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Gaur S, Stein EB, Schneider DK, Masotti M, Davenport MS, George AK, Ellis JH. Gold nanoshells for prostate cancer treatment: evidence for deposition in abdominal organs. Abdom Radiol (NY) 2024; 49:1929-1939. [PMID: 38376575 DOI: 10.1007/s00261-024-04184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Gold-silica nanoshell therapy [AuroShells with subsequent focal laser therapy (AuroLase)] is an emerging targeted treatment modality for prostate cancer. We reviewed pre- and post-treatment unenhanced CT imaging to assess for retained gold-silica nanoshells in the abdomen and pelvis. METHODS This single-institution retrospective study identified patients in the AuroLase pilot who underwent pre- and post-treatment unenhanced abdominopelvic CT. The attenuation, before and after gold-silica nanoshell administration, of the liver, spleen, pancreas, kidneys, prostate, blood pool, paraspinal musculature, and abnormal lymph nodes were manually measured by two readers. After inter-reader agreement was calculated using intraclass correlation (ICC), a permutation test was used to assess pre- and post-therapy attenuation differences. RESULTS Four patients met the inclusion criteria. Mean age was 72.3 ± 5.9 years. Median time interval between pre-treatment CT and treatment, and between treatment and post-treatment CT, was 232 days and 236.5 days, respectively. The two readers' attenuation measurements had very high agreement (ICC = 0.99, p < 0.001). The highest differences in organ attenuation between pre- and post-therapy scans were seen in all four patients in the liver and spleen (liver increased by an average of 28.9 HU, p = 0.010; spleen increased by an average of 63.7 HU, p = 0.012). A single measured lymph node increased by an average of 58.9 HU. In the remainder of the measured sites, the change in attenuation from pre- to post-therapy scans ranged from -0.1 to 3.8 HU (p > 0.05). CONCLUSION Increased attenuation of liver and spleen at CT can be an expected finding in patients who have received gold-silica nanoshell therapy.
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Affiliation(s)
- Sonia Gaur
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA
| | - Erica B Stein
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA
| | - Daniel K Schneider
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA
| | - Maria Masotti
- Department of Biostatistics, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Matthew S Davenport
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA
| | - Arvin K George
- Department of Urology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5330, USA
| | - James H Ellis
- Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA.
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Borkowetz A, Kwe J, Boehm K, Baunacke M, Herout R, Lucke M, Burcea A, Thomas C. Follow-up of vascular-targeted photodynamic therapy in a real-world setting. World J Urol 2024; 42:55. [PMID: 38244089 PMCID: PMC10799770 DOI: 10.1007/s00345-023-04738-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/30/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Vascular-targeted photodynamic therapy (VTP) is an approved treatment option for unilateral low-risk prostate cancer (PCa). METHODS Patients with unilateral low- or intermediate-risk PCa undergoing hemiablation by VTP were evaluated in a real-world setting. Oncological outcome after VTP was measured by MRI-based re-biopsy at 12 and 24 months. Functional outcome after 1 year was investigated by IIEF-5 and IPSS questionnaires. Progression was defined as the evidence3 of ISUP ≥ 2 PCa. RESULTS At any control biopsy (n = 46) after VTP, only 37% of patients showed no evidence of PCa. Recurrence-free survival was 20 months (95% CI 4.9-45.5) and progression-free survival was 38.5 months (95% CI 33.5-43.6 months). In-field and out-field recurrent PCa occurs in 37% (55% ISUP ≥ 2 PCa) and 35% (56% ISUP ≥ 2 PCa). Seventy-nine percent of patients preserved erectile function, respectively. Ten percent of patients presented long-term bladder outlet obstruction. None of the patients presented incontinence. CONCLUSION Due to the high-recurrence in- and out-field recurrence rate in a mainly low-risk prostate cancer cohort, VTP has to be regarded critically as a therapy option in these patients. Pre-interventional diagnostic evaluation is the main issue before focal therapy to reduce the risk of tumor recurrence and progression.
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Affiliation(s)
- Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- Working Group Focal and Micro Therapy, German Association of Urology, Berlin, Germany.
| | - Jeremy Kwe
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Katharina Boehm
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Roman Herout
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Marius Lucke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Adriana Burcea
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Ou R, Aodeng G, Ai J. Advancements in the Application of the Fenton Reaction in the Cancer Microenvironment. Pharmaceutics 2023; 15:2337. [PMID: 37765305 PMCID: PMC10536994 DOI: 10.3390/pharmaceutics15092337] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Cancer is a complex and multifaceted disease that continues to be a global health challenge. It exerts a tremendous burden on individuals, families, healthcare systems, and society as a whole. To mitigate the impact of cancer, concerted efforts and collaboration on a global scale are essential. This includes strengthening preventive measures, promoting early detection, and advancing effective treatment strategies. In the field of cancer treatment, researchers and clinicians are constantly seeking new approaches and technologies to improve therapeutic outcomes and minimize adverse effects. One promising avenue of investigation is the utilization of the Fenton reaction, a chemical process that involves the generation of highly reactive hydroxyl radicals (·OH) through the interaction of hydrogen peroxide (H2O2) with ferrous ions (Fe2+). The generated ·OH radicals possess strong oxidative properties, which can lead to the selective destruction of cancer cells. In recent years, researchers have successfully introduced the Fenton reaction into the cancer microenvironment through the application of nanotechnology, such as polymer nanoparticles and light-responsive nanoparticles. This article reviews the progress of the application of the Fenton reaction, catalyzed by polymer nanoparticles and light-responsive nanoparticles, in the cancer microenvironment, as well as the potential applications and future development directions of the Fenton reaction in the field of tumor treatment.
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Affiliation(s)
| | | | - Jun Ai
- Inner Mongolia Key Laboratory of Environmental Chemistry, College of Chemistry and Enviromental Science, Inner Mongolia Normal University, 81 Zhaowudalu, Hohhot 010022, China; (R.O.); (G.A.)
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Sun D, Lin A, Sun Z, Yang S, Sun Y, Chen A, Qian G, Ji Z, Wang L. Nomograms predict survival benefits of radical prostatectomy and chemotherapy for prostate cancer with bone metastases: A SEER-based study. Front Oncol 2022; 12:1020898. [PMID: 36561516 PMCID: PMC9764338 DOI: 10.3389/fonc.2022.1020898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose This study aimed to identify independent prognosis-associated factors of bone-metastatic prostate cancer. The nomograms were further developed to obtain indicators for the prognostic evaluation. Methods A total of 7315 bone-metastatic prostate cancer (PCa) patients from 2010 to 2016 were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided into the training cohort (n=5,120) and test cohort (n=2,195) in a ratio of 7:3. Univariate and multivariate Cox regression models were applied to evaluate potential risk factors. A 1:1 propensity score matching (PSM) was further performed to decrease the confounding effect and re-evaluate the influence of radical prostatectomy and chemotherapy on prognosis. Combining these potential prognosis factors, the nomograms of cancer-specific survival (CSS) and overall survival (OS) at different times were established. C-indexes, calibration curves, and decision curves were developed to evaluate the discrimination, calibration, and clinical benefit of the nomograms. Results Eleven independent prognosis factors for CSS and twelve for OS were utilized to conduct the nomograms respectively. The C-indexes of nomograms for CSS and OS were 0.712 and 0.702, respectively. A favorable consistency between the predicted and actual survival probabilities was demonstrated by adopting calibration curves. Decision curves also exhibited a positive clinical benefit of the nomograms. Conclusions Nomograms were formulated successfully to predict 3-year and 5-year CSS and OS for bone-metastatic PCa patients. Radical prostatectomy and chemotherapy were strongly associated with the bone-metastatic PCa prognosis.
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Affiliation(s)
- Donglin Sun
- Center for Cancer and Immunology Research, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Ao Lin
- The State Key Lab of Respiratory Disease, Institute of Public Health, Guangzhou Medical University, Xinzao, Guangzhou, China
| | - Zhun Sun
- Center for Cancer and Immunology Research, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Shuqi Yang
- Department of Clinical Medicine, The Second Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Yuexin Sun
- Department of Clinical Medicine, The Second Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Anning Chen
- Center for Cancer and Immunology Research, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Guojun Qian
- Center for Cancer and Immunology Research, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China,*Correspondence: Li Wang, ; Zhonghua Ji, ; Guojun Qian,
| | - Zhonghua Ji
- Department of Anesthesia, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Li Wang, ; Zhonghua Ji, ; Guojun Qian,
| | - Li Wang
- Nephrology Department, Southern Medical University Affiliated Longhua People’s Hospital, Shenzhen, China,*Correspondence: Li Wang, ; Zhonghua Ji, ; Guojun Qian,
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Bhat KRS, Covas Moschovas M, Sandri M, Noel J, Reddy S, Perera R, Rogers T, Roof S, Patel VR. Outcomes of Salvage Robot-assisted Radical Prostatectomy After Focal Ablation for Prostate Cancer in Comparison to Primary Robot-assisted Radical Prostatectomy: A Matched Analysis. Eur Urol Focus 2022; 8:1192-1197. [PMID: 34736871 DOI: 10.1016/j.euf.2021.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/08/2021] [Accepted: 10/05/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Focal therapy (FT) for prostate cancer is less invasive than radical treatment but carries a risk of recurrence. Salvage robot-assisted radical prostatectomy (S-RARP) is a possible option after FT failure. OBJECTIVE To evaluate the impact of FT on functional and oncological outcomes following S-RARP. DESIGN, SETTING, AND PARTICIPANTS In a retrospective analysis of data from a prospectively collected institutional database, 53 patients who underwent S-RARP following failure of focal ablation were selected as group I; patients who had whole-gland ablation and external beam therapy were excluded. This group was matched to a control sample (matched at ratios of 1:1, 1:2, 1:3, 1:4) of men who had undergone primary RARP, using age, prostate-specific antigen (PSA), PSA density, body mass index, Sexual Health Inventory for Men score, American Urological Association symptom score, Charlson comorbidity index, prostate weight, preoperative Gleason score (GS), and history of smoking as variables. SURGICAL PROCEDURE S-RARP after FT was performed using a standardized technique developed at our institute with the da Vinci Xi Surgical System. MEASUREMENTS Oncological and functional outcomes were compared between the S-RARP and primary RARP groups. RESULTS AND LIMITATIONS There was no difference in estimated blood loss (p = 0.8) between the 1:1 matched groups, but operating room time was significantly longer for S-RARP (p = 0.007). The primary RARP group had a higher proportion of patients who underwent a full nerve-sparing procedure. The S-RARP group had higher incidence of positive surgical margins (40% vs 15%; p = 0.008), GS ≥8 (25% vs 15%; p = 0.07), and positive lymph node status (9.4% vs 5.7%; p = 0.02). There was no significant difference in overall complications between the groups. The primary RARP group had a higher incidence of lymphocele drainage after surgery (15% vs 0%; p = 0.006). The main limitation of the study is its retrospective design. CONCLUSIONS S-RALP after FT failure is feasible; however, surgery following FT leads to poorer oncological and functional outcomes. Despite the targeted nature of FT, significant nonfocal collateral damage is evident in tissues surrounding the prostate, which in turn translates to poorer functional outcomes after S-RARP. PATIENT SUMMARY We studied the surgical challenges during robot-assisted removal of the prostate after previous focal treatment (FT) for prostate cancer and compared the outcomes to those for robot-assisted prostate removal in patients who had no previous FT. We found that this technique is safe and effective with a limited risk of complications, but poor urinary and sexual functional outcomes.
