Variant 5.
60-year-old man, asymptomatic in PSA screening program. PSA 5.2 ng/mL, prostate without palpable abnormalities. Multiple needle biopsies of the prostate showed adenocarcinoma. Gleason score 3 + 3 = 6. Patient has a history of inflammatory bowel disease.
| Treatment | Rating | Comments |
|---|---|---|
| Simulation | 8 | There is no effect on simulation. |
| Treatment Planning | ||
| IMRT (non-arc) | 8 | There are reportedly low complications with photon EBRT 109, 110. |
| IMRT (arc) | 8 | There are reportedly low complications with photon EBRT 109, 110. |
| Proton beam | 5 | This procedure may be appropriate but there was disagreement among panel members on the appropriateness rating as defined by the panel’s median rating. This reflects recognized controversy in the field. Treatment on a clinical trial is encouraged. |
| IGRT | ||
| CBCT with radiofrequency transponders | 7 | This is expert opinion. There is no published evidence on the optimal method for image guidance. |
| CBCT with fiducial markers, aligned to PTV | 8 | This is expert opinion. There is no published evidence on the optimal method for image guidance. |
| CBCT without fiducial markers, aligned to PTV | 7 | |
| CBCT, aligned to bony anatomy | 3 | The prostate gland is recognized to move independently of bony anatomy, so alignment based on the prostate PTV is recommended. |
| 2-D imaging with fiducial markers | 7 | |
| Ultrasound | 7 | |
| None | 2 | |
| RT Fractionation | ||
| CFRT | 8 | |
| HFRT | 4 | There is limited evidence regarding the safety of HFRT in inflammatory bowel disease. |
| SBRT | 4 | There is limited evidence in inflammatory bowel disease. |
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate