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Hahn O, Heining FM, Janzen J, Becker JCR, Bertlich M, Thelen P, Mansour JJ, Duensing S, Pahernik S, Trojan L, Popeneciu IV. Modulating the Heat Sensitivity of Prostate Cancer Cell Lines In Vitro: A New Impact for Focal Therapies. Biomedicines 2020; 8:E585. [PMID: 33316876 PMCID: PMC7763367 DOI: 10.3390/biomedicines8120585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022] Open
Abstract
Focal therapies such as high-intensity focused ultrasound (HiFU) are an emerging therapeutic option for prostate cancer (PCA). Thermal or mechanical effects mediate most therapies. Moreover, locally administered drugs such as bicalutamide or docetaxel are new focal therapeutic options. We assessed the impact of such focal medical treatments on cell viability and heat sensitivity by pre-treating PCA cell lines and then gradually exposing them to heat. The individual heat response of the cell lines tested differed largely. Vertebral-Cancer of the Prostate (VCaP) cells showed an increase in metabolic activity at 40-50 °C. Androgen receptor (AR)-negative PC3 cells showed an increase at 51.3 °C and were overall more resistant to higher temperatures. Pre-treatment of VCaP cells with testosterone (VCaPrev) leads to a more PC3-like kinetic of the heat response. Pre-treatment with finasteride and bicalutamide did not cause changes in heat sensitivity in any cell line. Mitoxantrone treatment, however, shifted heat-induced proliferation loss to lower temperature in VCaP cells. Further analysis via RNAseq identified a possible correlation of heat resistance with H3K27me3-dependent gene regulation, which could be related to an increase in the histone methyltransferase EZH2 and a possible neuroendocrine differentiation. Pre-treatment with mitoxantrone might be a perspective for HiFU treatment. Further studies are needed to evaluate possible combinations with Hsp90 or EZH2 inhibitors.
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Affiliation(s)
- Oliver Hahn
- Department of Urology, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.M.H.); (J.J.); (J.C.R.B.); (M.B.); (P.T.); (L.T.)
| | - Franziska M. Heining
- Department of Urology, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.M.H.); (J.J.); (J.C.R.B.); (M.B.); (P.T.); (L.T.)
| | - Jörn Janzen
- Department of Urology, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.M.H.); (J.J.); (J.C.R.B.); (M.B.); (P.T.); (L.T.)
| | - Johanna C. R. Becker
- Department of Urology, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.M.H.); (J.J.); (J.C.R.B.); (M.B.); (P.T.); (L.T.)
| | - Marina Bertlich
- Department of Urology, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.M.H.); (J.J.); (J.C.R.B.); (M.B.); (P.T.); (L.T.)
| | - Paul Thelen
- Department of Urology, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.M.H.); (J.J.); (J.C.R.B.); (M.B.); (P.T.); (L.T.)
| | - Josef J. Mansour
- Department of Urology, Heidelberg School of Medicine, University of Heidelberg, 69120 Heidelberg, Germany; (J.J.M.); (S.D.); (S.P.)
| | - Stefan Duensing
- Department of Urology, Heidelberg School of Medicine, University of Heidelberg, 69120 Heidelberg, Germany; (J.J.M.); (S.D.); (S.P.)
| | - Sascha Pahernik
- Department of Urology, Heidelberg School of Medicine, University of Heidelberg, 69120 Heidelberg, Germany; (J.J.M.); (S.D.); (S.P.)
- Department of Urology, Paracelsus Medical University Nuremberg, 90419 Nuremberg, Germany
| | - Lutz Trojan
- Department of Urology, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.M.H.); (J.J.); (J.C.R.B.); (M.B.); (P.T.); (L.T.)
| | - Ionel V. Popeneciu
- Department of Urology, University Medical Center Göttingen, 37075 Göttingen, Germany; (F.M.H.); (J.J.); (J.C.R.B.); (M.B.); (P.T.); (L.T.)
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Bonekamp D, Wolf MB, Roethke MC, Pahernik S, Hadaschik BA, Hatiboglu G, Kuru TH, Popeneciu IV, Chin JL, Billia M, Relle J, Hafron J, Nandalur KR, Staruch RM, Burtnyk M, Hohenfellner M, Schlemmer HP. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. Eur Radiol 2018; 29:299-308. [PMID: 29943185 DOI: 10.1007/s00330-018-5584-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/08/2018] [Accepted: 06/01/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE To quantitatively assess 12-month prostate volume (PV) reduction based on T2-weighted MRI and immediate post-treatment contrast-enhanced MRI non-perfused volume (NPV), and to compare measurements with predictions of acute and delayed ablation volumes based on MR-thermometry (MR-t), in a central radiology review of the Phase I clinical trial of MRI-guided transurethral ultrasound ablation (TULSA) in patients with localized prostate cancer. MATERIALS AND METHODS Treatment day MRI and 12-month follow-up MRI and biopsy were available for central radiology review in 29 of 30 patients from the published institutional review board-approved, prospective, multi-centre, single-arm Phase I clinical trial of TULSA. Viable PV at 12 months was measured as the remaining PV on T2-weighted MRI, less 12-month NPV, scaled by the fraction of fibrosis in 12-month biopsy cores. Reduction of viable PV was compared to predictions based on the fraction of the prostate covered by the MR-t derived acute thermal ablation volume (ATAV, 55°C isotherm), delayed thermal ablation volume (DTAV, 240 cumulative equivalent minutes at 43°C thermal dose isocontour) and treatment-day NPV. We also report linear and volumetric comparisons between metrics. RESULTS After TULSA, the median 12-month reduction in viable PV was 88%. DTAV predicted a reduction of 90%. Treatment day NPV predicted only 53% volume reduction, and underestimated ATAV and DTAV by 36% and 51%. CONCLUSION Quantitative volumetry of the TULSA phase I MR and biopsy data identifies DTAV (240 CEM43 thermal dose boundary) as a useful predictor of viable prostate tissue reduction at 12 months. Immediate post-treatment NPV underestimates tissue ablation. KEY POINTS • MRI-guided transurethral ultrasound ablation (TULSA) achieved an 88% reduction of viable prostate tissue volume at 12 months, in excellent agreement with expectation from thermal dose calculations. • Non-perfused volume on immediate post-treatment contrast-enhanced MRI represents only 64% of the acute thermal ablation volume (ATAV), and reports only 60% (53% instead of 88% achieved) of the reduction in viable prostate tissue volume at 12 months. • MR-thermometry-based predictions of 12-month prostate volume reduction based on 240 cumulative equivalent minute thermal dose volume are in excellent agreement with reduction in viable prostate tissue volume measured on pre- and 12-month post-treatment T2w-MRI.
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Affiliation(s)
- David Bonekamp
- Department of Radiology (E010), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - M B Wolf
- Department of Radiology (E010), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - M C Roethke
- Department of Radiology (E010), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - S Pahernik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - B A Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - G Hatiboglu
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - T H Kuru
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - I V Popeneciu
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - J L Chin
- Department of Urology, University of Western Ontario (UWO), London Health Sciences Center, Victoria Hospital, London, ON, Canada
| | - M Billia
- Department of Urology, University of Western Ontario (UWO), London Health Sciences Center, Victoria Hospital, London, ON, Canada
| | - J Relle
- Department of Urology, Beaumont Health System, Royal Oak, MI, USA
| | - J Hafron
- Department of Urology, Beaumont Health System, Royal Oak, MI, USA
| | - K R Nandalur
- Department of Radiology, Beaumont Health System, Royal Oak, MI, USA
| | - R M Staruch
- Clinical Science, Profound Medical Inc., Toronto, ON, Canada
| | - M Burtnyk
- Clinical Science, Profound Medical Inc., Toronto, ON, Canada
| | - M Hohenfellner
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - H-P Schlemmer
- Department of Radiology (E010), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Hatiboglu G, Popeneciu IV, Deppert M, Nyarangi-Dix J, Hadaschik B, Hohenfellner M, Teber D, Pahernik S. Quality of life and functional outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer. BMC Urol 2017; 17:5. [PMID: 28077116 PMCID: PMC5225650 DOI: 10.1186/s12894-017-0198-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/05/2017] [Indexed: 12/26/2022] Open
Abstract