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Affiliation(s)
| | | | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Jonathan Noel
- Global Robotics Institute, Advent Health, Celebration, FL, USA
| | - Sunil Reddy
- Global Robotics Institute, Advent Health, Celebration, FL, USA
| | | | - Travis Rogers
- Global Robotics Institute, Advent Health, Celebration, FL, USA
| | - Shannon Roof
- Global Robotics Institute, Advent Health, Celebration, FL, USA
| | - Vipul R Patel
- Global Robotics Institute, Advent Health, Celebration, FL, USA
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Flegar L, Baunacke M, Buerk BT, Proschmann R, Zacharis A, Propping S, Huber J, Thomas C, Borkowetz A. Decision Regret and Quality of Life after Focal Therapy with Vascular-Targeted Photodynamic Therapy (TOOKAD®) for Localized Prostate Cancer. Urol Int 2021; 106:903-908. [PMID: 34814157 PMCID: PMC9533463 DOI: 10.1159/000520084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the study was to assess quality of life (QoL), decision involvement, and decisional regret after treatment with vascular-targeted photodynamic therapy (VTP) (TOOKAD®) for unilateral low-risk prostate cancer. METHODS Validated questionnaires (EORTC QLQ-C30 and QLQ-PR25) capturing QoL post-treatment, involvement in decision-making (Control Preferences Scale) and decision regret (Decisional Regret Scale), were given to patients at the 12-month visit after undergoing VTP at our institution between May 2018 and February 2021. RESULTS Out of 44 patients, 36 patients were included in this study and 31 (86.1%) responded to the questionnaires. Mean overall health score capturing QoL at 12 months was 79.3 (standard deviation: ±18.1). 70.9% of the patients (n = 22) had no decision regret, and 67.8% of men (n = 21) had an active role in decision-making. In control biopsy at 12 months post-treatment, 19.4% of patients (n = 7) presented with local recurrence and progression to higher Gleason score (GS) was found in 13.8% of patients (n = 5). Patients (n = 3) presenting with tumor recurrence or progression to higher GS in control biopsy showed a significantly higher level of decision regret (p < 0.009). CONCLUSION Only 9.7% of men (n = 3) felt a strong emotion of regret at 12 months after VTP. Level of decision regret was significantly higher in patients with local recurrence or tumor progression detected in control biopsy. QoL was stable after VTP.
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Affiliation(s)
- Luka Flegar
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bjoern Thorben Buerk
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rick Proschmann
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Aristeidis Zacharis
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Propping
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Johannes Huber
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Stone N, Skouteris V, Chang S, Klimis A, Lucia MS. Transperineal prostate biopsy identifies locations of clinically significant prostate cancer in men considering focal therapy with PI‐RADS 3–5 regions of interest. BJUI COMPASS 2021; 2:395-401. [PMID: 35474703 PMCID: PMC8988820 DOI: 10.1002/bco2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To determine the benefit of performing transperineal prostate mapping biopsy (TPMB) following multiparametric magnetic resonance imaging (mpMRI) to increase the identification of clinically significant prostate cancer (csPCa) with Gleason grade group (GG) ≥ 2 and their locations outside of the PI‐RADS v2 3–5 category lesions. Methods mpMRI was performed in 80 men prior TPMB from two institutions. The mpMRI was considered clinically significant (csMRI) if it contained one or more PI‐RADS 3–5 category lesion. mpMRI findings were compared against csPCa diagnosed by TPMB, performed between 16 November 2010, and 13 September 2019, for the entire gland, both lobes and to the right and left anterior and right and left posterior quadrants (RA, LA, RP and LP). Sensitivity, specificity, positive and negative predictive values (PPV, NPV), accuracy and the area under curve (AUC) were determined. Thirteen men also underwent radical prostatectomy and had comparison of TPMB pathology to prostatectomy specimen grading. Results TPMB was positive in 60/80 (75%) of which 32 (53.3%) were csPCa. csPCa was present in the RA in 9 (11.3%), LA in 11 (13.8%), RP in 25 (31.3%) and LP in 27 (33.8%) and involved 1 quadrant in 7 (21.9%), 2 quadrants in 12 (37.5%), 3 quadrants in 11 (34.4%) and all 4 quadrants in 2 (6.3%) patients; 57/80 (71.3%) men had a mpMRIs with lesions designated as PI‐RADS 3 in 24 (30%), 4 in 25 (31.3%) and 5 in 8 (10%). A csMRI was present in the RA in 7 (8.8%), LA in 8 (10%), RP in 31 (38.8%) and in the LP in 29 (36.3%), which were limited to one quadrant in 39 (68.4%), 2 quadrants in 16 (28.1%), and 3 quadrants in 2 (3.5%). Sensitivity, specificity, PPV, and NPV were determined from the results of the TPMB and were for the entire gland 81.3%, 35.4%, 45.6% and 73.9%. There were 31 csMRIs involving the right posterior of the gland but only 25 csPCa by TPMB of which 12/31 (38.7%) were concordant for high grade disease. There were 29 men who have a csMRI in the left posterior quadrant, and 14 (48.3%) were concordant with csPCa from the TPMB. Conclusions MpMRI should be supplemented with TPMB to correctly identify the regions of the prostate that would require ablation in men considering focal therapy.
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Affiliation(s)
- Nelson Stone
- Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - Samuel Chang
- Departments Radiology and Pathology University of Colorado Anschutz Medical Campus Aurora CO USA
| | | | - M. Scott Lucia
- Departments Radiology and Pathology University of Colorado Anschutz Medical Campus Aurora CO USA
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Diagnostic Yield of Incremental Biopsy Cores and Second Lesion Sampling for In-Gantry MRI-Guided Prostate Biopsy. AJR Am J Roentgenol 2021; 217:908-918. [PMID: 33336582 DOI: 10.2214/ajr.20.24918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND. In-gantry MRI-guided biopsy (MRGB) of the prostate has been shown to be more accurate than other targeted prostate biopsy methods. However, the optimal number of cores to obtain during in-gantry MRGB remains undetermined. OBJECTIVE. The purpose of this study was to assess the diagnostic yield of obtaining an incremental number of cores from the primary lesion and of second lesion sampling during in-gantry MRGB of the prostate. METHODS. This retrospective study included 128 men with 163 prostate lesions who underwent in-gantry MRGB between 2016 and 2019. The men had a total of 163 lesions sampled with two or more cores, 121 lesions sampled with three or more cores, and 52 lesions sampled with four or more cores. A total of 40 men underwent sampling of a second lesion. Upgrade on a given core was defined as a greater International Society of Urological Pathology (ISUP) grade group (GG) relative to the previously obtained cores. Clinically significant prostate cancer (csPCa) was defined as ISUP GG 2 or greater. RESULTS. The frequency of any upgrade was 12.9% (21/163) on core 2 versus 10.7% (13/121) on core 3 (p = .29 relative to core 2) and 1.9% (1/52) on core 4 (p = .03 relative to core 3). The frequency of upgrade to csPCa was 7.4% (12/163) on core 2 versus 4.1% (5/121) on core 3 (p = .13 relative to core 2) and 0% (0/52) on core 4 (p = .07 relative to core 3). The frequency of upgrade on core 2 was higher for anterior lesions (p < .001) and lesions with a higher PI-RADS score (p = .007); the frequency of upgrade on core 3 was higher for apical lesions (p = .01) and lesions with a higher PI-RADS score (p = .01). Sampling of a second lesion resulted in an upgrade in a single patient (2.5%; 1/40); both lesions were PI-RADS category 4 and showed csPCa. CONCLUSION. When performing in-gantry MRGB of the prostate, obtaining three cores from the primary lesion is warranted to optimize csPCa diagnosis. Obtaining a fourth core from the primary lesion or sampling a second lesion has very low yield in upgrading cancer diagnoses. CLINICAL IMPACT. To reduce patient discomfort and procedure times, operators may refrain from obtaining more than three cores or second lesion sampling.
