9 / 103
B
rachytherapy
guideline
in
prostate
cancer
(
high
and
low
dose
rate
)
R
ev
A
ssoc
M
ed
B
ras
2017; 63(4):293-298
293
GUIDELINES IN FOCUS
Brachytherapy guideline in prostate cancer (high and low dose rate)
D
iretriz
de
tratamento
com
braquiterapia
em
câncer
de
próstata
(
alta
e
baixa
taxa
de
dose
)
Authorship:
Brazilian Society of Radiotherapy (SBR)
Participants:
Samir Abdallah Hanna
1
, Leonardo Pimentel
1
Final draft:
December, 2016
1
Sociedade Brasileira de Radioterapia (SBR)
http://dx.doi.org/10.1590/1806-9282.63.04.293The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize
procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending
on the conditions and the clinical status of each patient.
G
rades
of
recommendation
and
levels
of
evidence
•
•
A:
Experimental or observational studies of higher
consistency.
•
•
B:
Experimental or observational studies of lower
consistency.
•
•
C:
Cases reports (non-controlled studies).
•
•
D:
Opinion without critical evaluation, based on con-
sensus, physiological studies or animal models.
O
bjectives
and
description
of
evidence
collection method
Through the elaboration of seven relevant clinical questions
related to the proposed theme, we sought to present the
main evidences regarding safety, toxicity and effectiveness
of the presented radiotherapy (RT) techniques. The study
population consisted of male patients of all ages with
early primary prostate cancer and candidates for treatment
with curative intent. For this, a systematic review of the
literature was carried out in primary scientific databases
(MEDLINE – PubMed; Embase – Elsevier; LILACS – BIREME;
Cochrane Library – Record of Controlled Trials). All articles
available through February 22, 2015 were considered. The
search strategy used in MEDLINE searches is described in
Appendix 1. The articles were selected based on critical
evaluation, seeking the best evidence available. The recom-
mendations were elaborated from discussions held with a
drafting group composed of four members of the Brazilian
Society of Radiotherapy. The guideline was reviewed by an
independent group, which specializes in evidence-based
clinical guidelines. After completion, the guideline was
released for public consultation for 15 days; the suggestions
obtained were forwarded to the authors for evaluation and
possible insertion in the final text.
I
ntroduction
Prostate cancer is the most common cancer in men and
its incidence has been increasing in recent decades. The
main reasons for this are increased life expectancy, marked
presence of the Western lifestyle (sedentary lifestyle and
high-calorie diet) and the development of more accurate
diagnostic methods.
Around the world, in 2008, 903,000 new cases of pros-
tate cancer were estimated with 258,000 deaths attrib-
uted to the disease, making it the second most common-
ly diagnosed neoplasm in men.
1
Although globally it
accounts for 9.7% of tumors in man, this distribution
differs between developed and developing countries, reach-
ing 15.3% in the former and only 4.3% in the latter.
2
In 2014, in the United States, 233,000 new cases
were diagnosed with about 29,500 deaths related to
prostate cancer.
3
In Brazil, in 2014, there were 68,800 new cases of pros-
tate cancer. This figure corresponds to a risk of 62 new
cases per 100,000 men.
4
The discovery of prostate-specific antigen (PSA) three
decades ago revolutionized the diagnosis and treatment
of prostate cancer. Increased early detection was observed,
mostly in asymptomatic individuals.
5
The initial clinical diagnostic evaluation aims to
determine the precise extent of the disease, which has
prognostic implications, and indicates the most appro-
priate treatment. In addition to TNM staging,
6
which
includes digital rectal examination, the most important
factors to be analyzed for therapeutic decision are: his-
tological grade of the tumor according to Gleason score,
PSA level, age and the presence of comorbidities.
7-9
Thus,
patients are grouped by prognosis according to the fol-
lowing variables: