Richard G. Stock, MD

Richard G. Stock, MD

Icahn School of Medicine at Mount Sinai

New York, New York

Richard G. Stock, MD, is a Professor of Radiation Oncology and Director of Genitourinary Radiation Oncology at the Icahn School of Medicine at Mount Sinai in New York City. He has dedicated his career to delivering the highest quality care to patients using the most advanced technology available, including intensity modulated radiation therapy (IMRT), Novalis Shaped Beam Radiosurgery, real-time ultrasound guided prostate seed implants, and MammoSite, all of which allow him to meticulously target tumors while achieving maximal sparing of normal tissues. Dr. Stock has served on the board of American College of Radiology Testing and the American Brachytherapy Society, where he is member at large, and as guest editor of a special Brachytherapy issue of Techniques in Urology. He has lectured and presented at dozens of meetings and symposiums across the country and internationally, including in New York, San Francisco, Chicago, Philadelphia, Boston, Spain, Holland, France, and Japan. Dr. Stock completed his internship at Beth Israel Medical Center and his specialty training at Memorial Sloan-Kettering Cancer Center. He is listed in America's Top Doctors.

Disclosures:

Articles by Richard G. Stock, MD

Does Anatomic Rectal Displacement Improve Dosimetry and Reduce Injury?

Richard G. Stock, MD, Professor of Radiation Oncology and Director of Genitourinary Radiation Oncology at the Icahn School of Medicine at Mount Sinai in New York City, reviews the literature on rectal displacement to prevent damage to the rectum from prostate brachytherapy and external beam radiation therapy (EBRT). First, he summarizes the findings of numerous papers from the past 20 years that have identified a relationship between the dose and volume of radiation and damage to the rectum such as bleeding and mucosal changes. The more radiation reaches the rectum, and the greater the surface area of the rectum affected, the more likely patients will experience adverse effects, including greater levels of morbidity. Dr. Stock then considers how the rectum can be spared, focusing on the evidence around rectal spacers such as endorectal balloons and hydrogel spacers such as SpaceOAR. He explains that numerous studies demonstrate that by inserting a physical barrier between the rectum and the prostate, the rectum is kept separate from the radiation and therefore receives a lower rate of toxicity. Dr. Stock notes that patients experience more rectal discomfort with spacers like SpaceOAR than without, but suggests that the reduction of significant issues such as bleeding outweigh the downsides. He concludes by discussing a recent study of his which found that SpaceOAR can be inserted before brachytherapy and EBRT.

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Brachytherapy and Focal Therapy Outcomes

Richard G. Stock, MD, Professor of Radiation Oncology and Director of Genitourinary Radiation Oncology at the Icahn School of Medicine at Mount Sinai in New York City, discusses focal therapy and brachytherapy. He outlines the rationale for focal therapy, reviews patient selection, and provides an extensive evaluation of the supporting evidence. For the small percentage of patients that may not have bilateral, multifocal disease, partial gland treatment can reduce morbidity and leave open future partial gland treatment options, should they become necessary. In general, patients in most studies examining focal therapy have unilateral disease, an MRI detectable lesion, Gleason score of <=7, and PSA <= 10ng/ml. Dr. Stock considers the types of focal therapy such as cryotherapy, high-intensity focused ultrasound (HIFU), and brachytherapy, highlighting the importance of treating the margin surrounding the tumor in any focal therapy. He then describes focal low dose rate brachytherapy and provides recommendations including a preplan and real-time ultrasound to ensure accuracy and minimize side effects. Lastly, Dr. Stock reviews data analyzing changes in morbidity, erectile function, and quality of life in whole gland and hemigland treatment plans.

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Long-Term Outcomes of Permanent Brachytherapy

Richard G. Stock, MD, compares long-term overall survival and morbidity outcomes of brachytherapy alone versus a brachytherapy/ external beam combination in intermediate and high risk prostate cancer. He also discusses factors that could affect those outcomes, such as the patient’s intermediate-risk features, duration of androgen deprivation therapy (ADT), and technique of seed implantation.

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