Variant 3.
60-year-old man, asymptomatic in PSA screening program. 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).
| 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.95 |
| 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.92 |
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate