Prostatic Neoplasms: Moran BJ

Bice WS, Prestidge BR, Kurtzman SM, Beriwal S, Moran BJ, Patel RR, Rivard MJ, Anonymous00014. · Foundation for Medical Physics Research, San Antonio, TX 78216, USA. · Brachytherapy. · Pubmed #18782682 No free full text.

Abstract: PURPOSE: Published clinical information on the safety and efficacy of (131)Cs implants is limited. We provide consensus recommendations for (131)Cs prostate brachytherapy based on experience to date. METHODS AND MATERIALS: The Cesium Advisory Group (CAG) consists of experienced (131)Cs users. Recommendations are based on three clinical trials, one of which has completed accrual and has been published in the peer reviewed literature, and combined CAG experience of more than 1200 (131)Cs implants. RESULTS: We recommend using 1.059cGyh(-1)U(-1) as the dose rate constant for the IsoRay source. The prescription for monotherapy implants is 115Gy and when combined with 45-50Gy external beam it is 85Gy. Suggested individual source strength ranges from 1.6 to 2.2U. The release criterion for (131)Cs implants is 6mRh(-1) at 1m. (131)Cs brachytherapy should be performed differently from (125)I and (103)Pd brachytherapy: source placement is further from the urethra and rectum; the prostate V(150) should be < or =45%; sufficient margins may be obtained while limiting source placement to the capsule or close to the capsule. The increased dose rate may cause degradation of postimplant quantifiers due to edema. However, large variability in the magnitude and rate of resolution of edema make determination of the most representative postoperative imaging time impossible. The CAG recommends postimplant imaging on the day of the implant. Recommended postimplant evaluation goals include prostate D(90) greater than the prescription dose; maintaining D(u)(,30)<140% of the prescription dose and keeping V(r)(,100)<0.5cm(3). CONCLUSION: It was the consensus of the CAG that optimal (131)Cs implants should be performed differently from those performed with (125)I or (103)Pd. Guidelines have been established to allow for safe and effective delivery of (131)Cs prostate brachytherapy.

Moran BJ, Braccioforte MH, Conterato DJ. · Chicago Prostate Cancer Center, Westmont, Illinois 60559, USA. · J Urol. · Pubmed #16952636 No free full text.

Abstract: PURPOSE: In this study we investigated the detection rate and morbidity of stereotactic transperineal prostate re-biopsy with 3-dimensional mapping for diagnosis of nonpalpable isoechoic occult prostate malignancy. MATERIALS AND METHODS: A total of 180 consecutive patients with continued increasing total prostate specific antigen and at least 1 prior benign transrectal prostate biopsy underwent stereotactic transperineal prostate biopsy at a single outpatient institution between April 2004 and March 2006. Similar to a prostate brachytherapy procedure, patients were placed in the dorsal lithotomy position. With the patient under general anesthesia, and using transrectal ultrasound, a perineal brachytherapy template and stabilizing device, the prostate was positioned on the implant grid. It was equally divided into 8 sections (octants) according to x and y coordinates on the mid gland axial image. The midplanes of axial and sagittal prostate gland images for each patient determined the x, y and z coordinates that would occupy each octant. Tissue cores were initially obtained from the apical octants, followed by identical x and y coordinates of the basilar octants. Specimens from each specific octant were placed in 1 of 8 specimen jars and pathological review was reported accordingly. RESULTS: Stereotactic transperineal prostate biopsy yielded positive biopsies identifying adenocarcinoma in 68 of 180 (38%) patients. Acute urinary retention developed in 18 of 180 (10%) patients requiring an indwelling urinary catheter upon discharge home. In all patients estimated blood loss was less than 5 cc and median pain score was 1 of 10. CONCLUSIONS: Stereotactic transperineal prostate biopsy is extremely well tolerated and useful for diagnosis of nonpalpable isoechoic occult prostate malignancy. Additionally, stereotactic transperineal prostate biopsy provides comprehensive tissue sampling with accurate 3-dimensional mapping of malignancy in this select group of patients.

Moran BJ, Braccioforte MH. · Prostate Cancer Foundation of Chicago, Westmont, Illinois 60559, USA. · Urology. · Pubmed #19027936 No free full text.

Abstract: This study investigates the detection rate of nonpalpable, isoechoic occult prostate malignancy using a stereotactic transperineal prostate biopsy (STPB) technique in patients with a previously negative transrectal ultrasound-guided prostate biopsy.

Frank SJ, Grimm PD, Sylvester JE, Merrick GS, Davis BJ, Zietman A, Moran BJ, Beyer DC, Roach M, Clarke DH, Stock RG, Robert Lee W, Michalski JM, Wallner KE, Hurwitz M, Potters L, Kuban DA, Prestidge BR, Vera R, Hathaway S, Blasko JC. · Department of Radiation Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA. · Brachytherapy. · Pubmed #17284379 No free full text.

