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Oncology Advances April 2016

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Dana-Farber/Brigham and Women's Cancer Center | 5 Imagine handing a man with newly-diagnosed adenocarci- noma of the prostate a scale model of his own prostate gland, with the tumor, neurovascular bundle, and external urethral sphincter clearly mapped out. Radiologists and urologic sur- geons at Dana-Farber/Brigham and Women's Cancer Center are doing just that – creating 3-D images of individual prostates, and developing prototypes of 3-D printed plastic models that will show surgeons the best approach for achiev- ing tumor-free surgical margins, and help patients better un- derstand the anatomy of their disease. The models, created from high-resolution volumetric mag- netic-resonance images, show normal prostate tissue, the po- sition and shape of the tumor within the gland, and the location of the external urethral sphincter and left and right branches of the neurovascular bundle. "The idea is that we'll be able to use these models to do a better job of sparing patients' nerves, presumably leading to fewer positive margins, better cancer cure rates, and fewer sides effects such as erectile dysfunction and incontinence," said Adam S. Kibel, MD, Chief of Urology at Brigham and Women's Hospital (BWH) and Disease Center Leader, Urology at DF/BWCC. Multifaceted Use for 3D models In addition to aiding with surgical planning, the models can also serve as patient education tools, said radiologist Clare M. Tempany, MD, Co-Director of the Advanced Multimodality Image Guided Operating Suite (AMIGO) at BWH. "As radiologists we think in three dimensions, " she said. "De- veloping these 3-D plastic models helps us translate what we're really seeing for surgeons, and even more importantly, allows for the surgeon to show it to the patient." In many men, approximately 50 percent to 60 percent of the length of the external urethral sphincter lies within the prostate, meaning that an extensive excision of the gland could result in postoperative problems with urinary continence. In some men, however, most of the sphincter will lie outside the gland, and these men are more likely to have only minor, transient problems with incontinence after prostatectomy. "By showing the surgeon the volume of the sphincter, we're able to provide counseling information about the risk of incon- The Prostate in 3-D: A Model for Preserving Continence and Sexual Function tinence for discussion with the patient prior to the surgery," Dr. Tempany said. Prostate cancer researchers at the National Cancer Institute in Bethesda, Maryland, use 3-D printing to create molds for use in slicing and sectioning excised prostates, but to her knowl- edge, BWH is the first center to offer 3-D prostatic image mod- eling in the clinical setting, Dr. Tempany said. More Men Offered Nerve-Sparing Option To determine whether 3-D modeling of individual prostates could improve management of patients with prostate cancer, Dr. Kibel, Dr. Tempany and DF/BWCC colleagues conducted a pilot study of men scheduled to undergo robotic-assisted la- paroscopic surgery. All patients underwent preoperative MRI scans with a 3-Tesla magnet. The MRI images of the total prostate gland, neurovascular bundle, external urethral sphincter and tumor of each patient were manually segmented, and a patient-specific 3-D image was created from the assembled segments by Junichi Tokuda, PhD, (National Center for Image Guided Therapy investigator) using the 3D Slicer software tools. The surgeon was asked to provide, both before reviewing the MRI report and afterward, his or her decisions regarding the possibility of sparing the neurovascular bundle, the likelihood that the tumor had extended beyond the capsule of the prostate, and the likelihood of seminal vesicle involvement. Adam S. Kibel, MD, and colleagues are leading research to determine whether 3-D modeling could improve management of patients with prostate cancer. Refer a Patient to Dana-Farber/Brigham and Women's Cancer Center For more information or consultation, please call 1-877-332-4294. We now offer next business day access for first appointments at our main campus in Boston. continued on back cover

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