Radiotherapy for Prostate Cancer
DESCRIPTION
According to statistics from the American Cancer Society, "Prostate cancer is the most common cancer, excluding skin cancers, in American men. Prostate cancer is the second leading cause of cancer death in American men, exceeded only by lung cancer." Radiotherapy is a treatment option that may be offered for prostate cancer.
Radiotherapy for prostate cancer may include one of the following:
External Beam Radiation Therapy (EBRT)
EBRT has been widely used in the treatment of prostate cancer since the late 1950's. The radiation is focused from a source outside the body onto the area affected. The location of the prostate is defined according to the anatomy of nearby structures without the use of three-dimensional (3-D) visualization. Computed tomography (CT) images can be used to shape the radiotherapy fields to conform more closely to that of the prostate itself.
Interstitial Radiotherapy (Brachytherapy) - Permanent Seed Implantation
Brachytherapy for permanent seed implantation has been proposed for use in the treatment of localized prostate cancer as an alternative or complement to EBRT. It involves radioactive isotopes being directly implanted into the prostate gland as permanent seeds. The volume and shape of the prostate is accurately mapped out prior to surgery by use of transperineal CT or by ultrasound images. Needle placement and seed distribution is customized and evaluated by computer dosimetry planning systems. The number of seeds implanted is determined by the size of the prostate. The dose to the prostate is optimized and dose to the bladder and rectum is minimized by adjustment to seed placement and strength. This treatment is usually done as a single outpatient procedure with the use of spinal anesthesia.
Conformal Three-Dimensional (3-D) Radiotherapy
This type of radiotherapy uses digital information obtained with computed tomography (CT) scanners to obtain 3-D visualization of the prostate and nearby structures. The prostate, seminal vesicles, and surrounding normal tissue can be localized within the individual receiving the treatment. The radiation fields can then be tailored to the shape of the target tissue, thereby directing the highest dose of radiation to the malignant cells. The individual receiving treatment is fitted with a plastic mold resembling a body cast. The plastic mold is used to minimize movement so that the radiation can be more accurately aimed from several directions. More accurately aimed radiation may help to reduce radiation damage to normal tissues near the tumor.
Mixed-Beam (Photon/Neutron) Radiotherapy
Mixed-beam radiotherapy combines the higher therapeutic benefits of the neutron beam with the lower toxicity of the photon beam. This is done in an attempt to achieve tumor control in prostate cancer.
Mixed-beam radiotherapy may consist of photon treatments given 3 days per week and neutron treatments given 2 days per week.
Proton or Helium Ion Beam (Charged Particle) Radiation Therapy
See Proton or Helium Ion Beam (Charged Particle) Radiation Therapy policy (hyperlink below).
POLICY
Radiotherapy for the treatment of prostate cancer with either external beam radiation therapy (EBRT), brachytherapy without external beam radiation for localized prostate cancer, or conformal three-dimensional (3-D) radiotherapy is considered medically necessary.
Mixed-beam (Photon-Neutron) radiotherapy and brachytherapy with external beam radiation for localized prostate cancer for the treatment of prostate cancer are considered investigational.
Any device utilized for this procedure must have FDA approval specific to the indication otherwise it will be considered investigational.
See also: Proton or Helium Ion Beam (Charged Particle) Radiation
ADDITIONAL INFORMATION
Well-designed, randomized, controlled trials with long-term follow-up are not available to determine long-term benefits of mixed-beam (photon-neutron) radiotherapy and brachytherapy with external beam radiation for the treatment of localized prostate cancer compared to alternative treatments.
SOURCES
American Cancer Society. (2005, May). Detailed guide: Prostate cancer radiation therapy. Retrieved October 10, 2008 from http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_36.asp?sitearea.
American Cancer Society. (2005, May). What are the key statistics about prostate cancer? Retrieved October 10, 2008 from http://www.cancer.org/docroot/cri/content/cri_2_4_1x_what_are_the_key_statistics_for_prostate_cancer_36.asp?sitearea=&level.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2002). Brachytherapy for clinically localized prostate cancer using permanently implanted seeds (8.01.14). Retrieved October 10, 2008 from BlueWeb.
Borghede, G., Hedelin, H., Holmang, S., Johansson, K. A., Aldenborg, F., & Pettersson, S. Combined treatment of temporary short-term high dose rate iridium-192 brachytherapy and external beam radiotherapy for irradiation of localized prostatic carcinoma. Radiotherapy and Oncology. September 1997; 44 (3):237-44. Abstract retrieved December 20, 2000 from PubMed database.
Fowler, F. J., Collins, M. M., Albertson, P. C., Zietman, A., Elliott, D. A., & Barry, M. J. (2002). Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer. JAMA, 283 (24), 3217-3222.
Hayes Medical Technology Directory. (2006, October). Neutron bream therapy for prostate cancer. Retrieved October 13, 2008 from www.Hayesinc.com/subscribers. (51 articles and/or guidelines reviewed)
National Collaborating Center for Cancer. (2008, February). Prostate cancer: diagnosis and treatment. Retrieved October 10, 2008 from http://www.nice.org.uk/nicemedia/pdf/CG58FullGuideline.pdf
National Comprehensive Cancer Network. (2008, February). Clinical practice guidelines in oncology-v.1.2008: Prostate cancer. Retrieved October 22, 2008 from http://www.nccn.org/professionals/physician_gls/PDF/prostate.pdf.
Peschel, R. E., & Colberg, J. W. (2003, April). Surgery, brachytherapy, and external-beam radiotherapy for early prostate cancer. The Lancet Oncology, 4 (4), 233 - 241.
Pollack, A., Zagars, G. K., Smith, L. G., Lee, J. J., von Eschenbach, A. C., Antolak, J. A., et al. (2000). Preliminary results of a randomized radiotherapy dose-escalation study comparing 70 GY with 78 GY for prostate cancer. Journal of Clinical Oncology, 18 (23), 3904-3911.
U. S. Food and Drug Administration. (2000, May). Center for Devices and Radiological Health. 510(k) summary of safety and effectiveness. Retrieved October 10, 2008 from http://www.fda.gov/cdrh/pdf/k993280.pdf.
U. S. Food and Drug Administration. (2001). Center for Devices and Radiological Health. Premarket approval decisions for December 2001. Retrieved October 10, 2008 from http://www.fda.gov/cdrh/pma/pmadec01.html.
ORIGINAL EFFECTIVE DATE: 8/1983
MOST RECENT REVIEW DATE: 12/11/2008
ID_BT
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