Does photodynamic therapy have the necessary attributes to become a future treatment for organ-confined prostate cancer?

What Is the Impact of Antimicrobial Photodynamic Therapy on Oral Candidiasis? An In Vitro Study

This study aimed to evaluate the ability of photodynamic therapy, based on the use of a gel containing 5% delta aminolaevulinic acid (ALAD) for 45' followed by irradiation with 630 nm LED (PDT) for 7', to eradicate Candida albicans strains without damaging the gingiva. C. albicans oral strains and gingival fibroblasts (hGFs) were used to achieve these goals. The potential antifungal effects on a clinical resistant C. albicans S5 strain were evaluated in terms of biofilm biomass, colony forming units (CFU/mL) count, cell viability by live/dead analysis, and fluidity membrane changes. Concerning the hGFs, viability assays, morphological analysis (optical, scanning electronic (SEM), and confocal laser scanning (CLSM) microscopes), and assays for reactive oxygen species (ROS) and collagen production were performed. ALAD-mediated aPDT (ALAD-aPDT) treatment showed significant anti-biofilm activity against C. albicans S5, as confirmed by a reduction in both the biofilm biomass and CFUs/mL. The cell viability was strongly affected by the treatment, while on the contrary, the fluidity of the membrane remained unchanged. The results for the hGFs showed an absence of cytotoxicity and no morphological differences in cells subjected to ALAD-aPDT expected for CLSM results that exhibited an increase in the thickening of actin filaments. ROS production was augmented only at 0 h and 3 h, while the collagen appeared enhanced 7 days after the treatment.

Multiparametric magnetic resonance imaging in the management and diagnosis of prostate cancer: current applications and strategies

Magnetic resonance imaging (MRI) has become increasingly used worldwide in the diagnosis and management of prostate cancer. With advances in multiparametric MRI (mpMRI) technology, such as the use of dynamic contrast-enhanced and diffusion-weighted imaging sequences, observational studies have evaluated the utility for mpMRI in the continuum of prostate cancer management, from improving the detection of clinically significant prostate cancer, to planning radical prostatectomy and radiation therapy and the early detection of local recurrence. Furthermore, the potential for advanced imaging to reduce the burden of routine serial prostate needle biopsies for men on active surveillance is a promising area of research. MRI technology continues to evolve, and the potential applications in the management of prostate cancer care will require well-designed multi-institutional prospective clinical trials and rigorous efforts to standardize reporting and improve dissemination of expertise across institutions.

Temoporfin (Foscan®, 5,10,15,20-tetra(m-hydroxyphenyl)chlorin)--a second-generation photosensitizer

This review traces the development and study of the second-generation photosensitizer 5,10,15,20-tetra(m-hydroxyphenyl)chlorin through to its acceptance and clinical use in modern photodynamic (cancer) therapy. The literature has been covered up to early 2011.

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer: quality of life outcomes

BACKGROUND

A recent randomized trial to compare external beam radiation therapy (EBRT) to cryoablation for localized disease showed cryoablation to be noninferior to external beam EBRT in disease progression and overall and disease-specific survival. We report on the quality of life (QOL) outcomes for this trial.

METHODS

From December 1997 through February 2003, 244 men with newly diagnosed localized prostate cancer were randomly assigned to cryoablation or EBRT (median dose 68 Gy). All patients received neoadjuvant antiandrogen therapy. Patients completed the EORTC QLQ C30 and the Prostate Cancer Index (PCI) before treatment and at 1.5, 3, 6, 12, 18, 24, and 36 months post-treatment.

RESULTS

Regardless of treatment arm, participants reported high levels of QOL with few exceptions. cryoablation was associated with more acute urinary dysfunction (mean PCI urinary function cryoablation=69.4; mean EBRT=90.7; P<.001), which resolved over time. No late arising QOL issues were observed. Both EBRT and cryoablation participants reported decreases in sexual function at 3 months with the cryoablation patients reporting poorer functioning (mean cryoablation=7.2: mean EBRT=32.9; P<.001). Mean sexual function score was 15 points lower at 3 years for the cryoablation group and 13% more of the cryoablation men said that sexuality was a moderate or big problem.

CONCLUSIONS

In this randomized trial, no long-term QOL advantage for either treatment was apparent with the exception of poorer sexual function reported by those treated with cryoablation. Men who wish to increase their odds of retaining sexual function might be counseled to choose EBRT over cryoablation.

Photocytotoxicity of the fluorescent nonsteroidal androgen receptor ligand TDPQ

1,2,3,4-tetrahydro-2,2-dimethyl-6-(trifluoromethyl)-8-pyridono[5,6-g]quinoline (TDPQ), a selective nonsteroidal androgen receptor (AR) ligand, is a fluorescent compound. We characterized its spectral properties in comparison with the structural precursor carbostyril 151 (C151) and with its racemic structural isomer 4-ethyl-1,2,3,4-tetrahydro-6-(trifluoromethyl)-8-pyridino[5,6-g]quinoline (ETPQ). The absorption maximum in CH3CN of either TDPQ or ETPQ is 400 nm whereas that of C151 is 350 nm. The fluorescence lifetimes (tau) and quantum yields (phif) in CH3CN are typical of fluorescent dyes: TDPQ (4.2 ns, 0.8) and ETPQ (4.6 ns, 0.76). C151 showed lower tau and phif of 0.2 ns and 0.02, respectively. TDPQ can function as a fluorescent label at (sub)micromolar concentrations. We detected TDPQ fluorescence in human breast tumor cells using confocal microscopy. While the fluorescence maxima of the compounds were solvent insensitive, the phif for ETPQ decreased in aqueous solutions regardless of the presence of albumin or DNA. The phif of TDPQ was less affected. The quantum yield of singlet oxygen (1O2) photosensitization (phiso) by TDPQ and ETPQ was about 7% in CH3CN, sufficient to induce photocytotoxicity. TDPQ was photocytotoxic in AR-positive MDA-MB-453 breast cancer cells but not in AR-negative MDA-MB-231 cells. The combination of AR selectivity with photocytotoxicity makes TDPQ a promising candidate for selective targeting of AR-positive cells during photodynamic therapy.

Preliminary results of intraoperative photodynamic therapy with 5-aminolevulinic acid in dogs with prostate carcinoma

Six client-owned dogs with prostate carcinoma were treated with a combination of (1) partial subcapsular prostatectomy using an Nd:YAG laser, (2) intraoperative photodynamic therapy using a halogen broad band lamp after local administration of a photosensitiser, and (3) systemic treatment with meloxicam. Median survival time was 41days (range 10-68days), which compared negatively with previous reports of subtotal laser prostatectomy combined with topical interleukin-2 administration, and photodynamic therapy alone. Despite treatment, the disease progressed locally, causing signs of stranguria to recur, and in the form of distant metastases. The recurrence of clinical signs due to the primary tumour despite photodynamic therapy is probably largely explained by insufficient penetration of light into the tissue. Better results may be obtained using other light sources (e.g. laser) and alternative techniques of light delivery, such as fibres or catheters allowing interstitial diffusion of light.

Motexafin lutetium-photodynamic therapy of prostate cancer: short- and long-term effects on prostate-specific antigen

PURPOSE

The time course of serum prostate-specific antigen (PSA) response to photodynamic therapy (PDT) of prostate cancer was measured.

EXPERIMENTAL DESIGN

Seventeen patients were treated in a phase I trial of motexafin lutetium-PDT. PDT dose was calculated in each patient as the product of the ex vivo measured pre-PDT photosensitizer level and the in situ measured light dose. Serum PSA level was measured within 2 months before PDT (baseline), and at day 1; weeks 1 to 3; months 1, 2, and 3; months 4 to 6; and months 7 to 11 after PDT.

RESULTS

At 24 hours after PDT, serum PSA increased by 98% +/- 36% (mean +/- SE) relative to baseline levels (P = 0.007). When patients were dichotomized based on median PDT dose, those who received high PDT dose showed a 119% +/- 52% increase in PSA compared with a 54% +/- 27% increase in patients treated at low PDT dose. Patients treated with high versus low PDT dose showed a median biochemical delay of 82 versus 43 days (P = 0.024), with biochemical delay defined as the length of time between PDT and a nonreversible increase in PSA to a value greater than or equal to baseline.

CONCLUSIONS

Results show PDT to induce large, transient increases in serum PSA levels. Patients who experienced high PDT dose showed greater short-term increase in PSA and a significantly more durable PSA response (biochemical delay). These data strongly promote the need for individualized delivery of PDT dose and assessment of treatment effect in PDT of prostate cancer. Information gained from such patient-specific measurements could facilitate the introduction of multiple PDT sessions in patients who would benefit.

