Variant 6.

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

Treatment	Rating	Comments
IGRT
Daily CT with soft-tissue alignment	7	There are no specific recommendations on RTOG 0534.124 CBCT with fiducial markers is reasonable.35, 36
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.15
None	3

Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate