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Re: Complications, Recovery, and Early Functional Outcomes and Oncologic Control following In-Bore Focal Laser Ablation of Prostate Cancer
1782
IMAGING
Suggested Reading Ouzzane A, Renard-Penna R, Marliere F et al: Magnetic resonance imaging targeted biopsy improves selection of patients considered for active surveillance for clinically low risk prostate cancer based on systematic biopsies. J Urol 2015; 194: 350. Siddiqui MM, Truong H, Rais-Bahrami S et al: Clinical implications of a multiparametric magnetic resonance imaging based nomogram applied to prostate cancer active surveillance. J Urol 2015; 193: 1943. Lee DH, Koo KC, Lee SH et al: Tumor lesion diameter on diffusion weighted magnetic resonance imaging could help predict insignificant prostate cancer in patients eligible for active surveillance: preliminary analysis. J Urol 2013; 190: 1213. Vargas HA, Akin O, Afaq A et al: Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol 2012; 188: 1732.
Imaging Re: Benign Conditions that Mimic Prostate Carcinoma: MR Imaging Features with Histopathologic Correlation Y. X. Kitzing, A. Prando, C. Varol, G. S. Karczmar, F. Maclean and A. Oto Departments of Medical Imaging and Urology, Macquarie University Hospital and Douglass Hanly Moir Pathology, Sydney, Australia, Department of Radiology, Hospital Vera Cruz, Campinas, Brazil, and Department of Radiology, University of Chicago, Chicago, Illinois Radiographics 2016; 36: 162e175. doi: 10.1148/rg.2016150030
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26587887 Editorial Comment: This review article discusses and displays normal anatomy and benign conditions that may mimic prostate carcinoma on magnetic resonance imaging. Areas of review include the anterior fibromuscular stroma, the surgical capsule at the junction between the transition zone and peripheral zone, the central zone directly adjacent to the ejaculatory duct (best seen on the coronal images) and the periprostatic venous plexus. Periprostatic lymph nodes are discussed, as well as benign prostatic hyperplasia (BPH) and prostatitis. The stromal hyperplasia form of BPH tends to have a more dense fibrous muscular element and lacks the bubbly cystic appearance. This form of BPH may mimic a central zone tumor. The stroma hyperplasia tends to be more confined and encapsulated compared to ill defined anterior gland transition zone tumors. Unfortunately dynamic contrast enhancement is not helpful in distinguishing between the two. Prostatitis due to various etiologies is discussed and may be diffuse or focal and acute, subacute or chronic. Atrophy of the prostate gland may be associated with a high prostate specific antigen level, possibly due to its release from the atrophying cells. Necrosis of the prostate can occur after extensive inflammatory or infectious processes and can be seen after focal therapies such as cryoblation and high-intensity focused ultrasound. The authors nicely describe and illustrate normal anatomical findings and benign conditions often encountered when reviewing prostatic MR imaging. This article is well suited for radiologists and urologists. Cary Siegel, MD
Laparoscopy/New Technology Re: Complications, Recovery, and Early Functional Outcomes and Oncologic Control following In-Bore Focal Laser Ablation of Prostate Cancer € tterer H. Lepor, E. Llukani, D. Sperling and J. J. Fu Department of Urology, Smilow Comprehensive Prostate Cancer Center, New York University School of Medicine and Sperling Prostate Cancer Center, New York, New York, and Department of Radiology, Radboud UMC, Nijmegen, The Netherlands
TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY
1783
Eur Urol 2015; 68: 924e926. doi: 10.1016/j.eururo.2015.04.029
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25979568 Editorial Comment: Focal ablation of prostate cancer remains an investigational treatment with strong opinions held regarding the indications, value and efficacy. This well designed study of 25 patients with Gleason score less than 8 prostate cancer used laser energy to specifically ablate lesions suspicious for prostate cancer identified by magnetic resonance imaging (MRI). Tumor targeting and tissue temperature monitoring were performed in real time using MRI. Followup biopsies were performed in-bore or with MRI-ultrasound fusion. As such, the confidence was high that the tumor was identified, targeted, adequately treated with lethal temperatures and resampled. There were no changes in quality of life measures and no complications, and 96% of resampled tumors showed no evidence of prostate cancer. Jeffrey A. Cadeddu, MD
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Radiation Exposure from Diagnostic Imaging in Young Patients with Testicular Cancer C. J. Sullivan, K. P. Murphy, P. D. McLaughlin, M. Twomey, K. N. O’Regan, D. G. Power, M. M. Maher and O. J. O’Connor Department of Radiology, Cork and Mercy University Hospitals, Wilton, Cork, Ireland Eur Radiol 2015; 25: 1005e1013. doi: 10.1007/s00330-014-3507-0
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25500962 Editorial Comment: Testicular cancer can generally be cured, leaving young men with prolonged longevity during which impact from treatment or surveillance may manifest. Risks associated with higher cumulative effective dose (CED) are generally greater when imaging is performed in younger individuals. The authors review radiological imaging of 120 patients diagnosed with testicular cancer between 2001 and 2011. Mean patient age was 30.7 years. These patients underwent 1,410 radiological investigations with a median CED of 125 mSv. Computerized tomography accounted for 65% of imaging studies and 98.3% of CED. Overall 77.5% of patients received a high CED (greater than 75 mSv). Surveillance time was associated with a high CED with an OR of 2.1. The important message from this study is that young patients with testicular cancer are exposed to a high cumulative effect from radiation. Every effort should be made to develop low dose computerized tomography or alternatives to limit long-term effects. Jerome P. Richie, MD
IMAGING
Suggested Reading Ouzzane A, Renard-Penna R, Marliere F et al: Magnetic resonance imaging targeted biopsy improves selection of patients considered for active surveillance for clinically low risk prostate cancer based on systematic biopsies. J Urol 2015; 194: 350. Siddiqui MM, Truong H, Rais-Bahrami S et al: Clinical implications of a multiparametric magnetic resonance imaging based nomogram applied to prostate cancer active surveillance. J Urol 2015; 193: 1943. Lee DH, Koo KC, Lee SH et al: Tumor lesion diameter on diffusion weighted magnetic resonance imaging could help predict insignificant prostate cancer in patients eligible for active surveillance: preliminary analysis. J Urol 2013; 190: 1213. Vargas HA, Akin O, Afaq A et al: Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol 2012; 188: 1732.
