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PURPOSE: This practice parameter for the performance of proton beam radiation therapy was revised collaboratively by the American College of Radiology (ACR) and the American Radium Society (ARS). This practice parameter was developed to serve as a tool in the appropriate application of proton therapy in the care of cancer patients or other patients with conditions in which radiation therapy is indicated. It addresses clinical implementation of proton radiation therapy, including personnel qualifications, quality assurance (QA) standards, indications, and suggested documentation. MATERIALS AND METHODS: This practice parameter for the performance of proton beam radiation therapy was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters - Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. RESULTS: The qualifications and responsibilities of personnel, such as the proton center Chief Medical Officer or Medical Director, Radiation Oncologist, Radiation Physicist, Dosimetrist and Therapist, are outlined, including the necessity for continuing medical education. Proton therapy standard clinical indications and methodologies of treatment management are outlined by disease site and treatment group (e.g. pediatrics) including documentation and the process of proton therapy workflow and equipment specifications. Additionally, this proton therapy practice parameter updates policies and procedures related to a quality assurance and performance improvement program (QAPI), patient education, infection control, and safety. CONCLUSION: As proton therapy becomes more accessible to cancer patients, policies and procedures as outlined in this practice parameter will help ensure quality and safety programs are effectively implemented to optimize clinical care.

ImportanceRadiotherapy combined with androgen deprivation therapy (ADT) is a standard of care for high-risk prostate cancer. However, the interplay between radiotherapy dose and the required minimum duration of ADT is uncertain.ObjectiveTo determine the specific ADT duration threshold that provides a distant metastasis-free survival (DMFS) benefit in patients with high-risk prostate cancer receiving external beam radiotherapy (EBRT) or EBRT with a brachytherapy boost (EBRT+BT).Design, settings, and participantsThis was a cohort study of 3 cohorts assembled from a multicenter retrospective study (2000-2013); a post hoc analysis of the Randomized Androgen Deprivation and Radiotherapy 03/04 (RADAR; 2003-2007) randomized clinical trial (RCT); and a cross-trial comparison of the RADAR vs the Deprivación Androgénica y Radio Terapía (Androgen Deprivation and Radiation Therapy; DART) 01/05 RCT (2005-2010). In all, the study analyzed 1827 patients treated with EBRT and 1108 patients treated with EBRT+BT from the retrospective cohort; 181 treated with EBRT and 203 with EBRT+BT from RADAR; and 91 patients treated with EBRT from DART. The study was conducted from October 15, 2020, to July 1, 2021, and the data analyses, from January 5 to June 15, 2021.ExposuresHigh-dose EBRT or EBRT+BT for an ADT duration determined by patient-physician choice (retrospective) or by randomization (RCTs).Main outcomes and measuresThe primary outcome was DMFS; secondary outcome was overall survival (OS). Natural cubic spline analysis identified minimum thresholds (months).ResultsThis cohort study of 3 studies totaling 3410 men (mean age [SD], 68 [62-74] years; race and ethnicity not collected) with high-risk prostate cancer found a significant interaction between the treatment type (EBRT vs EBRT+BT) and ADT duration (binned to

ImportanceProstate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) can detect low-volume, nonlocalized (ie, regional or metastatic) prostate cancer that was occult on conventional imaging. However, the long-term clinical implications of PSMA PET/CT upstaging remain unclear.ObjectivesTo evaluate the prognostic significance of a nomogram that models an individual's risk of nonlocalized upstaging on PSMA PET/CT and to compare its performance with existing risk-stratification tools.Design, setting, and participantsThis cohort study included patients diagnosed with high-risk or very high-risk prostate cancer (ie, prostate-specific antigen [PSA] level >20 ng/mL, Gleason score 8-10, and/or clinical stage T3-T4, without evidence of nodal or metastatic disease by conventional workup) from April 1995 to August 2018. This multinational study was conducted at 15 centers. Data were analyzed from December 2020 to March 2021.ExposuresCurative-intent radical prostatectomy (RP), external beam radiotherapy (EBRT), or EBRT plus brachytherapy (BT), with or without androgen deprivation therapy.Main outcomes and measuresPSMA upstage probability was calculated from a nomogram using the biopsy Gleason score, percentage positive systematic biopsy cores, clinical T category, and PSA level. Biochemical recurrence (BCR), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and overall survival (OS) were analyzed using Fine-Gray and Cox regressions. Model performance was quantified with the concordance (C) index.ResultsOf 5275 patients, the median (IQR) age was 66 (60-72) years; 2883 (55%) were treated with RP, 1669 (32%) with EBRT, and 723 (14%) with EBRT plus BT; median (IQR) PSA level was 10.5 (5.9-23.2) ng/mL; 3987 (76%) had Gleason grade 8 to 10 disease; and 750 (14%) had stage T3 to T4 disease. Median (IQR) follow-up was 5.1 (3.1-7.9) years; 1221 (23%) were followed up for at least 8 years. Overall, 1895 (36%) had BCR, 851 (16%) developed DM, and 242 (5%) died of prostate cancer. PSMA upstage probability was significantly prognostic of all clinical end points, with 8-year C indices of 0.63 (95% CI, 0.61-0.65) for BCR, 0.69 (95% CI, 0.66-0.71) for DM, 0.71 (95% CI, 0.67-0.75) for PCSM, and 0.60 (95% CI, 0.57-0.62) for PCSM (P

AbstractThe present research is conducted in the southern region of Khyber Pakhtunkhwa, Pakistan, to identify groundwater potential zones (GWPZ). We used three models including Weight of Evidence (WOE), Frequency Ratio (FR), and Information Value (IV) with twelve parameters (elevation, slope, aspect, curvature, drainage network, LULC, precipitation, geology, Lineament, NDVI, road, and soil texture, that have been prepared and integrated into ArcGIS 10.8. The reliability of the applied models’ results was validated using Area Under the Receiver Operating Characteristics (AUROC). The GWPZ were reclassified into five classes, i.e. very low, low, medium, high, and very high zone. The area occupied by mentioned classes using WOE are very low (10.14%), low (19.58%), medium (26.75%), high (27.10%), very high (16.40%), while using FR are very low (20.93%), low (32.38%), medium (18.92%), high (13.13%), very high (14.61%) and using IV are very low (14.41%), low (17.17%), medium (29.01%), high (25.85%), and very High (13.53%). The Success Rate Curve of WOE, FR, and IV were 0.86, 0.91, and 0.87, while the Predicted Rate Curve values were 0.89, 0.93, and 0.90, respectively. The results revealed that all applied statistical models performed very well to delineate GWPZ. However, use of the FR technique is strongly encouraged to evaluate the GWPZ, and its findings are especially useful for managing groundwater resources in urban planning. Our approaches for assessing the GWPZ mapping can be applied in any region with similar scenarios and are recommended as a helpful tool for policymakers to manage groundwater.

This research used the Revised Universal Soil Loss Equation (RUSLE) with Sediment Delivery Ratio (SDR) model. The analytic hierarchy process (AHP) method, while also incorporating the use of a geographic information system (GIS) and remote sensing (RS) to predict the annual soil loss rate and spatialise the processes of water erosion at the scale of the Loukkos Watershed, Morocco. The RUSLE model and AHP parameters were estimated using RS data, and the erosion vulnerability zones were determined using GIS. We used five parameters, including precipitation erosivity, soil erodibility, slope length and steepness, vegetation cover, and soil erosion control practices in the RUSLE. For the AHP technique, we used seven geo‐environmental factors, including annual average precipitation, drainage density, lineament density, slope, soil texture, land use/land cover and landform maps. The results of RUSLE indicated that the average annual soil loss varied from 0 to 2388.27 t·ha−1·year−1. The total estimated annual potential soil loss was approximately 40 790 220.11 t·ha−1·year−1, and a sediment yield estimated by RUSLE‐SDR was 8 647 526.66 t·ha−1·year−1, equivalent to 6.65 Mm3. This value is very close to the measured value of 6.81 Mm3, for a difference of 0.16 Mm3. Furthermore, the results of the AHP indicate that the soil erosion potential index varies from 0 to 0.205315 t·ha−1·year−1. Overall, nearly 13.7% of the area suffered from severe soil erosion exceeding 50 t·ha−1·year−1. Approximately 80% of the Loukkos Watershed area experienced only slight erosion, while the remaining 6% incurred moderate erosion. Integrating GIS and RS into the RUSLE model and AHP helped us robustly estimate the extent and degree of erosion risk. Territorial decision‐makers should adopt our results to develop soil conservation strategies, water management plans and other necessary soil and water conservation measures for this region. [ABSTRACT FROM AUTHOR]

