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Topics:
Radiation Oncology • Genitourinary Cancers
How does the finding of incidental proximal seminal vesicle invasion on mpMRI alter your recommendation for brachytherapy in a patient with prostate cancer who was initially a candidate?
cT3 patients were a minority of patients in the data demonstrating superiority of tri-modality therapy. While cT3b patients have particularly poor outcomes, an incidental finding of cT3b disease may portend a better prognosis.
Would you
1. continue to plan for an implant?
2. How would you specifically approach implanting this patient? Would you avoid a Mick based loose seed technique in the vesicular structures and use pre-loaded needles?
3. What dosimetric parameters do you use to evaluate seminal vesicle coverage?
Answer from: Radiation Oncologist at Academic Institution
An additional thought...........
Regarding this question as well we need to be cautious about the word "incidental". Normally an "incidental" finding would be characterized as a patient who was undergoing a CT scan of the abdomen and pelvis for the workup of a high grade prostate cancer, for instan...
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Answer from: Radiation Oncologist at Academic Institution
The MRI finding of proximal seminal vesicle invasion in a patient who is thought to have earlier stage disease based on clinical exam and other parameters is not that unusual of a clinical scenario. Often, such situations are observed among patients who have a larger volume of disease at ...
Answer from: Radiation Oncologist at Community Practice
Based on the recent ASCEDE-RT trial and many other retrospective studies, we combine EBRT and permanent seed implant for these patient. Using preloaded stranded seeds, especially the newer strands which tend NOT to migrate, does cover the target area.In addition, based other prognostic features (PSA...
Answer from: Radiation Oncologist at Academic Institution
The comments above are 100% on the nose. Re-evaluation of the case as regards to other clinical factors is certainly warranted.ASCENDE is the trial of note here with a roughly 50% relative reduction in PSA failure with addition of brachytherapy boost with 12 months of androgen deprivation and extern...