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Polascik, Thomas James

Overview:

Prostate cancer imaging
Focal therapy of prostate cancer
Prostate cancer outcomes
Kidney cancer outcomes
Minimally invasive surgery
Nerve sparing cryotherapy

Positions:

Professor of Surgery

Surgery, Urology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1991

M.D. — University of Chicago

News:

Grants:

Early Detection of Clinically Significant Prostate Cancer using Ultrasonic Acoustic Radiation Force Impulse (ARFI) Imaging

Administered By
Biomedical Engineering
AwardedBy
United States Army Medical Research Acquisition Activity
Role
Co Investigator
Start Date
September 15, 2016
End Date
September 14, 2019

Prospective registry to optimize clinical care (DUCIMAS)

Administered By
Surgery, Urology
AwardedBy
Myriad Genetics, Inc.
Role
Principal Investigator
Start Date
September 01, 2016
End Date
August 31, 2019

A Pilot Study in Human Subjects Evaluating the Use of the NanoKnife System for Ablation of Prostate Cancer Tissue in a

Administered By
Duke Cancer Institute
AwardedBy
AngioDynamics
Role
Principal Investigator
Start Date
January 01, 2014
End Date
December 31, 2018

MIP proSPECT-AS

Administered By
Duke Cancer Institute
AwardedBy
Molecular Insight Pharmaceuticals, Inc.
Role
Principal Investigator
Start Date
July 01, 2016
End Date
June 30, 2018

Prostate Cancer Assessment and Treatment Guidance Via Integrated 3D ARFI Elasticity Imaging and Multi-Parametric MRI

Administered By
Biomedical Engineering
AwardedBy
Kitware Inc.
Role
Co Investigator
Start Date
April 01, 2015
End Date
September 30, 2016

Radiation Force Imaging of Prostate Cancer and Guidance of Biopsy Procedures

Administered By
Biomedical Engineering
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
January 18, 2010
End Date
December 31, 2015

Evaluation of Sexual Function after Primary and Salvage Prostate Cryoablation for Localized Prostate Cancer

Administered By
Surgery, Urology
AwardedBy
Josiah Charles Trent Memorial Foundation
Role
Principal Investigator
Start Date
March 01, 2010
End Date
February 28, 2011

Trent Foundation Grant

Administered By
Surgery, Urology
AwardedBy
Josiah Charles Trent Memorial Foundation
Role
Principal Investigator
Start Date
January 01, 2006
End Date
May 31, 2009

Psychobiology of male sexual dysfunction following treatment of prostate cancer

Administered By
Surgery, Urology
AwardedBy
Josiah Charles Trent Memorial Foundation
Role
Principal Investigator
Start Date
July 01, 2002
End Date
June 30, 2003
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Publications:

Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project.

Whole-gland extirpation or irradiation is considered the gold standard for curative oncological treatment for localized prostate cancer, but is often associated with sexual and urinary impairment that adversely affects quality of life. This has led to increased interest in developing therapies with effective cancer control but less morbidity. We aimed to provide details of physician consensus on patient selection for prostate focal therapy (FT) in the era of contemporary prostate cancer management.We undertook a four-stage Delphi consensus project among a panel of 47 international experts in prostate FT. Data on three main domains (role of biopsy/imaging, disease and patient factors) were collected in three iterative rounds of online questionnaires and feedback. Consensus was defined as agreement in ⩾80% of physicians. Finally, an in-person meeting was attended by a core group of 16 experts to review the data and formulate the consensus statement.Consensus was obtained in 16 of 18 subdomains. Multiparametric magnetic resonance imaging (mpMRI) is a standard imaging tool for patient selection for FT. In the presence of an mpMRI-suspicious lesion, histological confirmation is necessary prior to FT. In addition, systematic biopsy remains necessary to assess mpMRI-negative areas. However, adequate criteria for systematic biopsy remains indeterminate. FT can be recommended in D'Amico low-/intermediate-risk cancer including Gleason 4+3. Gleason 3+4 cancer, where localized, discrete and of favorable size represents the ideal case for FT. Tumor foci <1.5 ml on mpMRI or <20% of the prostate are suitable for FT, or up to 3 ml or 25% if localized to one hemi-gland. Gleason 3+3 at one core 1mm is acceptable in the untreated area. Preservation of sexual function is an important goal, but lack of erectile function should not exclude a patient from FT.This consensus provides a contemporary insight into expert opinion of patient selection for FT of clinically localized prostate cancer.Prostate Cancer and Prostatic Diseases advance online publication, 28 March 2017; doi:10.1038/pcan.2017.8.

Authors
Tay, KJ; Scheltema, MJ; Ahmed, HU; Barret, E; Coleman, JA; Dominguez-Escrig, J; Ghai, S; Huang, J; Jones, JS; Klotz, LH; Robertson, CN; Sanchez-Salas, R; Scionti, S; Sivaraman, A; de la Rosette, J; Polascik, TJ
MLA Citation
Tay, KJ, Scheltema, MJ, Ahmed, HU, Barret, E, Coleman, JA, Dominguez-Escrig, J, Ghai, S, Huang, J, Jones, JS, Klotz, LH, Robertson, CN, Sanchez-Salas, R, Scionti, S, Sivaraman, A, de la Rosette, J, and Polascik, TJ. "Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project." Prostate cancer and prostatic diseases (March 28, 2017).
PMID
28349978
Source
epmc
Published In
Prostate Cancer and Prostatic Diseases
Publish Date
2017
DOI
10.1038/pcan.2017.8

Body mass index and the clinicopathological characteristics of clinically localized renal masses-An international retrospective review.

To investigate the potential association between body mass index (BMI) and clinicopathological features of clinically localized renal masses.An international, multi-institutional retrospective review of patients who underwent surgery for clinically localized renal masses between 2000 and 2010 was undertaken after an institutional review board approval. Patients were divided into 4 absolute BMI groups based on the entire cohort׳s percentiles and 4 relative BMI groups based on their respective population (American or Italian). Renal mass pathological diagnosis, renal cell carcinoma (RCC) subtype, Fuhrman grade (low and high), and clinical stage were compared among groups using Fisher׳s exact test, Kruskal-Wallis test, and the Cochran-Armitage trend test. A multivariate logistic analysis was performed to evaluate independent association between tumor and patient characteristics with tumor pathology (Fuhrman grade).A total of 1,748 patients having a median BMI of 28 (interquartile range 25-32) were evaluated. Benign masses and RCC cases had similar proportion across BMI groups (P = 0.4). The most common RCC subtype was clear cell followed by papillary carcinoma, chromophobe, and other subtypes. Their distribution was comparable across BMI groups (P = 0.7). Similarly, clinical stage distribution was comparable with the overall cohort. The distribution of Fuhrman grade in RCC, however, demonstrated an increased proportions of low grade with increasing BMI (P<0.05). This trend was maintained in subgroups according to gender, stage and age (P<0.05 in all subgroup analysis). In a multivariable model that included potential confounders (i.e., age, sex, and tumor size) higher BMI groups had lower odds of presenting a high Fuhrman grade.In this study, higher BMI was associated with lower grade of RCC in clinically localized renal masses. This may, in part, explain better survival rates in patients with higher BMI and may correlate with a possible link between adipose tissue and RCC biology.

Authors
Tsivian, E; Tsivian, M; Tay, KJ; Longo, T; Zukerman, Z; Martorana, G; Schiavina, R; Brunocilla, E; Polascik, TJ
MLA Citation
Tsivian, E, Tsivian, M, Tay, KJ, Longo, T, Zukerman, Z, Martorana, G, Schiavina, R, Brunocilla, E, and Polascik, TJ. "Body mass index and the clinicopathological characteristics of clinically localized renal masses-An international retrospective review." Urologic oncology (March 8, 2017).
PMID
28284892
Source
epmc
Published In
Urologic Oncology: Seminars and Original Investigations
Publish Date
2017
DOI
10.1016/j.urolonc.2017.02.004

High-intensity focused ultrasound for focal therapy: reality or pitfall?

Progress in imaging, fusion software, and ablative modalities has fostered growth of the latest image-guided generation of high-intensity focused ultrasound (HIFU) for focal treatment of prostate cancer. Although early reports are encouraging, important questions remain regarding candidate selection, treatment, and outcomes. We review contemporary considerations for the use of HIFU for focal treatment of primary and radio-recurrent prostate cancer.HIFU has been used to treat prostate cancer for over two decades. More recently, stage migration from screening and improvements in pelvic imaging and fusion technology has resulted in wider clinical application of focal HIFU as a first-line treatment for localized prostate cancer. Advanced imaging has also improved targeting for focal salvage therapy of radio-recurrent disease. Proponents point to the minimally invasive nature, limited morbidity profile, and ability to perform retreatments in the future. Critics emphasize positive post-treatment biopsies, nonuniform treatment protocols, and absence of long-term follow-up. Thus, a review of clinical considerations and recently published data is warranted.Recent advances have strengthened support for the use of focal HIFU. Although HIFU has great potential, it must be applied judiciously, maintaining appropriate oncologic principles in the setting of standardized trials to determine its true clinical value.