Background To evaluate quality of life, functional and oncological outcome after infravesical desobstruction and HIFU treatment for localized prostate cancer. Methods One hundred thirty-one patients, treated with TURP and HIFU in a single institution were followed up for oncological and functional outcome. Oncological outcome was quantified by biochemical recurrence free survival using the Stuttgart and Phoenix criteria. Quality of life was assessed by usage of standardized QLQ-C30 and QLQ-PR25 questionnaires. In addition, functional questionnaires such as IPSS and IIEF-5 were used. Complications were assessed by the Clavien-Dindo classification. Results One hundred thirty-one patients with a mean age of 72.8 years (SD: 6.0) underwent HIFU for prostate cancer (29.0% low risk, 58.8% intermediate risk, 12.2% high risk). PSA nadir was 0.6 ng/ml (SD: 1.2) after a mean of 4.6 months (SD: 5.7). Biochemical recurrence free survival defined by Stuttgart criteria was 73.7%, 84.4% and 62.5% for low-, intermediate- and high-risk patients after 22.2 months. Complications were grouped according to Clavien-Dindo and occurred in 10.7% (grade II) and 11.5% (grade IIIa) of cases. 35.1% of patients needed further treatment for bladder neck stricture. Regarding incontinence, 14.3%, 2.9% and 0% of patients had de novo urinary incontinence grade I°, II° and III° and 3.8% urge incontinence due to HIFU treatment. Patients were asked for the ability to have intercourse: 15.8%, 58.6% and 66.7% of patients after non-, onesided and bothsided nervesparing procedure were able to obtain sufficient erection for intercourse, respectively. Regarding quality of life, mean global health score according to QLQ-C30 was 69.4%. Conclusion HIFU treatment for localized prostate cancer shows acceptable oncological safety. Quality of life after HIFU is better than in the general population and ranges within those of standard treatment options compared to literature. HIFU seems a safe valuable treatment alternative for patients not suitable for standard treatment.
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Affiliation(s)
- G Hatiboglu
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - I V Popeneciu
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M Deppert
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - J Nyarangi-Dix
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - B Hadaschik
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - M Hohenfellner
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - D Teber
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - S Pahernik
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt CD, Kesch C, Popeneciu IV, Huettenbrink C, Gasch C, Klein T, Bonekamp D, Duensing S, Roth W, Schueler S, Stock C, Schlemmer HP, Roethke M, Hohenfellner M, Hadaschik BA. Multiparametric Magnetic Resonance Imaging (MRI) and MRI–Transrectal Ultrasound Fusion Biopsy for Index Tumor Detection: Correlation with Radical Prostatectomy Specimen. Eur Urol 2016; 70:846-853. [DOI: 10.1016/j.eururo.2015.12.052] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/29/2015] [Indexed: 11/26/2022]
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Chin JL, Billia M, Relle J, Roethke MC, Popeneciu IV, Kuru TH, Hatiboglu G, Mueller-Wolf MB, Motsch J, Romagnoli C, Kassam Z, Harle CC, Hafron J, Nandalur KR, Chronik BA, Burtnyk M, Schlemmer HP, Pahernik S. Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Tissue in Patients with Localized Prostate Cancer: A Prospective Phase 1 Clinical Trial. Eur Urol 2016; 70:447-55. [PMID: 26777228 DOI: 10.1016/j.eururo.2015.12.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Magnetic resonance imaging-guided transurethral ultrasound ablation (MRI-TULSA) is a novel minimally invasive technology for ablating prostate tissue, potentially offering good disease control of localized cancer and low morbidity. OBJECTIVE To determine the clinical safety and feasibility of MRI-TULSA for whole-gland prostate ablation in a primary treatment setting of localized prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS A single-arm prospective phase 1 study was performed at three tertiary referral centers in Canada, Germany, and the United States. Thirty patients (median age: 69 yr; interquartile range [IQR]: 67-71 yr) with biopsy-proven low-risk (80%) and intermediate-risk (20%) PCa were treated and followed for 12 mo. INTERVENTION MRI-TULSA treatment was delivered with the therapeutic intent of conservative whole-gland ablation including 3-mm safety margins and 10% residual viable prostate expected around the capsule. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary end points were safety (adverse events) and feasibility (technical accuracy and precision of conformal thermal ablation). Exploratory outcomes included quality of life, prostate-specific antigen (PSA), and biopsy at 12 mo. RESULTS AND LIMITATIONS Median treatment time was 36min (IQR: 26-44) and prostate volume was 44ml (IQR: 38-48). Spatial control of thermal ablation was ±1.3mm on MRI thermometry. Common Terminology Criteria for Adverse Events included hematuria (43% grade [G] 1; 6.7% G2), urinary tract infections (33% G2), acute urinary retention (10% G1; 17% G2), and epididymitis (3.3% G3). There were no rectal injuries. Median pretreatment International Prostate Symptom Score 8 (IQR: 5-13) returned to 6 (IQR: 4-10) at 3 mo (mean change: -2; 95% confidence interval [CI], -4 to 1). Median pretreatment International Index of Erectile Function 13 (IQR: 6-28) recovered to 13 (IQR: 5-25) at 12 mo (mean change: -1; 95% CI, -5 to 3). Median PSA decreased 87% at 1 mo and was stable at 0.8 ng/ml (IQR: 0.6-1.1) to 12 mo. Positive biopsies showed 61% reduction in total cancer length, clinically significant disease in 9 of 29 patients (31%; 95% CI, 15-51), and any disease in 16 of 29 patients (55%; 95% CI, 36-74). CONCLUSIONS MRI-TULSA was feasible, safe, and technically precise for whole-gland prostate ablation in patients with localized PCa. Phase 1 data are sufficiently compelling to study MRI-TULSA further in a larger prospective trial with reduced safety margins. PATIENT SUMMARY We used magnetic resonance imaging-guided transurethral ultrasound to heat and ablate the prostate in men with prostate cancer. We showed that the treatment can be targeted within a narrow range (1mm) and has a well-tolerated side effect profile. A larger study is under way. TRIAL REGISTRATION NCT01686958, DRKS00005311.
