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Giganti F, Rosenkrantz AB, Villeirs G, Panebianco V, Stabile A, Emberton M, Moore CM. The Evolution of MRI of the Prostate: The Past, the Present, and the Future. AJR Am J Roentgenol 2019; 213:384-396. [PMID: 31039022 DOI: 10.2214/ajr.18.20796] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE. The purpose of this article is to discuss the evolution of MRI in prostate cancer from the early 1980s to the current day, providing analysis of the key studies on this topic. CONCLUSION. The rapid diffusion of MRI technology has meant that residual variability remains between centers regarding the quality of acquisition and the quality and standardization of reporting.
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Affiliation(s)
- Francesco Giganti
- 1 Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
| | | | - Geert Villeirs
- 4 Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Valeria Panebianco
- 5 Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Armando Stabile
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
- 6 Department of Urology, Division of Experiemental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mark Emberton
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
- 7 Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline M Moore
- 2 Division of Surgery and Interventional Science, University College London, 3rd Fl, Charles Bell House, 43-45 Foley St, London W1W 7TS, United Kingdom
- 7 Department of Urology, University College London Hospital NHS Foundation Trust, London, United Kingdom
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You Y, Liang X, Yin T, Chen M, Qiu C, Gao C, Wang X, Mao Y, Qu E, Dai Z, Zheng R. Porphyrin-grafted Lipid Microbubbles for the Enhanced Efficacy of Photodynamic Therapy in Prostate Cancer through Ultrasound-controlled In Situ Accumulation. Theranostics 2018; 8:1665-1677. [PMID: 29556348 PMCID: PMC5858174 DOI: 10.7150/thno.22469] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/23/2017] [Indexed: 01/20/2023] Open
Abstract
Photodynamic therapy (PDT) holds promise for focal therapy of prostate cancer (PCa). However, the therapeutic efficacy needs improvement, and further development of PDT for PCa has challenges, including uncertainty of photosensitizers (PSs) accumulation at the tumor site and difficulty in visualizing lesions using conventional ultrasound (US) imaging. We have developed novel porphyrin-grafted lipid (PGL) microbubbles (MBs; PGL-MBs) and propose a strategy to integrate PGL-MBs with US imaging to address these limitations and enhance PDT efficacy. METHODS PGL-MBs have two functions: imaging guidance by contrast-enhanced ultrasound (CEUS) and targeted delivery of PSs by ultrasound targeted microbubble destruction (UTMD). PGL-MBs were prepared and characterized before and after low-frequency US (LFUS) exposure. Then, in vitro studies validated the efficacy of PDT with PGL-MBs in human prostate cancer PC3 cells. PC3-xenografted nude mice were used to validate CEUS imaging, accumulation at the tumor site, and in vivo PDT efficacy. RESULTS PGL-MBs showed good contrast enhancement for US imaging and were converted into nanoparticles upon LFUS exposure. The resulting uniquely structured nanoparticles avoided porphyrin fluorescence quenching and efficiently accumulated at the tumor site through the sonoporation effect created with the assistance of US to achieve excellent PDT efficacy. CONCLUSIONS This is the first preclinical investigation of MBs applied in PDT for PCa. PGL-MBs possess favorable CEUS imaging effects to enhance the localization of tumors. PGL-MBs with LFUS control PS accumulation at the tumor site to achieve highly effective PDT of PCa. This strategy carries enormous clinical potential for PCa management.
