Purpose We quantified prostate swelling and the intraprostatic point shift during high intensity focused ultrasound using real-time ultrasound. Materials and Methods The institutional review board ...approved this retrospective study. Whole gland high intensity focused ultrasound was done in 44 patients with clinically localized prostate cancer. Three high intensity focused ultrasound sessions were required to cover the entire prostate, including the anterior zone (session 1), middle zone (session 2) and posterior zone (session 3). Computer assisted 3-dimensional reconstructions based on 3 mm step-section images of intraoperative transrectal ultrasound were compared before and after each session. Results Most prostate swelling and intraprostatic point shifts occurred during session 1. The median percent volume increase was 18% for the transition zone, 9% for the peripheral zone and 13% for the entire prostate. The volume percent increase in the transition zone (p <0.001), peripheral zone (p = 0.001) and entire prostate (p = 0.001) statistically depended on the volume of each area measured preoperatively. The median 3-dimensional intraprostatic shift was 3.7 mm (range 0.9 to 13) in the transition zone and 5.5 mm (range 0.2 to 14) in the peripheral zone. A significant negative linear correlation was found between the preoperative presumed circle area ratio, and the percent increase in prostate volume (p = 0.001) and shift (p = 0.01) during high intensity focused ultrasound. Conclusions We quantified significant prostate swelling and shift during high intensity focused ultrasound. Smaller prostates and a smaller preoperative presumed circle area ratio were associated with greater prostate swelling and intraprostatic shifts. Real-time intraoperative adjustment of the treatment plan impacts the achievement of precise targeting during high intensity focused ultrasound, especially in prostates with a smaller volume and/or a smaller preoperative presumed circle area ratio.
Objectives
To evaluate the effects of transrectal compression of the prostate for intra‐operative prostatic swelling and intraprostatic point shift during high‐intensity focused ultrasound treatment ...of localized prostate cancer.
Methods
Patients treated with whole‐gland high‐intensity focused ultrasound as primary monotherapy for localized prostate cancer were enrolled in the study. Using the standard and compression method, the volumes of degassed water in the balloon covering the high‐intensity focused ultrasound probe were 50 mL and 80–160 mL, respectively. To identify prostatic swelling and shift during high‐intensity focused ultrasound and the volume occupied by the non‐enhanced area, three‐dimensional prostate models were reconstructed using ultrasound and contrast‐enhanced magnetic resonance imaging.
Results
In comparison with the standard (n = 40) and compression (n = 48) methods, intraoperative increase in the prostate volume (21% vs 5.3%; P = 0.044), intraprostatic point shift (4 mm vs 2 mm, P = 0.040 in the transition zone; 3 mm vs 0 mm; P = 0.001 in the peripheral zone) and the volume occupied by the non‐enhanced area (89% vs 96%; P = 0.001) were significantly suppressed. The biochemical disease‐free survival rate in patients treated using the compression method was significantly improved relative to the standard method (92.6% vs 76.5%; P = 0.038). Regarding complications, there was no significant difference in the rate of urethral stricture (P = 0.9), urinary tract infection (P = 0.9), incontinence (P = 0.3), erectile dysfunction (P = 0.9) or recto‐urethral fistula between the patients treated using the standard and compression methods.
Conclusions
Intraoperative transrectal compression suppresses intraoperative increase in the prostate volume and intraprostatic point shift during high‐intensity focused ultrasound, having the potential to achieve precise whole‐gland and lesion‐targeted focal therapy.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVE
To explore the association between the prostate‐specific antigen (PSA) nadir after transrectal high‐intensity focused ultrasound (HIFU) therapy for organ‐confined prostate cancer and ...subsequent treatment failure, as defined by the presence of residual disease at biopsy 6 months after treatment.
PATIENTS AND METHODS
Between January 1999 and January 2005, 115 patients in a Japanese hospital were treated using a transrectal HIFU system (SonablateTM, Focus Surgery, IN, USA) for presumed localized adenocarcinoma of the prostate. All treatments were primary and none of the patients had received hormone therapy. The PSA level was measured at 2‐monthly intervals and all patients had a transrectal prostate biopsy taken at 6 months. Multiple logistic regression was used to examine the relationship between PSA nadir and treatment failure, as defined by the presence of disease at biopsy.
RESULTS
The PSA nadir was strongly associated with treatment failure (P < 0.001). Patients with a PSA nadir of 0.0–0.2 ng/mL had a treatment failure rate of only 11% (four of 36), compared to 46% (17 of 37) in patients with a PSA nadir of 0.21–1.00 ng/mL and 48% (20 of 42) with a PSA nadir of >1.0 ng/mL. In addition, the PSA nadir was strongly associated with both preoperative PSA level and residual prostate volume.
CONCLUSION
There is a clear and intuitive association between the PSA nadir and the risk of treatment failure after HIFU. These data can be used to predict the risk of residual disease in patients with prostate cancer undergoing HIFU therapy. They can also be used to inform where the target PSA nadir should be set for this novel therapy.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Avascular areas on contrast‐enhanced magnetic resonance imaging have been considered to be areas of localized prostate cancer successfully treated by high‐intensity focused ultrasound. However, the ...optimal timing of magnetic resonance imaging has not been discussed. The thermal effect of high‐intensity focused ultrasound is degraded by regional prostatic blood flow. Conversely, the mechanical effect of high‐intensity focused ultrasound (cavitation) is not affected by blood flow, and can induce vessel damage. In this series, the longitudinal change of blood flow on contrast‐enhanced magnetic resonance imaging was observed from postoperative day 1 to postoperative day 14 in 10 patients treated with high‐intensity focused ultrasound. The median rates of increase in the non‐enhanced volume of the whole gland, transition zone and peripheral zone from postoperative day 1 to postoperative day 14 were 36%, 39%, and 34%, respectively. In another pathological analysis of the prostate tissue of 17 patients immediately after high‐intensity focused ultrasound without neoadjuvant hormonal therapy, we observed diffuse coagulative degeneration and partial non‐coagulative prostate tissue around arteries with vascular endothelial cell detachment. These observations on contrast‐enhanced magnetic resonance imaging support a time‐dependent change of the blood flow in the prostate treated with high‐intensity focused ultrasound. Additionally, our pathological findings support the longitudinal changes of these magnetic resonance imaging findings. Further large‐scale studies will investigate the most appropriate timing of contrast‐enhanced magnetic resonance imaging for evaluation of the effectiveness of high‐intensity focused ultrasound for localized prostate cancer.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
KISS
-
1
is a metastasis-suppressor gene of human melanoma, and encodes metastin, which was identified as the ligand of a G-protein-coupled receptor (metastin receptor). The precursor protein is ...cleaved to 54 amino acids, which may be further truncated into carboxy-terminal fragments. Previous studies showed that lack of metastin receptor in clear cell renal cell carcinoma (RCC) is associated with tumor progression, but the prediction of metastasis in patients with pT1 clear cell RCC after radical nephrectomy is difficult. The objective of this study was to evaluate the usefulness of metastin receptor immunohistochemistry in predicting metastasis after nephrectomy for pT1 clear cell RCC. After verification of the correlation between immunostaining and mRNA expression, we evaluated the clinical value of metastin receptor immunohistochemistry. Fifty-four patients were enrolled in this study; following radical nephrectomy, seven patients were found to have lung metastasis. The sensitivity, specificity, positive predictive value, and negative predictive value with negative immunostaining of metastin receptor were 85.7, 97.6, 46.2, and 97.6 %, respectively. Metastasis-free survival rates were significantly higher in patients with positive staining (97.6 %) than in patients with negative staining (53.8 %) (
P
< 0.001). In univariate analysis for metastasis-free survival, negative immunostaining of metastin receptor was a significant risk factor for metastasis (
P
= 0.001). Furthermore, negative immunostaining of metastin receptor was an independent predictor for metastasis in multivariate analysis (hazard ratio, 3.735; 95 % CI 0.629–22.174;
P
