PROSTATE ANATOMY
WHY DO I NEED A DIGITAL
RECTAL EXAM AND PSA ?
PROSTATE CANCER
STATISTICS
• Number 1 cancer in
men
• 192,280 new cases
estimated for 2009 with
27,360 Deaths
• 300,000 by year 2015
• 2010 cases in
Mississippi in
2008 with 290 deaths
MALE CANCER RATES
% Cancers
18
16
14
12
10
8
6
4
2
0
prostate
Lung
Colon Rectal
Bladder
Lymphoma
Melanoma
Oral
Kidney
RISK OF PROSTATE CANCER
BY AGE*
•
•
•
•
< 39 years
40-59 years
60-79 years
Lifetime
1 in 10,100
1 in 38
1 in 14
1 in 6
*American Cancer Society 2006
TUMOR STAGING
• STAGING DESCRIBES THE
EXTENT OR SEVERITY OF A
TUMOR
– Staging helps the doctor plan a person’s
treatment.
– The stage can be used to estimate the
person’s prognosis (likely outcome or course
of the disease).
T STAGE (EXTENT OF THE
TUMOR)
• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• T1: Clinically unapparent tumor not palpable nor visible by imaging
– T1a: Tumor incidental histologic finding in 5% or less of tissue resected
– T1b: Tumor incidental histologic finding in more than 5% of tissue
resected
– T1c: Tumor identified by needle biopsy (e.g., because of elevated PSA)
• T2: Tumor confined within prostate*
– T2a: Tumor involves 50% or less of one lobe
– T2b: Tumor involves more than 50% of one lobe but not both lobes
– T2c: Tumor involves both lobes
• T3: Tumor extends through the prostate capsule**
– T3a: Extra capsular extension (unilateral or bilateral)
– T3b: Tumor invades seminal vesicle(s)
• T4: Tumor is fixed or invades adjacent structures other than seminal
vesicles: bladder neck, external sphincter, rectum, levator muscles,
and/or pelvic wall
TUMOR STAGE
PROGNOSTIC FACTORS
•
•
•
•
STAGE
GLEASON’S SCORE
PSA LEVEL
PERCENT OF POSITIVE
BIOPSIES
• PATIENT AGE AND HEALTH
TREATMENT OPTIONS
•
•
•
•
•
RADICAL PROSTATECTOMY
EXTERNAL BEAM RADIATION
BRACHYTHERAPY
CRYOTHERAPY
WATCHFUL OBSERVATION
PROSTATE BRACHYTHERAPY
WHAT IS BRACHYTHERAPY?
• BRACHYTHERAPY IS A FORM OF
RADIOTHERAPY WHERE A
RADIOACTIVE SOURCE IS PLACED
INSIDE OR NEXT TO THE AREA BEING
TREATED.
• BRACHYTHERAPY IS COMMONLY
USED TO TREAT LOCALIZED
PROSTATE CANCER.
• Prostate cancer is well
suited to brachytherapy.
• The prostate gland is
located under the bladder
and in front of the rectum.
• The gland is
encapsulated allowing
the radiation to be
focused in the prostate to
avoid serious side effects.
• The prostate gland is also
close enough to the skin
that it can be easily
accessed by
brachytherapy needles.
• Brachytherapy involves
injecting radioactive
seeds into the prostate
gland.
• They give off their
radiation at a low dose
rate over several
months.
• The seeds remain in the
prostate gland
permanently.
PROSTATE BRACHYTHERAPY IS
PERFORMED AS A TWO STAGE
PROCEDURE
• STAGE 1- THE VOLUME STUDY
• STAGE 2- THE SEEDS IMPLANT
VOLUME STUDY
•
•
•
•
Ultrasound images of the prostate
are obtained every 5 mm with a
transrectal ultrasound probe. Done
as an outpatient procedures, this
takes about 30 minutes. During the
volume study a catheter is placed
in the bladder to identify the water
pipe (urethra).
The images are downloaded into
the treatment planning computer to
create a three dimensional model
of the prostate that will be used to
plan the seed placement.
This plan will be unique to each
patient and will determine the
position and number of seeds
needed.
The seeds are then ordered for
each individual patient.
SEEDS IMPLANTATION
•
•
•
•
•
The implant is done under general
anesthesia in OR.
Radioactive seeds are implanted
into the prostate gland under
transrectal ultrasound guidance,
using needles that pass through
the skin between the legs behind
the scrotum (the perineum).
Each needle may deliver between
2-6 seeds and, usually, 20-30
needles are required to implant
80-140 seeds.
The seeds are woven into a strand
of absorbable material to help
maintain their position and reduce
the risk of seed migration.
The procedure takes about 90
minutes and after recovery the
patient can go home.
POST IMPLANT X-RAY
EXTERNAL BEAM RADIATION
• At the Forrest
General Cancer
Center we use state
of the art Varian linear
accelerators coupled
with IMRT and IGRT
technology to deliver
accurate focused
beams to destroy the
cancer cells within the
prostate gland.
IMRT
INTENSITY MODULATED RADIATION
THERAPY
INTENSITY MODULATED
RADIATION THERAPY
• IMRT, is a state-of-the-art radiation delivery system
offered at the Forrest General Cancer Center.
– It has been called the most significant breakthrough in radiation
treatments in the past 30 years.
– IMRT can treat difficult-to-reach tumors with new levels of
accuracy such as tumors in the spine, head, neck, prostate, lung,
liver, and brain.
– We are able to use higher radiation doses than traditional
methods would allow in these areas, and yet spare more of the
surrounding healthy tissue, compared to standard radiation
therapy.
– During IMRT, small beams (beamlets) with varying intensities of
radiation are aimed at a tumor from many angles.
– The intensity of each beamlet is tightly controlled, allowing the
radiation oncologist to deliver higher doses of radiation to the
tumor while significantly reducing the chances of damaging
surrounding healthy tissue.
IGRT
IMAGE GUIDED RADIATION THERAPY
WHAT IS IGRT?
• Image-guided radiation therapy is
conformal radiation treatment guided by
imaging equipment, such as a CT scan,
taken in the treatment room just before the
patient is given the radiation treatment.
• IGRT allows radiation to be delivered to
tumors with more precision and allows the
physician to account for any organ
movement since the last treatment.
WHY IS ORGAN MOTION
IMPORTANT DURING EXTERNAL
BEAM RADIATION THERAPY?
• Organ motion causes physicians to
virtually attempt to treat a moving target
with a fixed radiation beam.
• Because prostate organ motion during the
delivery of radiation therapy is
unpredictable and variable, ineffective
delivery of radiation treatment to the
prostate and damage to surrounding
healthy tissue may occur.
FIDUCIAL MARKERS
The use of fiducial
markers for prostate
cancer and portal
imaging integrated with
linear accelerators
provide high quality
images which can now
be used for 3D
verification of the actual
daily target position.