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ACR Appropriateness Criteria® Locally Advanced, High-Risk Prostate Cancer

McLaughlin, Patrick W. MD; Liss, Adam L. MD; Nguyen, Paul L. MD; Assimos, Dean G. MD; D’Amico, Anthony V. MD, PhD; Gottschalk, Alexander R. MD, PhD; Gustafson, Gary S. MD; Keole, Sameer R. MD; Liauw, Stanley L. MD; Lloyd, Shane MD; Movsas, Benjamin MD; Prestidge, Bradley R. MD, MS; Showalter, Timothy N. MD, MPH; Taira, Al V. MD; Vapiwala, Neha MD; Davis, Brian J. MD, PhDExpert Panel on Radiation OncologyProstate

American Journal of Clinical Oncology: February 2017 - Volume 40 - Issue 1 - p 1–10
doi: 10.1097/COC.0000000000000354
Original Articles: ACR Appropriateness Criteria®

Purpose: To present the most updated American College of Radiology consensus guidelines formed from an expert panel on treatment of locally advanced, high-risk prostate cancer

Methods: The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Results: The panel summarized the most recent and relevant literature on the topic and voted on 4 clinical variants illustrating the appropriate management of locally advanced, high-risk cancer. Numerical rating and commentary reflecting the panel consensus was given for each treatment approach in each variant.

Conclusions: Aggressive local approaches including surgery followed by adjuvant XRT, beam combined with androgen deprivation therapy, and beam combined with brachytherapy have resulted in unpresented success in locally advanced, high-risk prostate cancer. By combining most recent medical literature and expert opinion, this guideline can aid clinicians in the appropriate integration of available therapeutic modalities.

*University of Michigan, Novi

William Beaumont Hospital, Troy

††Henry Ford Health System, Detroit, MI

Dana-Farber Cancer Institute/Brigham and Women’s Hospital, American Society of Clinical Oncology, Boston, MA

University of Alabama School of Medicine, Birmingham, AL, American Urological Association

§University of California San Francisco, San Francisco

∥∥Mills Peninsula Hospital, San Mateo, CA

Mayo Clinic, Scottsdale, AZ

#The University of Chicago Medical Center, Chicago, IL

**Huntsman Cancer Hospital, Salt Lake City, UT

‡‡Bon Secours Cancer Institute, Norfolk

§§University of Virginia, Charlottesville, VA

¶¶University of Pennsylvania, Philadelphia, PA

##Mayo Clinic, Rochester, MN

The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.

This article is a revised version of the American College of Radiology Appropriateness Criteria Locally Advanced, High-Risk Prostate Cancer, excerpts of which are reprinted here with permission. Practitioners are encouraged to refer to the complete version at

B.M.: Research/educational support to department from Varian Inc. and Philips Inc.

The authors declare no conflicts of interest.

Corresponding Author: Patrick W. McLaughlin, MD, American College of Radiology, 1891 Preston White Drive, Reston, VA 20191. E-mail:


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