INTRODUCTION: To identify differences in acute urinary and sexual toxicity between a 6-fraction and 2-fraction high-dose-rate brachytherapy monotherapy regimen and correlate dosimetric constraints to short-term toxicity.
METHODS: A single institution retrospective study of 116 men with prostate cancer treated with HDR monotherapy from 2010 to 2015 was conducted. Eighty-one men had 7.25 Gy × 6-fractions and 35 men had 13.5 Gy × 2-fractions. Patients had two CT-planned implants spaced 1-2 weeks apart. Patient baseline characteristics, International Prostate Symptom Scores (IPSS) and Sexual Health Inventory for Men (SHIM) scores were collected pre-treatment and 3, 6 and 12 months post-implantation. Mixed effect modelling was undertaken to compare baseline, 1-6 month and 7-12 month scores between groups. Poisson regression analysis was performed to correlate dosimetric constraints with acute toxicity.
RESULTS: There was no difference between baseline and post-implantation IPSS scores between 6-fraction and 2-fraction groups. SHIM scores for men treated with 6-fractions had a steeper decline at 1-6 months, but resolved at 7-12 months. Pre-treatment alpha-blocker use correlated with worse short-term acute urinary toxicity. Worsened SHIM score correlated with increasing age, diabetes mellitus and androgen-deprivation therapy. In a dosimetric analysis of outcomes, prostate V150 dose and bladder wall (D01.cc, D1cc, D2cc) dose correlated with increased IPSS score.
CONCLUSION: No increased acute genitourinary or sexual dysfunction has been observed in men when transitioning from 6-fraction to 2-fraction HDR monotherapy. A dosimetric correlation was found between the V150 and bladder wall doses for acute urinary toxicity. Future research should continue to standardize and validate dose constraints for prostate HDR monotherapy patients.
The aim of this study was to determine the association between a novel urinary biomarker-based risk score (SelectMDx), multiparametric MRI (mpMRI) outcomes, and biopsy results for PCa detection AbstractText: This retrospective observational study used data from the validation study of the SelectMDx score, in which urine was collected after ...
... To determine if the use of reduced-dose computed tomography (CT) for evaluation of kidney stones increased in 2015-2016 compared with that in 2011 ... facility for this indication, and to establish a current average radiation dose for CT evaluation for kidney stones by querying a national dose registry ... Conclusion Use of reduced-radiation dose CT for evaluation of kidney stones has increased since 2011-2012, but remains low; variability ...
Modern technologic advances in medical imaging and the increasing use of imaging across all disciplines in medicine have led to a striking rise in incidental findings unrelated to the original study indication. Often, these findings have no clinical relevance and will not impact the current or future health status of the patient. It is incumbent on radiologists to report these findings in a definitive and unambiguous manner. Similarly, it is essential for clinicians to restrain from further diagnostic investigation of incidental findings that are conclusive by imaging. A classic and common example is the finding of a cyst. This article presents several cases of incidentally found cysts for which a confident diagnosis can be made without any need for follow-up.
PURPOSE: To describe anatomic sites of recurrence among prostate cancer patients with biochemical recurrence following radical prostatectomy (RP) and postoperative radiotherapy (RT) and/or androgen deprivation therapy (ADT) using (11)C-Choline PET/CT and multiparametric-MRI.
MATERIALS AND METHODS: RP patients evaluated with (11)C-Choline PET/CT and multiparametric-MRI following RT and/or ADT were evaluated for patterns of recurrence and clinicopathologic features. Recurrent sites were described as either local-only (seminal vesicle bed/prostate fossa, vesicourethral anastomosis and bladder neck) or distant metastatic disease. Features associated with identification of any distant metastatic disease were evaluated using multivariable logistic regression.
RESULTS: A total of 550 patients were identified. Treatment included 108 with ADT, 201 with RT, and 241 with both. Median PSA at evaluation was 3.9, 3.6, and 2.8 ng/mL for patients treated with ADT, RT, or a combination, respectively. 77 patients (14%) recurred locally, 411 (75%) recurred with distant metastasis only, and 62 (11%) recurred with both local and distant metastatic disease. On multivariable analysis, treatment with radiotherapy (OR 7.18; 95%CI 2.92-17.65; p<0.01) and radiotherapy and hormonal therapy (OR 9.23; 95%CI 3.90-21.87; p<0.01) were associated with an increased odds of distant failure at evaluation.
CONCLUSIONS: The combination of (11)C-choline PET/CT and multiparametric-MRI successfully identified patterns of recurrence following postoperative RT, ADT, or both, at median PSA less than 4. Half of this cohort had local only recurrence and/or low disease burden limited to pelvic lymph nodes and may benefit from additional local therapy. This data and analysis may facilitate the evaluation of such patients with biochemically recurrent prostate cancer.
