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Click here to buy A Breakthrough In Prostrate Cancer Treatment: What Every Man Should Know. 3-D Stereotaxis |
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Results published in Koutrouvelis PG, et al. J Urol 2003; 169:1331-1336.
We have treated patients with large prostate glands (>= 60 cm3). Below is a CT-dosimetry
of a large gland during radioactive seed implant. The prostate is outlined in red, the rectum in blue,
and the 100% isodose line of 144 Gy in purple. The green circle indicates the peripheral and posterior
position of the urethra near the rectum. The stereotactic template used in directing precise seed
implant is at the top and placed pararectally on the patient.
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Submitted for publication in Journal of Urology April 2004.
According to the American Cancer Society (ACS), there are approximately 74,500 new cases of male colorectal cancer per year,
and an estimated 46,000 males survivors from colorectal cancer (American Cancer Society. Cancer Facts & Figures-2003. Atlanta, Georgia, 2003).
Of these 46,000 male survivors from colorectal cancer, 5,000 will experience prostate cancer after colorectal cancer with
the same incidence as the general population.
With transrectal ultrasound-guided transperineal brachytherapy, a rectum is required for radioactive seed
implant, and thus, cannot be used in patients without rectum. Our technique uses computerized tomography (CT)-guidance
and can be performed in patients without rectum. The figure below is a one month post-implant dosimetry
of a patient without rectum. As you can see, there is excellent seed coverage.
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Results published in Koutrouvelis PG, et al. Radiotherapy & Oncology 2001; 60:31-35.
At our Institute, 79 of 596 (13%) cases were upstaged from T1-T2 to T3b disease prior to 3-D CT-guided brachytherapy.
Studies have reported extra capsular extension to range from 15% to 60% in patients with clinically organ-confined disease
and may have local recurrence after radical prostatectomy (Sohayda, C., et al. Extent of extracapsular
extension in localized prostate cancer. Urology, 55: 382, 2000; Rosen M, et al. Frequency and location of extracapsular extension and
positive surgical margins in radical prostatectomy specimens. J Urol., 148(2 Pt 1):331, 1998; Stock RG, et al. Does prostate
brachytherapy treat the seminal vesicles? A dose-volume histogram analysis of seminal vesicles in patients
undergoing combined Pd-103 prostate implantation and external beam irradiation. Int J Radiat Oncol Biol Phys., 1; 45(2): 385, 1999).
The figure below is a 3-D CT-guided seminal vesicle biopsy. As you can see, we avoid interference
of the coccyx.
The figure below is a post-implant CT dosimetry and dose volume histogram (DVH) of seminal vesicles.
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We can spare penile prosthesis with 3-D CT-guided pararectal brachytherapy.
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Koutrouvelis PG, et al. Technology in Cancer Research Treatment 2003; 2(4):339-344.
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