Abstract: PURPOSE: This study is aimed at understanding and defining the current patterns of care with respect to prostate brachytherapy for patients with intermediate-risk localized disease in the combined academic and community setting. METHODS AND MATERIALS: A nomogram-based survey was developed at the Seattle Prostate Institute defining the accepted criteria for intermediate-risk prostate cancer. Patients were defined as having intermediate-risk prostate cancer if they met one of the following criteria: prostate-specific antigen (PSA) >10 ng/dL, Gleason score (GS) > or = 7, or cT2b or cT2c disease. Additional potential predictive factors including perineural invasion (PNI), GS 3+4 vs. 4+3, and high-volume disease were included. RESULTS: In the absence of PNI, all of those surveyed would perform monotherapy for intermediate-risk patients, GS 7 (3+4) or PSA 10-20, with cT1c and <30% cores +. Up to 80% would perform monotherapy for patients with cT1c, GS 7 (4+3), and <30% cores +. Eighty to 90% of physicians would perform an implant alone with cT2a and either a PSA of 10-20 or GS of 7 (3+4) and <30% cores +. Fifty to 60% of those surveyed stated that they would treat a patient with cT2b disease, GS 7 (3+4), or PSA 11-20, with less than two-thirds of the biopsy cores positive in the absence of PNI. CONCLUSIONS: This Patterns of Care (POC) study reveals that certain subsets of intermediate-risk localized prostate cancer patients are considered appropriate candidates for an interstitial implant alone.

Zelefsky MJ, Kuban DA, Levy LB, Potters L, Beyer DC, Blasko JC, Moran BJ, Ciezki JP, Zietman AL, Pisansky TM, Elshaikh M, Horwitz EM. · Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #17084558 No free full text.

Abstract: PURPOSE: To assess long-term prostate-specific antigen (PSA) outcome after permanent prostate brachytherapy (BT) and identify predictors of improved disease-free survival. METHODS AND MATERIALS: Eleven institutions combined data on 2,693 patients treated with permanent interstitial BT monotherapy for T1-T2 prostate cancer. Of these patients, 1,831 (68%) were treated with I-125 (median dose, 144 Gy) and 862 (32%) were treated with Pd-103 (median dose, 130 Gy). Criteria for inclusion were: available pre-BT PSA, BT > or =5 years before data submission, BT between 1988-1998, and no androgen deprivation before failure. The median follow-up was 63 months. RESULTS: Among patients where the I-125 dose to 90% of the prostate (D90) was > or =130 Gy, the 8-year PSA relapse-free survival (PRFS) was 93% compared with 76% for those with lower D90 dose levels (p < 0.001). A multivariable analysis identified tumor stage (p = 0.002), Gleason score (p < 0.001), pretreatment PSA level (p < 0.001), treatment year (p = 0.001), and the isotope used (p = 0.004) as pretreatment and treatment variables associated with PRFS. When restricted to patients with available postimplantation dosimetric information, D90 emerged as a significant predictor of biochemical outcome (p = 0.01), and isotope was not significant. The 8-year PRFS was 92%, 86%, 79%, and 67%, respectively, for patients with PSA nadir values of 0-0.49, 0.5-0.99, 1.0-1.99, and >2.0 ng/mL (p < 0.001). Among patients free of biochemical relapse at 8 years, the median nadir level was 0.1 ng/mL, and 90% of these patients achieved a nadir PSA level <0.6 ng/mL. CONCLUSIONS: Outcome after permanent BT for prostatic cancer relates to tumor stage, Gleason score, pretreatment PSA, BT year, and post-BT dosimetric quality. PSA nadir < or =0.5 ng/mL was particularly associated with durable long-term PSA disease-free survival. The only controllable factor to impact on long-term outcome was the D90 which is a reflection of implant quality.

Kuban DA, Levy LB, Potters L, Beyer DC, Blasko JC, Moran BJ, Ciezki JP, Zietman AL, Zelefsky MJ, Pisansky TM, Elshaikh M, Horwitz EM. · Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #16750326 No free full text.

