title: ACR Appropriateness Criteria® definitive external beam irradiation in stage T1 and T2 prostate cancer.
abstract: OBJECTIVE
  : External beam radiation therapy is a standard of care treatment for men who present with clinically localized (T1-T2) 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 external beam radiation therapy.
  
  
  METHODS
  : A panel consisting of physicians with expertise on prostate cancer was assembled and provided with a number of 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 external beam radiotherapy literature. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances, where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
  
  
  RESULTS
  : Modern external beam radiation therapy series demonstrate favorable biochemical control rates for patients with localized prostate cancer. Morbidity profiles are also favorable and it is clear that this is enhanced by modern techniques like 3-dimensional conformal radiation therapy and intensity-modulated radiation therapy. An active area of investigation is evaluating the use of hypofractionated dosing.
  
  
  CONCLUSIONS
  : Continued investigation to refine patient selection, external beam radiation technology application, and alternative dosing schedules should result in further improvements in biochemical outcome and decreased morbidity with external beam radiation treatment for localized prostate cancer.
authors.affiliation: Chicago Prostate Cancer Center, Westmont, IL, USA. seeds@prostateimplant.com
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.forename: Paul
authors.initials: P
authors.lastname: DeRose
authors.forename: I-Chow Joe
authors.initials: IC
authors.lastname: Hsu
authors.forename: May
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: V Elayne
authors.initials: VE
authors.lastname: Arterbery
authors.forename: Jay P
authors.initials: JP
authors.lastname: Ciezki
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.forename: James Lloyd
authors.initials: JL
authors.lastname: Mohler
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 S
authors.initials: GS
authors.lastname: Merrick
mesh_terms: D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011878:Radiotherapy / Q000379:methods*