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Physician Resource

Important Updates for Treating Prostate Cancer

At a Glance

  • The ACR recently updated criteria for the treatment of prostate cancer with external beam radiation.
  • UVA radiation oncologist served as the principal author of two reports.
  • The evidence-based guidelines represent both a holistic overview of the latest developments in prostate radiation and a hands-on guidebook for its application.

The latest guidelines from the American College of Radiology on the use of external beam radiation for the treatment of prostate cancer were so sweeping that they had to be published in two parts. These new ACR Appropriateness Criteria added unprecedented depth to what had been a much more modest overview, providing physicians an easy way to catch up with the latest developments and stay at the very forefront of best practices.

Timothy Showalter, MD, a radiation oncologist at the University of Virginia Cancer Center, was the principal author of the two reports from this massive effort. He sat down with Physician Resource to explain why the major updates were needed and the benefits it could have for radiation oncologists, urologists and other healthcare providers.

“These guidelines provide more technical guidance than previously available,” Showalter says. “Highlights of the new additions include the definition of volumetric modulated radiation therapy, which we use at UVA, as a method to address intrafraction prostate motion [movement during treatment delivery], identification of a range of acceptable methods for image guidance and description of prostate-rectal spacers as an exciting development for prostate cancer radiation therapy.”

As part of their review process, Showalter and the other members of the expert panel did an extensive analysis of the medical literature and looked at established methodologies, such as the RAND/UCLA Appropriateness Method, to determine the best imaging and treatment modalities for various situations. The resulting evidence-based guidelines represent both a holistic overview of the latest developments in prostate radiation and a hands-on guidebook for its application.

“We go into detailed description to provide guidance for practicing physicians about use of complementary imaging like MRI, how to deal with the prostate motion, patient positioning, use of prostate-rectal spacers and then specific scenarios about challenging situations like hip prostheses and obesity,” Showalter says. “In the past, guidance documents on this topic have been really brief and didn’t address this amount of technical detail.”

The authors wanted to ensure the latest revisions reflected a wide variety of voices and approaches, Showalter says. “As one of many prostate cancer experts included in the American College of Radiology committee for this work, I was fortunate to interact with and learn from many great doctors and to hear how everyone approaches things a little bit differently,” he says. “The good thing about this document is that it’s very inclusive of different approaches and techniques for prostate radiation but sets a standard for quality and provides some overall guidance and perspective on why the techniques are what they are.”

He hopes that the revised ACR Appropriateness Criteria document will be a great benefit for physicians and patients alike. “For me, I focus most on pelvic tumors, and I’m lucky that my research and clinical efforts intersect, so that I can stay at the leading edge of prostate cancer,” Showalter says. “But if you’re a community provider and you’re seeing every cancer from head to toe, things like this are really efficient ways to catch up on the latest thinking and best practices.”

The guidelines have been published in Advances in Radiation Oncology, a journal of the American Society for Radiation Oncology. The articles are open access and can be read for free at and

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