Publications
621 results found
Chandak P, Byrne N, Lynch H, et al., 2018, Three-dimensional printing in robot-assisted radical prostatectomy - an Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) Phase 2a study, BJU International, Vol: 122, Pages: 360-361, ISSN: 1464-4096
Lovegrove CE, Matanhelia M, Randeva J, et al., 2018, Prostate imaging features that indicate benign or malignant pathology on biopsy, Translational andrology and urology, Vol: 7, Pages: S420-S435, ISSN: 2223-4691
Accurate diagnosis of clinically significant prostate cancer is essential in identifying patients who should be offered treatment with curative intent. Modifications to the Gleason grading system in recent years show that accurate grading and reporting at needle biopsy can improve identification of clinically significant prostate cancers. Extracapsular extension of prostate cancer has been demonstrated to be an adverse prognostic factor with greater risk of metastatic spread than organ-confined disease. Tumor volume may be an independent prognostic factor and should be considered in conjunction with other factors. Multi-parametric magnetic resonance imaging (MP-MRI) has become an increasingly important tool in the diagnosis and characterization of prostate cancer. MP-MRI allows T2-weighted (T2W) anatomical imaging to be combined with functional and physiological assessment. Diffusion-weighted imaging (DWI) has shown greater sensitivity, specificity and negative predictive value compared to prostate specific antigen (PSA) testing and T2W imaging alone and has a more positive correlation with Gleason score and tumour volume. Dynamic gadolinium contrast-enhanced (DCE) imaging can exhibit difficulties in distinguishing prostatitis from malignancy in the peripheral zone, and between benign prostatic hyperplasia (BPH) and malignancies in the transition zone (TZ). Computer aided diagnosis utilizes software to aid radiologists in detecting and diagnosing abnormalities from diagnostic imaging. New techniques of quantitative MRI, such as VERDICT MRI use tissue-specific factors to delineate different cellular and microstructural phenotypes, characterizing tissue properties with greater detail. Proton MR spectroscopic imaging (MRSI) is a more technically challenging imaging modality than DCE and DWI MRI. Over the last decade, choline and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) have developed as better tools for staging than conventional imag
Hamdy FC, Elliott D, le Conte S, et al., 2018, Partial ablation versus radical prostatectomy in intermediate-risk prostate cancer: the PART feasibility RCT, Health Technology Assessment, Vol: 22, ISSN: 1366-5278
BackgroundProstate cancer (PCa) is the most common cancer in men in the UK. Patients with intermediate-risk, clinically localised disease are offered radical treatments such as surgery or radiotherapy, which can result in severe side effects. A number of alternative partial ablation (PA) technologies that may reduce treatment burden are available; however the comparative effectiveness of these techniques has never been evaluated in a randomised controlled trial (RCT).ObjectivesTo assess the feasibility of a RCT of PA using high-intensity focused ultrasound (HIFU) versus radical prostatectomy (RP) for intermediate-risk PCa and to test and optimise methods of data capture.DesignWe carried out a prospective, multicentre, open-label feasibility study to inform the design and conduct of a future RCT, involving a QuinteT Recruitment Intervention (QRI) to understand barriers to participation.SettingFive NHS hospitals in England.ParticipantsMen with unilateral, intermediate-risk, clinically localised PCa.InterventionsRadical prostatectomy compared with HIFU.Primary outcome measureThe randomisation of 80 men.Secondary outcome measuresFindings of the QRI and assessment of data capture methods.ResultsEighty-seven patients consented to participate by 31 March 2017 and 82 men were randomised by 4 May 2017 (41 men to the RP arm and 41 to the HIFU arm). The QRI was conducted in two iterative phases: phase I identified a number of barriers to recruitment, including organisational challenges, lack of recruiter equipoise and difficulties communicating with patients about the study, and phase II comprised the development and delivery of tailored strategies to optimise recruitment, including group training, individual feedback and ‘tips’ documents. At the time of data extraction, on 10 October 2017, treatment data were available for 71 patients. Patient characteristics were similar at baseline and the rate of return of all clinical case report forms (CRFs) was 95%; the retu
Brizmohun Appayya M, Adshead J, Ahmed HU, et al., 2018, National implementation of multi-parametric MRI for prostate cancer detection - recommendations from a UK consensus meeting, BJU International, Vol: 122, Pages: 13-25, ISSN: 1464-4096
OBJECTIVES: To identify areas of agreement and disagreement in the implementation of multi-parametric MRI (mpMRI) of the prostate in the diagnostic pathway. MATERIALS AND METHODS: Fifteen UK experts in prostate mpMRI and/or prostate cancer management across the UK (involving 9 NHS centres to provide for geographical spread) participated in a consensus meeting following the UCLA-RAND Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mpMRI, prostate mpMRI protocol, reporting guidelines, training, quality assurance (QA) and patient management based on mpMRI levels of suspicion for cancer. Each item was rated for agreement on a 9-point scale. A panel median score of >/= 7 constituted 'agreement' for an item; for an item to reach 'consensus', a panel majority scoring was required. RESULTS: Consensus was reached on 59% of items (208/354); these were used to provide recommendations for the implementation of prostate mpMRI in the UK. Key findings include prostate mpMRI requests should be made in consultation with the urological team; mpMRI scanners should undergo quality assurance checks to guarantee consistently high diagnostic quality scans; scans should only be reported by trained and experienced radiologists to ensure that men with non-suspicious prostate mpMRI might consider avoiding an immediate biopsy. CONCLUSIONS: Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high quality prostate mpMRI as a diagnostic test prior to biopsy in men at risk. This article is protected by copyright. All rights reserved.
