Sexual Function Preservation

A discussion of vessel sparing, ADT, overcoming rectal interference, and PSA screening.

Introduction to the Prostate Atlas
The Prostate Atlas serves several purposes. First, it is a review of pelvic MRI anatomy. T2 pelvic scans disclose details of prostate anatomy as well as anatomy of adjacent critical structures with much greater detail than CT scans. It is likely that MRI-based planning will ultimately replace CT scanning due to this clarity and a review of the details of prostate associated anatomy will be useful.

A second goal is to improve CT contouring of the prostate. We have noted that with increased experience with MRI scans CT defined prostate volumes begin to approach MRI defined volumes. There are also a number of clues on registered images that allow improved interpretation when CT alone is available. The CT scans in the atlas were obtained on a CT simulator without contrast. They would not be considered diagnostic level CT scans in the current era. In some respects, the lack of clarity serves the atlas well. In spite of the limited detail, it is possible to contour the prostate on the basis of adjacent anatomy defined on CT.

The atlas was created from multiple patients registered with MRI and CT data sets. The atlas includes both post implant scans and non-implant scans.


How to use the Prostate Atlas and Prost- a-doodle
This website offers 4 modules. The recommended starting point is the Prostate Atlas which exhaustively reviews MRI and CT anatomy. After reviewing the prostate, the user should practice contouring the prostate in the 3 Prost-a-doodle programs, which allow the user to receive immediate feedback for contouring accuracy.

Download the Prostate Atlas and Prost-a- doodle
Prostate Atlas (58MB Powerpoint Presentation) - review of MRI and CT anatomy.
Prost-a-doodle 1 (17MB for Windows) - contains 8 cases with axial CT and MRI correlation
Prost-a-doodle 2 (42MB for Windows) - 3 cases with all views presented (axial CT, axial, sagittal and coronal T2 MRI, the user may practice contouring on all views
Prost-a-doodle 3 (18MB for Windows) - 6 additional CT cases without MRI correlation but with MRI prostate contours for review of contouring accuracy

Other Resources
Prostate TriMap Tool (Excel Spreadsheet)
Composite Margin Tool (Excel Spreadsheet)

Magnetic resonance imaging-guided functional anatomy approach to prostate brachytherapy - Payal D. Soni, Alejandro Berlin, Aradhana M. Venkatesan, Patrick W. McLaughlin