Prognosis of prostate gland morphology study using artificial neural network

The research goal is to optimize the management of patients with serum PSA level falling in the range of 4-10 ng/ ml by designing and educating of an artificial neural network, which may be used to predict prostate gland morphology basing on clinical, laboratory and imaging data. Material and methods. Data of 254 patients, who were admitted to the oncological Department of S. R. Mirotvortsev Clinical hospital for transrectal prostate biopsy, was collected to construct several artificial neural networks with different architecture. External validation was performed on 27 patients, who had prostate biopsy in January-February 2014. Results. One-layer network, consisting of 11 input, 9 hidden and 3 output neurons, was determined to be the most successful: in 92.6% cases it was correct in predicting prostate cancer or its absence. Input factors were evaluated according to their relative importance, from more important to less important: prostate volume, serum PSA, patient's age, prostate consistency, PSA velocity, prostate symmetry, previous negative biopsy, free serum PSA, intake of 5-alpha-reductase inhibitors. Conclusion. Artificial neural networks may be used to predict morphological findings in prostate biopsy. High PSA density and firm prostate consistency should cause suspicion of prostate cancer

Endoscopic correction of obstructive complications after HIFU-ablation of the prostate with holmium laser

Purpose: to improve the results of treatment of the obstructive complications (an urethra stenosis, a bladder neck sclerosis) caused by application of the high-intensity focused ultrasonic ablation (HIFU) concerning treatment of the localized prostate cancer. Material and Methods. An object of the research included 41 patients, with the infravesical obstruction (IVO) which has arisen in the postoperative period to which elimination the holmium laser is used. Results. The bladder neck was the most frequent place of obstruction. Average time before emergence of the first episode of IVO: 8.2±1.3 months. Distinctions on time before development of an episode of IVO depending on the fact of carrying out TURP before HIFU not confirmed (p=0.440). More advanced age for a moment HIFU-ablation has been associated with much higher frequency of IVO (p=0.021). Considerably smaller frequency repeated was observed by IVO at a larger ratio transurethral resection to the initial volume of a prostate (p=0.031). Duration of a laser endoscopic ure-throtomy was 27 [10-70] minutes, serious perioperative or postoperative complications were not determined. Average term before removal of a catheter of Foley: 3 [1-5] days, hospitalization duration included 4 [3-6] days. After treatment considerable improvement on indicators of the maximum speed of a stream of urine (Qmax) and volume of residual urine was observed. The total score according to the questionnaires of IPSS and QoL has considerably improved, significant changes on symptoms of accumulation are noted. After the first holmium laser urethrotomy of 80.4% of patients have noted satisfactory results without recurrence of IVO; 19.6% of patients were required a repeated laser endoscopic urethrotomy. Recurrence term after the first laser urethrotomy is on average equal to 2.5 months. Conclusion. The endoscopic urethrotomy by means of the holmium laser is safe, effective and minimum invasive type of treatment of a stenosis of a neck of the bladder / urethra after ablative cancer therapy of prostate. The advantages are the minimum of traumas of surrounding tissues and preservation of the mechanism of deduction of urine.</p

Postoperative monitoring of prostate-specific antigen (PSA) after treatment with high-intensive focused ultrasound (HIFU

Research objective: to estimate efficiency of treatment of prostate cancer using high-intensive focused ultrasound on the basis of laboratory analysis of postoperative level prostate-specific antigen (PSA). Objects of research. Objects of research consisted of 110 patients treated in urological clinic of Hospital n.a. S. R. Mirotvortsev (Saratov State Medical University) during the period February, 2009 — March, 2012. Patients took 110 sessions of primary operative treatment of prostate cancer by HIFU therapy method. Technique and research methods. Concentration of PSA in blood changed in all patients every 1,5 month within 6 months after operation, irrespective of its kind (including after repeated HIFU), further — after every 3 month till one year, and later on after 6 months. We were guided by references of the International Consensus, which considers PSA level more than 0,5 ng/ml in blood after 3 months of treatment to be unsatisfactory result. We also headed for PSA level before treatment and oncological risk degree. Results. Median nadir formed 0,5 ng/ml PSA by 3 months after treatment. Patients demonstrated different indicators of PSA dynamics depending on oncological risk, stage and hormonal therapy management. Patients with low oncological risk had initially lower PSA concentration, further PSA concentration reached nadir level faster. At patients with widespread forms of prostate cancer accurate dependence of PSA concentration according to prevalence of process was traced. Time of PSA nadir amount did not differ and was marked as 12-14 weeks on average. At patients received hormonal therapy, lower value of PSA nadir was marked. The conclusion. Monitoring of PSA concentration (PSA nadir by 3 months, dynamics of PSA concentration change) is of great importance in early revealing of relapse after prostate HIFU therapy. High level of PSA nadir and PSA growth according to time period are important prognostic factors

First Experience Of Application Of High-Intensity Focused Ultrasonic Ablation (Hifu) In Prostate Cancer Treatment

The scientific article points out that 40 sessions of HIFU prostate ablation have been performed for estimation of clinical efficiency. Average frequency of influences presents 628±164 impulses; average volume of tissues subjected to influence during one procedure is 33,8±16,3 smi (132 %) of prostate volume; average operation time constitutes 150 minutes (from 90 to 200 minutes). During the operation no complications have been occurred. In the first days after the session of HIFU there was a peak of PSA increase and then during 1,5-3 months there was decrease to the lowest index. Minimal PSA level was reached in 10-12 weeks after treatment and it constituted from 0,04 till 1,1 ngml depending on the disease state. Reduction of prostate volume occurred in average from the 30th day of postoperative period and lasted for 6 months, reaching in average 50 % from initial volume. Postoperative period varied from 10 till 16 days and constituted in average 12±0,8 days. Thus application of high-intensity focused ultrasonic ablation allows treating successfully various stages of prostate cancer with minimal number of side-effects and makes possible the early estimation of treatment efficienc