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Affiliation(s)
- Yujia You
- Department of Medical Ultrasonic, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xiaolong Liang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Tinghui Yin
- Department of Medical Ultrasonic, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Min Chen
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Chen Qiu
- Department of Medical Ultrasonic, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Chuang Gao
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Xiaoyou Wang
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Yongjiang Mao
- Department of Medical Ultrasonic, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Enze Qu
- Department of Medical Ultrasonic, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Zhifei Dai
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Rongqin Zheng
- Department of Medical Ultrasonic, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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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: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Le Nobin J, Rosenkrantz AB, Villers A, Orczyk C, Deng FM, Melamed J, Mikheev A, Rusinek H, Taneja SS. Image Guided Focal Therapy for Magnetic Resonance Imaging Visible Prostate Cancer: Defining a 3-Dimensional Treatment Margin Based on Magnetic Resonance Imaging Histology Co-Registration Analysis. J Urol 2015; 194:364-70. [PMID: 25711199 PMCID: PMC4726648 DOI: 10.1016/j.juro.2015.02.080] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE We compared prostate tumor boundaries on magnetic resonance imaging and radical prostatectomy histological assessment using detailed software assisted co-registration to define an optimal treatment margin for achieving complete tumor destruction during image guided focal ablation. MATERIALS AND METHODS Included in study were 33 patients who underwent 3 Tesla magnetic resonance imaging before radical prostatectomy. A radiologist traced lesion borders on magnetic resonance imaging and assigned a suspicion score of 2 to 5. Three-dimensional reconstructions were created from high resolution digitalized slides of radical prostatectomy specimens and co-registered to imaging using advanced software. Tumors were compared between histology and imaging by the Hausdorff distance and stratified by the magnetic resonance imaging suspicion score, Gleason score and lesion diameter. Cylindrical volume estimates of treatment effects were used to define the optimal treatment margin. RESULTS Three-dimensional software based registration with magnetic resonance imaging was done in 46 histologically confirmed cancers. Imaging underestimated tumor size with a maximal discrepancy between imaging and histological boundaries for a given tumor of an average ± SD of 1.99 ± 3.1 mm, representing 18.5% of the diameter on imaging. Boundary underestimation was larger for lesions with an imaging suspicion score 4 or greater (mean 3.49 ± 2.1 mm, p <0.001) and a Gleason score of 7 or greater (mean 2.48 ± 2.8 mm, p = 0.035). A simulated cylindrical treatment volume based on the imaging boundary missed an average 14.8% of tumor volume compared to that based on the histological boundary. A simulated treatment volume based on a 9 mm treatment margin achieved complete histological tumor destruction in 100% of patients. CONCLUSIONS Magnetic resonance imaging underestimates histologically determined tumor boundaries, especially for lesions with a high imaging suspicion score and a high Gleason score. A 9 mm treatment margin around a lesion visible on magnetic resonance imaging would consistently ensure treatment of the entire histological tumor volume during focal ablative therapy.
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Affiliation(s)
- Julien Le Nobin
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York; Departments of Urology, University Hospital of Lille, Lille and Unités Mixtes de Recherche 6301-CERVOxy Group, University Hospital of Caen, Caen, France.
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University Langone Medical Center, New York, New York
| | - Arnauld Villers
- Departments of Urology, University Hospital of Lille, Lille and Unités Mixtes de Recherche 6301-CERVOxy Group, University Hospital of Caen, Caen, France
| | - Clément Orczyk
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York
| | - Fang-Ming Deng
- Department of Pathology, New York University Langone Medical Center, New York, New York
| | - Jonathan Melamed
- Department of Pathology, New York University Langone Medical Center, New York, New York
| | - Artem Mikheev
- Department of Radiology, New York University Langone Medical Center, New York, New York
| | - Henry Rusinek
- Department of Radiology, New York University Langone Medical Center, New York, New York
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York