Authors
Schulman, AA; Tay, KJ; Robertson, CN; Polascik, TJ
MLA Citation
Schulman, AA, Tay, KJ, Robertson, CN, and Polascik, TJ. "High-intensity focused ultrasound for focal therapy: reality or pitfall?." Current opinion in urology 27.2 (March 2017): 138-148.
PMID
27997415
Source
epmc
Published In
Current Opinion in Urology
Volume
27
Issue
2
Publish Date
2017
Start Page
138
End Page
148
DOI
10.1097/mou.0000000000000372

Assessing clinically significant prostate cancer: Diagnostic properties of multiparametric magnetic resonance imaging compared to three-dimensional transperineal template mapping histopathology.

To evaluate the diagnostic properties of multiparametric magnetic resonance imaging in the detection, localization and characterization of prostate cancer using three-dimensional transperineal template mapping biopsy histopathology as the comparator.A retrospective analysis of patients undergoing prostate multiparametric magnetic resonance imaging followed by three-dimensional transperineal template mapping biopsy was carried out. For imaging and pathology data, the prostate was divided in octants with the urethra being the midline. The index test properties were calculated using the biopsy histopathology as the reference test with the following end-points: any cancer, any Gleason ≥7, any Gleason ≥7 or cancer length of ≥4 mm and any Gleason ≥7 or 6 mm in any given core. The latter two definitions correspond to 0.2 and 0.5 mL of cancer volume, respectively. Diagnostic properties including sensitivity, specificity, positive and negative predictive values were calculated.A total of 50 patients were included in the study. A median of 55 (interquartile range 42-63) biopsy cores were obtained per patient. Of 400 prostate octants evaluated, 28.5% had prostate cancer on mapping biopsy, whereas 23% of octants were considered suspicious for cancer on imaging. Multiparametric magnetic resonance imaging negative predictive values for Gleason ≥7 and clinically significant cancers were 84-100%. Similarly, specificity ranged between 79% and 85%. Sensitivity and positive predictive value remained moderate for all the reference test definitions.Multiparametric magnetic resonance imaging is a useful minimally-invasive tool for detection, localization and characterization of prostate cancer. This imaging modality has high negative predictive value and specificity, and therefore it could be used to reliably rule out clinically significant cancer, obviating the multicore mapping biopsy.

Authors
Tsivian, M; Gupta, RT; Tsivian, E; Qi, P; Mendez, MH; Abern, MR; Tay, KJ; Polascik, TJ
MLA Citation
Tsivian, M, Gupta, RT, Tsivian, E, Qi, P, Mendez, MH, Abern, MR, Tay, KJ, and Polascik, TJ. "Assessing clinically significant prostate cancer: Diagnostic properties of multiparametric magnetic resonance imaging compared to three-dimensional transperineal template mapping histopathology." International journal of urology : official journal of the Japanese Urological Association 24.2 (February 2017): 137-143.
PMID
27859637
Source
epmc
Published In
International Journal of Urology
Volume
24
Issue
2
Publish Date
2017
Start Page
137
End Page
143
DOI
10.1111/iju.13251

Expanding thermal ablation to the 'intermediate-sized' renal mass: clinical utility in T1b tumors.

Authors
Schulman, AA; Tay, KJ; Polascik, TJ
MLA Citation
Schulman, AA, Tay, KJ, and Polascik, TJ. "Expanding thermal ablation to the 'intermediate-sized' renal mass: clinical utility in T1b tumors." Translational andrology and urology 6.1 (February 2017): 127-130.
PMID
28217461
Source
epmc
Published In
Translational Andrology and Urology
Volume
6
Issue
1
Publish Date
2017
Start Page
127
End Page
130
DOI
10.21037/tau.2017.01.08

New and Established Technology in Focal Ablation of the Prostate: A Systematic Review.

