title: ACR appropriateness criteria: Permanent source brachytherapy for prostate cancer.
abstract: To provide updated American College of Radiology (ACR) appropriateness criteria for transrectal ultrasound-guided transperineal interstitial permanent source brachytherapy.
  
  
  
  The ACR appropriateness criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 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.
  
  
  
  Permanent prostate brachytherapy (PPB) is a treatment option for appropriately selected patients with localized prostate cancer with low to very high risk disease. PPB monotherapy remains an appropriate and effective curative treatment for low-risk prostate cancer patients demonstrating excellent long-term cancer control and acceptable morbidity. PPB monotherapy can be considered for select intermediate-risk patients with multiparametric MRI useful in evaluation of such patients. High-risk patients treated with PPB should receive supplemental external beam radiotherapy (EBRT) along with androgen deprivation. Similarly, patients with involved pelvic lymph nodes may also be considered for such combined treatment but reported long-term outcomes are limited. Computed tomography-based postimplant dosimetry completed within 60 days of PPB is essential for quality assurance. PPB may be considered for treatment of local recurrence after EBRT but is associated with an increased risk of toxicity.
  
  
  
  Updated appropriateness criteria for patient evaluation, selection, treatment, and postimplant dosimetry are given. These criteria are intended to be advisory only with the final responsibility for patient care residing with the treating clinicians.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN. Electronic address: davis.brian@mayo.edu.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Davis
authors.affiliation: Dorothy Schneider Cancer Center, San Mateo, CA.
authors.forename: Al V
authors.initials: AV
authors.lastname: Taira
authors.affiliation: Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Department of Urology, University of Alabama School of Medicine, Birmingham, AL; American Urological Association, Linthicum, MD.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Assimos
authors.affiliation: Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Gottschalk
authors.affiliation: Radiation Oncology, William Beaumont Hospital, Troy, MI.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Gustafson
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Scottsdale, Phoenix, AZ.
authors.forename: Sameer R
authors.initials: SR
authors.lastname: Keole
authors.affiliation: Department of Radiation and Cellular Oncology, The University of Chicago Medical Center, Chicago, IL.
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Liauw
authors.affiliation: Department of Radiation Oncology, Huntsman Cancer Hospital, Salt Lake City, UT.
authors.forename: Shane
authors.initials: S
authors.lastname: Lloyd
authors.affiliation: Department of Radiation Oncology, University of Michigan, Novi, MI.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: McLaughlin
authors.affiliation: Department of Radiation Oncology, Henry Ford Health System, Detroit, MI.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Movsas
authors.affiliation: Bon Secours Cancer Institute, Norfolk, VA.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Prestidge
authors.affiliation: Department of Radiation Oncology, University of Virginia, Charlottesville, VA.
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Showalter
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Neha
authors.initials: N
authors.lastname: Vapiwala
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D018579:Patient Selection; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000534:rehabilitation; D011788:Quality of Life; D011874:Radiometry / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods
keywords: Brachytherapy; Guideline; Prostate cancer; Radiation therapy; Radiotherapy; Standard