Simple Summary: In our paper, we examine various facets of prostate cancer lung metastasis. We explore their clinical manifestations, such as respiratory symptoms and potential complications. Diagnostic modalities, including imaging techniques and biomarker analysis, are scrutinized for accurate identification. Treatment strategies, encompassing surgery, radiation therapy, chemotherapy, and targeted therapies, are discussed for their efficacy. Survival outcomes are assessed to gauge the effectiveness of different interventions. Through comprehensive analysis, we aim to provide insights into managing prostate cancer lung metastasis and enhancing patient care and outcomes. Prostate cancer lung metastasis represents a clinical conundrum due to its implications for advanced disease progression and the complexities it introduces in treatment planning. As the disease progresses to distant sites such as the lung, the clinical management becomes increasingly intricate, requiring tailored therapeutic strategies to address the unique characteristics of metastatic lesions. This review seeks to synthesize the current state of knowledge surrounding prostate cancer metastasis to the lung, shedding light on the diverse array of clinical presentations encountered, ranging from subtle radiological findings to overt symptomatic manifestations. By examining the diagnostic modalities utilized in identifying this metastasis, including advanced imaging techniques and histopathological analyses, this review aims to provide insights into the diagnostic landscape and the challenges associated with accurately characterizing lung metastatic lesions in prostate cancer patients. Moreover, this review delves into the nuances of therapeutic interventions employed in managing prostate cancer lung metastasis, encompassing systemic treatments such as hormonal therapies and chemotherapy, as well as metastasis-directed therapies including surgery and radiotherapy. [ABSTRACT FROM AUTHOR]

Competing Interests: P.E.W. previously served as an Associate Executive Director for Radiation Oncology of the American Board of Radiology (ABR) and represented the ABR as an ex officio member of the Accreditation Council for Graduate Medical Education (ACGME) Radiation Oncology Review Committee (RO RC). M.L.S. currently serves as chair of the ACGME RO RC. J.B. serves as chair of the ABR RO Medical Physics Committee. P.D. currently serves as vice-chair of the ACGME RO RC. B.J.D. is a trustee of the ABR and member of the ACGME RO RC. B.G.H. previously served as a trustee and president of the ABR and chair of the ACGME RO RC. B.M. currently serves as chair of the ABR RO Radiation and Cancer Biology Committee. A.L.Z. previously served on the ACGME RO RC and as a trustee of the ABR. The other author declares no conflicts of interest.

Purpose: Outcomes for resistant metastatic castration-resistant prostate cancer (CRPC) are poor. Stereotactic ablative radiotherapy (SABR) induces antitumor immunity in clinical and preclinical studies, but immunologic biomarkers are lacking., Patients and Methods: Eighty-nine patients with oligometastatic CRPC were identified by 11 C-Choline-PET (Choline-PET) from August 2016 to December 2019 and treated with SABR. Prespecified coprimary endpoints were 2-year overall survival (OS) and PSA progression. Secondary endpoints included 2-year SABR-treated local failure and 6-month adverse events. Correlative studies included peripheral blood T-cell subpopulations before and after SABR., Results: 128 lesions in 89 patients were included in this analysis. Median OS was 29.3 months, and 1- and 2-year OS were 96% and 80%, respectively. PSA PFS was 40% at 1 year and 21% at 2 years. Local PFS was 84.4% and 75.3% at 1 and 2 years, respectively, and no grade ≥3 AEs were observed. Baseline high levels of tumor-reactive T cells (T TR ; CD8 + CD11a high ) predicted superior local, PSA, and distant PFS. Baseline high levels of effector memory T cells (T EM ; CCR7 - CD45RA - ) were associated with improved PSA PFS. An increase in T TR at day 14 from baseline was associated with superior OS., Conclusions: This is the first comprehensive effector T-cell immunophenotype analysis in a phase II trial before and after SABR in CRPC. Results are favorable and support the incorporation of immune-based markers in the design of future randomized trials in patients with oligometastatic CRPC treated with SABR., (©2021 American Association for Cancer Research.)