title: American College of Radiology Appropriateness Criteria permanent source brachytherapy for prostate cancer.
abstract: OBJECTIVE
  Permanent prostate brachytherapy has emerged as a standard of care treatment for approximately 50,000 men annually who present with clinically localized prostate cancer. The purpose of this review was to provide clarification on the appropriateness criteria and management considerations for the treatment of prostate cancer with permanent prostate brachytherapy.
  
  
  METHODS
  Panel members with expertise on prostate cancer were assembled and provided several clinical scenarios for consensus treatment and management guidelines. Prostate cancer patient vignettes were presented along with specific management recommendations based on an extensive review of the modern brachytherapy literature. The brachytherapy topic development and review consists of two parts which require extensive participation by the expert panel. The American College of Radiology (ACR) Appropriateness Criteria (AC) are derived from a multidisciplinary panel of experts from both the academic and private practice settings. The first activity is a review of the current literature with development of an evidence table, referenced narrative, and ratings table of treatments. The second activity is the consensus-building process using a modified Delphi technique via an anonymous voting process.
  
  
  RESULTS
  Most brachytherapy series have demonstrated favorable morbidity profiles and durable biochemical control rates for patients with low-, intermediate-, and high-risk features. However, as brachytherapy followups have matured, it has become increasingly apparent that efficacy and morbidity are highly dependent on implant quality.
  
  
  CONCLUSIONS
  Continued attempts to refine patient selection, brachytherapy treatment planning philosophy, technique, and postimplant management should result in further improvements in biochemical outcome and decreased brachytherapy-related morbidity.
authors.affiliation: Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.forename: V Elayne
authors.initials: VE
authors.lastname: Arterbery
authors.forename: I-Chow Joe
authors.initials: IC
authors.lastname: Hsu
authors.forename: May
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
authors.forename: Noah M
authors.initials: NM
authors.lastname: Hahn
authors.forename: James Lloyd
authors.initials: JL
authors.lastname: Mohler
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.forename: Seth A
authors.initials: SA
authors.lastname: Rosenthal
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Rossi
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
authors.forename: Gregory
authors.initials: G
authors.lastname: Merrick
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D018579:Patient Selection; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D019736:Prostheses and Implants; D011788:Quality of Life; D011868:Radioisotopes / Q000627:therapeutic use
chemical_list: D000726:Androgen Antagonists; D011868:Radioisotopes; D017430:Prostate-Specific Antigen