Brown LC, Ahmed HU, Faria R, et al., 2018, Multiparametric MRI to improve detection of prostate cancer compared with transrectal ultrasound-guided prostate biopsy alone: the PROMIS study, Health Technology Assessment, Vol: 22, ISSN: 1366-5278
BackgroundMen with suspected prostate cancer usually undergo transrectal ultrasound (TRUS)-guided prostate biopsy. TRUS-guided biopsy can cause side effects and has relatively poor diagnostic accuracy. Multiparametric magnetic resonance imaging (mpMRI) used as a triage test might allow men to avoid unnecessary TRUS-guided biopsy and improve diagnostic accuracy.ObjectivesTo (1) assess the ability of mpMRI to identify men who can safely avoid unnecessary biopsy, (2) assess the ability of the mpMRI-based pathway to improve the rate of detection of clinically significant (CS) cancer compared with TRUS-guided biopsy and (3) estimate the cost-effectiveness of a mpMRI-based diagnostic pathway.DesignA validating paired-cohort study and an economic evaluation using a decision-analytic model.SettingEleven NHS hospitals in England.ParticipantsMen at risk of prostate cancer undergoing a first prostate biopsy.InterventionsParticipants underwent three tests: (1) mpMRI (the index test), (2) TRUS-guided biopsy (the current standard) and (3) template prostate mapping (TPM) biopsy (the reference test).Main outcome measuresDiagnostic accuracy of mpMRI, TRUS-guided biopsy and TPM-biopsy measured by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using primary and secondary definitions of CS cancer. The percentage of negative magnetic resonance imaging (MRI) scans was used to identify men who might be able to avoid biopsy.ResultsDiagnostic study – a total of 740 men were registered and 576 underwent all three tests. According to TPM-biopsy, the prevalence of any cancer was 71% [95% confidence interval (CI) 67% to 75%]. The prevalence of CS cancer according to the primary definition (a Gleason score of ≥ 4 + 3 and/or cancer core length of ≥ 6 mm) was 40% (95% CI 36% to 44%). For CS cancer, TRUS-guided biopsy showed a sensitivity of 48% (95% CI 42% to 55%), specificity of 96% (95% CI 94% to 98%)
Faria R, Soares MO, Spackman E, et al., 2018, Re: Jochen Walz. The "PROMIS" of Magnetic Resonance Imaging Cost Effectiveness in Prostate Cancer Diagnosis? Eur Urol 2018;73:31-2, European Urology, Vol: 73, Pages: e151-e152, ISSN: 0302-2838
Shah TT, Valerio M, Ahmed HU, 2018, Re: Effect of prior focal therapy on perioperative, oncologic and functional outcomes of salvage robotic assisted radical prostatectomy, The Journal of Urology, Vol: 199, Pages: 1634-1635, ISSN: 0022-5347
To the Editor:The authors report functional and oncologic outcomes after salvage radical prostatectomy (RP) following failed focal therapy (FT) compared to up-front RP. We would like to address some issues concerning this study.
