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“The Radial Distance of Extraprostatic Extension of Prostate Carcinoma”
Brian J. Davis. M.D., PHD, Thomas M. Pisansky, M.D., Torrence M. Wilson, MD, Harold J. Rothenberg, M.D., Anna Pacelli, M.D., David W. Hillman, MS, Daniel J. Sargent, PHD, and David G. Bostwick, M.D. Cancer, Vol. 85, No. 12, 1999
When determining an acceptable treatment
for localized prostate
cancer, extaprostatic
extension is important. Certain procedures are conducted
based on the extraprostatic extension of prostate carcinoma.
If the cancer has not extended 5mm beyond the main cancerous
region than many physicians will commonly recommend
brachytherapy treatment. Advantages to prostate brachytherapy
patients include a minimally
invasive, cost efficient surgery and speedy outpatient
recovery. For the purpose of this study, doctors both
defined and evaluated a widespread measure of prostate
cancer that has extended in a large group of radical
prostatectomy specimens. The results of this study reveal
that brachytherapy may prove to be a legitimate method
in cancer management. Researchers focused on 376 radical
retropubic prostatectomy
patients that underwent surgery between September 1991
and June 1993. Each patient was evaluated based on whole
mount radical retropubic prostatectomy specimens, otherwise
known as a microscopic examination where the whole specimen
is placed on the slide. Doctors also reviewed the location
of the extraprostatic extension (or the extended prostate
cancer), and its distance perpendicular to the edge
of the prostate. Once physicians analyzed whole mount
specimens, the location and distance of the extended
cancer, results could be calculated. This study found
that 105 of 376 specimens, 28 percent were identified
at 248 sites. The average distance ranged from .03mm
to .8mm. Out of the 105 patients included in the trial,
general PSA levels ranged from 11.8 ng/mL to 17.9 ng/mL,
Gleason scores were approximately 6.3, and prostate
volume was normally 39cc. What influences treatment
strategies for patients with localized cancer is the
radial distance, (or the measurement from a central
point outward), of any noted extraprostatic extension
of prostate cancer. From this study it was determined
that doctors could manage extension with brachytherapy.
Brachytherapy in conjunction with prostatectomy could
treat all known disease in 99%-100% of specimens with
extended prostate cancer and in 99.5%-100% of all specimens
examined. The radiation dose administered during brachytherapy
provides an effective coverage of extended prostate
tumors.
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