers is reasonable.174, 175
Daily CT with implanted fiducial markers	6	It is uncertain if fiducial markers are stable, similar to the intact prostate setting.
Daily CT with surgical clips	7	This procedure may be used if other options are not available; however, clinicians should note that these clips may not appear clearly on CBCT.
Daily CT with alignment of bony anatomy	4	The prostate gland is recognized to move independently of bony anatomy, so alignment based on the prostate PTV is recommended.
Daily kV orthogonals	6	The prostate gland is recognized to move independently of bony anatomy, so alignment based on the prostate PTV is recommended.
Electromagnetic transponders	6	There are typically 3 beacons placed: 2 lateral to the ureterovesicular anastomosis and 1 distal in the retrovesical tissue where the SVs had been. The beacons are typically 1 cm apart from each other.¹⁷⁶
None	3

Rating scale: 1, 2, 3 = usually not appropriate; 4, 5, 6 = may be appropriate; 7, 8, 9 = usually appropriate.

Abbreviations as in Variants 1, 3, 4, and 5.

^∗

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. Patient has radical prostatectomy that reveals pT2 disease, positive apical margin, postoperative PSA of 0.2 ng/mL. Adjuvant EBRT recommended.