Abstract: PURPOSE: To assess prostate-specific antigen (PSA) failure definitions for patients with Stage T1-T2 prostate cancer treated by permanent prostate brachytherapy. METHODS AND MATERIALS: A total of 2,693 patients treated with radioisotopic implant as solitary treatment for T1-T2 prostatic adenocarcinoma were studied. All patients had a pretreatment PSA, were treated at least 5 years before analysis, 1988 to 1998, and did not receive hormonal therapy before recurrence. Multiple PSA failure definitions were tested for their ability to predict clinical failure. RESULTS: Definitions which determined failure by a certain increment of PSA rise above the lowest PSA level to date (nadir + x ng/mL) were more sensitive and specific than failure definitions based on PSA doubling time or a certain number of PSA rises. The sensitivity and specificity for the nadir + 2 definition were 72% and 83%, vs. 51% and 81% for 3 PSA rises. The surgical type definitions (PSA exceeding an absolute value) could match this sensitivity and specificity but only when failure was defined as exceeding a PSA level in the 1-3 ng/mL range and only when patients were allowed adequate time to nadir. When failure definitions were compared by time varying covariate regression analysis, nadir + 2 ng/mL retained the best fit. CONCLUSIONS: For patients treated by permanent radioisotopic implant for prostate cancer, the definition nadir + 2 ng/mL provides the best surrogate for failure throughout the entire follow-up period, similar to patients treated by external beam radiotherapy. Therefore, the same PSA failure definition could be used for both modalities. For brachytherapy patients with long-term follow-up, at least 6 years, defining failure as exceeding an absolute PSA level in the 0.5 ng/mL range may be reasonable.

Merrick GS, Butler WM, Wallner KE, Blasko JC, Michalski J, Aronowitz J, Grimm P, Moran BJ, McLaughlin PW, Usher J, Lief JH, Allen ZA. · Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV 26003-6300, USA. · Brachytherapy. · Pubmed #16344253 No free full text.

Abstract: PURPOSE: To conduct a multi-institutional comparison of prostate brachytherapy pre-implant dosimetry of Pd-103 and I-125. METHODS AND MATERIALS: Eight experienced brachytherapists submitted Pd-103 and I-125 monotherapeutic and boost pre-implant dosimetry plans for central review. All 32 plans were calculated using the same transrectal ultrasound volumetric study. Seeds of any strength were acceptable, but were restricted to Theraseed Model 200 (Theragenics Inc., Buford, GA) and Oncura Oncoseed Model 6711 (Oncura, Plymouth Meeting, PA). The dosimetric analysis included evaluation of target volume, target to prostate ratio, target length, number of needles, seed activity, number of seeds, total activity, total activity divided by treatment planning volume, the use of extracapsular seeds, and average treatment margins (defined as the perpendicular distance between the prostate capsule and the 100% isodose line). Prostate coverage was defined in terms of V(100)/V(150)/V(200)/V(300) and D(100)/D(90)/D(50), whereas urethral dosimetry consisted of UV(100)/UV(150)/UV(200) and UD(90)/UD(50). RESULTS: The mean planning target volume to prostate volume ratio varied dramatically (mean 1.29, range 0.99-1.76) with the target length ranging from 3.5 to 4.5 cm. Although the prostate V(100) was >95% in all cases, the V(150) ranged from 29.9% to 92.1% and the V(200) from 6.72% to 52.5%. The urethral V(100) was 100% in all cases with six of the eight brachytherapists limiting the UV(150) to <3%. However, the median urethral dose varied by up to 50%. Treatment margins also varied significantly (average 3.98 mm, range 0.32-7.68 mm). All brachytherapists used extracapsular seeds with five implanting >25% of the seeds in extracapsular locations (range 6.4-58.2%). In addition, significant variability existed in the number of needles, number of seeds, and seed strength. CONCLUSIONS: This study highlights the substantial variability that exists regarding target volume, seed strength, dose homogeneity, treatment margins, and extracapsular seed placement, although prostate brachytherapy prescription doses are uniform. The standardization of pre-implant dosimetry is essential for meaningful multi-institutional comparisons of biochemical outcomes and morbidity.

Moran BJ, Stutz MA, Gurel MH. · Chicago Prostate Cancer Center, Westmont, IL 60559, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #15145153 No free full text.

Abstract: PURPOSE: To evaluate urinary function and bother after prostate brachytherapy (PB) in patients who have had prior transurethral resection of the prostate (TURP). METHODS AND MATERIALS: A total of 171 patients with stage T1a-T2b prostate cancer, Gleason score <or=7 who underwent prior TURP received PB at a single institution. In January 2002, all 171 patients were mailed the University of California-Los Angeles Prostate Cancer Index and International Prostate Symptom Score sheet. One hundred patients (60%) returned completed surveys. Time of TURP before implant ranged from 2 to 300 months (median, 6.5 years). Mean patient age was 74 +/- 5.2 years, follow-up time after implant ranged from 6.1 to 50.9 months (median, 25 months). RESULTS: The mean urinary function score and bother score for the entire study group was 83.5 +/- 19.5 and 82.5 +/- 23.7, respectively. Multivariate analysis revealed higher pretreatment International Prostate Symptom Scores to have significant negative impact (p = 0.001) on urinary function and bother scores. CONCLUSION: With accurate ultrasound identification of the urethral defect and precise dosimetry, brachytherapy can be performed in selected patients who have had prior TURP with resultant low impact on urinary function and bother scores.

