Prostate Cancer Brachytherapy Guidelines Due

PALM BEACH, Fla--The increased use of prostate brachytherapy has promptedthe American Brachytherapy Society to establish a group to formulate standardsand treatment guidelines, Peter D. Grimm, DO, said at the Society's 19thannual meeting.

"It's clear to us that if we don't do this, it will be very difficultto compare results and may result in some poor treatments," said Dr.Grimm, of the Northwest Tumor Institute, Seattle.

The Prostate Brachytherapy Quality Assurance Group (PBQAG), which includes21 experts from various US medical centers and universities, is seekingto establish guidelines in seven areas (see table ).

ISSUES IN PROSTATE BRACHYTHERAPY

Under review by the American Brachytherapy Society's Prostate BrachytherapyQuality Assurance Group (PBQAG).

1. Postoperative dosimetry--The group will attempt to set standardson how and by whom the radioactive dose is calculated after seed implantation.

2. Implant planning guidelines will focus on all three membersof the implant team--the urologist, radiation oncolo-gist, and physicist.By looking at the size and shape of the prostate, as well as other factorssuch as whether TURP (transure-thral resection of the prostate) has alreadybeen done, the group will try to set standards for prescribing how thebrachytherapy procedure is performed.

One question to be examined is the value of pre-planning vs decisionmaking in the operating room. Dr. Grimm's personal prejudice is for pre-planning."It gives all of the team time to think about the best course of action,"he said. "In the operating room, it becomes expensive thinking."

3. Physician, physicist, and nurse training. Here, the main questionis whether there should be minimum education standards to qualify peoplefor brachy-therapy use and follow-up care. The panel will look at whatthis might entail in terms of course programs and collateral educationalmaterials. Dr. Grimm said that the Prostate Institute at the Swedish MedicalCenter, Seattle, is currently training about 30 physicians a month in prostatebrachytherapy.

4. Radiation safety guidelines will establish protocols and safetystandards for handling the radioactive seeds.

5. Patient selection. The panel will review clinical trials inan attempt to define which patients are most likely to benefit from brachytherapyalone or various combinations of brachytherapy, external beam radiationtherapy, and hormonal blockade.

6. Quality assurance monitoring. The panel will set protocolsas to how often quality assurance monitoring should be done and by whom.

7. Intraoperative quality assurance. The committee will alsoestablish guidelines for monitoring quality in the operating room, includingthe best method (ultrasound, fluoroscope, or some other method) for guidingand assessing the placement of the radioactive seeds.

"The standards set today will help to project the future,"Dr. Grimm said in an interview. "It will be a fluid, ongoing effortthat is constantly improved upon as more information becomes available."

Dr. Grimm and his colleagues are encouraging members of the Societyand other physicians in the field to publish papers that address the questionsraised by the PBQAG. Dr. Grimm is adamant that randomized trials are neededalong with assessments of the procedure as it is currently used.

He said that the group hopes to have a rough set of guidelines and aclearer definition of goals for prostate brachytherapy available for reviewby the Society's next annual meeting.