1/26. Daily CT planning during boost irradiation of prostate cancer. Feasibility and time requirements.BACKGROUND: In the irradiation of prostate cancer internal organ movement leads to uncertainties in the daily localization of the clinical target volume. Therefore more or less large safety margins are added when designing the treatment portals. With daily CT planning internal organ movement can be compensated to some extent, safety margins can be reduced and irradiated normal tissue can be spared. The feasibility of daily CT-based 3D treatment planning is studied in a patient with localized prostate carcinoma using a new patient positioning system. methods: Daily CT planning was applied during boost irradiation of a patient with prostate cancer: After patient immobilization the pelvis was scanned in 3 mm CT slices. Planning was done with the BrainSCAN planning system for stereotactic body irradiation. The prostate was contoured in all slices and the safety margins of the micromultileafs were automatically set to the distance chosen by the physician (0.8 cm). patient positioning was done with the BrainLAB ExacTrac positioning system on the basis of skin attached stereotactic body markers. Before each treatment verification images of the isocenter were taken. RESULTS: The total time requirement for planning and irradiation was about 1 hour 15 minutes. patient positioning on the treatment couch took about 10 minutes. The accuracy of the positioning system was good (75% of the deviations were smaller than 3 mm). The shift of the single markers from CT scan to CT scan was more extensive than those of the center of all 7 markers combined (47% of the deviations were smaller than 3 mm). The location of the markers seems to influence the magnitude of their dislocation. CONCLUSION: Daily CT planning is feasible but time consuming. The new patient positioning system ExacTrac is an interesting tool especially for daily CT planning since conventional simulation can be omitted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/26. diagnosis of prostate adenocarcinoma using transurethral resection of the prostate after multiple negative transrectal biopsies and persistently elevated prostate-specific antigen level.We report a case of prostate cancer diagnosis by transurethral resection of the prostate in a man who underwent more than 50 needle biopsies by three different physicians for an increasing prostate-specific antigen level. Radical prostatectomy resulted in removal of an organ-confined tumor (T2aN0M0), and a short follow-up revealed an undetectable prostate-specific antigen level.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/26. Married couples' perspectives on prostate cancer diagnosis and treatment decision-making.Prostate cancer is a disease of men. But for married men, it is commonly and quite reasonably expected that their wives will be significantly involved in dealing with the disease and its treatment. Yet, there are few data on how wives perceive the diagnosis and their role in responding to it. This study explores men's and their wives' perceptions of the prostate cancer diagnosis and their role in treatment decision-making. We conducted separate focus group interviews with seven married men with metastatic prostate cancer and their wives. The accounts of receiving the diagnosis and deciding on treatment that were told by the men differed in significant ways from the stories told in the wives' groups. We found that many men do not share their prostate-related health problems with their wives and some men choose their treatment without much spousal consideration. Our findings suggest that physicians may be in a position to influence how men and their wives interact in reaching a treatment decision.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/26. Temporary PSA rises and repeat prostate biopsies after brachytherapy.PURPOSE: The long-standing confusion regarding the clinical relevance of postimplant biopsies is complicated by the common occurrence of temporary PSA rises between 1 and 2 years after brachytherapy. We report here 4 patients with temporary, self-limited PSA rises and postimplant biopsies, for whom radical prostatectomy was strongly advised but for whom surgery would probably have been the wrong choice. MATERIALS AND methods: Transperineal I-125 or Pd-103 implants were performed as previously described. After implantation, patients were followed routinely, with repeat PSA and physical examination at approximately every 4 to 6 months. Timing of postimplant PSAs was at the discretion of the patient and his doctors. Postimplant biopsies were performed in all cases out of concern for a persistently elevated serum PSA. Sections of fixed and embedded tissue were stained with standard hematoxylin and eosin. RESULTS: All 4 patients presented here were advised to have a salvage prostatectomy based primarily on their PSA changes. However, all of the patients have subsequently had a dramatic PSA fall, consistent with long-term cancer control, despite the fact that 3 of the 4 had histologic evidence of persistent cancer on repeat prostate biopsy. CONCLUSIONS: It is crucial that clinicians be aware of the potential for the doubly confusing situation of temporary PSA rises and apparently positive rebiopsies and the pressure it puts on both patients and their physicians to go ahead with inappropriate salvage therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/26. male genital schwannoma, review of 5 cases.AIM: To study the clinical features of male genital schwannoma. methods: Five male patients with genital schwannoma admitted from 1991 to 2000 were reviewed. The lesions were located in the prostate, spermatic cord, testis or penis. Tumors were simply resected in 3 patients and radically eradicated in 2. RESULTS: The average age of the cohort was 37 years. The most common sign at presentation was a palpable genital mass accidentally discovered by the patient or detected by the physician during a physical check. diagnosis was made through postoperative pathological examination. Follow-up ranged from 2 years to 6 years (mean 4.5 years). Four cases were cured by simple excision and 1 patient with malignant testis schwannoma died of recurrence 1 year after surgery. CONCLUSION: Owing to the lack of characteristic clinical manifestation, the final diagnosis relies on postoperative pathological examination. S-100 and vimentin are useful markers for the diagnosis of these tumors.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/26. Moral lessons from the jury box.A decade ago a north carolina jury awarded millions of dollars in damages because of a healthcare institution's failure to provide appropriate pain relief to a dying patient. In 2001, a california jury found a physician guilty of elder abuse for his failure to properly manage the pain of a cancer patient. In both instances, state licensing boards had failed to take any disciplinary action against those involved. These cases dramatically illustrate a significant and persistent gulf between the lay public and the health professions with regard to the moral significance they attach to the duty to relieve suffering. Measures to insure that all patients receive effective assessment and management of their pain must take into account this disparity, and endeavor to achieve congruence by reconnecting the health professions to their ancient and core value--the relief of suffering.