BlueCross BlueShield of Tennessee Medical Policy Manual

Radiotherapy for Prostate Cancer


Prostate cancer is the second most common cancer in American men. Prostate cancer treatment options include surgery, chemotherapy, cryotherapy, hormonal therapy, and/or radiation therapy. Highly conformal radiation techniques are recommended to treat localized prostate cancer.

Conformal 3D radiotherapy is a form of EBRT using three-dimensional images, usually from computed tomography (CT) scans, to delineate the boundaries of the tumor and discriminate tumor tissue from adjacent normal tissue and organs at risk for radiation damage. Computer algorithms were developed to estimate cumulative radiation dose delivered to each volume of interest by summing the contribution from each shaped beam. The individual receiving treatment is fitted with a plastic mold resembling a body cast. The plastic mold is used to minimize movement so the radiation can be more accurately aimed from several directions, thereby reducing radiation damage to normal tissues near the tumor.

Another type of radiotherapy being investigated is mixed-beam utilizing photons and neutrons. Neutron beam therapy uses accelerated neutral subatomic particles to target tumor mass using a high linear energy transfer.

Other forms of highly conformal radiotherapy, such as brachytherapy, IMRT and stereotactic body radiotherapy therapy, are addressed in MCG guidelines. Proton beam therapy is addressed in a separate medical policy.




Agency for Healthcare Research and Quality. (2014) Therapies for clinically localized prostate cancer: update of a 2008 systematic review. Retrieved April 1, 2014 from  

Dolezel, M., Odrazka, K., Zouhar, M., Vaculikova, M, Sefrova, J., Jansa, J., et al. (2015). Comparing morbidity and cancer control after 3D-conformal (70/74 GY) and intensity modulated radiotherapy (78/82 GY) for prostate cancer. Strahlentherapie und Onkologie, 191 (4), 338-346. Abstract retrieved February 27, 2019 from PubMed database.

National Comprehensive Cancer Network. (2018, August). NCCN Clinical practice guidelines in oncology (NCCN GuidelinesĀ®) Prostate cancer v4.2018. Retrieved November 28, 2018 from the National Comprehensive Cancer Network.




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