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Zhou Z, Zhou Y, Yan W, Sun H, Li Q, Li H, Ji Z. Unilateral lesion detected on preoperative multiparametric magnetic resonance imaging and MRI/US fusion-guided prostate biopsy is not an appropriate indication for focal therapy in prostate cancer. Urol Oncol 2021; 39:730.e17-730.e22. [PMID: 34175215 DOI: 10.1016/j.urolonc.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/03/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to investigate if preoperative assessments of multiparametric magnetic resonance imaging (mpMRI) and Magnetic resonance imaging /ultrasound (MRI/US) fusion-guided prostate biopsy could be used to guide focal therapy for prostate cancer. MATERIALS AND METHODS A total of 101 prostate cancer patients undergoing radical prostatectomy were included. Preoperative findings included mpMRI and MRI/US fusion-guided prostate biopsy, while postoperative whole mount pathology was based on surgical specimen. RESULTS Of the 101 patients preoperatively diagnosed with a unilateral tumor, postoperative whole mount pathology showed 73.27% were bilateral tumors, and 71.62% of bilateral lesions were clinically significant. Comparison between preoperative and postoperative findings, the correct rate of preoperative mpMRI on the lesion side (left or right) was only 20.79%. As for the Gleason score, the correct rate of preoperative MRI/US fusion-guided prostate pathology was 67.33%. Judging from postoperative whole mount pathology, 47.52% of patients had a unilateral clinically significant tumor, which is an indication for focal therapy. CONCLUSION Preoperative examinations of mpMRI and MRI/US fusion-guided prostate biopsy cannot be used to guide focal therapy for prostate cancer.
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Affiliation(s)
- Zhien Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qianyue Li
- Department of Urology, General Hospital of Xinjiang Production and Construction Corps, Xinjiang, China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Hur S, Tzeng M, Cricco-Lizza E, Basourakos S, Yu M, Ancker J, Abramson E, Saigal C, Ross A, Hu J. Perceptions of partial gland ablation for prostate cancer among men on active surveillance: A qualitative study. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2021; 3:e000068. [PMID: 34458727 PMCID: PMC8388575 DOI: 10.1136/bmjsit-2020-000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/18/2021] [Accepted: 04/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES – Partial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS). DESIGN – 92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semi-structured telephone interviews on PGA. SETTING – Single tertiary care center located in New York City. PARTICIPANTS – 20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews. MAIN OUTCOME MEASURES – Emerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology. RESULTS – Four themes were derived from twenty interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while 9 men (45%) expressed interest at the current moment. CONCLUSIONS – Though an emerging treatment modality, patients were broadly accepting of PGA for PCa with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men's preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.
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Affiliation(s)
- Sonia Hur
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Michael Tzeng
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Eliza Cricco-Lizza
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Spyridon Basourakos
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Miko Yu
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Jessica Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Erika Abramson
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Christopher Saigal
- Department of Urology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Ashley Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jim Hu
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
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11
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Djohossou M, Ben Halima A, Valérie A, Bert J, Visvikis D. Design and Kinematics of a Comanipulated Robot Dedicated to Prostate Brachytherapy. ROBOTICA 2021; 39:468-482. [DOI: 10.1017/s026357472000051x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARYIn brachytherapy, the manual implantation of seeds is not accurate leading to side effects and limiting the use of new procedures. Robotics solutions have to be fully suitable for medical applications especially considering the operating room. This paper investigates a delta robot solution for improving the accuracy of the prostate brachytherapy procedure by proposing a compact and lightweight robot. In addition, the design was thought as a comanipulated robot for a better acceptability and human–machine interaction. The robot kinematics and singularities were determined and the theoretical capability in term of resolution and force feedback was evaluated. A prototype was built in order to experimentally measure the capability of this first prototype.
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12
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Flegar L, Buerk B, Proschmann R, Propping S, Groeben C, Baunacke M, Herout R, Huber J, Thomas C, Borkowetz A. Vascular-targeted Photodynamic Therapy in Unilateral Low-risk Prostate Cancer in Germany: 2-yr Single-centre Experience in a Real-world Setting Compared with Radical Prostatectomy. Eur Urol Focus 2021; 8:121-127. [PMID: 33602642 DOI: 10.1016/j.euf.2021.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/27/2020] [Accepted: 01/25/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Vascular-targeted photodynamic therapy (VTP) is an approved treatment option for unilateral low-risk prostate cancer (PCa). OBJECTIVE Herein, we report our initial experience of patients treated by VTP. We compared short-term functional and oncological outcomes with those of a consecutive cohort of patients undergoing radical prostatectomy (RP) for unilateral low-risk PCa. DESIGN, SETTING, AND PARTICIPANTS Patients with unilateral low-risk PCa undergoing VTP (n = 41) and RP (n = 49) were evaluated in a real-world setting. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Oncological outcome after VTP was measured by magnetic resonance imaging-based rebiopsy at 12 and 24 mo. Functional outcome after 1 yr was investigated by International Index of Erectile Function 5 and International Prostate Symptom Score questionnaires. Continence was evaluated by pad use. RESULTS AND LIMITATIONS In 12- and 24-mo control biopsy (n = 22) after VTP, 45% of VTP patients showed no evidence of PCa. Both low- and intermediate-risk PCa were detected in 27% of patients. None of the RP patients had a PCa recurrence. Of VTP and RP patients, 71% and 30%, respectively, preserved erectile function. Of VTP patients, 88% had no bladder outlet obstruction. Of RP patients, 96% and 4% used zero to one and two or more pads per day, respectively. Data acquisition was performed outside of a clinical trial. The short-term follow-up and the small number of rebiopsied patients have to be considered. CONCLUSIONS VTP is a promising treatment option in unilateral low-risk PCa presenting a lower complication profile than RP in a real-world setting. However, recurrence and progression after VTP are common in this low-risk PCa cohort, and have to be discussed critically with patients who wish VTP instead of active surveillance. Therefore, a rigorous surveillance strategy with multiparametric magnetic resonance imaging and control biopsy is required. PATIENT SUMMARY Vascular-targeted photodynamic therapy (VTP) is a promising therapy option in patients with unilateral low-risk prostate cancer. However, tumour recurrence has to be taken into account. Noninferiority of VTP to standard curative treatment options still has to be confirmed.
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Affiliation(s)
- Luka Flegar
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Björn Buerk
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rick Proschmann
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Propping
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christer Groeben
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Roman Herout
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Johannes Huber
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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13
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Cózar JM, Hernández C, Miñana B, Morote J, Alvarez-Cubero MJ. The role of prostate-specific antigen in light of new scientific evidence: An update in 2020. Actas Urol Esp 2021; 45:21-29. [PMID: 33408046 DOI: 10.1016/j.acuro.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review and update the latest scientific evidence gathered in recent years regarding prostate-specific antigen (PSA) for better implementation into routine clinical practice. EVIDENCE ACQUISITION Analysis of the available evidence on the current role of PSA, based on the experience of an expert panel in the subject under analysis. EVIDENCE SYNTHESIS Currently, PSA cannot be considered only as a guide for the presence or absence of prostate cancer. This determination can also help the urologist to decide on the most convenient treatment for a patient with benign prostatic hypertrophy (BPH) as a criterion for disease progression, and it can also suggest the suspicious existence of a prostatic tumor when there is PSA rise of>0.3 ng/ml over the level reached 6 months after having initiated treatment with 5-alpha-reductase inhibitor. However, the limits of this PSA rise with derivatives of alternative 5-alpha-reductase (5-ARI) inhibitors to dutasteride are controversial. Moreover, PSA is a key factor for the follow-up of patients with prostate adenocarcinoma at any stage who have received treatment (surgery, radiotherapy or focal therapies, hormone therapy), it acts as a guide to identify biochemical recurrence, to suspect the existence of local or distant recurrence, as well as to propose or discard adjuvant treatments. Finally, the role of PSA as a screening tool has been recently reinforced, demonstrating increased mortality rates or the existence of more aggressive cases of prostate cancer in those countries where the use of this tool has declined. CONCLUSIONS We present new data about the current role of PSA in the management of patients treated for BPH and/or prostate cancer that should be implemented into routine clinical practice, with special emphasis on the relevant role of this biomarker in the screening and follow-up of prostate cancer, as well as in the progression of BPH in dutasteride treatment.
