PALM BEACH, Fla--The increased use of prostate brachytherapy has prompted
the American Brachytherapy Society to establish a group to formulate standards
and treatment guidelines, Peter D. Grimm, DO, said at the Society's 19th
"It's clear to us that if we don't do this, it will be very difficult
to 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 includes
21 experts from various US medical centers and universities, is seeking
to establish guidelines in seven areas (see table ).
ISSUES IN PROSTATE BRACHYTHERAPY
Under review by the American Brachytherapy Society's Prostate Brachytherapy
1. Postoperative dosimetry--The group will attempt to set standards
on how and by whom the radioactive dose is calculated after seed implantation.
2. Implant planning guidelines will focus on all three members
of the implant team--the urologist, radiation oncolo-gist, and physicist.
By looking at the size and shape of the prostate, as well as other factors
such as whether TURP (transure-thral resection of the prostate) has already
been done, the group will try to set standards for prescribing how the
brachytherapy procedure is performed.
One question to be examined is the value of pre-planning vs decision
making 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 question
is whether there should be minimum education standards to qualify people
for brachy-therapy use and follow-up care. The panel will look at what
this might entail in terms of course programs and collateral educational
materials. Dr. Grimm said that the Prostate Institute at the Swedish Medical
Center, Seattle, is currently training about 30 physicians a month in prostate
4. Radiation safety guidelines will establish protocols and safety
standards for handling the radioactive seeds.
5. Patient selection. The panel will review clinical trials in
an attempt to define which patients are most likely to benefit from brachytherapy
alone or various combinations of brachytherapy, external beam radiation
therapy, and hormonal blockade.
6. Quality assurance monitoring. The panel will set protocols
as to how often quality assurance monitoring should be done and by whom.
7. Intraoperative quality assurance. The committee will also
establish guidelines for monitoring quality in the operating room, including
the best method (ultrasound, fluoroscope, or some other method) for guiding
and 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 effort
that is constantly improved upon as more information becomes available."
Dr. Grimm and his colleagues are encouraging members of the Society
and other physicians in the field to publish papers that address the questions
raised by the PBQAG. Dr. Grimm is adamant that randomized trials are needed
along with assessments of the procedure as it is currently used.
He said that the group hopes to have a rough set of guidelines and a
clearer definition of goals for prostate brachytherapy available for review
by the Society's next annual meeting.