Focal therapy of prostate cancer has been proposed as an alternative to whole-gland treatments.To summarize the evidence regarding sources of energy employed in focal therapy.Embase and Medline (PubMed) were searched from 1996 to October 31, 2015 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Ongoing trials were selected from electronic registries. The stage of assessment of each source of energy was determined using the Idea, Development, Exploration, Assessment, Long-term study recommendations.Thirty-seven articles reporting on 3230 patients undergoing focal therapy were selected. Thirteen reported on high-intensity focused ultrasound, 11 on cryotherapy, three on photodynamic therapy, four on laser interstitial thermotherapy, two on brachytherapy, three on irreversible electroporation, and one on radiofrequency. High-intensity focused ultrasound, cryotherapy, photodynamic therapy, and brachytherapy have been assessed in up to Stage 2b studies. Laser interstitial thermotherapy and irreversible electroporation have been evaluated in up to Stage 2a studies. Radiofrequency has been evaluated in one Stage 1 study. Median follow-up varied between 4 mo and 61 mo, and the median rate of serious adverse events ranged between 0% and 10.6%. Pad-free leak-free continence and potency were obtained in 83.3-100% and 81.5-100%, respectively. In series with intention to treat, the median rate of significant and insignificant disease at control biopsy varied between 0% and 13.4% and 5.1% and 45.9%, respectively. The main limitations were the length of follow-up, the absence of a comparator arm, and study heterogeneity.Focal therapy has been evaluated using seven sources of energy in single-arm retrospective and prospective development studies up to Stage 2b. Focal therapy seems to have a minor impact on quality of life and genito-urinary function. Oncological effectiveness is yet to be defined against standard of care.Seven sources of energy have been employed to selectively ablate discrete areas of prostate cancer. There is high evidence that focal therapy is safe and has low detrimental impact on continence and potency. The oncological outcome has yet to be evaluated against standard of care.

Authors
Valerio, M; Cerantola, Y; Eggener, SE; Lepor, H; Polascik, TJ; Villers, A; Emberton, M
MLA Citation
Valerio, M, Cerantola, Y, Eggener, SE, Lepor, H, Polascik, TJ, Villers, A, and Emberton, M. "New and Established Technology in Focal Ablation of the Prostate: A Systematic Review." European urology 71.1 (January 2017): 17-34.
PMID
27595377
Source
epmc
Published In
European Urology
Volume
71
Issue
1
Publish Date
2017
Start Page
17
End Page
34
DOI
10.1016/j.eururo.2016.08.044

Comparison between 3D ARFI imaging and mpMRI in detecting clinically-significant prostate cancer lesions

© 2016 IEEE.Current prostate cancer screening methods involve non-targeted needle biopsies and detection of clinically-insignificant lesions that receive excessive treatments, exposing patients to unnecessary adverse side effects and placing a burden on our health care systems. There is a strong clinical need for improved prostate imaging methods that are sensitive and specific for clinically-significant prostate cancer lesions to guide needle biopsies, target focal treatments, and improve overall patient outcomes. In this study, we compared 3D in vivo Acoustic Radiation Force Impulse (ARFI) imaging with 3 Tesla, endorectal coil, multi-parametric magnetic resonance imaging (mpMRI) to correlate the ability for each modality to identify clinically-significant prostate cancer lesions. We also correlated Apparent Diffusion Coefficient (ADC) values from Diffusion Weighted Imaging (DWI) MR sequences with ARFI indices of suspicion and MR Prostate Imaging - Reporting and Data Systems (PI-RADS) scores, testing the hypothesis that increased cellular density is associated with regions suspicious for prostate cancer in ARFI images. Overall, ARFI and mpMR imaging were well-correlated in identifying clinically-significant prostate cancer lesions. There were several cases where only one of the imaging modalities was able to identify the prostate cancer lesion, highlighting the potential to further improve prostate cancer lesion detection and localization with a fused ARFI:mpMRI imaging system. ADC values were decreased in all prostate cancer lesions identified with mpMRI, but there were no obvious trends between the absolute ADC values and the ARFI image indices of suspicion.