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Affiliation(s)
- Joseph L Chin
- University of Western Ontario, London Health Sciences Centre, London, ON, Canada.
| | - Michele Billia
- University of Western Ontario, London Health Sciences Centre, London, ON, Canada
| | | | | | | | - Timur H Kuru
- University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | - Cesare Romagnoli
- University of Western Ontario, London Health Sciences Centre, London, ON, Canada
| | - Zahra Kassam
- University of Western Ontario, London Health Sciences Centre, London, ON, Canada
| | - Christopher C Harle
- University of Western Ontario, London Health Sciences Centre, London, ON, Canada
| | | | | | - Blaine A Chronik
- University of Western Ontario, London Health Sciences Centre, London, ON, Canada
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Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt C, Kesch C, Popeneciu IV, Huettenbrink C, Bergstraesser-Gasch C, Klein T, Duensing S, Roth S, Schlemmer HP, Roethke M, Hohenfellner M, Hadaschik B. Multiparametric magnetic resonance tomography and MRI/TRUS-fusion-biopsy for index lesion detection: correlation with radical prostatectomy specimen. Cancer Imaging 2015. [PMCID: PMC4601104 DOI: 10.1186/1470-7330-15-s1-s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hatiboglu G, Huber J, Herpel E, Popeneciu IV, Nyarangi-Dix J, Teber D, Hadaschik BA, Pahernik S, Duensing S, Hohenfellner M. [Structure of biobanks for urological research]. Urologe A 2014; 54:1256-60. [PMID: 25503899 DOI: 10.1007/s00120-014-3722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Biomedical research plays an important role in the development of novel diagnostic procedures, drugs and treatment strategies with regard to cancerous and chronic inflammatory diseases. Biobanks are essential tools in this process. The complex structures and benefits of biobanks are presented in this article.
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Affiliation(s)
- G Hatiboglu
- Klinik und Poliklinik für Urologie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland,
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Wolf MB, Roethke M, Pahernik S, Hadaschik B, Kuru T, Popeneciu IV, Hatiboglu G, Chin J, Billia M, Relle J, Hafron J, Nandalur K, Burtnyk M, Schlemmer HP. Localised prostate cancer treated with MRI-guided transurethral ultrasound ablation: phase I trial results. Cancer Imaging 2014. [PMCID: PMC4242781 DOI: 10.1186/1470-7330-14-s1-s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Kuru TH, Zhu J, Popeneciu IV, Rudhardt NS, Hadaschik BA, Teber D, Roethke M, Hohenfellner M, Zeier M, Pahernik SA. Volumetry may predict early renal function after nephron sparing surgery in solitary kidney patients. Springerplus 2014; 3:488. [PMID: 25202653 PMCID: PMC4156575 DOI: 10.1186/2193-1801-3-488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/20/2014] [Indexed: 12/27/2022]
Abstract
We investigate the impact of the residual kidney volume measured by tumor volumetry on preoperative imaging in predicting post-operative renal function. Nephron sparing surgery (NSS) in renal cell carcinoma (RCC) is the standard treatment for T1 kidney tumors. Resection of kidney tumors in solidary kidneys needs precise preoperative counseling of patients regarding post-operative renal function. Patients planned for renal tumor surgery who underwent prior nephrectomy on the contralateral side were included. We identified 35 patients in our database that underwent NSS in solitary kidneys and met the inclusion criteria. Tumor volumetry was performed on computer tomography (CT) or magnetic resonance imaging (MRI) with the Medical Imaging Interaction Toolkit (MITK). Clinical and pathological data were assessed. Follow-up data included renal function over 3 years. Mean age was 64 ± 8.1 years. Mean tumor volume on imaging was 27.5 ± 48.6 cc. Mean kidney volume was 195.2 ± 62.8 cc and mean residual kidney volume was 173.4 ± 65.3 cc. We found a correlation between renal function (MDRD) and residual kidney volume on imaging 1-week post-surgery (p = 0.038). Mid- and long-term renal function was not associated with residual kidney volume. In conclusion, renal volumetry may predict early renal function after NSS.