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/26. Posterior uveitis: an under-recognized adverse effect of pamidronate: 2 case reports.Ocular adverse effects of pamidronic acid are rare but well documented. Pamidronate, an inhibitor of bone resorption used primarily in the management of tumor-induced hypercalcemia and Paget's disease, is reported to cause conjunctivitis, anterior uveitis, and infrequently episcleritis and scleritis. It is hypothesized that an allergic or immunologic phenomenon caused by drug-indued immune complex formation is at fault. The reason why the uvea is a target organ is unclear. The acute inflammatory response seems unrelated to the dose of the drug, the way of administration, or the activity of Paget's disease or malignancy. We report two cases of pamidronate-induced posterior uveitis, following the WHO causality Assessment Guide of Suspected Adverse Reactions. uveitis and scleritis have been reported in association with a variety of topical, intraocular, periocular, and systemic medications. Seven criteria were proposed to establish causality of adverse events by drugs. Only systemically administered biphosphonates meet all seven criteria. Where pamidronate is currently considered as the drug of choice in diverse strategies, the adverse ocular effects should be well known to physicians in order to make rapid diagnosis and stop the drug causing adverse reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/26. epididymitis after prostate brachytherapy.OBJECTIVES: To analyze the incidence, time-course, and potential predisposing factors for what was clinically diagnosed as postimplant epididymitis. methods: Of 517 patients randomized and treated on two treatment protocols, with a planned total accrual of 1200, 5 patients were identified who developed clinically diagnosed epididymitis after iodine-125 or pallidium-103 prostate brachytherapy. Implants were performed by standard techniques, using a modified peripheral loading pattern. Perioperative antibiotics (cefazolin and ciprofloxacin) were given to 258 patients, according to physician preference. Treatment-related morbidity was monitored by mailed questionnaires, using standard American Urological association (AUA) and radiation Therapy Oncology Group criteria at 1, 3, 6, 12, and 24 months. patients who did not respond to the mailed questionnaires were interviewed by telephone. Although the patients were not queried specifically regarding epididymitis, its occurrence was noted when discovered in the course of follow-up examinations. RESULTS: Postimplant epididymitis occurred in 5 (1%) of 517 consecutive brachytherapy patients. None of the 5 patients had had a prior history of orchitis, epididymitis, vasectomy, or preimplant catheterization. The symptoms of epididymitis first appeared at 4, 7, 10, 150, and 300 days after implantation. patients with epididymitis had prostate volumes, preimplant AUA scores, and ages typical of other implant patients. No association was apparent between postimplant epididymitis and the degree of implant-related prostate swelling or the number of seeds implanted. Only the preimplant AUA score predicted for epididymitis, but 2 of the 5 patients had low scores. Only 1 (0.4%) of the 258 patients who received perioperative antibiotics developed epididymitis, and 4 (1.5%) of the 259 patients with prophylactic antibiotics developed epididymitis. CONCLUSIONS: epididymitis is an uncommon postimplant complication occurring in 1% of a large patient cohort. That epididymitis patients had greater preimplant AUA scores is consistent with a retrograde infection route, at least in some cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/26. A hidden cause of hypokalemic paralysis in a patient with prostate cancer.Hypokalemic paralysis is a medical emergency due to the risks of cardiac arrhythmia, respiratory failure, and rhabdomyolysis. Besides supplementing patients with KCl to hasten recovery, the astute physician must search for the underlying cause to avoid missing a treatable and curable disorder. We report on an elderly Korean man who presented with marked limb paralysis, myalgias, and mild hypertension. He had prostate cancer treated with orchiectomy and hormone therapy 2 years previously. The major biochemical abnormalities were hypokalemia (K : 1.7 mmol/l) associated with high renal K wasting and metabolic alkalosis (HCO3-: 42.6 mmol/l). Low plasma renin activity, low aldosterone concentration, and normal cortisol concentration pointed to a state of pseudohyperaldosteronism. While reviewing his drug history, the patient revealed he had been consuming eight packs (100 ml/pack) of a Korean herbal tonic daily to treat his prostate cancer for the past 2 months. A significant amount of glycyrrhizic acid (0.23 mg/ml), an active ingredient of licorice, was detected in the tonic. Discontinuation of the herbal tonic along with KCl supplementation achieved recovery in 2 weeks. As many complementary/alternative medicines for cancer contain licorice, this must be kept in mind as a cause of hypokalemia in cancer patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/26. Chronic pelvic pain following prostate brachytherapy: a case report.PURPOSE: To alert physicians and potential patients that chronic postimplant pelvic pain syndromes can occur, and that dosimetric parameters (i.e., implant technique) may predispose patients to it. methods AND MATERIALS: The authors are currently following 3 prostate brachytherapy patients with what appear to be chronic radiation-related pelvic pain, variously exacerbated by urination or perineal pressure. The 3 patients were identified in the course of routine follow-up, and do not represent a concerted attempt to identify such patients from a larger group of patients being followed by the authors. Three control groups of 10 patients each treated with (125)I, (103)Pd, or (103)Pd external beam radiation and with no reported dysuria at 6 months postimplant were taken from two ongoing prospective trials. The 3 patients reported here were each administered a brief questionnaire regarding the effect of their urinary pain on daily activities. RESULTS: patients with chronic pain tended to have high central prostatic doses, at least on some planes. Maximal, mean, and median urethral doses were higher for patients with chronic pain, but there was some overlap with control patients. The prostate V100s were similar between patients with chronic pain and controls, but there was a trend toward higher V200s and V300s in pain syndrome patients. CONCLUSION: Recalcitrant brachytherapy-related pelvic pain is an uncommon occurrence that may be partly related to higher central prostatic doses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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