MRI, CFD & OTHER NOVEL METHODS  PCa STAGING/TREATMENT

MRI, CFD AND OTHER NOVEL METHODS FOR PCa STAGING AND TREATMENT

Dr. Michael Dattoli,

Dattoli Cancer Center, Sarasota, Florida

Dr. Dattoli started his lecture by stating that PC is multi-focal and therefore the concept of a male lumpectomy has inherently a high potential for failure. He pointed out that when breast lumpectomies are performed, they are also treated adjunctively with radiation.

[Ed. Note: Because the Dattoli Clinic is a major site for radio-therapy of prostate cancers, the “Male Lumpectomy” could represent a serious potential threat in the future. It is much too early in the game to forecast how prostate lumpectomies will ultimately fit into the total schema of primary prostate treatments but it is worth watching as more and more data gets published about it].

He reported that some 30,000 men will experience biochemical failures after radical prostatectomies. Up to 50% of men treated for PCa will be found to have had extra-capsular extension.

He also pointed out that low PSAs are often associated with high Gleason scores and aggressive tumors. Dattoli made a point of how seed placement can be done outside the capsule membrane to attempt to destroy tumor cells that may have escaped. He also showed some 14 year data for brachytherapy results in his clinic.

These results showed 75-80% DFS for their patients.

According to Dr. Dattoli, the combination of IMRT plus brachytherapy was superior in producing DFS (disease free survival) than was the traditional radical prostatectomy.

He also discussed his Clinic’s use of the PAP (Prostatic Acid Phosphatase) test as an independent predictor for future failure of primary tx. They consider PSA, Gleason Score, and PAP tests to be the most useful independent predictors of treatment failure downstream.

PAP is an old test that gave way to PSA as it came more into use. As the weaknesses of PSA alone became more evident, some prostate specialists went back to PAP and began measuring it again. It is a simple blood test still used for many other diagnostic procedures and would be worthwhile adding to one’s own database early in the dx process.

Dattoli then discussed a variety of studies, the results of which showed significant survival advantages for brachytherapy treatments including a range of tumors from high to low risk (as stratified by Gleason Score, PSA, and Stage. He cited literature references that described results from a variety of authors.

In most cases cited, brachytherapy results were equal to or better than those from other tx methods.

It is important to recognize that Dr. Dattoli is a recognized authority in this procedure having performed thousands of brachy treatments over the years.

Therefore once may assume that his clinic employs all the most modern methodology that has been developed to bring brachytherapy to its present stage of advanced development. The same is true for XBRT using IMRT and modern imaging technologies.

Dr. Dattoli discussed things he called 4D IG-IMRT and DART. The acronyms stand for “4 Dimensional”, Image Guided-Intensity Modulated Radio Therapy and “Dynamic Adaptive Radiation Therapy”. Both approaches involve controlling the radiation beam by linking the actual beam direction to the exact position of the gland during delivery.

The prostate gland’s position is constantly shifting for a variety of reasons: bowel load or distension, breathing, diaphragm position and all the other normal body functions that can result in displacement of the prostate during irradiation.

That results in uneven dosage and possible inadequate doses to selected target areas. The techniques described by Dr. Dattoli and designed to minimize this effect.

Intl Prostate Cancer Conference

October 2006

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