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Matsuoka Y, Numao N, Saito K, Tanaka H, Kumagai J, Yoshida S, Ishioka J, Koga F, Masuda H, Kawakami S, Fujii Y, Kihara K. Candidate selection for quadrant-based focal ablation through a combination of diffusion-weighted magnetic resonance imaging and prostate biopsy. BJU Int 2015; 117:94-101. [DOI: 10.1111/bju.12901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yoh Matsuoka
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Noboru Numao
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Kazutaka Saito
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Hiroshi Tanaka
- Department of Radiology; Ochanomizu Surugadai Clinic; Tokyo Japan
| | - Jiro Kumagai
- Department of Pathology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Soichiro Yoshida
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Junichiro Ishioka
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Fumitaka Koga
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Hitoshi Masuda
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Satoru Kawakami
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Yasuhisa Fujii
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Kazunori Kihara
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
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Chang JH, Lim Joon D, Davis ID, Lee ST, Hiew CY, Esler S, Gong SJ, Wada M, Clouston D, O'Sullivan R, Goh YP, Bolton D, Scott AM, Khoo V. Comparison of [(11)C]choline Positron Emission Tomography With T2- and Diffusion-Weighted Magnetic Resonance Imaging for Delineating Malignant Intraprostatic Lesions. Int J Radiat Oncol Biol Phys 2015; 92:438-45. [PMID: 25864171 DOI: 10.1016/j.ijrobp.2015.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to compare the accuracy of [(11)C]choline positron emission tomography (CHOL-PET) with that of the combination of T2-weighted and diffusion-weighted (T2W/DW) magnetic resonance imaging (MRI) for delineating malignant intraprostatic lesions (IPLs) for guiding focal therapies and to investigate factors predicting the accuracy of CHOL-PET. METHODS AND MATERIALS This study included 21 patients who underwent CHOL-PET and T2W/DW MRI prior to radical prostatectomy. Two observers manually delineated IPL contours for each scan, and automatic IPL contours were generated on CHOL-PET based on varying proportions of the maximum standardized uptake value (SUV). IPLs identified on prostatectomy specimens defined reference standard contours. The imaging-based contours were compared with the reference standard contours using Dice similarity coefficient (DSC), and sensitivity and specificity values. Factors that could potentially predict the DSC of the best contouring method were analyzed using linear models. RESULTS The best automatic contouring method, 60% of the maximum SUV (SUV60) , had similar correlations (DSC: 0.59) with the manual PET contours (DSC: 0.52, P=.127) and significantly better correlations than the manual MRI contours (DSC: 0.37, P<.001). The sensitivity and specificity values were 72% and 71% for SUV60; 53% and 86% for PET manual contouring; and 28% and 92% for MRI manual contouring. The tumor volume and transition zone pattern could independently predict the accuracy of CHOL-PET. CONCLUSIONS CHOL-PET is superior to the combination of T2W/DW MRI for delineating IPLs. The accuracy of CHOL-PET is insufficient for gland-sparing focal therapies but may be accurate enough for focal boost therapies. The transition zone pattern is a new classification that may predict how well CHOL-PET delineates IPLs.
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Affiliation(s)
- Joe H Chang
- Radiation Oncology Centre, Austin Health, Victoria, Australia; University of Melbourne, Victoria, Australia
| | - Daryl Lim Joon
- Radiation Oncology Centre, Austin Health, Victoria, Australia
| | - Ian D Davis
- Monash University Eastern Health Clinical School, Victoria, Australia
| | - Sze Ting Lee
- University of Melbourne, Victoria, Australia; Centre for PET, Austin Health, Victoria, Australia; Ludwig Institute for Cancer Research, Victoria, Australia
| | - Chee-Yan Hiew
- Department of Radiology, Austin Health, Victoria, Australia
| | - Stephen Esler
- Department of Radiology, Austin Health, Victoria, Australia
| | | | - Morikatsu Wada
- Radiation Oncology Centre, Austin Health, Victoria, Australia
| | | | | | - Yin P Goh
- Diagnostic Imaging, Monash Health, Victoria, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Victoria, Australia
| | - Andrew M Scott
- University of Melbourne, Victoria, Australia; Centre for PET, Austin Health, Victoria, Australia; Ludwig Institute for Cancer Research, Victoria, Australia
| | - Vincent Khoo
- Radiation Oncology Centre, Austin Health, Victoria, Australia; University of Melbourne, Victoria, Australia; Royal Marsden Hospital, National Health Service Foundation Trust, London, United Kingdom; Department of Medical Imaging and Radiation Sciences, Monash University, Victoria, Australia.
