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116 Radium
course of a routine physical examination. A rectal examination should
be a part of every physical examination, but unfortunately is frequently
omitted. One would not think of subjecting a female to a general physical
examination without a bimanual vaginal examination. Is there a
better way of examining the male pelvis than a bimanual rectal examination?
If this was practiced as a routine, more cases of prostatic cancer
could be discovered before metastases have developed.
In order to carry out accurate irradiation of the malignant prostate.
one must have a knowledge of the gross pathology of this disease, and
of the lymphatic drainage of the prostate gland.
Fukase1* has shown that rudimentary lymph nodes are present in
the normal prostate, appearing as small aggregations of lymphocytes
located beneath the glandular and duct epithelium. These drain into
lymph channels on the surface of the gland, which finally unite into four
main trunks, one from the anterior surface and three from the lateral
Fig. 1.—Lateral virw. showing needles embedded into area under
trigon ihrough which lymphatics pais.
and posterior surfaces (Fig. i). All four trunks pass upward, through
an area bounded behind by the rectum, in front by the trigon and on
either side by the seminal vesicles, and finally drain into the lvmph nodes
about the iliac vessels (Fig. »). It is this supra prostatic area which
must receive early attention if we may hope to prevent metastases.
Careful, painstaking and accurate embedding of radium into this region,
even though apparently uninvolved. will have a tendency to lock off the
lymphatics at this point and prevent the spread of the disease into the
pelvic lymphatics and beyond our control. This is the equivalent of going
well beyond a cancerous growth in excision.