Towards accurate in vivo spectroscopy of the human prostate

The recent interest in photodynamic therapy of human prostate cancer is accompanied by a need for techniques for in vivo monitoring of optical and physiological characteristics. We propose time-of-flight (TOF) spectroscopy in combination with Monte Carlo evaluation as a reliable optical technique for quantitative assessment of absorption, scattering, hemoglobin content and tissue oxygenation in the human prostate. For the first time, we demonstrate Monte Carlo-based evaluation of in vivo TOF photon migration data. We show that this approach is crucial in order to avoid the large errors associated with the use of time-resolved diffusion theory of light propagation in prostate-like tissues. This progress also allows us to present the first in vivo scattering spectroscopy of human prostate tissue. Furthermore, TOF spectroscopy, in contrast to the more common steady-state approach, is insensitive to bleedings, and has been found highly reliable (100% success rate).

[Photodynamic therapy in localised prostate cancer]

Photodynamic therapy is based on the administration of an energy source in form of light of a specific wavelength, on a previously photosensitized tissue by a chemical compound, in the presence of oxygen, so that the great deal of free radicals and oxygen derivatives generated (hydroxyl compounds) produces necrosis of the treated tissue. Technique improvement during the last years has allowed its recent development as a therapeutic method for localised prostate cancer. At present, several clinical trials are ongoing in patients with organ-confined prostate cancer both as a first line and salvage treatment. There is no risk either of cancer dissemination in surrounding tissues or accumulative pharmaco-toxicity. Therefore, the technique can be repeated as often as needed and can be administered on a previously irradiated tissue. The literature review shows that photodynamic treatment will become a therapeutic option for patients with prostate cancer in the very near future.

In vivo optical characterization of human prostate tissue using near-infrared time-resolved spectroscopy

The development of photodynamic therapy into a modality for treatment of prostate cancer calls for reliable optical dosimetry. We employ, for the first time, interstitial time-resolved spectroscopy to determine in vivo optical properties of human prostate tissue. Nine patients are included in the study, and measurements are conducted prior to primary brachytherapy treatment of prostate cancer. Intrasubject variability is examined by measuring across three tissue volumes within each prostate. The time-resolved instrumentation proves its usefulness by producing good signal levels in all measurements. We are able to present consistent values on reduced scattering coefficients (mu(s)'), absorption coefficients (mu(a)), and effective attenuation (mu(eff)) at the wavelengths 660, 786, and 916 nm. At 660 nm, mu(s)' is found to be 9+/-2 cm(-1), and mu(a) is 0.5+/-0.1 cm(-1). Derived values of mu(eff) are in the range of 3 to 4 cm(-1) at 660 nm, a result in good agreement with previously published steady state data. Total hemoglobin concentration (THC) and oxygen saturation are spectroscopically determined using derived absorption coefficients. Derived THC values are fairly variable (215+/-65 microM), while derived values of oxygen saturation are gathered around 75% (76+/-4%). Intrasubject variations in derived parameters correlate (qualitatively) with the heterogeneity exhibited in acquired ultrasound images.

How good is MRI at detecting and characterising cancer within the prostate?

OBJECTIVES

As well as detecting prostate cancer, it is becoming increasingly important to estimate its location, size and grade. We aim to summarise current data on the efficacy of magnetic resonance imaging (MRI) in this setting.

METHODS

Literature review of original research correlating MRI and histologic appearances.

RESULTS

Estimates of the sensitivity of MRI for the detection of cancer vary widely depending on method of analysis used and the definition of significant disease. Recent estimates using T2-weighted sequences and endorectal coils vary from 60% to 96%. Several groups have convincingly shown that dynamic contrast enhancement and spectroscopy each improve detection and that the sensitivity of MRI is comparable to and may exceed that of transrectal biopsy. Specificity is not yet good enough to consider the use of MRI in screening. High-grade and large tumours are detected significantly more often with both T2 sequences and spectroscopy. Estimation of size is improved by dynamic contrast and spectroscopy, but errors of >25% are common.

CONCLUSIONS

The sensitivity of MRI has improved to the point that it has potential in several new areas: targeting of biopsies, monitoring of disease burden both during active surveillance and after focal therapy, and exclusion of cancer in patients with a raised prostate-specific antigen level.