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Cepek J, Lindner U, Ghai S, Louis AS, Davidson SRH, Gertner M, Hlasny E, Sussman MS, Fenster A, Trachtenberg J. Mechatronic system for in-bore MRI-guided insertion of needles to the prostate: An in vivo needle guidance accuracy study. J Magn Reson Imaging 2014; 42:48-55. [PMID: 25195664 DOI: 10.1002/jmri.24742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 08/11/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To present our experiences in initial clinical evaluation of a novel mechatronic system for in-bore guidance of needles to the prostate for MRI-guided prostate interventions in 10 patients. We report accuracy of this device in the context of focal laser ablation therapy for localized prostate cancer. METHODS An MRI-compatible needle guidance device was developed for transperineal prostate interventions. Ten patients underwent MRI-guided focal laser ablation therapy with device-mediated laser fiber delivery. We recorded needle guidance error and needle delivery time. RESULTS A total of 37 needle insertions were evaluated. Median needle guidance error was 3.5 mm (interquartile range, 2.1-5.4 mm), and median needle delivery time was 9 min (interquartile range, 6.5-12 min). CONCLUSION This system provides a reliable method of accurately aligning needle guides for in-bore transperineal needle delivery to the prostate.
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Affiliation(s)
- Jeremy Cepek
- Department of Surgical Oncology, Division of Urology, University Health Network, Toronto, Canada.,Robarts Research Institute, The University of Western Ontario, London, Canada
| | - Uri Lindner
- Department of Surgical Oncology, Division of Urology, University Health Network, Toronto, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Alyssa S Louis
- Department of Surgical Oncology, Division of Urology, University Health Network, Toronto, Canada
| | - Sean R H Davidson
- Ontario Cancer Institute, University Health Network, Toronto, Canada
| | - Mark Gertner
- Division of Biophysics and Bioimaging, Ontario Cancer Institute, University Health Network, Toronto, Canada
| | - Eugen Hlasny
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Marshall S Sussman
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Aaron Fenster
- Robarts Research Institute, The University of Western Ontario, London, Canada.,Biomedical Engineering, The University of Western Ontario, London, Canada
| | - John Trachtenberg
- Department of Surgical Oncology, Division of Urology, University Health Network, Toronto, Canada
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Wu X, Zhang F, Chen R, Zheng W, Yang X. Recent advances in imaging-guided interventions for prostate cancers. Cancer Lett 2014; 349:114-9. [PMID: 24769076 DOI: 10.1016/j.canlet.2014.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
The numbers of patients diagnosed with prostate cancers is increasing due to the widespread application of prostate-specific antigen screening and subsequent prostate biopsies. The methods of systemic administration of therapeutics are not target-specific and thus cannot efficiently destroy prostate tumour cells while simultaneously sparing the surrounding normal tissues and organs. Recent advances in imaging-guided minimally invasive therapeutic techniques offer considerable potential for the effective management of prostate cancers. An objective understanding of the feasibility, effectiveness, morbidity, and deficiencies of these interventional techniques is essential for both clinical practice and scientific progress. This review presents the recent advances in imaging-guided interventional techniques for the diagnosis and treatment of prostate cancers.
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Affiliation(s)
- Xia Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China; Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
| | - Feng Zhang
- Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
| | - Ran Chen
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University,3 East Qingchun Road, Hangzhou 310016, China.
| | - Weiliang Zheng
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China.
| | - Xiaoming Yang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine and Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China; Image-Guided Bio-Molecular Intervention Research and Section of Vascular & Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican Street, Seattle, WA 98109, USA.