Authors
Palmeri, M; Glass, T; Gupta, R; McCormick, M; Brown, A; Polascik, T; Rosenzweig, S; Buck, A; Nightingale, K
MLA Citation
Palmeri, M, Glass, T, Gupta, R, McCormick, M, Brown, A, Polascik, T, Rosenzweig, S, Buck, A, and Nightingale, K. "Comparison between 3D ARFI imaging and mpMRI in detecting clinically-significant prostate cancer lesions." November 1, 2016.
Source
scopus
Published In
IEEE International Ultrasonics Symposium : [proceedings]. IEEE International Ultrasonics Symposium
Volume
2016-November
Publish Date
2016
DOI
10.1109/ULTSYM.2016.7728618

Integration of multiparametric MRI into active surveillance of prostate cancer.

Prostate cancer is the most common noncutaneous cancer in men though many men will not die of this disease and may not require definitive treatment. Active surveillance (AS) is an increasingly utilized potential solution to the issue of overtreatment of prostate cancer. Traditionally, prostate cancer patients have been stratified into risk groups based on clinical stage on digital rectal examination, prostate-specific antigen and biopsy Gleason score, though each of these variables has significant limitations. This review will discuss the potential role for prostate multiparametric MRI and targeted biopsy techniques incorporating MRI in the selection of candidates for AS, monitoring patients on AS and as triggers for definitive treatment.

Authors
Holtz, JN; Tay, KJ; Polascik, TJ; Gupta, RT
MLA Citation
Holtz, JN, Tay, KJ, Polascik, TJ, and Gupta, RT. "Integration of multiparametric MRI into active surveillance of prostate cancer." Future oncology (London, England) 12.21 (November 2016): 2513-2529.
PMID
27322161
Source
epmc
Published In
Future oncology (London, England)
Volume
12
Issue
21
Publish Date
2016
Start Page
2513
End Page
2529

Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project.

To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa).A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated.Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text.Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.

Authors
Postema, AW; De Reijke, TM; Ukimura, O; Van den Bos, W; Azzouzi, AR; Barret, E; Baumunk, D; Blana, A; Bossi, A; Brausi, M; Coleman, JA; Crouzet, S; Dominguez-Escrig, J; Eggener, S; Ganzer, R; Ghai, S; Gill, IS; Gupta, RT; Henkel, TO; Hohenfellner, M; Jones, JS; Kahmann, F; Kastner, C; Köhrmann, KU; Kovacs, G; Miano, R; van Moorselaar, RJ; Mottet, N; Osorio, L; Pieters, BR; Polascik, TJ; Rastinehad, AR; Salomon, G; Sanchez-Salas, R; Schostak, M; Sentker, L; Tay, KJ; Varkarakis, IM; Villers, A et al.
MLA Citation
Postema, AW, De Reijke, TM, Ukimura, O, Van den Bos, W, Azzouzi, AR, Barret, E, Baumunk, D, Blana, A, Bossi, A, Brausi, M, Coleman, JA, Crouzet, S, Dominguez-Escrig, J, Eggener, S, Ganzer, R, Ghai, S, Gill, IS, Gupta, RT, Henkel, TO, Hohenfellner, M, Jones, JS, Kahmann, F, Kastner, C, Köhrmann, KU, Kovacs, G, Miano, R, van Moorselaar, RJ, Mottet, N, Osorio, L, Pieters, BR, Polascik, TJ, Rastinehad, AR, Salomon, G, Sanchez-Salas, R, Schostak, M, Sentker, L, Tay, KJ, Varkarakis, IM, and Villers, A et al. "Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project." World journal of urology 34.10 (October 2016): 1373-1382.
PMID
26892160
Source
epmc
Published In
World Journal of Urology
Volume
34
Issue
10
Publish Date
2016
Start Page
1373
End Page
1382
DOI
10.1007/s00345-016-1782-x

Targeted Anterior Gland Focal Therapy-a Novel Treatment Option for a Better Defined Disease.

The goal of focal therapy is to achieve long-term oncological control by eradicating only the clinically significant focus/foci of cancer within the prostate, while preserving erectile function and continence. Anterior prostate cancers may have a PZ or TZ origin and share commonalities in location and biology. While anterior prostate cancers previously constituted a diagnostic blind spot in the prostate and were often not detected or discovered late, with the rapid dissemination of advanced imaging and biopsy techniques, they can now be identified at an earlier, organ-confined stage due to MR imaging and targeted biopsies. Due to their anterior location, they represent a therapeutic target that allows for thorough ablation of the cancer focus/foci with an adequate margin while remaining far from the neurovascular bundles bilaterally. However, the TZ origin cancers are mostly anterior to the distal urethra close to the apex and the striated sphincter. Men having early stage anterior cancers may represent good candidates to achieve a balance between oncological control and functional preservation with focal therapy. Thus, this class of tumor based on location, along with the proposed treatment, represents a novel form of targeted image-guided therapy.