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Affiliation(s)
- J M Cózar
- Servicio de Urología, Hospital Universitario Virgen de la Nieves, Granada, España; Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - C Hernández
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - B Miñana
- Servicio de Urología, Hospital CUN de Madrid, Madrid, España
| | - J Morote
- Servicio de Urología, Hospital Universitario Vall de Hebrón, Barcelona, España
| | - M J Alvarez-Cubero
- Departamento de Bioquímica y Biología Molecular e Inmunología, Facultad de Medicina, Universidad de Granada, Granada, España
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14
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Wake N, Rosenkrantz AB, Sodickson DK, Chandarana H, Wysock JS. MRI guided procedure planning and 3D simulation for partial gland cryoablation of the prostate: a pilot study. 3D Print Med 2020; 6:33. [PMID: 33141272 PMCID: PMC7607830 DOI: 10.1186/s41205-020-00085-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/25/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study reports on the development of a novel 3D procedure planning technique to provide pre-ablation treatment planning for partial gland prostate cryoablation (cPGA). METHODS Twenty men scheduled for partial gland cryoablation (cPGA) underwent pre-operative image segmentation and 3D modeling of the prostatic capsule, index lesion, urethra, rectum, and neurovascular bundles based upon multi-parametric MRI data. Pre-treatment 3D planning models were designed including virtual 3D cryotherapy probes to predict and plan cryotherapy probe configuration needed to achieve confluent treatment volume. Treatment efficacy was measured with 6 month post-operative MRI, serum prostate specific antigen (PSA) at 3 and 6 months, and treatment zone biopsy results at 6 months. Outcomes from 3D planning were compared to outcomes from a series of 20 patients undergoing cPGA using traditional 2D planning techniques. RESULTS Forty men underwent cPGA. The median age of the cohort undergoing 3D treatment planning was 64.8 years with a median pretreatment PSA of 6.97 ng/mL. The Gleason grade group (GGG) of treated index lesions in this cohort included 1 (5%) GGG1, 11 (55%) GGG2, 7 (35%) GGG3, and 1 (5%) GGG4. Two (10%) of these treatments were post-radiation salvage therapies. The 2D treatment cohort included 20 men with a median age of 68.5 yrs., median pretreatment PSA of 6.76 ng/mL. The Gleason grade group (GGG) of treated index lesions in this cohort included 3 (15%) GGG1, 8 (40%) GGG2, 8 (40%) GGG3, 1 (5%) GGG4. Two (10%) of these treatments were post-radiation salvage therapies. 3D planning predicted the same number of cryoprobes for each group, however a greater number of cryoprobes was used in the procedure for the prospective 3D group as compared to that with 2D planning (4.10 ± 1.37 and 3.25 ± 0.44 respectively, p = 0.01). At 6 months post cPGA, the median PSA was 1.68 ng/mL and 2.38 ng/mL in the 3D and 2D cohorts respectively, with a larger decrease noted in the 3D cohort (75.9% reduction noted in 3D cohort and 64.8% reduction 2D cohort, p 0.48). In-field disease detection was 1/14 (7.1%) on surveillance biopsy in the 3D cohort and 3/14 (21.4%) in the 2D cohort, p = 0.056) In the 3D cohort, 6 month biopsy was not performed in 4 patients (20%) due to undetectable PSA, negative MRI, and negative MRI Axumin PET. For the group with traditional 2D planning, treatment zone biopsy was positive in 3/14 (21.4%) of the patients, p = 0.056. CONCLUSIONS 3D prostate cancer models derived from mpMRI data provide novel guidance for planning confluent treatment volumes for cPGA and predicted a greater number of treatment probes than traditional 2D planning methods. This study prompts further investigation into the use of 3D treatment planning techniques as the increase of partial gland ablation treatment protocols develop.
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Affiliation(s)
- Nicole Wake
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA. .,Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Andrew B Rosenkrantz
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel K Sodickson
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - James S Wysock
- Division of Urologic Oncology, Department of Urology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
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15
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Amirrad F, Pytak PA, Sadeghiani-Pelar N, Nguyen JPT, Cauble EL, Jones AC, Bisoffi M. Prostate field cancerization and exosomes: Association between CD9, early growth response 1 and fatty acid synthase. Int J Oncol 2020; 56:957-968. [PMID: 32319557 DOI: 10.3892/ijo.2020.4980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/23/2020] [Indexed: 11/06/2022] Open
Abstract
Intracapsular and well‑defined adenocarcinomas of the prostate are often surrounded by tissue areas that harbor molecular aberrations, including those of genetic, epigenetic and biochemical nature. This is known as field cancerization, or a field effect and denotes a state of pre‑malignancy. Such alterations in histologically normal tumor‑adjacent prostatic tissues have been recognized as clinically important and are potentially exploitable as biomarkers of disease and/or targets for preventative/therapeutic intervention. The authors have previously identified and validated two protein markers of field cancerization: The expressional upregulation of the transcription factor early growth response 1 (EGR‑1) and the lipogenic enzyme fatty acid synthase (FASN). However, the molecular etiology of prostate field cancerization, including EGR‑1 and FASN upregulation, remains largely unknown. It was thus hypothesized that extracellular vesicles, notably exosomes, released by tumor lesions may induce molecular alterations in the surrounding tissues, resulting in field cancerization, priming the tissue, and ultimately promoting multifocal tumorigenesis, which is often observed in prostate cancer. Towards testing this hypothesis, the current study, to the best of our knowledge, for the first time, presents correlative protein expression data, generated in disease‑free, tumor‑adjacent and cancerous human prostate tissues by quantitative immunofluorescence, between the exosomal marker CD9, and EGR‑1 and FASN. Despite the pilot character of the present study, and the static nature and heterogeneity of human tissues, the data suggest that CD9 expression itself is part of a field effect. In support of this hypothesis, the results suggest a possible contribution of exosomes to the induction of field cancerization in the prostate, particularly for EGR‑1. These findings were corroborated in established cell models of cancerous (LNCaP) and non‑cancerous (RWPE‑1) human prostate epithelial cells. The findings of this study warrant further investigation into the functional interface between exosomes and field cancerization, as a detailed understanding of this characterization may lead to the development of clinical applications related to diagnosis and/or prognosis and targeted intervention to prevent progression from pre‑malignancy to cancer.
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Affiliation(s)
- Farideh Amirrad
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, Irvine, CA 92618, USA
| | - Philip A Pytak
- Division of Chemistry and Biochemistry, Chapman University Schmid College of Science and Technology, Keck Center for Science and Engineering, Orange, CA 92866, USA
| | - Neda Sadeghiani-Pelar
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, Irvine, CA 92618, USA
| | - Julie P T Nguyen
- Division of Chemistry and Biochemistry, Chapman University Schmid College of Science and Technology, Keck Center for Science and Engineering, Orange, CA 92866, USA
| | - Emily L Cauble
- Division of Biological Sciences, Chapman University Schmid College of Science and Technology, Keck Center for Science and Engineering, Orange, CA 92866, USA
| | - Anna C Jones
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA
| | - Marco Bisoffi
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Harry and Diane Rinker Health Science Campus, Irvine, CA 92618, USA
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16
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Persistent Discordance in Grade, Stage, and NCCN Risk Stratification in Men Undergoing Targeted Biopsy and Radical Prostatectomy. Urology 2020; 135:117-123. [DOI: 10.1016/j.urology.2019.07.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022]
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17
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Ruiqing LMD, Yaqiong LP, Bing MMD, Na LP, Shaobo DMD, Zhiyang CMS, Ye ZMS, Shuaiyang WMS, Lianzhong ZMD. Focal Ablation Therapy for Prostate Cancer: A Literature Review. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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18
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Baladakis J, Perera M, Bolton D, Lawrentschuk N, Adam A. Is There an Optimal Curative Option in HIV-Positive Men with Localized Prostate Cancer? A Systematic Review. Curr Urol 2019; 12:169-176. [PMID: 31602182 DOI: 10.1159/000499309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/10/2017] [Indexed: 12/30/2022] Open
Abstract
Aims We aimed to compare the outcome of curative treatment options in localised Prostate Cancer (PCa) amongst HIV positive (HIV+) men. Methods A systematic search of the Cochrane Library of Systematic Reviews, the Scopus and PubMed databases was performed (January 1995 to November 2015) using pre-determined search terms. Outcome measures for comparison included the rate of biochemical failure (BCF), survival benefit and complications. Results A total of 14 eligible articles were identified for inclusion, representing a total of 202 HIV+ men with PCa. Radical Prostatectomy was performed in 40/153 compared to 109/153 patients undergoing alternative (non-surgical) treatments options. Only 3 studies compared outcomes within their respective study cohort. One study (n = 10) reported BCF results with 1/2 BCF patient in the surgical arm vs. 1/8 BCF positive patients in the non-surgical arm (mean 46 months follow-up), while two other studies reported no occurrences of BCF within both arms of their studies. Conclusion Due to paucity in the literature, there is insufficient evidence to support a certain treatment modality arm specifically for HIV+ men with localized PCa. An individualized management algorithm seems feasible within this cohort, until more definitive studies are performed.
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Affiliation(s)
- John Baladakis
- Department of Urology, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Division of Urology, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC.,Department of Surgery, University of Queensland, Brisbane, QLD
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC.,Olivia-Newton John Cancer Centre, University of Melbourne, Melbourne, VIC
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC.,Olivia-Newton John Cancer Centre, University of Melbourne, Melbourne, VIC.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ahmed Adam
- Department of Urology, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Division of Urology, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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19
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Alvim R, Nagar K, Das S, Lebdai S, Wong N, Somma A, Hughes C, Thomas J, Monette S, Scherz A, Kim K, Grimm J, Coleman JA. Positron Emission Tomography/Computed Tomography with Gallium-68-labeled Prostate-specific Membrane Antigen Detects Relapse After Vascular-targeted Photodynamic Therapy in a Prostate Cancer Model. Eur Urol Focus 2019; 7:472-478. [PMID: 31227464 DOI: 10.1016/j.euf.2019.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/10/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evaluating the efficacy of focal therapy for prostate cancer is limited by current approaches and may be improved with biological imaging techniques. OBJECTIVE We assessed whether positron emission tomography/computed tomography with gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA PET/CT) can be used to predict relapse after vascular-targeted photodynamic therapy (VTP). DESIGN, SETTING, AND PARTICIPANTS A total of 1×106 LNCaP cells were grafted subcutaneously in the flanks of 6-8-wk-old SCID mice. Of 24 mice with measurable tumors 6 wk after tumor implantation, 20 were treated with VTP (150mW/cm2) to ablate the tumors. Blood prostate-specific antigen (PSA) levels were assessed, and ⁶⁸Ga-PSMA PET/CT images were performed 1 d before VTP and 1 and 4 wk after. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Local tumor relapse was evaluated by histology, and tumors were analyzed by prostate-specific membrane antigen (PSMA) and PSA immunohistochemistry. T tests and Kruskal-Wallis tests were used to determine significance. RESULTS AND LIMITATIONS Four weeks after VTP, 11 (65%) mice had complete responses and six (35%) had tumor relapses confirmed by histology (hematoxylin and eosin, and PSMA immunohistochemistry). All mice with local relapse had positive 68Ga-PSMA PET/CT findings 4 wk after VTP; all complete responders did not. One week after VTP, the relapse detection sensitivity of 68Ga-PSMA PET/CT was 75%, whereas the sensitivity of PSA was only 33%. Compared with controls, relapsed tumors had a three-fold reduction in the number of cells with strong PSA staining by immunohistochemistry (1.5% vs 4.5%; p=0.01). CONCLUSIONS In a preclinical prostate cancer model, we show that 68Ga-PSMA PET/CT can identify and predict relapse earlier than blood PSA level. These findings support further testing in clinical trials. PATIENT SUMMARY Positron emission tomography/computed tomography with gallium-68-labeled prostate-specific membrane antigen may be used to follow and evaluate treatment outcomes in men who receive focal therapy for prostate cancer.