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9
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Cepek J, Lindner U, Davidson SRH, Haider MA, Ghai S, Trachtenberg J, Fenster A. Treatment planning for prostate focal laser ablation in the face of needle placement uncertainty. Med Phys 2013; 41:013301. [DOI: 10.1118/1.4842535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Schade GR, Keller J, Ives K, Cheng X, Rosol TJ, Keller E, Roberts WW. Histotripsy focal ablation of implanted prostate tumor in an ACE-1 canine cancer model. J Urol 2012; 188:1957-64. [PMID: 22999534 DOI: 10.1016/j.juro.2012.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Histotripsy is a nonthermal ablative focused ultrasound technology with possible future applications for prostate cancer focal therapy. We used the ACE-1 prostate tumor model and evaluated the feasibility of treating prostate tumors with histotripsy. MATERIALS AND METHODS A total of 10 immunosuppressed (cyclosporine treated) canine subjects received transrectal ultrasound guided percutaneous intraprostatic injection of ACE-1 canine prostate cancer cells. Prostates were serially imaged with transrectal ultrasound to monitor tumor growth. Subjects were sham treated (3) or underwent transabdominal histotripsy of the prostate, which targeted implanted tumor and adjacent parenchyma using a 750 kHz piezoelectric ultrasound therapy transducer. Prostates were examined histologically to confirm tumor and the histotripsy treatment effect. RESULTS ACE-1 tumors were visualized on transrectal ultrasound in all 10 subjects within 2 weeks of tumor injection. Lesions demonstrated growth in the prostatic capsule, glandular lobules, fibrous septa and periurethral stroma with significant desmoplastic reaction and areas of central necrosis on histology. Lymph node and/or pulmonary metastases developed in 4 subjects. Ultrasound tumor localization and initiation of cavitation during histotripsy therapy were feasible in all treated subjects. Histologically there was evidence of homogenization of tumor and prostatic parenchyma in all 4 acute subjects with necrosis and hemorrhage in the 3 chronic subjects. CONCLUSIONS This study shows the feasibility of histotripsy destruction of prostate tumors in a canine ACE-1 model. It suggests a potential role for histotripsy based focal therapy for prostate cancer. Further studies are needed to better characterize the effects of histotripsy on malignant tissues.
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Affiliation(s)
- George R Schade
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA
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Correlation of magnetic resonance imaging tumor volume with histopathology. J Urol 2012; 188:1157-1163. [PMID: 22901591 DOI: 10.1016/j.juro.2012.06.011] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE The biology of prostate cancer may be influenced by the index lesion. The definition of index lesion volume is important for appropriate decision making, especially for image guided focal treatment. We determined the accuracy of magnetic resonance imaging for determining index tumor volume compared with volumes derived from histopathology. MATERIALS AND METHODS We evaluated 135 patients (mean age 59.3 years) with a mean prostate specific antigen of 6.74 ng/dl who underwent multiparametric 3T endorectal coil magnetic resonance imaging of the prostate and subsequent radical prostatectomy. Index tumor volume was determined prospectively and independently by magnetic resonance imaging and histopathology. The ellipsoid formula was applied to determine histopathology tumor volume, whereas manual tumor segmentation was used to determine magnetic resonance tumor volume. Histopathology tumor volume was correlated with age and prostate specific antigen whereas magnetic resonance tumor volume involved Pearson correlation and linear regression methods. In addition, the predictive power of magnetic resonance tumor volume, prostate specific antigen and age for estimating histopathology tumor volume (greater than 0.5 cm(3)) was assessed by ROC analysis. The same analysis was also conducted for the 1.15 shrinkage factor corrected histopathology data set. RESULTS There was a positive correlation between histopathology tumor volume and magnetic resonance tumor volume (Pearson coefficient 0.633, p <0.0001), but a weak correlation between prostate specific antigen and histopathology tumor volume (Pearson coefficient 0.237, p = 0.003). On linear regression analysis histopathology tumor volume and magnetic resonance tumor volume were correlated (r(2) = 0.401, p <0.00001). On ROC analysis AUC values for magnetic resonance tumor volume, prostate specific antigen and age in estimating tumors larger than 0.5 cm(3) at histopathology were 0.949 (p <0.0000001), 0.685 (p = 0.001) and 0.627 (p = 0.02), respectively. Similar results were found in the analysis with shrinkage factor corrected tumor volumes at histopathology. CONCLUSIONS Magnetic resonance imaging can accurately estimate index tumor volume as determined by histology. Magnetic resonance imaging has better accuracy in predicting histopathology tumor volume in tumors larger than 0.5 cm(3) than prostate specific antigen and age. Index tumor volume as determined by magnetic resonance imaging may be helpful in planning treatment, specifically in identifying tumor margins for image guided focal therapy and possibly selecting better active surveillance candidates.
