New study questions retrograde urethrography
It's unpleasant enough to receive a diagnosis of prostate cancer and to face a course of radiotherapy that can cause a number of side effects, ranging from incontinence to a loss of potency. The last thing patients facing these grim prospects need is a painful procedure designed to help the radiation oncologist plan treatment. But that is what many prostate cancer patients still are subjected to.
A new study suggests there is no need for the extra dose of suffering.1 The study was completed by Gregory Swanson, MD, a radiation oncologist and an associate professor in the departments of radiation oncology and urology at the University of Texas Health Sciences Center in San Antonio. For years Swanson has been using 3-D CT to plan radiotherapy for prostate cancer patients, but because many radiation oncologists still use the older procedure, retrograde urethrography, he devised a study to show that you just as easily can identify the area of the prostate to be treated without subjecting the patient to the pain and discomfort that typically goes along with the older procedure.
Retrograde urethrography involves inserting a catheter into the male urethra to inject contrast, but Swanson says patients absolutely hate the procedure. "It is easy when you have someone else [put these in the patient], because then you don't have to watch the patient suffer, but I used to do them myself, and I probably did 300 or 400 of them," he says. Swanson points out that it was this aspect of treatment that patients most dreaded. Further, the procedure can result in injuries or infections.
Change could take time
Eventually, Swanson realized that simply knowing the anatomic relationships of the prostatic base was sufficient to carry out treatment planning along with 3-D CT. And he devised a study to show other clinicians that this alternative was highly preferable, given the absence of patient suffering.
In the study, 15 patients first underwent a CT simulation, both with and without bladder, urethral, and rectal contrast. Researchers report that they were able to identify the prostatic base and apex easily and consistently on both scans by taking a side view of the patient and drawing a line from the pubic bone straight down to the floor of the pelvis. The process was repeated in 57 additional patients for confirmation.
Swanson hopes that other clinicians will try the approach for themselves. "I imagine it is going to take a generation of having to re-educate residents to get [retrograde urethrography] out of the system…but that is the nature of medicine," he says. "This is not going to change the quality of radiotherapy, but I am just hoping that it will make it easier on patients to not put them through an invasive procedure that they don't need."
Reference
- Boersma M, Swanson G, Baacke D, et al. Anatomic-based three-dimensional planning precludes use of a catheter-delivered contrast for treatment of prostate cancer. Int J Rad Onc Biol Physics 2008; 71:51-57.
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