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Affiliation(s)
- Ricardo Alvim
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karan Nagar
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sudeep Das
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Souhil Lebdai
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nathan Wong
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Somma
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher Hughes
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jasmine Thomas
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sébastien Monette
- Laboratory of Comparative Pathology, Memorial Sloan Kettering Cancer Center, The Rockefeller University, Weill Cornell Medicine, New York, NY, USA
| | - Avigdor Scherz
- Department of Plant and Environmental Sciences, The Weizmann Institute of Science, Rehovot, Israel
| | - Kwanghee Kim
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jan Grimm
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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20
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AICAR Induces Apoptosis and Inhibits Migration and Invasion in Prostate Cancer Cells Through an AMPK/mTOR-Dependent Pathway. Int J Mol Sci 2019; 20:ijms20071647. [PMID: 30987073 PMCID: PMC6480054 DOI: 10.3390/ijms20071647] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 03/21/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023] Open
Abstract
Current clinical challenges of prostate cancer management are to restrict tumor growth and prohibit metastasis. AICAR (5-aminoimidazole-4-carbox-amide-1-β-d-ribofuranoside), an AMP-activated protein kinase (AMPK) agonist, has demonstrated antitumor activities for several types of cancers. However, the activity of AICAR on the cell growth and metastasis of prostate cancer has not been extensively studied. Herein we examine the effects of AICAR on the cell growth and metastasis of prostate cancer cells. Cell growth was performed by MTT assay and soft agar assay; cell apoptosis was examined by Annexin V/propidium iodide (PI) staining and poly ADP ribose polymerase (PARP) cleavage western blot, while cell migration and invasion were evaluated by wound-healing assay and transwell assay respectively. Epithelial–mesenchymal transition (EMT)-related protein expression and AMPK/mTOR-dependent signaling axis were analyzed by western blot. In addition, we also tested the effect of AICAR on the chemosensitivity to docetaxel using MTT assay. Our results indicated that AICAR inhibits cell growth in prostate cancer cells, but not in non-cancerous prostate cells. In addition, our results demonstrated that AICAR induces apoptosis, attenuates transforming growth factor (TGF)-β-induced cell migration, invasion and EMT-related protein expression, and enhances the chemosensitivity to docetaxel in prostate cancer cells through regulating the AMPK/mTOR-dependent pathway. These findings support AICAR as a potential therapeutic agent for the treatment of prostate cancer.
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Jensen C, Carl J, Boesen L, Langkilde NC, Østergaard LR. Assessment of prostate cancer prognostic Gleason grade group using zonal-specific features extracted from biparametric MRI using a KNN classifier. J Appl Clin Med Phys 2019; 20:146-153. [PMID: 30712281 PMCID: PMC6370983 DOI: 10.1002/acm2.12542] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/27/2018] [Accepted: 01/11/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose To automatically assess the aggressiveness of prostate cancer (PCa) lesions using zonal‐specific image features extracted from diffusion weighted imaging (DWI) and T2W MRI. Methods Region of interest was extracted from DWI (peripheral zone) and T2W MRI (transitional zone and anterior fibromuscular stroma) around the center of 112 PCa lesions from 99 patients. Image histogram and texture features, 38 in total, were used together with a k‐nearest neighbor classifier to classify lesions into their respective prognostic Grade Group (GG) (proposed by the International Society of Urological Pathology 2014 consensus conference). A semi‐exhaustive feature search was performed (1–6 features in each feature set) and validated using threefold stratified cross validation in a one‐versus‐rest classification setup. Results Classifying PCa lesions into GGs resulted in AUC of 0.87, 0.88, 0.96, 0.98, and 0.91 for GG1, GG2, GG1 + 2, GG3, and GG4 + 5 for the peripheral zone, respectively. The results for transitional zone and anterior fibromuscular stroma were AUC of 0.85, 0.89, 0.83, 0.94, and 0.86 for GG1, GG2, GG1 + 2, GG3, and GG4 + 5, respectively. CONCLUSION This study showed promising results with reasonable AUC values for classification of all GG indicating that zonal‐specific imaging features from DWI and T2W MRI can be used to differentiate between PCa lesions of various aggressiveness.
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Affiliation(s)
- Carina Jensen
- Department of Medical Physics, Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Carl
- Department of Oncology, Naestved Sygehus, Zealand University Hospital, Roskilde, Denmark
| | - Lars Boesen
- Department of Urology, Herlev Gentofte University Hospital, Herlev, Denmark
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Choi YH, Yu JW, Kang MY, Sung HH, Jeong BC, Seo SI, Jeon SS, Lee HM, Jeon HG. Combination of multiparametric magnetic resonance imaging and transrectal ultrasound-guided prostate biopsies is not enough for identifying patients eligible for hemiablative focal therapy for prostate cancer. World J Urol 2019; 37:2129-2135. [DOI: 10.1007/s00345-018-02617-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023] Open
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Demirel CH, Altok M, Davis JW. Focal therapy for localized prostate cancer: is there a "middle ground" between active surveillance and definitive treatment? Asian J Androl 2018; 21:240302. [PMID: 30178774 PMCID: PMC6337958 DOI: 10.4103/aja.aja_64_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/12/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their "middle ground" place between definitive therapies and active follow-up.
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Affiliation(s)
- Cihan H Demirel
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Muammer Altok
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Is Prostate Imaging Reporting and Data System Version 2 Sufficiently Discovering Clinically Significant Prostate Cancer? Per-Lesion Radiology-Pathology Correlation Study. AJR Am J Roentgenol 2018; 211:114-120. [DOI: 10.2214/ajr.17.18684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Lu J, Dong W, He H, Han Z, Zhuo Y, Mo R, Liang Y, Zhu J, Li R, Qu H, Zhang L, Wang S, Ma R, Jia Z, Zhong W. Autophagy induced by overexpression of DCTPP1 promotes tumor progression and predicts poor clinical outcome in prostate cancer. Int J Biol Macromol 2018; 118:599-609. [PMID: 29874556 DOI: 10.1016/j.ijbiomac.2018.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/21/2018] [Accepted: 06/02/2018] [Indexed: 01/15/2023]
Abstract
Although dCTP pyrophosphatase 1 (DCTPP1) has been reported to be associated with poor clinical outcomes in various cancers, whether it plays an important role in prostate cancer (PCa) remains unclear. In this study, an immunohistochemical assay showed the protein expression level of DCTPP1 was significantly higher in PCa tissues than in non-cancerous tissues. Moreover, DCTPP1 was upregulated at both protein and mRNA levels in the PCa tissues from high Gleason score patients versus low Gleason score patients. The analysis of The Cancer Genome Atlas RNA-seq data suggested that upregulation of DCTPP1 was inversely correlated with biochemical recurrence free survival and overall survival. The roles of DCTPP1 in tumor progression and autophagy were further validated through cells invasion, migration, apoptosis and proliferation assays in vitro, as well as EMT and autophagy assays in vivo. Advanced bioinformatics analysis identified the evidence supporting the promotional role of DCTPP1 in tumor progression associated with autophagy. We conclude that DCTPP1 may play an important role in PCa progression associated with high autophagy. Overexpression of DCTPP1 may server as a biomarker for predicting poor BCR-free survival and overall survival for PCa patients.
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Affiliation(s)
- Jianming Lu
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China; Department of Botany and Plant Sciences, University of California, Riverside 92507, USA
| | - Weimin Dong
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China; Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510230, China
| | - Huichan He
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China; Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510230, China
| | - Zhaodong Han
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China
| | - YangJia Zhuo
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China
| | - RuJun Mo
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China
| | - Yingke Liang
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China
| | - JianGuo Zhu
- Department of Urology, Guizhou Provincial People's Hospital, The Affiliated Hospital of Guizhou Medicine University, Guiyang, Guizhou Province 550002, China
| | - Ruidong Li
- Department of Botany and Plant Sciences, University of California, Riverside 92507, USA
| | - Han Qu
- Department of Botany and Plant Sciences, University of California, Riverside 92507, USA
| | - Le Zhang
- Department of Botany and Plant Sciences, University of California, Riverside 92507, USA
| | - Shibo Wang
- Department of Botany and Plant Sciences, University of California, Riverside 92507, USA
| | - Renyuan Ma
- Department of Botany and Plant Sciences, University of California, Riverside 92507, USA; Department of Mathematics, Bowdoin College, Brunswick, ME 04011, USA
| | - Zhenyu Jia
- Department of Botany and Plant Sciences, University of California, Riverside 92507, USA.
| | - Weide Zhong
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China; Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510230, China.