Imaging Re: Benign Conditions that Mimic Prostate Carcinoma: MR Imaging Features with Histopathologic Correlation Y. X. Kitzing, A. Prando, C. Varol, G. S. Karczmar, F. Maclean and A. Oto Departments of Medical Imaging and Urology, Macquarie University Hospital and Douglass Hanly Moir Pathology, Sydney, Australia, Department of Radiology, Hospital Vera Cruz, Campinas, Brazil, and Department of Radiology, University of Chicago, Chicago, Illinois Radiographics 2016; 36: 162e175. doi: 10.1148/rg.2016150030
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26587887 Editorial Comment: This review article discusses and displays normal anatomy and benign conditions that may mimic prostate carcinoma on magnetic resonance imaging. Areas of review include the anterior fibromuscular stroma, the surgical capsule at the junction between the transition zone and peripheral zone, the central zone directly adjacent to the ejaculatory duct (best seen on the coronal images) and the periprostatic venous plexus. Periprostatic lymph nodes are discussed, as well as benign prostatic hyperplasia (BPH) and prostatitis. The stromal hyperplasia form of BPH tends to have a more dense fibrous muscular element and lacks the bubbly cystic appearance. This form of BPH may mimic a central zone tumor. The stroma hyperplasia tends to be more confined and encapsulated compared to ill defined anterior gland transition zone tumors. Unfortunately dynamic contrast enhancement is not helpful in distinguishing between the two. Prostatitis due to various etiologies is discussed and may be diffuse or focal and acute, subacute or chronic. Atrophy of the prostate gland may be associated with a high prostate specific antigen level, possibly due to its release from the atrophying cells. Necrosis of the prostate can occur after extensive inflammatory or infectious processes and can be seen after focal therapies such as cryoblation and high-intensity focused ultrasound. The authors nicely describe and illustrate normal anatomical findings and benign conditions often encountered when reviewing prostatic MR imaging. This article is well suited for radiologists and urologists. Cary Siegel, MD
Laparoscopy/New Technology Re: Complications, Recovery, and Early Functional Outcomes and Oncologic Control following In-Bore Focal Laser Ablation of Prostate Cancer € tterer H. Lepor, E. Llukani, D. Sperling and J. J. Fu Department of Urology, Smilow Comprehensive Prostate Cancer Center, New York University School of Medicine and Sperling Prostate Cancer Center, New York, New York, and Department of Radiology, Radboud UMC, Nijmegen, The Netherlands
TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY
1783
Eur Urol 2015; 68: 924e926. doi: 10.1016/j.eururo.2015.04.029
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25979568 Editorial Comment: Focal ablation of prostate cancer remains an investigational treatment with strong opinions held regarding the indications, value and efficacy. This well designed study of 25 patients with Gleason score less than 8 prostate cancer used laser energy to specifically ablate lesions suspicious for prostate cancer identified by magnetic resonance imaging (MRI). Tumor targeting and tissue temperature monitoring were performed in real time using MRI. Followup biopsies were performed in-bore or with MRI-ultrasound fusion. As such, the confidence was high that the tumor was identified, targeted, adequately treated with lethal temperatures and resampled. There were no changes in quality of life measures and no complications, and 96% of resampled tumors showed no evidence of prostate cancer. Jeffrey A. Cadeddu, MD
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Radiation Exposure from Diagnostic Imaging in Young Patients with Testicular Cancer C. J. Sullivan, K. P. Murphy, P. D. McLaughlin, M. Twomey, K. N. O’Regan, D. G. Power, M. M. Maher and O. J. O’Connor Department of Radiology, Cork and Mercy University Hospitals, Wilton, Cork, Ireland Eur Radiol 2015; 25: 1005e1013. doi: 10.1007/s00330-014-3507-0
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25500962 Editorial Comment: Testicular cancer can generally be cured, leaving young men with prolonged longevity during which impact from treatment or surveillance may manifest. Risks associated with higher cumulative effective dose (CED) are generally greater when imaging is performed in younger individuals. The authors review radiological imaging of 120 patients diagnosed with testicular cancer between 2001 and 2011. Mean patient age was 30.7 years. These patients underwent 1,410 radiological investigations with a median CED of 125 mSv. Computerized tomography accounted for 65% of imaging studies and 98.3% of CED. Overall 77.5% of patients received a high CED (greater than 75 mSv). Surveillance time was associated with a high CED with an OR of 2.1. The important message from this study is that young patients with testicular cancer are exposed to a high cumulative effect from radiation. Every effort should be made to develop low dose computerized tomography or alternatives to limit long-term effects. Jerome P. Richie, MD