Simulation for localized prostate cancer: a comparison of urethrography techniques.

Forty-five patients having conventional fluoroscopic, or CT scan simulation of the prostate gland from January 1999 to June 1999 were studied. Patients were consecutively assigned (not randomized) in groups of 15 to 3 different urethrography techniques: air contrast alone (group 1), hypaque contrast alone (group 2), and xylocaine jelly and hypaque contrast (group 3). Outcome measures were pain scores, visualization of the apex (indicated by urethrogram tip), and frequency of corrections necessary on the basis of verification port films. Group 3 patients had the lowest mean pain score and required fewer lateral setup corrections at the time of portal imaging on the first day of treatment. A comparison of radiographs also revealed that group 2 and 3 patients (hypaque contrast) had better delineation of the prostatic anatomy than group 1 patients (air contrast). We found that of the 3 techniques tested, urethrography utilizing xylocaine jelly and hypaque was associated with the least amount of pain, least amount of corrective shifts, and best quality in defining the prostatic anatomy.