Transperineal Targeted Biopsy with Real-Time Fusion Image of Multiparametric Magnetic Resonance Image and Transrectal Ultrasound Image for the Diagnosis of Prostate Cancer

Objectives: To report clinical results of early experience of manually controlled targeted biopsy with real-time multiparametric magnetic resonance image (mpMRI)-transrectal ultrasound (TRUS) fusion images for the diagnosis of prostate cancer

The Role of the Magnetic Resonance Imaging for the Accurate Management of Focal Therapy with High-Intensity Focused Ultrasound for the Localized Prostate Cancer

The concept of the currently attracted focal therapy is to treat clinical significant cancer with minimal invasion of health-related functions such as urethra, sphincter, neurovascular bundle, and bladder neck. The patients\u27 criteria have been decided with pathologic tumor features characterized according to a combination of cancer core length and Gleason grade with prostate biopsy. Because the area involved in a single treatment using high-intensity focused ultrasound (HIFU) is extremely small, only minor temperature changes are observed outside of the focal zone. HIFU has been considered as an attractive therapeutic modality for the focal treatment of the prostate with the aim of curing the cancer while preserving continence and erectile function. Clinical trials of focal ablation of prostate cancer with HIFU have been reported. In our protocol, magnetic resonance imaging (MRI) has played a major role in the diagnosis of the spatial location of the significant cancer, treatment planning, and the evaluation of the treatment efficacy and recurrence after the treatment. In the chapter in “MR Imaging,” we want to present the role of MRI in the accurate management of focal therapy with HIFU for the localized prostate cancer

High-intensity focused ultrasound with visually directed power adjustment for focal treatment of localized prostate cancer: systematic review and meta-analysis

Purpose: To characterize patient outcomes following visually directed high-intensity focused ultrasound (HIFU) for focal treatment of localized prostate cancer. // Methods: We performed a systematic review of cancer-control outcomes and complication rates among men with localized prostate cancer treated with visually directed focal HIFU. Study outcomes were calculated using a random-effects meta-analysis model. // Results: A total of 8 observational studies with 1,819 patients (median age 67 years; prostate-specific antigen 7.1 mg/ml; prostate volume 36 ml) followed over a median of 24 months were included. The mean prostate-specific antigen nadir following visually directed focal HIFU was 2.2 ng/ml (95% CI 0.9–3.5 ng/ml), achieved after a median of 6 months post-treatment. A clinically significant positive biopsy was identified in 19.8% (95% CI 12.4–28.3%) of cases. Salvage treatment rates were 16.2% (95% CI 9.7–23.8%) for focal- or whole-gland treatment, and 8.6% (95% CI 6.1–11.5%) for whole-gland treatment. Complication rates were 16.7% (95% CI 9.9–24.6%) for de novo erectile dysfunction, 6.2% (95% CI 0.0–19.0%) for urinary retention, 3.0% (95% CI 2.1–3.9%) for urinary tract infection, 1.9% (95% CI 0.1–5.3%) for urinary incontinence, and 0.1% (95% CI 0.0–1.4%) for bowel injury. // Conclusion: Limited evidence from eight observational studies demonstrated that visually directed HIFU for focal treatment of localized prostate cancer was associated with a relatively low risk of complications and acceptable cancer control over medium-term follow-up. Comparative, long-term safety and effectiveness results with visually directed focal HIFU are lacking

Cytokine expression in rat molar gingival periodontal tissues after topical application of lipopolysaccharide

