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February 26, 2008

IMRT external beam radiation review

UroToday - Current Status of Intensity-Modulated Radiation Therapy (IMRT)

In the International Journal of Clinical Oncology, Dr. Hatano and colleagues from Chiba, Japan provide an excellent overview of intensity-modulated radiation therapy (IMRT). Problems with conventional, four field radiotherapy have been ineffective dose distribution and overdoses to organs at risk (OARs), such as the bladder and rectum. The use of dose escalation from 64Gy to 81Gy improves tumor response but increases toxicity. Three-dimensional conformal radiotherapy (3D-CRT) is a technique to increase dose while conforming the beam to the target organ but still has toxicity limitations. IMRT has been introduced for dose escalation with the goal of minimizing toxicity to the bladder and rectum. In fact, IMRT is an advanced form of 3D-CRT where there is enhanced control over the 3D-CRT dose distribution through the superposition of a large number of independent segmented fields either from a number of fixed directions or from directions distributed on one or multiple arcs. IMRT therefore, requires dose specifications for both the target and the surrounding normal structures.

An explanation of image guided radiation and some of its side effects. There is a new quality marker made by the government that suggests that image guided therapy is preferred over conventional radiation.

February 13, 2008

Screening for prostate cancer

The controversy over screening for prostate cancer will continue.
clipped from www.medscape.com
Information is not adequate to recommend screening men for prostate cancer with digital rectal examination or measurement of prostate-specific antigen (PSA), according to a position statement by the American College of Preventive Medicine (ACPM) published in the February issue of the American Journal of Preventive Medicine.
The American Urological Association recommends that men who are 50 years and older and who have an estimated life expectancy of more than 10 years should be offered PSA screening. The American Cancer Society recommends that men who are 50 years and older and who have a life expectancy of more than 10 years should be offered both DRE and PSA screening. The United States Preventive Services Task Force and American Academy of Family Physicians do not find sufficient evidence to recommend for or against PSA or DRE screening. The Canadian Task Force on Preventive Health Care recommends against routine screening with PSA.
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Effect on prostate size on prostatectomy recovery

clipped from www.medwire-news.md
"Prostate size has no effect on continence or biochemical recurrence at 1 year after laparoscopic radical prostatectomy, but affects intra-operative blood loss, potency and surgical margins," Aron et al write in the BJU International.
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The study points out what most people are concluding in regards to positive margins. Smaller prostate tend to have higher rates of positive margins. The results show that at 1 year the continence is similar, but the short term recovery of urinary function is not addressed. I think men with larger prostates take longer to regain urinary control.

February 10, 2008

New genetic tests to be developed for prostate cancer

Genetic test in three years to detect prostate cancer | Science | The Guardian:

"A genetic test that identifies men most at risk of prostate cancer could be available within three years, scientists said yesterday. British doctors will use the test in screening programmes to spot the disease in its earliest stages, before it has become dangerously advanced or has spread throughout the body."

I had a patient in my office last week who was young, was done having children, and had a strong family history of prostate cancer. He was wondering if it would be reasonable to remove his prostate prophyllactically. I told him that I wasn't ready to do that today, but in the near future I thought it would be reasonable. Breakthroughs like this will help diagnose prostate cancer earlier and more accurately than with prostate biopsies.