Shah TT, Valerio M, Ahmed HU, 2018, Re: Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy: I. Nunes-Silva, E. Barret, V. Srougi, M. Baghdadi, P. Capogrosso, S. Garcia-Barreras, S. Kanso, R. Tourinho-Barbosa, A. Carneiro, R. Sanchez-Salas, F. Rozet, M. Galiano and X. Cathelineau J Urol 2017;198:1069-1076., J Urol, Vol: 199, Pages: 1634-1635
Ganzer R, Arthanareeswaran VKA, Ahmed HU, et al., 2018, Which technology to select for primary focal treatment of prostate cancer?-European Section of Urotechnology (ESUT) position statement, Prostate Cancer and Prostatic Diseases, Vol: 21, Pages: 175-186, ISSN: 1365-7852
BACKGROUND: With growing interest in focal therapy (FT) of prostate cancer (PCa) there is an increasing armamentarium of treatment modalities including high-intensity focused ultrasound (HIFU), cryotherapy, focal laser ablation (FLA), irreversible electroporation (IRE), vascular targeted photodynamic therapy (VTP), focal brachytherapy (FBT) and stereotactic ablative radiotherapy (SABR). Currently there are no clear recommendations as to which of these technologies are appropriate for individual patient characteristics. Our intention was to review the literature for special aspects of the different technologies that might be of advantage depending on individual patient and tumour characteristics. METHODS: The current literature on FT was screened for the following factors: morbidity, repeatability, tumour risk category, tumour location, tumour size and prostate volume and anatomical issues. The ESUT expert panel arrived at consensus regarding a position statement on a structured pathway for available FT technologies based on a combination of the literature and expert opinion. RESULTS: Side effects were low across different studies and FT modalities with urinary continence rates of 90-100% and erectile dysfunction between 5 and 52%. Short to medium cancer control based on post-treatment biopsies were variable between ablative modalities. Expert consensus suggested that posterior lesions are better amenable to FT using HIFU. Cryotherapy provides best possible outcomes for anterior tumours. Apical lesions, when treated with FBT, may yield the least urethral morbidity. CONCLUSIONS: Further prospective trials are required to assess medium to long term disease control of different ablative modalities for FT. Amongst different available FT modalities our ESUT expert consensus suggests that some may be better for diffe`rent tumour locations. Tumour risk, tumour size, tumour location, and prostate volume are all important factors to consider and might aid in designing future
Rouhani MJ, Burleigh EJ, Hobbis C, et al., 2018, Expanding management and leadership education in medical schools Response, ADVANCES IN MEDICAL EDUCATION AND PRACTICE, Vol: 9, Pages: 277-278, ISSN: 1179-7258
Bonmati E, Hu Y, Villarini B, et al., 2018, Technical Note: Error metrics for estimating the accuracy of needle/instrument placement during transperineal MR/US-guided prostate interventions, Medical Physics, Vol: 45, Pages: 1408-1414, ISSN: 0094-2405
PURPOSE: Image-guided systems that fuse magnetic resonance imaging (MRI) with three-dimensional (3D) ultrasound (US) images for performing targeted prostate needle biopsy and minimally-invasive treatments for prostate cancer are of increasing clinical interest. To date, a wide range of different accuracy estimation procedures and error metrics have been reported, which makes comparing the performance of different systems difficult. METHODS: A set of 9 measures are presented to assess the accuracy of MRI-US image registration, needle positioning, needle guidance, and overall system error, with the aim of providing a methodology for estimating the accuracy of instrument placement using a MR/US-guided transperineal approach. RESULTS: Using the SmartTarget fusion system, an MRI-US image alignment error was determined to be 2.0±1.0 mm (mean ± SD), and an overall system instrument targeting error of 3.0±1.2 mm. Three needle deployments for each target phantom lesion was found to result in a 100% lesion hit rate and a median predicted cancer core length of 5.2 mm. CONCLUSIONS: The application of a comprehensive, unbiased validation assessment for MR/TRUS guided systems can provide useful information on system performance for quality assurance and system comparison. Furthermore, such an analysis can be helpful in identifying relationships between these errors, providing insight into the technical behaviour of these systems.