BACKGROUND: Erectile dysfunction (ED) after treatment for prostate cancer with radiotherapy (RT) is well known, and pooled estimates of ED after RT will provide more accurate patient education.
AIM: To systematically evaluate the natural history of ED in men with previous erectile function after prostate RT and to determine clinical factors associated with ED.
METHODS: We performed a review of the PubMed and Medline, Embase, Cochrane Library, and Web of Science databases in April 2016 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports included a measurement of ED before and after prostate RT. Two hundred seventy-eight abstracts were screened and 105 publications met the criteria for inclusion. Only men with known erectile function before RT were included in the analysis.
OUTCOME: ED after RT of the prostate.
RESULTS: In total, 17,057 men underwent brachytherapy (65%), 8,166 men underwent external-beam RT (31%), and 1,046 men underwent both (4%). Seven common instruments were used to measure ED, including 23 different cutoffs for ED. The Sexual Health Inventory for Men (SHIM) was used in 31 studies (30%). Pooled estimates of SHIM-confirmed ED (score <10-17) suggested the prevalence of ED after RT is 34% of men (95% CI = 0.29-0.39) at 1 year and 57% (95% CI = 0.53-0.61) at 5.5 years. Compared with brachytherapy, studies of the two types of radiation increased the proportion of new-onset ED found by 12.3% of studies (95% CI = 2.3-22.4). For every 10% who were lost to follow-up, the proportion of ED reported increased by 2.3% (95% CI = 0.03-4.7).
CLINICAL IMPLICATIONS: ED is common regardless of RT modality and increases during each year of follow-up. Using the SHIM, ED is found in approximately 50% patients at 5 years.
STRENGTHS AND LIMITATIONS: The strengths of this systematic review include strict inclusion criteria of studies that measured baseline erectile function, no evidence for large effect size bias, and a large number of studies, which allow for modeling techniques. However, all data included in this analysis were observational, which leaves the possibility that residual confounding factors increase the rates of ED.
CONCLUSION: Definitions and measurements of ED after RT vary considerably in published series and could account for variability in the prevalence of reported ED. Loss to follow-up in studies could bias the results to overestimate ED. Gaither TW, Awad MA, Osterberg EC, et al. The Natural History of Erectile Dysfunction After Prostatic Radiotherapy: A Systematic Review and Meta-Analysis. J Sex Med 2017;14:1071-1078.
Men's Health (22), Oncology (2) Erectile Dysfunction (4), Prostatic Neoplasms (2), more mentions
... parameters AbstractText: The study subjects included 120 patients with clinical signs of renal dysfunction who had undergone ultrasound followed by angiography (either digital subtraction angiography or MR angiography) between January ... Five ultrasound variables were evaluated: ratio of highest renal artery velocity to iliac artery velocity, highest renal artery velocity, spectral broadening ...
... guide test choice is safety AbstractText: We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and functional testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain ... CTA had similar 90-day cumulative radiation dose to functional testing... Compared to nuclear stress testing, CTA's lower radiation dose, independent of patient characteristics, makes it an attractive test ...
... objective of our study was to determine the clinical and MRI characteristics of clinically significant prostate cancer (PCA) (Gleason score ≥ 3 + 4) in men with ProstateImaging Reporting and Data System Version 2 (PI-RADSv2) category 3 ... TZ) lesions AbstractText: From 2014 to 2016, 865 men underwent prostateMRI and MRI/ultrasound (US) fusion biopsy (FB.
In men who do not respond to initial radiation therapy, accurate knowledge of the site of cancer recurrence or persistence is necessary to understand treatment failure. We evaluated the pathologic characteristics of recurrent/persistent prostate cancer with tumor maps from the whole-mount slides of salvage radical prostatectomies performed between 2000 and 2014. Of 216 consecutive patients, detailed tumor maps were available for 77. Sixty-nine patients (90%) were found to have tumor in the apex, of which 46% occurred in the most apical 3mm. Fifty-three patients (69%) had tumors at a distance of ≤5mm from the urethra. Five patients had tumor directly involving the urethra, all of whom had urethral invasion at the apex. Seminal vesicle involvement was seen in 32 patients (42%), two of whom had tumor only in the seminal vesicles. Sixty-two patients (81%) had tumors in the distal apex, periurethral area, or seminal vesicles, that is, areas that are not routinely biopsied. Targeting these areas could improve the accuracy of biopsy when cancer recurrence is suspected.
PATIENT SUMMARY: When recurrence is suspected, clinicians should include biopsy of the distal apex, areas surrounding the urethra, and seminal vesicles. This information will help tailor successful salvage treatments.