It is well known that proinflammatory cytokines produced by host cells play an important role in periodontal tissue destruction. However, the localization of the cytokines in in vivo periodontal tissues during development of periodontal disease has not been determined. Immunohistochemical expression of proinflammatory cytokines including IL-1α, IL-1β, and TNF-α was examined at 1 and 3 h, and 1, 2, 3, and 7 days after topical application of lipopolysaccharide (LPS; 5 mg/ml in physiological saline) from E. coli into the rat molar gingival sulcus. In the normal periodontal tissues, a small number of cytokine-positive epithelial cells were seen in the junctional epithelium (JE), oral sulcular and oral gingival epithelium, in addition to macrophages infiltrating in the subjunctional epithelial area and osteoblasts lining the alveolar bone surface. Epithelial remnants of Malassez existing throughout periodontal ligament were intensely positive for IL-1β but negative for the other two cytokines. At 3 h after the LPS treatment, almost all cells in the JE were strongly positive for the cytokines examined. In addition, several cytokine-positive cells, including neutrophils, macrophages, and fibroblasts, were seen in the subjunctional epithelial connective tissue. At day 2, expression of the cytokines in the JE gradually decreased, while cytokine-positive cells in the connective tissue increased in number. Positive staining of the cytokines was seen in osteoclasts and preosteoclasts which appeared along the alveolar bone margin in this period. The number of cytokine-positive cells decreased by day 7. These findings indicate that, in addition to macrophages, neutrophils, and fibroblasts, the JE cells are a potent source of TNF-α, IL-1α, and IL-1β reacting to LPS application, and suggest that JE cells may play an important role in the first line of defense against LPS challenge, and the proinflammatory cytokines transiently produced by various host cells may be involved in the initiation of inflammation and subsequent periodontal tissue destruction.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42233/1/418-116-1-57_s004180100298.pd

Molecular biomarkers in the context of focal therapy for prostate cancer: Recommendations of a delphi consensus from the focal therapy society

BACKGROUND: Focal therapy (FT) for prostate cancer (PCa) is promising. However, long-term oncological results are awaited and there is no consensus on follow-up strategies. Molecular biomarkers (MB) may be useful in selecting, treating and following up men undergoing FT, though there is limited evidence in this field to guide practice. We aimed to conduct a consensus meeting, endorsed by the Focal Therapy Society, amongst a large group of experts, to understand the potential utility of MB in FT for localized PCa. METHODS: A 38-item questionnaire was built following a literature search. The authors then performed three rounds of a Delphi Consensus using DelphiManager, using the GRADE grid scoring system, followed by a face-to-face expert meeting. Three areas of interest were identified and covered concerning MB for FT, 1) the current/present role; 2) the potential/future role; 3) the recommended features for future studies. Consensus was defined using a 70% agreement threshold. RESULTS: Of 95 invited experts, 42 (44.2%) completed the three Delphi rounds. Twenty-four items reached a consensus and they were then approved at the meeting involving (N.=15) experts. Fourteen items reached a consensus on uncertainty, or they did not reach a consensus. They were re-discussed, resulting in a consensus (N.=3), a consensus on a partial agreement (N.=1), and a consensus on uncertainty (N.=10). A final list of statements were derived from the approved and discussed items, with the addition of three generated statements, to provide guidance regarding MB in the context of FT for localized PCa. Research efforts in this field should be considered a priority. CONCLUSIONS: The present study detailed an initial consensus on the use of MB in FT for PCa. This is until evidence becomes available on the subject

Magnetic resonance imaging-transrectal ultrasound fusion image-guided prostate biopsy: Current status of the cancer detection and the prospects of tailor-made medicine of the prostate cancer

Multi-parametric magnetic resonance imaging (mpMRI) has been increasingly used to diagnose clinically significant prostate cancer (csPCa) because of its growing availability and its ability to combine anatomical and functional data. Magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion imaging provides MRI information with TRUS images for prostate biopsies. This technique combines the superior sensitivity of MRI for targeting suspicious lesions with the practicality and familiarity of TRUS. MRI-TRUS fusion image-guided prostate biopsy is performed with different types of image registration (rigid vs. elastic) and needle tracking methods (electromagnetic tracking vs. mechanical position encoders vs. image-based software tracking). A systematic review and meta-analysis showed that MRI-targeted biopsy detected csPCa at a significantly higher rate than did TRUS-guided biopsy, while it detected significantly fewer cases of insignificant PCas. In addition to the high accuracy of MRI-targeted biopsy for csPCa, localization of csPCa is accurate. The ability to choose the route of biopsy (transperineal vs. transrectal) is required, depending on the patients' risk and the location and size of suspicious lesions on mpMRI. Fusion image-guided prostate biopsy has the potential to allow precise management of prostate cancer, including active surveillance, radical treatment, and focal therapy