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Kumar V, Bora GS, Kumar R, Jagannathan NR. Multiparametric (mp) MRI of prostate cancer. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2018; 105:23-40. [PMID: 29548365 DOI: 10.1016/j.pnmrs.2018.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/17/2018] [Accepted: 01/28/2018] [Indexed: 06/08/2023]
Abstract
Prostate cancer (PCa) is one of the most prevalent cancers in men. A large number of men are detected with PCa; however, the clinical behavior ranges from low-grade indolent tumors that never develop into a clinically significant disease to aggressive, invasive tumors that may rapidly progress to metastatic disease. The challenges in clinical management of PCa are at levels of screening, diagnosis, treatment, and follow-up after treatment. Magnetic resonance imaging (MRI) methods have shown a potential role in detection, localization, staging, assessment of aggressiveness, targeting biopsies, etc. in PCa patients. Multiparametric MRI (mpMRI) is emerging as a better option compared to the individual imaging methods used in the evaluation of PCa. There are attempts to improve the reproducibility and reliability of mpMRI by using an objective scoring system proposed in the prostate imaging reporting and data system (PIRADS) for standardized reporting. Prebiopsy mpMRI may be used to detect PCa in men with elevated prostate-specific antigen or abnormal digital rectal examination and to enable targeted biopsies. mpMRI can also be used to decide on clinical management of patients, for example active surveillance, and may help in detecting only the pathology that requires detection. It can potentially not only guide patient selection for initial and repeat biopsy but also reduce false-negative biopsies. This review presents a description of the MR methods most commonly applied for investigations of prostate. The anatomical, functional and metabolic parameters obtained from these MR methods are discussed with regard to their physical basis and their contribution to mpMRI investigations of PCa.
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Affiliation(s)
- Virendra Kumar
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | - Girdhar S Bora
- Department of Urology, Post-Graduate Institute of Medical Sciences, Chandigarh 160012, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Naranamangalam R Jagannathan
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Demirel HC, Davis JW. Multiparametric magnetic resonance imaging: Overview of the technique, clinical applications in prostate biopsy and future directions. Turk J Urol 2018; 44:93-102. [PMID: 29511576 PMCID: PMC5832385 DOI: 10.5152/tud.2018.56056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 12/23/2022]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) has managed to change the paradigms on prostate cancer detection and risk classification. The most clear-cut indication of mpMRI in guidelines is the patients with a history of negative biopsy/increasing prostate-specific antigen (PSA), and presence of additional findings supporting its use in non biopsied patients and active surveillance. mpMRI complements standard clinical exam, PSA measurements, and systematic biopsy, and will miss some tumors that lack enough size or change in tissue density. Use of mpMRI is likely to increase, and further developments in the technique will be important for safe adoption of focal therapy concepts. Here we present a brief summary about mpMRI and its use in detection, risk classification and follow-up of prostate cancer.
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Nassiri N, Chang E, Lieu P, Priester AM, Margolis DJA, Huang J, Reiter RE, Dorey FJ, Marks LS, Natarajan S. Focal Therapy Eligibility Determined by Magnetic Resonance Imaging/Ultrasound Fusion Biopsy. J Urol 2018; 199:453-458. [PMID: 28830754 PMCID: PMC5780241 DOI: 10.1016/j.juro.2017.08.085] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE We assessed focal therapy eligibility in men who underwent multiparametric magnetic resonance imaging and targeted biopsy with correlation to whole mount histology after radical prostatectomy. MATERIALS AND METHODS Subjects were selected from among the 454 men in whom targeted biopsy proven prostate cancer was derived from regions of interest on multiparametric magnetic resonance imaging from 2010 to 2016. Focal therapy eligibility was limited to a maximum Gleason score of 4 + 3 in regions of interest with or without other foci of low risk prostate cancer (Gleason score 3 + 3 and less than 4 mm). Men who did not meet NCCN® intermediate risk criteria were classified as ineligible for focal therapy. Of the 454 men 64 underwent radical prostatectomy and biopsy findings were compared to final pathology findings. RESULTS Of the 454 men with a biopsy proven region of interest 175 (38.5%) were eligible for focal therapy. Fusion biopsy, which combined targeted and template biopsy, had 80.0% sensitivity (12 of 15 cases), 73.5% specificity (36 of 49) and 75.0% accuracy (48 of 64) for focal therapy eligibility. Targeted cores alone yielded 73.3% sensitivity (11 of 15 cases), 47.9% specificity (23 of 48) and 54.7% accuracy (35 of 64). Gleason score and extension across the midline differed in 4 and 9, respectively, of the 13 cases that showed discordant biopsy and whole mount histology. CONCLUSIONS Using intermediate risk eligibility criteria more than a third of men with a targeted biopsy proven lesion identified on multiparametric magnetic resonance imaging would have been eligible for focal therapy. Eligibility determined by fusion biopsy was concordant with whole mount histology in 75% of cases. Improved selection criteria are needed to reliably determine focal therapy eligibility.
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Affiliation(s)
- Nima Nassiri
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Edward Chang
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California
| | - Daniel J A Margolis
- Department of Radiology, Weill Cornell at New York Presbyterian, New York, New York
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Frederick J Dorey
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Shyam Natarajan
- Department of Urology, David Geffen School of Medicine, Los Angeles, California; Department of Bioengineering, University of California-Los Angeles, Los Angeles, California.
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Winoker JS, Anastos H, Rastinehad AR. Targeted Ablative Therapies for Prostate Cancer. Cancer Treat Res 2018; 175:15-53. [PMID: 30168116 DOI: 10.1007/978-3-319-93339-9_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Men diagnosed with low- to intermediate-risk, clinically localized prostate cancer (PCa) often face a daunting and difficult decision with respect to treatment: active surveillance (AS) or radical therapy. This decision is further confounded by the fact that many of these men diagnosed, by an elevated PSA, will have indolent disease and never require intervention. Radical treatments, including radical prostatectomy and whole-gland radiation, offer greater certainty for cancer control, but at the risk of significant urinary and/or sexual morbidity. Conversely, AS preserves genitourinary function and quality of life in exchange for burdensome surveillance and the psychological impact of living with cancer.
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Affiliation(s)
- Jared S Winoker
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Harry Anastos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ardeshir R Rastinehad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA. .,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA.
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Barrier A, Ouzzane A, Villers A. Rôle de l’IRM prostatique dans le cancer de la prostate en 2016: mise au point et perspectives d’avenir. AFRICAN JOURNAL OF UROLOGY 2017. [DOI: 10.1016/j.afju.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
The target of focal therapy (FT) in prostate cancer (PC) is partial treatment of the prostate aiming at preserving surrounding anatomical structures. The intention is to minimize typical side effects of radical treatment options combined with local tumor control. Numerous established and new technologies are used. Results of published studies showed a good safety profile, few side effects and good preservation of functional results. Oncologic long-term data are lacking so far. Photodynamic therapy (PDT) is the only technology that has been studied in a published prospective randomized trial. The FT is challenged by the multifocality of PC; therefore, the quality of prostate biopsy, histopathological assessment as well as imaging are of paramount importance. Multiparametric magnetic resonance imaging (MRI) has gained increasing importance. The FT is experimental and should only be offered within clinical trials.
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Couñago F, Sancho G, Catalá V, Hernández D, Recio M, Montemuiño S, Hernández JA, Maldonado A, del Cerro E. Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know. World J Clin Oncol 2017; 8:305-319. [PMID: 28848697 PMCID: PMC5554874 DOI: 10.5306/wjco.v8.i4.305] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/30/2017] [Accepted: 06/12/2017] [Indexed: 02/06/2023] Open
Abstract
External beam radiotherapy (EBRT) is one of the principal curative treatments for patients with prostate cancer (PCa). Risk group classification is based on prostate-specific antigen (PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging (MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI (mpMRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrast-enhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpMRI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decision-making for EBRT. mpMRI is also being used in salvage radiotherapy (SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence - pelvic (local, nodal, or bone) or distant - in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpMRI in detecting local recurrences - even in patients with low PSA levels (0.3-0.5 ng/mL) - and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpMRI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.
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Andras I, Crisan N, Vesa S, Rahota R, Romanciuc F, Lazar A, Socaciu C, Matei DV, de Cobelli O, Bocsan IS, Coman RT. Serum metabolomics can predict the outcome of first systematic transrectal prostate biopsy in patients with PSA <10 ng/ml. Future Oncol 2017; 13:1793-1800. [PMID: 28776421 DOI: 10.2217/fon-2017-0078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
AIM To assess the predictive value of metabolomic analysis for the presence of prostate cancer (PCa) at first systematic biopsy. PATIENTS & METHODS Ninety serum samples from patients with suspicion for PCa were included. Targeted and nontargeted metabolomic analysis was performed. RESULTS Six metabolites were combined into a predictive score. A cutoff value of 0.528 for the metabolomic score showed a good accuracy for the prediction of PCa at biopsy (Area under the curve (AUC): 0.779; p < 0.001). These results were validated in a subgroup of patients, showing similar accuracy (p = 0.1). For patients with prostate specific antigen (PSA) less than 10 ng/ml, the score showed a Se 80.95%, Sp 64.52% for the detection of PCa at biopsy. CONCLUSION Metabolomic analysis can predict the outcome of the first systematic biopsy.