Giancarlo M, Ploussard G, Ost P, et al., 2018, AN INTERNATIONAL SURVEY ABOUT FOCAL THERAPY FOR PROSTATE CANCER FROM THE YOUNG ACADEMIC UROLOGISTS (YAU): THE OPINION OF 484 PHYSICIANS, Publisher: INT INST ANTICANCER RESEARCH, Pages: 2567-2568, ISSN: 0250-7005
Shah TT, Peters M, Guillaumier S, et al., 2018, PREDICTORS OF POOR FUNCTIONAL OUTCOMES AFTER FOCAL HIGH INTENSITY FOCUSSED ULTRASOUND (HIFU), American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E378-E379, ISSN: 0022-5347
Orczyk C, Brew-graves C, WIlliams N, et al., 2018, PROSTATE RADIOFREQUENCY ABLATION FOCAL TREATMENT (PRORAFT): RESULTS OF A PROSPECTIVE DEVELOPMENT STUDY FOR LOCALISED PROSTATE CANCER, American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E376-E376, ISSN: 0022-5347
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Marra G, Ploussard G, Ost P, et al., 2018, ATTRACTIVENESS AND ACCESSIBILITY OF FOCAL THERAPY FOR PROSTATE CANCER: RESULTS OF AN INTERNATIONAL WEB-BASED SURVEY, American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E659-E660, ISSN: 0022-5347
Stavrinides V, Olivier J, Kay J, et al., 2018, DISTINCT PROTEIN EXPRESSION PATTERNS FOR COMMON BIOMARKERS IN MALIGNANT AND ADJACENT BENIGN PROSTATE TISSUE: AN IMMUNOHISTOCHEMICAL STUDY ON NEEDLE BIOPSY MICROARRAYS DERIVED FROM AN IMAGING-BASED PATIENT COHORT, American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E1150-E1151, ISSN: 0022-5347
Shah TT, Peters M, Gomez-Gomez E, et al., 2018, T-STAGE MIGRATION WITH ROUTINE MRI STAGING MAY IMPACT ON RISK ASSESSMENT WITH CURRENT RISK CALCULATORS, American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E202-E203, ISSN: 0022-5347
Dinneen E, McCartan N, Ahmed HU, et al., 2018, DETERMINANTS OF ERECTILE DYSFUNCTION FOLLOWING FOCAL ABLATIVE THERAPY FOR LOCALISED PROSTATE CANCER., American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E658-E659, ISSN: 0022-5347
Echeverria LC, Johnston T, Rosenfeld A, et al., 2018, DISCOVERY AND VALIDATION OF A NOVEL FLUID BIOMARKER FOR THE DIAGNOSIS AND RISK STRATIFICATION OF PROSTATE CANCER, American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E1146-E1146, ISSN: 0022-5347
Huber PM, Afzal N, Arya M, et al., 2018, PSA FAILS TO PREDICT TREATMENT FAILURE IN FOCAL HIGH-INTENSITY FOCUSED ULTRASOUND THERAPY IN PROSTATE CANCER, American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E658-E658, ISSN: 0022-5347
Huber PM, Afzal N, Arya M, et al., 2018, HIFU DOSE ESCALATION LEADS TO FEWER RECURRENCES IN FOLLOWING FOCAL HIFU IN PROSTATE CANCER, American-Urological-Association(AUA) Annual Meeting, Publisher: ELSEVIER SCIENCE INC, Pages: E378-E378, ISSN: 0022-5347
Orczyk C, Brew-Graves C, Williams N, et al., 2018, Prostate radiofrequency ablation focal treatment (proRAFT): Results of a prospective development study for localised prostate cancer, European Urology Supplements, Vol: 17, Pages: e784-e785, ISSN: 1569-9056
Rouhani MJ, Burleigh EJ, Hobbis C, et al., 2018, UK medical students' perceptions, attitudes, and interest toward medical leadership and clinician managers, Advances in Medical Education and Practice, Vol: 9, Pages: 119-124, ISSN: 1179-7258
Background: We aimed to determine UK medical students’ perceptions and attitudes and interest toward medical leadership and clinician managers.Methods: A cross-sectional study was conducted during the academic year 2015–2016. An online questionnaire was distributed to 2,349 final-year students from 10 UK medical schools. Participants were asked to complete a 5-point Likert scale on their current perceptions, attitudes, and interest toward medical leadership and clinician managers. They were also asked to self-rate their leadership competences set by the Medical Leadership Competency Framework and to rate the quality of management and leadership training they received from their medical school.Results: In total, we received 114 complete responses. Only 7.9% of respondents were in agreement (strongly agree or agree) when asked whether they felt they were well informed about what a managerial position in medicine entails. When asked whether clinicians should influence managerial decisions within a clinical setting, 94.7% of respondents were in agreement with the statement. About 85% of respondents were in agreement that it is important for clinicians to have managerial or leadership responsibilities, with 63.2% of students in agreement that they would have liked more management or leadership training during medical school. Over half the respondents rated their management and leadership training they received during medical school as “very poor” or “poor” (54.4%).Conclusion: Our study suggests that UK medical students have an appetite for management and leadership training and appreciate its importance but feel that the training they are receiving is poor. This suggests that there is a gap between the demand for management and leadership training and the quality of training supplied by UK medical schools.
