Mukesh Gobind Harisinghani MD, Presenter: Nothing to Disclose

Helen A. Shih MD, Abstract Co-Author: Nothing to Disclose

Mansi Awasthi Saksena MD, Abstract Co-Author: Nothing to Disclose

Anthony Zietman MD, Abstract Co-Author: Nothing to Disclose

Ralph Weissleder MD, PhD, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to better define sites of nodal involvement in prostate cancer by developing a unique anatomic map of regions of prostate nodal drainage at high risk for harboring metastatic disease

21 prostate cancer patients with pathologically confirmed node positive disease had a total of 66 nodes identifiable by MRI with ferumoxtran-10 [Combidex®; Advanced Magnetics, Cambridge, MA; Sinerem®; Guerbet, Paris, France]. The position of each of these malignant nodes was mapped to a common template based upon either its relation to either fixed skeletal landmarks or vascular anatomy.

When the nodes were plotted relative to skeletal anatomy they covered a diffuse volume from the top of the lumbar spine to the superior ramus of the pubis, and were found along most of the sacrum, extending inferiorly along the lateral pelvic walls. 20 para-aortic nodes were found along the lumbar spine. All were within 2.5 cm of the anterior surface of the lumbar vertebral bodies. 95% of nodes within the pelvis were within 3.5 cm of a bony surface. No positive nodes were identified inferior to the superior pubic rami. When mapped in relation to the vessels they were in three regions: right and left external iliac and para-aortic vessels. The latter were seen along the inferior 12 cm of the aorta and extending an additional 2 cm below the level of the aortic bifurcation. All were within 1.2 cm of the aorta. All nodal metastases along the external iliac vessels were seen along a length extending from a point 2 cm superior to the common iliac bifurcation to 11 cm inferior. Fewer nodes were found along the proximal internal iliac vessels. 89% of all nodes were within 2.5 cm of a major vessel. The relationship of the nodes was much closer to vascular than bony anatomy

Nodal metastates from prostate cancer are largely localized along the abdominal aorta, the external iliac vessels, and the proximal internal iliacs. The anatomic map opens new options for defining radiation treatment portals for high risk prostate cancer patients

Harisinghani, M, Shih, H, Saksena, M, Zietman, A, Weissleder, R, Radiotherapy Mapping of Nodal Disease in Locally Advanced Prostate Cancer.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4408686.html