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Affiliation(s)
- Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania.,Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania.,Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Stefan Vesa
- Department of Pharmacology, Toxicology & Clinical Pharmacology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Razvan Rahota
- Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Florina Romanciuc
- Center for Applied Biotechnology BIODIATECH, SC Proplanta, Cluj-Napoca, Romania
| | - Andrei Lazar
- Center for Applied Biotechnology BIODIATECH, SC Proplanta, Cluj-Napoca, Romania
| | - Carmen Socaciu
- Center for Applied Biotechnology BIODIATECH, SC Proplanta, Cluj-Napoca, Romania
| | | | | | - Ioan-Stelian Bocsan
- Department of Epidemiology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Radu-Tudor Coman
- Department of Epidemiology, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
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Jadvar H. Multimodal Imaging in Focal Therapy Planning and Assessment in Primary Prostate Cancer. Clin Transl Imaging 2017; 5:199-208. [PMID: 28713796 DOI: 10.1007/s40336-017-0228-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE There is increasing interest in focal therapy (male lumpectomy) of localized low-intermediate risk prostate cancer. Focal therapy is typically associated with low morbidity and provides the possibility of retreatment. Imaging is pivotal in stratification of men with localized prostate cancer for active surveillance, focal therapy or radical intervention. This article provides a concise review of focal therapy and the evolving role of imaging in this clinical setting. METHODS We performed a narrative and critical literature review by searching PubMed/Medline database from January 1997 to January 2017 for articles in the English language and the use of search keywords "focal therapy", "prostate cancer", and "imaging". RESULTS Most imaging studies are based on multiparametric magnetic resonance imaging. Transrectal ultrasound is inadequate independently but multiparametric ultrasound may provide new prospects. Positron emission tomography with radiotracers targeted to various underlying tumor biological features may provide unprecedented new opportunities. Multimodal Imaging appears most useful in localization of intraprostatic dominant index lesions amenable to focal therapy, in early assessment of therapeutic efficacy and potential need for additional focal treatments or transition to whole-gland therapy, and in predicting short-term and long-term outcomes. CONCLUSION Multimodal imaging is anticipated to play an increasing role in the focal therapy planning and assessment of low-intermediate risk prostate cancer and thereby moving this form of treatment option forward in the clinic.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, University of Southern California, Los Angeles, California, USA
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Abstract
A successful paradigm shift toward personalized management strategies for patients with prostate cancer (PCa) is heavily dependent on the availability of noninvasive diagnostic tools capable of accurately establishing the true extent of disease at the time of diagnosis and estimating the risk of subsequent disease progression and related mortality. Although there is still considerable scope for improvement in its diagnostic, predictive, and prognostic capabilities, multiparametric prostate magnetic resonance imaging (MRI) is currently regarded as the imaging modality of choice for local staging of PCa. A negative MRI, that is, the absence of any MRI-visible intraprostatic lesion, has a high negative predictive value for the presence of clinically significant PCa and can substantiate the consideration of active surveillance as a preferred initial management approach. MRI-derived quantitative and semi-quantitative parameters can be utilized to noninvasively characterize MRI-visible prostate lesions and identify those patients who are most likely to benefit from radical treatment, and differentiate them from patients with benign or indolent prostate pathology that may also be visible on MRI. This literature review summarizes current strategies how MRI can be used to determine a tailored management strategy for an individual patient.
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Abstract
There is growing consensus that multiparametric magnetic resonance imaging (mpMRI) is an effective modality in the detection of locally recurrent prostate cancer after prostatectomy and radiation therapy. The emergence of magnetic resonance (MR)-guided focal therapies, such as cryoablation, high-intensity focused ultrasound, and laser ablation, have made the use of mpMRI even more important, as the normal anatomy is inevitably altered and the detection of recurrence is made more difficult. The aim of this article is to review the utility of mpMRI in detecting recurrent prostate cancer in patients following radical prostatectomy, radiation therapy, and focal therapy and to discuss expected post-treatment mpMRI findings, the varied appearance of recurrent tumors, and their mimics.
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High expression of ASPM correlates with tumor progression and predicts poor outcome in patients with prostate cancer. Int Urol Nephrol 2017; 49:817-823. [DOI: 10.1007/s11255-017-1545-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/10/2017] [Indexed: 02/04/2023]
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Rhee H, Thomas P, Shepherd B, Gustafson S, Vela I, Russell P, Nelson C, Chung E, Wood G, Malone G, Wood S, Heathcote P. Prostate Specific Membrane Antigen Positron Emission Tomography May Improve the Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Localized Prostate Cancer. J Urol 2016; 196:1261-7. [DOI: 10.1016/j.juro.2016.02.3000] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 12/12/2022]
Affiliation(s)
- H. Rhee
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
| | - P. Thomas
- Department of Nuclear Medicine, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - B. Shepherd
- Pathology Queensland, Princess Alexandra Hospital, Queensland, Australia
| | - S. Gustafson
- Department of Radiology, Princess Alexandra Hospital, Queensland, Australia
| | - I. Vela
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
| | - P.J. Russell
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
| | - C. Nelson
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
| | - E. Chung
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
| | - G. Wood
- Department of Urology, Greenslopes Private Hospital, Queensland, Australia
| | - G. Malone
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Department of Urology, Greenslopes Private Hospital, Queensland, Australia
| | - S. Wood
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Department of Urology, Greenslopes Private Hospital, Queensland, Australia
| | - P. Heathcote
- Department of Urology, Princess Alexandra Hospital, Queensland, Australia
- Department of Urology, Greenslopes Private Hospital, Queensland, Australia
- Australian Prostate Cancer Research Centre–Queensland, Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Princess Alexandra Hospital, Translational Research Institute, Queensland, Australia
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Perera M, Krishnananthan N, Lindner U, Lawrentschuk N. An update on focal therapy for prostate cancer. Nat Rev Urol 2016; 13:641-653. [DOI: 10.1038/nrurol.2016.177] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Villers A, Puech P, Flamand V, Haber GP, Desai MM, Crouzet S, Leroy X, Chopra S, Lemaitre L, Ouzzane A, Gill IS. Partial Prostatectomy for Anterior Cancer: Short-term Oncologic and Functional Outcomes. Eur Urol 2016; 72:333-342. [PMID: 27613061 DOI: 10.1016/j.eururo.2016.08.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Focal ablative therapy may be a suboptimal option for anterior prostate cancers (APCs) reaching the prostate apex due to concerns for thermal injury to the external sphincter. OBJECTIVE To explore the technical feasibility of anterior partial prostatectomy (APP) for isolated APCs detected by magnetic resonance imaging (MRI), and to report short-term oncologic and functional outcomes. DESIGN, SETTING, AND PARTICIPANTS Following institutional review board approval, over an 8-yr period (2008-2015) 17 consenting patients were enrolled in a prospective single-arm single-center Innovation, Development, Exploration, Assessment, Long-term (IDEAL) phase 2a study. Inclusion criteria comprised preurethral, low- to intermediate-risk APC diagnosed by MRI, and targeted biopsies. Robotic template APP was performed; posterolateral aspect of the submontanal urethra, peripheral zone, and periprostatic tissues were preserved intact. Median follow-up was 30 mo (interquartile range [IQR]: 25-70). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We noted the incidence of perioperative complications and examined reports of pathology, prostate-specific antigen (PSA), imaging, biopsies, and questionnaires. RESULTS AND LIMITATIONS Preoperatively, median PSA was 9.8 ng/ml, Gleason score was 6-7 (3 + 4), and cancer volume was 3.7cm3 (IQR: 1.7-4.6). The technique was feasible in all cases. Perioperative complications included anastomotic leak (12%; G2), urinary tract infection (6%; G2), and transient intestinal ileus in one case (6%; G2). At 3 mo, continence and potency rates were 100% and 83%, respectively. Median nadir PSA was 0.4 ng/ml (IQR: 0.3-0.7). All margins and posterolateral margins rates were 55% and 35%, respectively. APC recurrence-free survival at 2 yr was 0.86 (95% confidence interval [CI], 0.55-0.96). Four patients (24%) who recurred underwent an uncomplicated completion of robot-assisted prostatectomy. Regarding limitations, CIs are quite wide for reported outcomes. CONCLUSIONS Robotic partial prostatectomy for isolated APC is feasible with good functional results. While promising, much more research is needed to verify our initial outcomes and appropriately position APP in the treatment paradigms for APC. PATIENT SUMMARY We explored a novel approach for partial prostatic surgical ablation for prostate cancer located in the anterior part of the prostate as an alternative to other focal ablative techniques.
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Affiliation(s)
- Arnauld Villers
- Department of Urology, CHU Lille, Université de Lille, Lille, France; Inserm, U1189 - ONCO-THAI, CHRU Lille, Université de Lille, Lille, France.