Chau EM, Arya M, Petrides N, et al., 2018, Performance characteristics of multiparametric-MRI at a non-academic hospital using transperineal template mapping biopsy as a reference standard, International Journal of Surgery Open, Vol: 10, Pages: 66-71, ISSN: 2405-8572
ObjectivesTo evaluate diagnostic accuracy of mpMRI in a non-academic hospital using transperineal template prostate mapping (TPM) biopsy as a reference standard. Secondary objectives included evaluating why mpMRI missed significant cancer.Materials and methods101 men received pre-biopsy mpMRI and TPM-biopsy over 16 months. Disease status was assigned at hemigland level. Primary histological definition of clinical significance was Gleason grade >/ = 4 + 3 or maximum cancer core length (MCCL) >/ = 6 mm. Positive mpMRI was defined as Prostate Imaging Reporting and Data System (PI-RADS) score >/ = 3.ResultsMedian age 69 (IQR 62–76). Median PSA 7 ng/ml (IQR 4.6–9.8). mpMRI had sensitivity 76.9%, specificity 60.7%, PPV 40.4% and NPV 88.3% at primary definitions. For detecting any Gleason >/ = 7 mpMRI had sensitivity 73.2%, specificity 60.3%, PPV 41.4% and NPV 85.4%. Mean MCCL was lower where significant cancer was missed compared to those correctly identified (5.8 mm versus 7.7 mm respectively, p = 0.035).ConclusionmpMRI performance characteristics were very encouraging when compared to contemporary clinical trials. In a non-academic hospital setting, negative mpMRI was just as good at ruling-out significant disease, though the ability of positive mpMRI to accurately detect significant disease was lower. An mpMRI-guided diagnostic pathway should be accompanied by appropriate mpMRI protocol optimisation, training, and quality control.
Arya M, Shergill IS, Fernando HS, et al., 2018, Viva Practice for the FRCS(Urol) and Postgraduate Urology Examinations, Second Edition, ISBN: 9780815367314
This is the first revision book to be published specifically for candidates sitting the FRCS(Urol) examination, which tests the required standard of a recognised Urology specialist. It provides a selection of common clinical scenarios together with a guide to answering the FRCS(Urol) questions. Each chapter is written by Consultant Urological Surge.
Ahmed HU, Boddy J, Doherty A, et al., 2018, Prostate cancer, Viva Practice for the FRCS(Urol) and Postgraduate Urology Examinations, Second Edition, Pages: 1-36, ISBN: 9780815367314
Q. A 66-year-old man with a PSA of 5.3 is referred to you. Testing was performed during a routine health check with his GP. He has mild lower urinary tract symptoms but is otherwise fit and well. Examination revealed a small benign feeling prostate. How would you assess this man?.
Gibson E, Hu Y, Ghavami N, et al., 2018, Inter-site Variability in Prostate Segmentation Accuracy Using Deep Learning, 21st International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI), Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 506-514, ISSN: 0302-9743
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Faure Walker NA, Norris JM, Shah TT, et al., 2017, A comparison of time taken to return to baseline erectile function following focal and whole gland ablative therapies for localized prostate cancer: A systematic review., Urologic Oncology: Seminars and Original Investigations, Vol: 36, Pages: 67-76, ISSN: 1078-1439
OBJECTIVES: To systematically review erectile function (EF) outcomes following primary whole gland (WG) and focal ablative therapies for localized prostate cancer to ascertain whether the treatment modality or intended treatment volume affects the time taken to recover baseline EF. METHOD AND MATERIALS: A systematic review was performed according to the preferred reporting items for systematic review and meta-analysis statement. Inclusion criteria were men with localized prostate cancer treated with primary, ablative therapy. Primary outcome was the return to baseline EF measured with objective, validated symptoms scores. Secondary outcome was use of phosphodiesterase inhibitors or erectile aids. Meta-analysis was not performed owing to heterogenous outcome measures. RESULTS: Of 222 articles identified in February 2017, 55 studies which reported EF after ablative therapy were identified but only 17 used validated outcome measures and met inclusion criteria. WG cryotherapy was used in 2 studies, WG high-intensity focused ultrasound (HIFU) in 5, focal cryotherapy in 2, focal HIFU in 3, focal phototherapy or laser therapy in 4, vascular-targeted photodynamic therapy in 3, and irreversible electroporation in 2. WG cryotherapy was associated with a significant decline in EF at 6 months with minimal improvement at 36 months. Baseline IIEF-15 of patients undergoing focal HIFU fell 30 points at 1 month but returned to baseline by 6 months. The remaining focal therapies demonstrated minimal or no effect on EF, but the men in these studies had small foci of disease. The review is limited by lack of randomized studies and heterogenous outcome measures. CONCLUSIONS: Most studies assessing the outcomes of focal therapy on sexual function were not of high quality, used heterogenous outcomes, and had relatively short follow up, highlighting the need for more robustly designed studies using validated patient reported outcome measures for comparison. However, FT in general res