Authors
Tay, KJ; Villers, A; Polascik, TJ
MLA Citation
Tay, KJ, Villers, A, and Polascik, TJ. "Targeted Anterior Gland Focal Therapy-a Novel Treatment Option for a Better Defined Disease." Current urology reports 17.10 (October 2016): 69-.
PMID
27502428
Source
epmc
Published In
Current Urology Reports
Volume
17
Issue
10
Publish Date
2016
Start Page
69
DOI
10.1007/s11934-016-0628-9

Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project.

To codify the use of multiparametric magnetic resonance imaging (mpMRI) for the interrogation of prostate neoplasia (PCa) in clinical practice and focal therapy (FT).An international collaborative consensus project was undertaken using the Delphi method among experts in the field of PCa. An online questionnaire was presented in three consecutive rounds and modified each round based on the comments provided by the experts. Subsequently, a face-to-face meeting was held to discuss and finalize the consensus results.mpMRI should be performed in patients with prior negative biopsies if clinical suspicion remains, but not instead of the PSA test, nor as a stand-alone diagnostic tool or mpMRI-targeted biopsies only. It is not recommended to use a 1.5 Tesla MRI scanner without an endorectal or pelvic phased-array coil. mpMRI should be performed following standard biopsy-based PCa diagnosis in both the planning and follow-up of FT. If a lesion is seen, MRI-TRUS fusion biopsies should be performed for FT planning. Systematic biopsies are still required for FT planning in biopsy-naïve patients and for patients with residual PCa after FT. Standard repeat biopsies should be taken during the follow-up of FT. The final decision to perform FT should be based on histopathology. However, these consensus statements may differ for expert centers versus non-expert centers.The mpMRI is an important tool for characterizing and targeting PCa in clinical practice and FT. Standardization of acquisition and reading should be the main priority to guarantee consistent mpMRI quality throughout the urological community.

Authors
Scheltema, MJ; Tay, KJ; Postema, AW; de Bruin, DM; Feller, J; Futterer, JJ; George, AK; Gupta, RT; Kahmann, F; Kastner, C; Laguna, MP; Natarajan, S; Rais-Bahrami, S; Rastinehad, AR; de Reijke, TM; Salomon, G; Stone, N; van Velthoven, R; Villani, R; Villers, A; Walz, J; Polascik, TJ; de la Rosette, JJMCH
MLA Citation
Scheltema, MJ, Tay, KJ, Postema, AW, de Bruin, DM, Feller, J, Futterer, JJ, George, AK, Gupta, RT, Kahmann, F, Kastner, C, Laguna, MP, Natarajan, S, Rais-Bahrami, S, Rastinehad, AR, de Reijke, TM, Salomon, G, Stone, N, van Velthoven, R, Villani, R, Villers, A, Walz, J, Polascik, TJ, and de la Rosette, JJMCH. "Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project." World journal of urology (September 16, 2016).
PMID
27637908
Source
epmc
Published In
World Journal of Urology
Publish Date
2016

Pilot Study to Assess Safety and Clinical Outcomes of Irreversible Electroporation for Partial Gland Ablation in Men with Prostate Cancer EDITORIAL COMMENT

Authors
Polascik, TJ; Tay, KJ
MLA Citation
Polascik, TJ, and Tay, KJ. "Pilot Study to Assess Safety and Clinical Outcomes of Irreversible Electroporation for Partial Gland Ablation in Men with Prostate Cancer EDITORIAL COMMENT." JOURNAL OF UROLOGY 196.3 (September 2016): 889-889.
Source
wos-lite
Published In
The Journal of Urology
Volume
196
Issue
3
Publish Date
2016
Start Page
889
End Page
889

Defining the Incremental Utility of Prostate Multiparametric Magnetic Resonance Imaging at Standard and Specialized Read in Predicting Extracapsular Extension of Prostate Cancer.