Oncology (4) Neoplasms (9), Prostatic Neoplasms (3), more mentions
With the development of three-dimensional (3-D) reconstructive technique, 3-D urethralimage can provide more accurate and useful information to allow the surgeon make the best surgical decision. The purpose of this study is to evaluate the accuracy and efficacy of a 3-D reconstructed digital model of the urethra based on the sonourethrogram for assessing anterior urethral ...
PURPOSE: Fistula formation is a rare and poorly described complication following radical cystectomy with urinary diversion. We sought to identify patients who experienced any type of fistulous complication and analyze the risk factors for formation as well as management outcomes.
MATERIALS AND METHODS: We performed a retrospective review of patients who underwent radical cystectomy for bladder cancer at our institution. Patients who experienced any fistula were identified. Risk factors, management strategies, and outcomes were analyzed. Patients underwent initial conservative management and those who failed underwent surgical repair. Univariable and multivariable analyses were performed to identify predictors of fistula formation as well as the need for surgical repair.
RESULTS: Of the 1041 patients, 31 (3.0%) experienced fistula formation. Median time to fistula presentation was 31 days. Entero-diversion was the most common fistula type (54.8%), followed by entero-cutaneous (29.0%), and diversion-cutaneous (12.9%). On multivariable analyses, a history of radiation therapy (OR 3.1, p = 0.03) and orthotopic neobladder (OR 3.1, p = 0.04) were both predictors of fistula formation. Conservative management was successful in 41.9%. There were no predictors of failing conservative management. Of those requiring surgical repair, success was achieved in a single operation in 94.4%.
CONCLUSIONS: Fistulae are rare after radical cystectomy and are most common between the urinary diversion and small bowel. History of radiation therapy and orthotopic neobladder are risk factors for formation. When required, surgical repair is generally successful in a single operation.
Oncology (3) Fistula (8), Urinary Bladder Neoplasms (3), more mentions
BACKGROUND: Early abdominal computed tomography (CT) or magnetic resonance (MR) imaging is common in acute pancreatitis (AP). Guidelines (2007-2013) indicate routine use is unwarranted.
AIMS: To compare the frequency and evaluate the predictors of early CT/MR utilization for AP between September 2006-2007 (period A) and September 2014-2015 (period B).
METHODS: AP patients presenting directly to a large academic emergency department were prospectively enrolled during each period. Cases requiring imaging to fulfill diagnostic criteria were excluded. Early CT/MR (within 24 h of presentation) utilization rates were compared using Fisher's exact test. Predictors of early imaging usage were assessed with multivariate logistic regression.
RESULTS: The cohort included 96 AP cases in period A and 97 in period B. There were no significant differences in patient demographics, comorbidity scores, or AP severity. Period B cases manifested decreased rates of the systemic inflammatory response syndrome (SIRS) during the first 24 h of hospitalization (67% period A vs. 43% period B, p = 0.001). Independent predictors of early imaging included age >60 and SIRS or organ failure on day 1. No significant decrease in early CT/MR usage was observed from period A to B on both univariate (49% period A vs. 40% period B, p = 0.25) and multivariate (OR 1.0 for period B vs. A, 95% CI 0.5-1.9) analysis.
CONCLUSIONS: In a comparison of imaging practices for AP, there was no significant decrease in early abdominal CT/MR utilization from 2007 to 2015. Quality improvement initiatives specifically targeting early imaging overuse are needed.
Pancreatitis (2), Systemic Inflammatory Response Syndrome (1), more mentions
Re: Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient Specific Molds to Correlate Images with Whole Mount Pathology: A. Priester, S. Natarajan, P. Khoshnoodi, D. J. Margolis, S. S. Raman, R. E. Reiter, J. Huang, W. Grundfest and L. S. Marks J Urol 2017;197:320-326 ...
... reading frame 72 repeat expansion (C9orf72RE) AbstractText: Presymptomatic C9orf72RE carriers (n = 18) and first-degree family members without a pathogenic expansion (healthy controls [HC], n = 15) underwent a standardized protocol of neuropsychological tests, T1-weighted MRI, and diffusion tensor imaging within our cohort study of autosomal dominant frontotemporal dementia (FTD.
Neuroscience (2), Neurological and Central Nervous System Diseases (1) Amyotrophic Lateral Sclerosis (1), Frontotemporal Dementia (1), more mentions
The reference standard was histology or > 12 months of clinical follow-up. The primary outcome measure was the negative predictive value (NPV) of FDG-PET/CT scans and other supporting diagnostic test characteristics, including time dependency with increasing follow-up time. Results Of 152 patients, 125 had adequate primary tumor control after CCRT and entered follow-up (median, 20.4 months.