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Affiliation(s)
- Timur H Kuru
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany ; Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Jie Zhu
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Ionel V Popeneciu
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Nora S Rudhardt
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Boris A Hadaschik
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Matthias Roethke
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, UniversityHospital, Heidelberg, Germany
| | - Sascha A Pahernik
- Department of Urology, UniversityHospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Radtke JP, Kuru TH, Boxler S, Alt CD, Popeneciu IV, Huettenbrink C, Klein T, Steinemann S, Bergstraesser C, Roethke M, Roth W, Schlemmer HP, Hohenfellner M, Hadaschik BA. Comparative analysis of transperineal template saturation prostate biopsy versus magnetic resonance imaging targeted biopsy with magnetic resonance imaging-ultrasound fusion guidance. J Urol 2014; 193:87-94. [PMID: 25079939 DOI: 10.1016/j.juro.2014.07.098] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Multiparametric magnetic resonance imaging and magnetic resonance imaging targeted biopsy may improve the detection of clinically significant prostate cancer. However, standardized prospective evaluation is limited. MATERIALS AND METHODS A total of 294 consecutive men with suspicion of prostate cancer (186 primary, 108 repeat biopsies) enrolled in 2013 underwent 3T multiparametric magnetic resonance imaging (T2-weighted, diffusion weighted, dynamic contrast enhanced) without endorectal coil and systematic transperineal cores (median 24) independently of magnetic resonance imaging suspicion and magnetic resonance imaging targeted cores with software registration (median 4). The highest Gleason score from each biopsy method was compared. McNemar's tests were used to evaluate detection rates. Predictors of Gleason score 7 or greater disease were assessed using logistic regression. RESULTS Overall 150 cancers and 86 Gleason score 7 or greater cancers were diagnosed. Systematic, transperineal biopsy missed 18 Gleason score 7 or greater tumors (20.9%) while targeted biopsy did not detect 11 (12.8%). Targeted biopsy of PI-RADS 2-5 alone overlooked 43.8% of Gleason score 6 tumors. McNemar's tests for detection of Gleason score 7 or greater cancers in both modalities were not statistically significant but showed a trend of superiority for targeted primary biopsies (p=0.08). Sampling efficiency was in favor of magnetic resonance imaging targeted prostate biopsy with 46.0% of targeted biopsy vs 7.5% of systematic, transperineal biopsy cores detecting Gleason score 7 or greater cancers. To diagnose 1 Gleason score 7 or greater cancer, 3.4 targeted and 7.4 systematic biopsies were needed. Limiting biopsy to men with PI-RADS 3-5 would have missed 17 Gleason score 7 or greater tumors (19.8%), demonstrating limited magnetic resonance imaging sensitivity. PI-RADS scores, digital rectal examination findings and prostate specific antigen greater than 20 ng/ml were predictors of Gleason score 7 or greater disease. CONCLUSIONS Compared to systematic, transperineal biopsy as a reference test, magnetic resonance imaging targeted biopsy alone detected as many Gleason score 7 or greater tumors while simultaneously mitigating the detection of lower grade disease. The gold standard for cancer detection in primary biopsy is a combination of systematic and targeted cores.
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Affiliation(s)
- Jan P Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Timur H Kuru
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Silvan Boxler
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany; Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Celine D Alt
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ionel V Popeneciu
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Tilman Klein
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Steinemann
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Matthias Roethke
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wilfried Roth
- Department of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Boris A Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
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