Multiparametric magnetic resonance imaging (mpMRI) is increasingly used in staging early prostate cancer (PCa) but remains heavily reader-dependent. We aim to define the incremental utility of mpMRI over clinical parameters in determining the pathologic extracapsular extension (pECE) of PCa interpreted in a standard radiologic setting and when further over-read by a specialized reader. We retrospectively reviewed 120 men with clinically localized PCa undergoing mpMRI and radical prostatectomy. We obtained radiologic prediction of pECE from standard radiologic reports (standard read) and by a specialized reader blinded to clinical and pathologic findings (specialized read). We determined the incremental benefit of standard read and specialized read by sequential addition to a baseline clinical parameters-only logistic regression model predicting pECE. The sensitivity and specificity of standard read were 77% and 44%, respectively, whereas those of specialized read were 86% and 81%. The positive likelihood ratio was 1.7 at baseline, 1.7 adding standard read, and 6.5 adding specialized read. The negative likelihood ratio was 0.6 at baseline, 0.5 adding standard read, and 0.1 adding specialized read. Standard read modestly improved prediction of pECE, whereas specialized read improved it moderately.The incremental benefit of mpMRI over clinical information is small but increases to moderate with a specialized second opinion. This second opinion may be useful when considering active surveillance, nerve-sparing surgery, or focal therapy.

Authors
Tay, KJ; Gupta, RT; Brown, AF; Silverman, RK; Polascik, TJ
MLA Citation
Tay, KJ, Gupta, RT, Brown, AF, Silverman, RK, and Polascik, TJ. "Defining the Incremental Utility of Prostate Multiparametric Magnetic Resonance Imaging at Standard and Specialized Read in Predicting Extracapsular Extension of Prostate Cancer." European urology 70.2 (August 2016): 211-213.
PMID
26553331
Source
epmc
Published In
European Urology
Volume
70
Issue
2
Publish Date
2016
Start Page
211
End Page
213
DOI
10.1016/j.eururo.2015.10.041

Effect of positive end-expiratory pressure on blood loss during retropubic and robot-assisted laparoscopic radical prostatectomy.

To study the effect of end-expiratory pressure used during anesthesia on blood loss during radical prostatectomy.We evaluated 247 patients who underwent either radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy at a single institution from 2008 to 2013 by one of four surgeons. Patient characteristics were compared using t-tests, rank sum or χ(2) -tests as appropriate. The association between positive end-expiratory pressure and estimated blood loss was tested using linear regression.Patients were classified into high (≥4 cmH2 O) and low (≤1 cmH2 O) positive-end expiratory pressure groups. Estimated blood loss in radical retropubic prostatectomy was higher in the high positive end-expiratory pressure group (1000 mL vs 800 mL, P = 0.042). Estimated blood loss in robot-assisted laparoscopic prostatectomy was lower in the high positive end-expiratory pressure group (150 mL vs 250 mL, P = 0.015). After adjusting for other factors known to influence blood loss, a 5-cmH2 O increase in positive end-expiratory pressure was associated with a 34.9% increase in estimated blood loss (P = 0.030) for radical retropubic prostatectomy, and a 33.0% decrease for robot-assisted laparoscopic prostatectomy (P = 0.038).In radical retropubic prostatectomy, high positive end-expiratory pressure was associated with higher estimated blood loss, and the benefits of positive end-expiratory pressure should be weighed against the risk of increased estimated blood loss. In robot-assisted laparoscopic prostatectomy, high positive end-expiratory pressure was associated with lower estimated blood loss, and might have more than just pulmonary benefits.

Authors
Ehieli, EI; Howard, LE; Monk, TG; Ferrandino, MN; Polascik, TJ; Walther, PJ; Freedland, SJ
MLA Citation
Ehieli, EI, Howard, LE, Monk, TG, Ferrandino, MN, Polascik, TJ, Walther, PJ, and Freedland, SJ. "Effect of positive end-expiratory pressure on blood loss during retropubic and robot-assisted laparoscopic radical prostatectomy." International journal of urology : official journal of the Japanese Urological Association 23.8 (August 2016): 674-678.
PMID
27225958
Source
epmc
Published In
International Journal of Urology
Volume
23
Issue
8
Publish Date
2016
Start Page
674
End Page
678
DOI
10.1111/iju.13125

Can Radiologic Staging With Multiparametric MRI Enhance the Accuracy of the Partin Tables in Predicting Organ-Confined Prostate Cancer?