Brizmohun Appayya M, Sidhu HS, Dikaios N, et al., 2017, Characterizing indeterminate (Likert-scored 3/5) peripheral zone prostate lesions with PSA density, PI-RADS scoring and qualitative descriptors on multi-parametric MRI, British Journal of Radiology, Vol: 91, ISSN: 0007-1285
OBJECTIVE: To determine whether indeterminate (Likert-score 3/5) peripheral zone (PZ) multi-parametric MRI (mpMRI) studies are classifiable by Prostate-Specific Antigen (PSA), PSA density (PSAD), PI-RADS_v2 rescoring and morphological MRI features. METHODS: Men with maximum Likert-score 3/5 within their PZ were retrospectively selected from 330 men who prospectively underwent prostate mpMRI (3T) without an endorectal coil, followed by twenty-zone trans-perineal template prostate mapping biopsies ± focal lesion-targeted biopsy. PSAD was calculated using pre-biopsy PSA and MRI-derived volume. Two readers A and B independently assessed included men with both subjective Likert-score and PI-RADS_v2. Both readers then classified mpMRI morphological features in consensus. Men were divided into two groups: significant cancer (≥Gleason 3+4) or insignificant cancer (≤Gleason 3+3)/no cancer. Comparisons between groups were made separately for PSA&PSAD using Mann-Whitney test and morphological descriptors with Fisher's exact test. PI-RADS_v2 and subjective Likert assessment were descriptively compared and percentage inter-reader agreement calculated. RESULTS: 76 men were eligible for PSA&PSAD analyses, 71 for PI-RADS scoring, and 67 for morphological assessment (excluding significant image artefacts). Unlike PSA (p=0.915), PSAD was statistically different (p=0.004) between the significant 0.19 ng/ml2 (IQR: 0.13-0.29) and non-significant/no cancer 0.13 ng/ml2 (IQR: 0.10-0.17) groups. Presence of mpMRI morphological features wasn't significantly different between groups. Subjective Likert assessment discriminated patients with significant cancer better than PI-RADS_v2. Inter-reader percentage agreement was 83% for subjective Likert-scoring and 56% for PI-RADS_v2. CONCLUSION: PSAD may categorize presence of significant cancer in patients with Likert-scored 3/5 PZ mpMRI findings. Advances in knowledge: PSAD may be used in indeterminate PZ mpMRI to guide decisio
Campelo S, Valerio M, Ahmed HU, et al., 2017, An evaluation of irreversible electroporation thresholds in human prostate cancer and potential correlations to physiological measurements, APL Bioengineering, Vol: 1, ISSN: 2473-2877
Irreversible electroporation (IRE) is an emerging cancer treatment that utilizes non-thermal electric pulses for tumor ablation. The pulses are delivered through minimally invasive needle electrodes inserted into the target tissue and lead to cell death through the creation of nanoscale membrane defects. IRE has been shown to be safe and effective when performed on tumors in the brain, liver, kidneys, pancreas, and prostate that are located near critical blood vessels and nerves. Accurate treatment planning and prediction of the ablation volume require a priori knowledge of the tissue-specific electric field threshold for cell death. This study addresses the challenge of defining an electric field threshold for human prostate cancer tissue. Three-dimensional reconstructions of the ablation volumes were created from one week post-treatment magnetic resonance imaging (MRIs) of ten patients who completed a clinical trial. The ablation volumes were incorporated into a finite element modeling software that was used to simulate patient-specific treatments, and the electric field threshold was calculated by matching the ablation volume to the field contour encompassing the equivalent volume. Solutions were obtained for static tissue electrical properties and dynamic properties that accounted for electroporation. According to the dynamic model, the electric field threshold was 506 ± 66 V/cm. Additionally, a potentially strong correlation (r = −0.624) was discovered between the electric field threshold and pre-treatment prostate-specific antigen levels, which needs to be validated in higher enrollment studies. Taken together, these findings can be used to guide the development of future IRE protocols.
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