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Sinnott M, Falzarano SM, Hernandez AV, Jones JS, Klein EA, Zhou M, Magi-Galluzzi C. Discrepancy in prostate cancer localization between biopsy and prostatectomy specimens in patients with unilateral positive biopsy: implications for focal therapy. Prostate 2012; 72:1179-86. [PMID: 22161896 DOI: 10.1002/pros.22467] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 11/11/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Unilateral ablative strategy success depends on reliable prediction of prostate cancer (PCA) location. We evaluated the discrepancy in PCA localization between unilateral positive biopsy (PBx) and radical prostatectomy (RP). METHODS Between 2004 and 2008, 431 patients were diagnosed with unilateral PCA by 12-core PBx; 179 underwent RP and constituted our study cohort. Specimens were reviewed to map tumor outline and determine number of cancer foci, tumor volume, Gleason score (GS), zone of origin, localization, and pathologic stage. RESULTS In 50 men, biopsy and prostatectomy findings correlated (unilateral tumor); in 129, PCA was detected in the contralateral side of the prostate. In 52 patients, 54 clinically significant tumors were missed by biopsy. When patients with true unilateral and missed contralateral disease at RP were compared with respect to prognostic parameters no significant differences were detected. Sixty-one of the 88 patients with preoperative low-risk disease had true unilateral (n = 21) or missed insignificant contralateral (n = 40) PCA; 27 had missed significant contralateral PCA at RP. PSA > 4 ng/ml predicted presence of significant bilateral disease in low-risk population (P = 0.004). Twenty-four of 27 patients with significant bilateral cancer had PSA > 4, although 33/61 with unilateral or bilateral insignificant cancer had similar elevated PSA values. CONCLUSIONS Twelve-core biopsy is inadequate to identify candidates for organ-sparing therapy. Most men with unilateral positive biopsies have bilateral cancer at prostatectomy. Tumors missed by biopsy were clinically significant in 40% of patients, but no prognostic parameters could predict unilateral disease. Hemi-ablative treatment might fail to eradicate significant lesions in the contralateral side.
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Affiliation(s)
- Michael Sinnott
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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13
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Advances in imaging and in non-surgical salvage treatments after radiorecurrence in prostate cancer: what does the oncologist, radiotherapist and radiologist need to know? Eur Radiol 2012; 22:2848-58. [PMID: 22797953 DOI: 10.1007/s00330-012-2546-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 04/20/2012] [Accepted: 05/18/2012] [Indexed: 01/09/2023]
Abstract
OBJECTIVES In this article the state of art the of prostate cancer (Pca) imaging and non-surgical salvage treatments (STs) is surveyed in order to explore the impact of imaging findings on the identification of radiorecurrent Pca after external beam radiotherapy (EBRT). METHODS A computerised search was performed to identify all relevant studies in Medline up to 2012. Additional articles were extracted based on recommendations from an expert panel of authors. RESULTS Definitive EBRT for Pca is increasingly used as treatment. After radiorecurrent Pca, non-surgical STs are emerging and shifting from investigational status to more established therapeutic options. Therefore, several scientific societies have published guidelines including clinical and imaging recommendations, even if the timing, efficacy and long-term toxicity of these STs have to be established. In some measure, accurately delineating the location and the extent of cancer is critical in selecting target lesions and in identifying patients who are candidates for STs. However, there is increasing awareness that anatomical approaches based on measurements of tumour size have substantial limitations, especially for tumours of unknown activity that persist or recur following irradiation CONCLUSIONS To date, the main focus for innovations in imaging is the combination of excellence in anatomical resolution with specific biological correlates that depict metabolic processes and hallmarks at the tumour level. The emergence of new molecular markers could favour the development of methods that directly determine their presence, thereby improving tumour detection. KEY POINTS Imaging may influence therapeutic decisions during non-surgical STs. MRI findings correlate with parametric maps derived from multiple functional techniques. Non-surgical salvage treatments allow local tumour control in patients with radiorecurrent PCa.