| | - Philippe Puech
- Inserm, U1189 - ONCO-THAI, CHRU Lille, Université de Lille, Lille, France; Department of Radiology, CHU Lille, Université de Lille, Lille, France
| | - Vincent Flamand
- Department of Urology, CHU Lille, Université de Lille, Lille, France
| | | | - Mihir M Desai
- USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Sebastien Crouzet
- Urology and Transplantation Department, Edouard Herriot Hospital, Université de Lyon, Lyon, France
| | - Xavier Leroy
- Department of Pathology, CHU Lille, Université de Lille, Lille, France
| | - Sameer Chopra
- USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Laurent Lemaitre
- Inserm, U1189 - ONCO-THAI, CHRU Lille, Université de Lille, Lille, France; Department of Radiology, CHU Lille, Université de Lille, Lille, France
| | - Adil Ouzzane
- Department of Urology, CHU Lille, Université de Lille, Lille, France; Inserm, U1189 - ONCO-THAI, CHRU Lille, Université de Lille, Lille, France
| | - Inderbir S Gill
- USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA
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Gabriel KN, Jones AC, Nguyen JPT, Antillon KS, Janos SN, Overton HN, Jenkins SM, Frisch EH, Trujillo KA, Bisoffi M. Association and regulation of protein factors of field effect in prostate tissues. Int J Oncol 2016; 49:1541-1552. [PMID: 27634112 PMCID: PMC5021247 DOI: 10.3892/ijo.2016.3666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/08/2016] [Indexed: 12/16/2022] Open
Abstract
Field effect or field cancerization denotes the presence of molecular aberrations in structurally intact cells residing in histologically normal tissues adjacent to solid tumors. Currently, the etiology of prostate field‑effect formation is unknown and there is a prominent lack of knowledge of the underlying cellular and molecular pathways. We have previously identified an upregulated expression of several protein factors representative of prostate field effect, i.e., early growth response-1 (EGR‑1), platelet-derived growth factor‑A (PDGF‑A), macrophage inhibitory cytokine‑1 (MIC‑1), and fatty acid synthase (FASN) in tissues at a distance of 1 cm from the visible margin of intracapsule prostate adenocarcinomas. We have hypothesized that the transcription factor EGR‑1 could be a key regulator of prostate field‑effect formation by controlling the expression of PDGF‑A, MIC‑1, and FASN. Taking advantage of our extensive quantitative immunofluorescence data specific for EGR‑1, PDGF‑A, MIC‑1, and FASN generated in disease‑free, tumor‑adjacent, and cancerous human prostate tissues, we chose comprehensive correlation as our major approach to test this hypothesis. Despite the static nature and sample heterogeneity of association studies, we show here that sophisticated data generation, such as by spectral image acquisition, linear unmixing, and digital quantitative imaging, can provide meaningful indications of molecular regulations in a physiologically relevant in situ environment. Our data suggest that EGR‑1 acts as a key regulator of prostate field effect through induction of pro‑proliferative (PDGF‑A and FASN), and suppression of pro‑apoptotic (MIC‑1) factors. These findings were corroborated by computational promoter analyses and cell transfection experiments in non‑cancerous prostate epithelial cells with ectopically induced and suppressed EGR‑1 expression. Among several clinical applications, a detailed knowledge of pathways of field effect may lead to the development of targeted intervention strategies preventing progression from pre-malignancy to cancer.
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Affiliation(s)
- Kristin N Gabriel
- Biochemistry and Molecular Biology, Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | - Anna C Jones
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Julie P T Nguyen
- Biochemistry and Molecular Biology, Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | - Kresta S Antillon
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Sara N Janos
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Heidi N Overton
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Shannon M Jenkins
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Emily H Frisch
- Biochemistry and Molecular Biology, Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | - Kristina A Trujillo
- Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Marco Bisoffi
- Biochemistry and Molecular Biology, Schmid College of Science and Technology, Chapman University, Orange, CA, USA
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Horiuchi A, Muto S, Horie S. Holmium laser enucleation of the prostate followed by high-intensity focused ultrasound treatment for patients with huge prostate adenoma and localized prostate cancer: 5-Year follow-up. Prostate Int 2016; 4:49-53. [PMID: 27358843 PMCID: PMC4916062 DOI: 10.1016/j.prnil.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/12/2016] [Accepted: 01/17/2016] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) followed by high-intensity focused ultrasound (HIFU) for patients with huge prostate adenoma and localized prostate cancer (CaP) and compare the morbidity and efficacy results with those observed in a similar population treated only with HIFU for a follow-up period of up to 5 years. Methods The present retrospective study included 30 CaP patients who underwent HIFU alone and 10 patients who underwent HoLEP followed by HIFU. Selection criteria for this study were no previous treatment for CaP, aged 60 years or older, cT1c-T2N0M0, prostate volume of 30 mL or more, and a follow-up period of 5 years or more. Prostate-specific antigen (PSA) biochemical recurrence-free survival (RFS) rates and functional outcomes including complications and uroflowmetry after HIFU were compared between the HIFU monotherapy and HoLEP + HIFU groups. Results The enrolled patients had a mean age of 70.3 years and 68.8 years in the HIFU monotherapy and HoLEP + HIFU groups, respectively. The 5-year PSA biochemical RFS rates of the two groups were similar (HIFU monotherapy group: 57.2%; HoLEP + HIFU group: 67.5%). The duration of indwelling urethral catheter after HIFU significantly decreased in the HoLEP + HIFU group compared with the HIFU monotherapy group (15.5 ± 2.7 days vs. 27.5 ± 2.3 days, P = 0.022). In terms of functional outcomes, patients who received HoLEP + HIFU had significantly higher maximum (12 months: P = 0.015, 36 months: P = 0.014) and average (36 months: P = 0.002, 60 months: P = 0.047) flow rates than those who received HIFU monotherapy. The frequency of urethral stricture (13.3% vs. 0%), symptomatic urinary tract infection (10.0% vs. 0%), and bladder stone and urethrorectal fistula (3.3% vs. 0%) tended to be higher in the HIFU monotherapy group as compared with the HoLEP + HIFU group. Conclusion The HoLEP + HIFU treatment decreases urinary catheterization time and improves post-treatment urinary status without additional morbidity.
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Affiliation(s)
| | - Satoru Muto
- Department of Urology, Teikyo University, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Luo HW, Chen QB, Wan YP, Chen GX, Zhuo YJ, Cai ZD, Luo Z, Han ZD, Liang YX, Zhong WD. Protein regulator of cytokinesis 1 overexpression predicts biochemical recurrence in men with prostate cancer. Biomed Pharmacother 2016; 78:116-120. [PMID: 26898432 DOI: 10.1016/j.biopha.2016.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Protein regulator of cytokinesis 1 (PRC1) has been reported to be implicated into the completion of cytokinesis and is dys-regulated in a cancer-specific manner. However, it roles in human prostate cancer (PCa) remain unclear. In the current study, we aimed to investigate the expression pattern of PRC1 and its clinical significance in this malignancy. MATERIALS AND METHODS PRC1 protein expression in human PCa and non-cancerous prostate tissues was detected by immunohistochemistry, which was validated by microarray-based Taylor data at mRNA level. Then, the associations of PRC1 expression with clinicopathological features and clinical outcome of PCa patients were statistically analyzed. RESULTS PRC1 expression in PCa tissues, at both mRNA and protein levels, were significantly higher than those in non-cancerous prostate tissues. In addition, the PCa patients with PRC1 overexpression more frequently had high Gleason score, advanced pathological stage, positive metastasis, short overall survival time and positive PSA failure than those with low Gleason score, early pathological stage, negative metastasis, long overall survival time and negative PSA failure (all P<0.05). Moreover, PRC1 expression was identified as an unfavorable prognostic factor of biochemical recurrence-free survival in PCa patients (P<0.001). CONCLUSION These findings suggest that the aberrant expression of PRC1 may predict biochemical recurrence in men with PCa highlighting its potential as a prognostic marker of this malignancy.
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Affiliation(s)
- Hong-Wei Luo
- Department of Urology, Huadu District People's Hospital, Southern Medical University, Guangzhou 510800, China
| | - Qing-Biao Chen
- Department of Urology, Huadu District People's Hospital, Southern Medical University, Guangzhou 510800, China; Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yue-Ping Wan
- Department of Urology, Huadu District People's Hospital, Southern Medical University, Guangzhou 510800, China
| | - Guan-Xing Chen
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China
| | - Yang-Jia Zhuo
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zhi-Duan Cai
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zheng Luo
- School of Marine Sciences, Sun Yat-sen University, Guangzhou 510275,China
| | - Zhao-Dong Han
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China
| | - Yu-Xiang Liang
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China
| | - Wei-De Zhong
- Department of Urology, Huadu District People's Hospital, Southern Medical University, Guangzhou 510800, China; Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China; Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510230, China.
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Knüchel R. Gleason Score 6 - Prostate Cancer or Benign Variant? Oncol Res Treat 2015; 38:629-32. [PMID: 26633167 DOI: 10.1159/000441735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/16/2015] [Indexed: 11/19/2022]
Abstract
The leading motivation behind wanting to call a 'malignant' prostate lesion 'benign' is the evidence of indolent prostate cancer that is not associated with a fatal outcome and in part makes therapeutic measures such as surgery and radiotherapy appear like overtreatment for some or possibly the majority of such patients. The present article reviews the definitions of 'precancerous lesion' and 'cancer' from a histopathologic point of view as the basis and gold standard for diagnosis. It is clear that with the 2 modifications implemented since its first publication, the Gleason score as the grading system for prostate cancer has shifted towards a low malignant subgroup diagnosed as Gleason 6. The recommendation of the International Society of Urological Pathology to change the Gleason score to a 5-tiered system, starting with grade group 1, is presented here, and may help doctor-patient communication especially in the active surveillance setting.
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Affiliation(s)
- Ruth Knüchel
- Institute of Pathology, University Hospital, RWTH Aachen, Aachen, Germany
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Notley M, Yu J, Fulcher AS, Turner MA, Cockrell CH, Nguyen D. Pictorial review. Diagnosis of recurrent prostate cancer and its mimics at multiparametric prostate MRI. Br J Radiol 2015; 88:20150362. [PMID: 26268143 DOI: 10.1259/bjr.20150362] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Biochemical recurrence after treatment for prostate cancer (PCa) is a significant issue. Early diagnosis of local recurrence is important for making prompt treatment decisions and is strongly associated with patient prognosis. Without salvage therapy, the average time from development of local recurrence to distant metastasis is approximately 3 years. Biochemical recurrence does not differentiate local recurrence from systemic disease; there is no reliable way to clinically diagnose local recurrence. Recent advances in multiparametric MRI (mp-MRI) techniques have markedly improved detection of local recurrence following therapy. However, a wide variety of entities can mimic recurrent PCa at mp-MRI. Therefore, the purpose of this pictorial review is to discuss the MRI findings of locally recurrent PCa and its mimics, emphasizing the key MRI features that help to differentiate local recurrence from its mimics.
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Affiliation(s)
- Mark Notley
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Jinxing Yu
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Ann S Fulcher
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Mary Ann Turner
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Charles H Cockrell
- 1 Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Don Nguyen
- 2 Department of Radiology, Allegheny General Hospital, Pittsburgh, PA, USA
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