Integrative approach to pre-operative determination of clinically significant prostate cancer

Aim: improvement of early diagnostics of prostate cancer by developing a technique, which makes possible to predict its clinical significance in outpatient setting before initiation of invasive procedures. Material and Methods. Clinical data of 398 patients who underwent transrectal prostate biopsy in 2012-2014 in SSMU S. R. Mirotvortsev Clinical Hospital, was used to build an artificial neural network, while its output allowed to determine whether the tumour corresponds to Epstein criteria and which D'Amico risk group it belongs to. Internal validation was performed on 80 patients, who underwent prostate biopsy in September 2014 — December 2014. Sensitivity, specificity, positive and negative predictive value of artificial neural network were calculated. Results. Accuracy of predicting adenocarcinoma presence in biopsy specimen was 93,75%; accuracy of predicting whether the cancer meets active surveillance criteria was 90%. Accuracy of predicting T stage (T1c, T2a, T2b, T2c)was 57,1%. Prediction of D'Amico risk group was accurate in 70% of cases; for low-risk cancer accuracy was 81,2%. Conclusion. Artificial neural networks may be responsible for prostate cancer risk stratification and determination of its clinical significance prior to biopsy

VARIABILITY OF FASTNESS PROPERTIES OF URETERS OF ADULT PEOPLE

Investigated fastness properties of ureters of adult people in view of a floor, age and topography-anatomic features. Statistically significant decrease of their fastness with the years is revealed, are noted sexual and bilateral features. The general fastness of ureters increases in caudal a direction, and strength during a member does not variate

High intensity focused ultrasound (HIFU) as the alternative method of treatment of oncourological diseases

Increasing interest devoted to technology of high intensity focused ultrasound (high-intensity focused ultrasound, HIFU), basically, is explained by a wide spectrum of potential fields of application at minimum invasiveness of the given method. In oncourology HIFU is applied in prostate and kidney cancer. In case of tumors of renal parenchyma the given technique is being clinically tested, while HIFU is currently used in the practice of European oncourologists in treatment of prostate cancer. The majority of the references describing the results of HIFU application in prostate cancer is based on data of a number of clinical observations. It has been proved that HIFU is a possible method of treatment of highly — and moderate-differentiated tumors, and local relapses after remote radial therapy

Identification of risk factors of prostate adenocarcinoma recurrence after HIFU therapy using immunohistochemical markers

The purpose of this study was to identify risk factors for recurrence of prostate adenocarcinoma after HIFU therapy. Material and methods: Material for the study was obtained from patients diagnosed with adenocarcinoma before and after HIFU treatment. Morphological study was conducted using a standard staining, and immunohistochemical markers: PCNA, Amacr, E-cadherin, Bel2, Andr, Estr, VEGF, P53, PCNA. Results: After treatment in 89% of patients with initial prostate volume greater than 50 cc the signs of recurrence of adenocarcinoma were showed. At low risk for D'Amico after treatment the expression of proliferation markers, VEGF, Amacr significantly decreased. With a high degree of risk — increased expression of Bel2. After treatment the expression of the following markers: PCNA, Amacr, VEGF significantly increased in the group of patients with the presence of invasion. Conclusion: Patients with initial prostate volume less than 50 cc, low risk to D'Amico, the lack of perineural and perivascular invasion have a low risk of recurrence after HIFU therapy; patients at high risk for D'Amico, the presence of perineural and perivascular invasion initial and prostate volume greater than 50 cc, low-grade cribriform form of adenocarcinoma have a high risk of recurrence of adenocarcinoma. Recurrence of adenocarcinoma develops independently of the period after HIFU therapy

Combination of the transurethral resection and prostate HIFU ablation at treatment of the localized cancer

Research objective: to estimate results of treatment of patients with the localized form of a cancer of a prostate at a combination of a transurethral resection (TURP) and HIFU of an ablation. Objects and research methods: From February, 2009 to February, 2014 of 100 patients with the localized form of a cancer of a prostate were selected for research: 26 patients were included into HIFU and 74 group in group of the combined treatment (TURP+HIFU). Selection criteria for HIFU ablation were the localized cancer of a prostate concerning which earlier it wasn't carried out treatments, and level of a PSA at the time of statement of the diagnosis 15 ng/ml. All patients corresponding to these by criteria, were considered as candidates for treatment and inclusion in the analysis. The nadir and stability of PSA, the histologic conclusion, IPSS, quality of life and complication were estimated at time of postoperative supervision. Results: Statistically significant influence of a combination TURP+HIFU for the term of transurethral drainage of a bladder (a median of 40 days against 7 days), incontience frequency (15.4% against 6.9%), infections of urinary ways (47.9% against 11.4%) and IPSS change during the postoperative period (on the average 8.91 against 3.37) is noted. During the short period of supervision it wasn't observed considerable changes in relation to efficiency: in HIFU group the frequency of repeated sessions made 25%, in TUR/HIFU group 4%. Conclusion: HIFU therapy is modern, minimum invasive method of a cancer therapy of a prostate. The combination of a transurethral resection and HIFU ablation significantly reduces the frequency of the complications connected with treatment. Maintaining the patient after combined TURP and HIFU ablation is comparable with maintaining the patient after usual TURP