= 0.002). In conclusion, our study suggests that negative expression of metastin receptor in clear cell RCC is significantly related to metastasis.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose We evaluated the association between long-term clinical outcomes and morbidity with high intensity focused ultrasound. Materials and Methods We included patients with stage T1c-T3N0M0 ...prostate cancer who were treated with Sonablate® (SB) devices during 1999 to 2012 and followed for more than 2 years. Risk stratification and complication rates were compared among the treatment groups (ie SB200/500 group, SB500 version 4 group and SB500 tissue change monitor group). Primary study outcomes included overall, cancer specific and biochemical disease-free survival rates determined using Kaplan-Meier analysis (Phoenix definition). Secondary outcomes included predictors of biochemical disease-free survival using Cox models. Results A total of 918 patients were included in the study. Median followup in the SB200/500, SB500 version 4 and the SB500 tissue change monitor groups was 108, 83 and 47 months, respectively. The 10-year overall and cancer specific survival rates were 89.6% and 97.4%, respectively. The 5-year biochemical disease-free survival rate in the SB200/500, SB500 version 4 and SB500 tissue change monitor group was 48.3%, 62.3% and 82.0%, respectively (p <0.0001). The overall negative biopsy rate was 87.3%. On multivariate analysis pretreatment prostate specific antigen, Gleason score, stage, neoadjuvant androgen deprivation therapy and high intensity focused ultrasound devices were significant predictors of biochemical disease-free survival. Urethral stricture, epididymitis, urinary incontinence and rectourethral fistula were observed in 19.7%, 6.2%, 2.3% and 0.1% of cases, respectively. Conclusions Long-term followup of patients with high intensity focused ultrasound demonstrated improved clinical outcomes due to technical, imaging and technological advancements.
Objectives. To evaluate the therapeutic efficacy of bacille Calmette-Guérin (BCG) for carcinoma in situ (CIS) of the urothelium involving the upper urinary tract when the vaccine was administered by ...way of the bladder using vesicoureteral reflux created by a double-pigtail (DP) catheter.
Methods. Thirteen upper urinary tracts of 9 patients with cytologically diagnosed CIS, with concomitant bladder CIS in 4, were treated by intravesical BCG instillation. A DP catheter was placed retrogradely, and the appearance of vesicoureteral reflux was confirmed by cystography. BCG (1 to 2 mg/mL) in a volume sufficient to fill the renal caliceal system was administered into the bladder weekly for 6 weeks. The mean follow-up was 36 months (range 8 to 97).
Results. The voided urine cytology turned negative in all 9 patients at a mean of 86 days after the first administration of BCG. The voided urine cytology returned positive afterward in 3 patients, and positive cytology in the upper urinary tract was confirmed in 1 of 13 treated urinary tracts, which were successfully treated by another course of BCG therapy with the DP catheter. Minor adverse effects related to BCG and the DP catheter were seen in 5 patients.
Conclusions. BCG therapy for the CIS involving the upper urinary tract using a DP catheter might have the potential to be an effective procedure preserving renal units and could be adopted not only as an imperative, but also as an elective, treatment option.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Cancer metastasis is a leading cause of death in cancer patients and is a multistep process involving complex interactions between tumor and host cells. To metastasize, tumor cells must invade or ...migrate from the primary tumor and be transported to close or distant secondary sites. A tumor cell should successfully accomplish each step of the pathway or metastasis may not develop. KiSS-1 is a human metastasis suppressor gene that inhibits metastasis of human melanomas and breast carcinomas without affecting tumorigenicity. KiSS-1 encodes a carboxy-terminally amidated peptide with 54 amino-acid residues. The peptide was isolated from human placenta as the endogenous ligand of an orphan G-protein-coupled receptor and termed 'metastin'. The literature reports metastin related to human carcinoma, such as melanoma, thyroid cancer, esophageal squamous cell carcinoma (ESCC), hepatocellular carcinoma, pancreatic carcinoma, as well as breast, ovarian, bladder and kidney cancer. These malignancies are difficult to treat and, even in early-stage cancer, a number of patients develop metastasis shortly after surgery. Studies have suggested that metastin inhibits tumor invasion or migration through focal adhesion kinase, paxillin, MAP kinase or Rho A. Additionally, metastin may be a biomarker in ESCC, pancreatic carcinoma and bladder cancer. Metastin has potential as a suitable biomarker in the identification of tumors with high metastatic potential and as a novel effective treatment modality for patients with metastasis.
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