Lee PC, Parks EK, Moran BJ. · Alexian Brothers Radiation Oncology Center, Elk Grove Village, IL 60007, USA. · Med Dosim. · Pubmed #14684189 No free full text.

Abstract: An innovative (and yet simple) dosimetric model is proposed that provides a semi-analytical solution to the total activity-volume relationship in ultrasound-guided transperineal prostate implant. This dosimetric model is based on 4 simple assumptions. First, the prostate target volume is approximated as a sphere. Second, the urethra is presumed to transverse through the center of the prostate target volume. Third, peripheral loading is applied as the seed-loading technique. Fourth, as the major innovation of the proposed model, the radial dose function of the Iodine-125 125I seed is forced to fit a simple power function of the distance r. Pursuant to the third assumption, the peripherally-loaded seeds also define a spherical volume defined as the loading volume w. Also pursuant to the fourth assumption, the radial dose function is expressed as 1.139*r(-0.474) for r = 1.5 to 2.5 cm. Thereafter, a simple analytical power-law equation, A = 1.630* w(0.825), for the relationship between the total activity A in mCi and the loading volume w in cc is derived for 125I monotherapy. Isodose plans for loading volumes corresponding to r = 1.5, 1.8, 2.2, and 2.5 cm were performed. The maximal isodose coverage volume maxV100 was calculated for each case and was found to be on the average 65% larger than the loading volume w. Matching prostate target volume V to the loading volume w therefore yields a generous implant (with a margin of approximately 3.3 mm). Conversely, matching the prostate target volume V to the maxV100 yields a tight implant (with 0.0 mm or no margin). Matching the prostate target volume V to a midpoint between the loading volume w and maxV100 yields a moderate implant (with approximately 1- to 2-mm margin). Three individual equations are derived for each type of implants: A = 1.630* V(0.825), A = 1.288* V(0.825), or A = 1.078 V(0.825) for generous, tight, or moderate implants, respectively. Patient data at the Chicago Prostate Cancer Center are found to support the above dosimetric model and the 3 semi-analytically derived equations. The above equations are also compared favorably with some of the previously published equations from other authors. These results support the efficacy of the proposed dosimetric model.

Lee PC, Starr SJ, Zuhlke K, Moran BJ. · Alexian Brothers Cancer Care Center, Elk Grove Village, Illinois 60007, USA. · Radiat Oncol Investig. · Pubmed #10644061 No free full text.

Abstract: A simple five-seed assay method was proposed and investigated. A commercial well ion chamber system with an NIST-traceable single-seed calibration constant was used for the single-seed assays. A batch seed holder was used for batch assays. For the five-seed assays, a second single-seed holder was modified such that all five seeds were loaded in a central region of the well ion chamber. Compared with the same seed in the standard single-seed holder, the relative chamber responses for the five seed positions were 0.993, 0.993, 1.000, 1.001, and 0.977, respectively, indicating little or no position-dependent chamber response and no self-attenuation among seeds. Subsequent comparison of assays with the single-seed and five-seed methods indicated only 0.4% difference in charge collection. The five-seed calibration constant was therefore taken to be the same as the single-seed calibration constant. The reproducibility of the five-seed assay method was found to be better than 0.8%. When a dummy seed replaced an active seed, a nearly 20% reduction in charge was found, indicating that the proposed five-seed assay method can detect a dead seed. Clinical comparison of all three assay methods showed that they produced qualitatively the same assay results when the batch assay method was performed with extra care. Compared with the single-seed assay method, the five-seed method is equally simple, rigid, and reproducible, but it demands much less assay time. Compared with the batch assay method, the five-seed method is much more reproducible and reliable because of its rigid assay geometry; it only demands a moderate amount of assay time and can detect dead seeds. The American Association of Physicists in Medicine Task Group 40 (AAPM TG40) states that, for brachytherapy, ideally every (i.e., 100%) loose seed should be calibrated. For procedures involving large number of loose seeds, it then recommends that 10% of seeds be calibrated. The proposed five-seed assay is very simple to implement. It will facilitate the compliance of the "10%" recommendation from the AAPM TG40; it will make the "ideally 100%" statement from AAPM TG40 a more realistic and practical QA procedure in seed assaying.

Lee PC, Moran BJ. · No affiliation provided · Int J Radiat Oncol Biol Phys. · Pubmed #11265653 No free full text.

This publication has no abstract.

Lee PC, Moran BJ. · No affiliation provided · Med Phys. · Pubmed #10757615 No free full text.

This publication has no abstract.