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Buckle T, Brouwer OR, Valdés Olmos RA, van der Poel HG, van Leeuwen FW. Relationship Between Intraprostatic Tracer Deposits and Sentinel Lymph Node Mapping in Prostate Cancer Patients. J Nucl Med 2012; 53:1026-33. [DOI: 10.2967/jnumed.111.098517] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Current Challenges in Prostate Cancer Management and the Rationale behind Targeted Focal Therapy. Adv Urol 2012; 2012:862639. [PMID: 22649447 PMCID: PMC3357537 DOI: 10.1155/2012/862639] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 02/28/2012] [Accepted: 03/01/2012] [Indexed: 11/18/2022] Open
Abstract
Among men, prostate cancer has a high prevalence, with relatively lower cancer-specific mortality risk compared to lung and colon cancer. Prostate-specific antigen (PSA) screening has increased prostate cancer awareness since its implementation as a screening tool almost 25 years ago, but, due to the largely indolent course of this disease and the unspecific nature of the PSA test, increased incidence has largely been associated with cancers that would not go on to cause death (clinically insignificant), leading to an overdiagnosis challenge and an ensuing overtreatment consequences. The overtreatment problem is exacerbated by the high risk of side effects that current treatment techniques have, putting patients' quality of life at risk with little or no survival benefit. The goals of this paper are to evaluate the rise, prevalence, and impact of the overdiagnosis and ensuing overtreatment problems, as well as highlight potential solutions. In this effort, a review of major epidemiological and screening studies, cancer statistics from the advent of prostate-specific antigen screening to the present, and reports on patient concerns and treatment outcomes was conducted to present the dominant factors that underlie current challenges in prostate cancer treatment and illuminate potential solutions.
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Current world literature. Curr Opin Urol 2012; 22:254-62. [PMID: 22469752 DOI: 10.1097/mou.0b013e328352c3f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Au JT, Gonzalez L, Chen CH, Serganova I, Fong Y. Bioluminescence Imaging Serves as a Dynamic Marker for Guiding and Assessing Thermal Treatment of Cancer in a Preclinical Model. Ann Surg Oncol 2012; 19:3116-22. [DOI: 10.1245/s10434-012-2313-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Indexed: 02/04/2023]
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Re: Salvage Radical Prostatectomy Following Primary High Intensity Focused Ultrasound for Treatment of Prostate Cancer. J Urol 2011; 186:1159-60; author reply 1160-1. [DOI: 10.1016/j.juro.2011.04.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Indexed: 11/18/2022]
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Lindner U, Lawrentschuk N, Schatloff O, Trachtenberg J, Lindner A. Evolution from active surveillance to focal therapy in the management of prostate cancer. Future Oncol 2011; 7:775-87. [DOI: 10.2217/fon.11.51] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Organ-preserving therapies are widely accepted in many facets of medicine and, more recently, in oncology. For example, partial nephrectomy is now accepted as a preferred alternative over radical nephrectomy for small (up to 4 cm or T1) tumors. Focal therapy (FT) is another organ-preserving strategy applying energy (cryotherapy, laser ablation and/or high-intensity focused ultrasound) to destroy tumors while leaving the majority of the organ, surrounding tissue and structures unscathed and functional. Owing to the perceived multifocality of prostate cancer (PCa) technology limitations, in the past PCa was not considered suitable for FT. However, with the rise of active surveillance for the management of low-risk PCa in carefully selected patients, FT is emerging as an alternative. This is owing to technology improvements in imaging and energy-delivery systems to ablate tissue, as well as the realization that many men and clinicians still desire tumor control. With the postulated ability to ablate tumors with minimal morbidity, FT may have found a role in the management of PCa; the aim of FT a being long-term cancer control without the morbidity associated with radical therapies. Data for FT in PCa have been derived from case series and small Phase I trials, with larger cohort studies with longer follow-up having only just commenced. More data from large trials on the safety and efficacy of FT are required before this approach can be recommended in men with PCa. Importantly, studies must confirm that no viable cancer cells remain in the region of ablation. FT might eventually prove to be a ‘middle ground’ between active surveillance and radical treatment, combining minimal morbidity with cancer control and the potential for retreatment.
