Current status of transrectal ultrasound techniques in prostate cancer.

Purpose of review: Present the current status of transrectal ultrasound imaging in prostate cancer (PCa) and discuss the latest techniques now under preclinical evaluation. Recent findings: Three-dimensional ultrasound and quantification techniques are superior to two-dimensional ultrasound in visualizing PCa and can be beneficial in staging prior to operation. Doppler-guided biopsies are more likely to yield positive results, especially when high Gleason scores are present. Furthermore, Vardenafil usage strengthens Doppler enhancement and can help in increasing the diagnostic accuracy of Doppler. Multiple studies show elastography to be a promising new addition to the ultrasound investigations for detection of PCa. Especially the recently introduced Shear Wave Elastography shows decreased user dependency and increased PCa detection rates. MRI can also aid in the diagnostics of PCa. However, MRI-guided biopsies are more complicated compared to ultrasound guidance. MRI/ultrasound fusion combines best of both techniques and, although just recently emerged, the studies available show promising PCa detection rates. Summary: Technical improvements in classical ultrasound modalities (2D/3D-greyscale, Doppler) and new modalities (elastography/MRI/ultrasound fusion) raised the accuracy of PCa detection. Especially latest elastography and MRI/ultrasound fusion are showing promising results in PCa visualization

Contrast-enhanced ultrasound for prostate cancer imaging

\u3cp\u3eProstate cancer is the number one non-skin malignancy of males in Western countries. Analysis of the care cycle for prostate cancer patients indicates the lack of an accurate screening test, and the lack of a widely available and reliable imaging method for local tumors. This article presents a new approach to imaging localized prostate cancer: contrast-enhanced ultrasonography (CEUS). The method is based on the visualization of microvessel density by microbubble contrastagents. In this pilot project, contrast-enhanced ultrasound (CEUS) imaging was correlated with histology. The results indicate that changes in theperfusion characteristics revealed by CEUS correlate with malignant tissue.\u3c/p\u3

Transrectal contrast enhanced ultrasound for diagnosis of prostate cancer

The diagnosis of prostate cancer is based on histology. Prostate biopsies are obtained based on the triad of prostate specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasound. Because prostate biopsies still have a large percentage of negative outcomes, patient selection and biopsy direction need improvement. This paper describes the recent improvements in prostate cancer imaging, especially contrast-enhanced transrectal ultrasound

Evaluation of renal masses with contrast-enhanced ultrasound

The clinical need for characterising small renal masses (SRMs) is increasing due to their rising incidental detection. This increase is especially seen in younger and older generations and concerns mainly SRMs. Diagnostics is mainly made by contrast-enhanced CT or MRI. However, these imaging methods fail to accurately distinguishing benign from malignant SRMs. Other disadvantages of CT or MRI are high costs, the use of ionizing radiation, nephrotoxicity induced by iodine contrast agents or nephrogenic systemic fibrosis (NSF) induced by gadolinium contrast agents. Contrast-enhanced ultrasound (CEUS) is based on ultrasonography and microbubbles to real-time visualize the renal blood flow without the use of nephrotoxic agents or ionizing radiation. This comprehensive review evaluates the capabilities of CEUS in the diagnostics of benign (angiomyolipomas, cysts, oncocytomas, pseudotumors) and malignant masses (renal cell carcinomas), and focuses on possible future treatment

Quality of life and perceived pain after laparoscopic-assisted renal cryoablation

Purpose: Assessing changes in quality of life (QoL) and perceived pain after laparoscopic-assisted cryoablation (LAC) of renal tumors. Patients and Methods: Data for 57 patients who were treated with LAC were prospectively collected. QoL, divided into various domains, and postoperative pain were assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36), the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC-QLQ-C30), and Visual Analog Scale (VAS). Assessment was performed at baseline and at different time intervals until 1 year after LAC. Using a repeated measures analysis of variance, the influence of the following parameters was evaluated: Time of assessment, age, comorbidity, the occurrence of a complication, and tumor histology Results: SF-36: At baseline, only general health perceptions scored lower compared with the general population. Time of assessment and a complication did not affect QoL. Comorbidity and age >70 years led to a significantly lower QoL. Tumor histology affected general health perceptions. EORTC-QLQ-C30: Time of assessment affected 7 of 15 domains because of lower scores after 2 weeks. Age and comorbidity each negatively influenced five domains. A complication increased three symptoms scores and lowered general health status. Tumor histology significantly altered role functioning. VAS: VAS reached a peak 1 day after LAC, then quickly declined. Patients >70 years had significant higher VAS. Conclusions: QoL of patients who were treated with LAC showed a decrease 2 weeks after surgery but normalized to baseline within 3 months. Age and comorbidities especially affected QoL negatively. The VAS showed a peak 1 day after LAC and then quickly declined

Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia

Background Detrusor overactivity is one known cause of lower urinary tract symptoms and has been linked to bladder storage symptoms (urgency, frequency, or urge incontinence). Objective To determine clinical and urodynamic parameters associated with detrusor overactivity in patients with suspected benign prostatic hyperplasia. Design, Setting, and Participants During 1993–2003, urodynamic investigations were performed in patients aged 40 yr or older and with lower urinary tract symptoms, benign prostatic enlargement, and/or suspicion of bladder outlet obstruction (maximum flow rate <15 ml/s or postvoid residual urine > 50 ml). Measurements Detrusor overactivity was defined according to the new International Continence Society classification (2002) as involuntary detrusor contractions during cystometry, which may be spontaneous or provoked, regardless of amplitude. The Schäfer algorithm was used to determine bladder outlet obstruction. Results In total, 1418 men were investigated (median age: 63 yr) of whom 864 men (60.9%) had detrusor overactivity. In univariate analysis, men with detrusor overactivity were significantly older, more obstructed, had larger prostates, higher irritative International Prostate Symptoms Score subscores, a lower voiding volume at free uroflowmetry, and a lower bladder capacity at cystometry. The prevalence of detrusor overactivity rose continuously with increasing bladder outlet obstruction grade. Multivariate analysis showed that only age and bladder outlet obstruction grade were independently associated with detrusor overactivity. After age adjustment, the odds ratios of detrusor overactivity compared to Schäfer class 0 were 1.2 for class I, 1.4 for class II, 1.9 for class III, 2.5 for class IV, 3.4 for class V, and 4.7 for class VI. Conclusions In patients with clinical benign prostatic hyperplasia, detrusor overactivity is independently associated with age and bladder outlet obstruction. The probability of detrusor overactivity rises with increasing age and bladder outlet obstruction grade

Targeted microbubble prostate cancer imaging with BR55

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