catheter drainage, although this was not necessary in the currentreport. Intermittent or continuous androgen deprivation to delayprogression is a consideration. Surveillance should not be consideredin low risk (Gleason 6 or less, PSA less than 10 ng/ml and a limitednumber of cores positive) situations.

These authors describe a posterior CT guided approach that theyhave routinely used (800 patients) in their practice to deliver inter-stitial therapy. In the 5 patients who are the subject of this report theapproach was eminently suited to the situation.

However, in addition to the risk profile of prostate cancer, the criticalinformation necessary before initiating any therapy in these cases in-cludes anticipated life expectancy based on comorbidity and specificallyrelating to the primary colorectal lesion (the disease-free interval fromcolorectal cancer treatment to prostate cancer diagnosis) and also anevaluation of post-APR bladder function. While the options of therapyare more limited in the circumstance described this report, all possibil-ities, including the methods used, require consideration.

Paul F. SchellhammerVirginia Prostate CenterEastern Virginia Medical SchoolNorfolk, Virginia

REPLY BY AUTHORS

Adjuvant hormone therapy was not considered an option becausewe do not recommend it as monotherapy for the management ofprostate cancer in patients with a mean age of 64 years and whosemedical condition was good. All of the patients were disease-freefrom colorectal cancer at least 5 years before 3-D CT guided brachy-therapy for second primary prostate cancer.

It is seldom that we do not recommend surveillance because pros-tate cancer is often multigraded and multicentric, and it is underes-timated with routine biopsy. We also routinely perform 3-D CTguided stereotactic biopsy of the seminal vesicles for staging. Wereported on 79 of 563 patients with positive biopsy.1 Valicenti et alalso reported 14% seminal vesicle invasion in post-prostatectomycases.2

1. Technology in Cancer Research and Treatment. Washington,D.C.: ISSN1533-0346, vol. 2, no. 4, August 2003

2. Valicenti, R. K., Gomella, L. G., Ismail, M., Mullholland, S. G.,Petersen, R. O. and Corn, B. W.: Pathologic seminal vesicleinvasion after radical prostatectomy for patients with prostatecarcinoma: effect of early adjuvant radiation therapy on bio-chemic control. Cancer, 82: 1909, 1998

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