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Affiliation(s)
- Uri Lindner
- Department of Urology, Tel Hashomer Hospital (affiliated with Tel Aviv University), 52621, Israel
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Urology Unit & Ludwig Institute for Cancer Research, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Oscar Schatloff
- Department of Urology, Assaf Harofe Medical Center (affiliated with Tel Aviv University), Zerifin 70300, Israel
| | - John Trachtenberg
- Department of Urology & Surgical Oncology, Princess Margaret Hospital, 610 University Ave., Toronto, ON M5G 2M9, Canada
| | - Arie Lindner
- Department of Urology, Assaf Harofe Medical Center (affiliated with Tel Aviv University), Zerifin 70300, Israel
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Walz J, Marcy M, Pianna JT, Brunelle S, Gravis G, Salem N, Bladou F. Identification of the prostate cancer index lesion by real-time elastography: considerations for focal therapy of prostate cancer. World J Urol 2011; 29:589-94. [PMID: 21614469 DOI: 10.1007/s00345-011-0688-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/22/2011] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Focal therapy of prostate cancer is gaining more and more interest. One of the drawbacks of focal therapy of prostate cancer is the problem of correct identification of prostate cancer lesions. The aim of the study was to evaluate the ability of real-time elastography to correctly identify the prostate cancer index lesion. MATERIALS AND METHODS In 32 patients, real-time elastography was performed the day before prostatectomy. During the examination, the location of the main lesion suspicious for prostate cancer was prospectively recorded. Moreover, the results of the randomized multicore biopsies were also used to predict the location of the index lesion. The preoperative elastography results, the biopsy results, and a combined use of elastography and biopsy results were then compared with the pathological results to calculate the diagnostic values for correct index lesion identification. RESULTS When using real-time elastography alone to identify the prostate cancer index lesion, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 58.8, 43.3, 54.1, 48.1, and 51.6%, respectively. Data from randomized biopsies alone achieved 67.8, 48.4, 56.8, 60.0, and 58.1%, respectively. The combination of elastography and biopsy data increased the values to, respectively, 84.9, 48.4, 61.9, 75.0, and 66.1%. CONCLUSION In this study, real-time elastography alone did not allow to identify the prostate cancer index lesion with satisfactory reliability. The combination of real-time elastography and data from randomized 12 core biopsies allows promising ability to correctly identify the prostate cancer index lesion.
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Affiliation(s)
- Jochen Walz
- Department of Urology, Institut Paoli-Calmettes, 232, Boulevard Ste. Marguerite/B.P.: 156, 13273 Marseille, France.
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Abstract
Active surveillance is now an accepted management strategy for men with low-risk localized prostate cancer, in recognition of the knowledge that the majority of men with such cancers are likely to die from other causes. The most obvious benefit of active surveillance is the reduction of morbidity associated with surgery by delaying or avoiding radical gland therapy. Other advantages include lower overall costs to the health-care system and potentially a better quality of life. These advantages should be balanced against the risks of delayed therapy, the most considerable of which being development of more-aggressive disease. Appropriate selection criteria and the definition of triggers for intervention with radical therapy are critical components of an active surveillance protocol. The ability to accurately identify and cure the men whose cancers will progress using clinical, biopsy and imaging data is yet to be resolved, as is the psychological burden of living with an untreated cancer. The benefit of 5α-reductase inhibitors as secondary chemoprevention in men on active surveillance is a new avenue of research. Focal therapy, which has the similar aim of reducing morbidity while maintaining oncological control, is an emerging competitor for active surveillance. Nevertheless, active surveillance is an appealing management option for selected men with prostate cancer.
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Affiliation(s)
- Nathan Lawrentschuk
- Ludwig Institute for Cancer Research and University of Melbourne Department of Surgery, Austin Hospital, Studley Road, Melbourne, Vic 3084, Australia.
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