The purpose of this study is to investigate the accuracy of multiparametric MRI with endorectal coil and Partin tables in predicting organ-confined (OC) prostate cancer in a contemporary cohort undergoing radical prostatectomy (RP) and to assess the possible added value of radiologic staging based on multiparametric MRI to the predictive accuracy of Partin tables.One hundred fifty-eight consecutive subjects underwent 3-T multiparametric MRI with endorectal coil before RP between November 2010 and November 2013. Data were randomly split 60% and 40% into derivation (n = 95) and validation (n = 62) datasets. Multiparametric MRI was used to assess the radiologic stage, and logistic regression models were created using the derivation dataset and were fit on the independent validation dataset using multiparametric MRI staging alone and with prostate-specific antigen (PSA) level as the covariate. The probability of each patient to harbor OC disease was calculated using an updated version of Partin tables, using either clinical staging from digital rectal examination (DRE) or radiologic staging (multiparametric MRI). The AUC was calculated to evaluate accuracy of these predictive methods.The accuracy of multiparametric MRI to predict OC disease on pathologic analysis was greater (AUC, 0.88) than that of Partin tables (AUC, 0.70) and improved when multiparametric MRI was combined with PSA level (AUC, 0.91). The accuracy of Partin nomograms to predict OC disease decreased (AUC, 0.63) when staging was based on multiparametric MRI versus DRE.The superior predictive accuracy of multiparametric MRI compared with Partin tables to predict OC disease validates the results of smaller previously published studies. Although there is no added benefit of substituting multiparametric MRI stage for clinical stage when using Partin tables, multiparametric MRI staging information is valuable as a stand-alone test.

Authors
Gupta, RT; Brown, AF; Silverman, RK; Tay, KJ; Madden, JF; George, DJ; Polascik, TJ
MLA Citation
Gupta, RT, Brown, AF, Silverman, RK, Tay, KJ, Madden, JF, George, DJ, and Polascik, TJ. "Can Radiologic Staging With Multiparametric MRI Enhance the Accuracy of the Partin Tables in Predicting Organ-Confined Prostate Cancer?." AJR. American journal of roentgenology 207.1 (July 2016): 87-95.
PMID
27064383
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
207
Issue
1
Publish Date
2016
Start Page
87
End Page
95
DOI
10.2214/ajr.15.15878

Focal Cryotherapy for Localized Prostate Cancer.

To systematically review the oncological and functional outcomes of contemporary primary prostate focal cryotherapy for localized prostate cancer in the context of current developments in prostate focal therapy.We performed a systematic search of the Pubmed, Cochrane and Embase databases to identify studies where primary prostate focal cryotherapy was performed to treat prostate cancer. These included reports on focal/ lesion/ sector ablation, hemi-ablation and partial prostate ablation. We excluded salvage focal therapy studies. Where multiple reports were published over time from a single cohort, the latest one was used.Our search yielded 290 publications, including 17 primary reports on eight single-center cohort studies and one multi-center registry report. Of 1,595 men identified, mean age was 60.5-69.5 years and mean PSA 5.1-7.8 ng/ml. When stratified by D'Amico risk criteria, 52% of the aggregate total number of men were low-risk, 38% intermediate-risk and 10% high-risk. Besides 12-core TRUS biopsy, 3 cohorts reported using TTMB and one included mpMRI to select men for focal treatment. Median follow-up ranged from 13-63 months. BPFS ranged from 71-98%. The overall post-treatment positive biopsy rate was 8-25%. Among 5 cohorts with a mandatory 6-12 month posttreatment biopsy, 216 of 272 men (79%) did undergo biopsy, with 47 positive (21.8%). Of these, 15 were infield, 26 outfield, 2 bilateral and 4 undeclared. Ten upgraded to Gleason≥7. Overall, two men had metastatic disease and none died of prostate cancer. Post-treatment continence rates were 96-100% and rates of erectile dysfunction ranged from 0-42%. The rate of post-treatment urinary retention ranged from 0-15%. The rate of recto-urethral fistula was 0-0.1%.Focal cryotherapy for localized prostate cancer is a safe and provides good preservation of sexual and urinary function. Accurate cancer localization and risk stratification is key to patient selection. In highly selected patients, focal therapy has good short to medium term oncological efficacy.

Authors
Tay, KJ; Polascik, TJ
MLA Citation
Tay, KJ, and Polascik, TJ. "Focal Cryotherapy for Localized Prostate Cancer." Archivos espanoles de urologia 69.6 (July 2016): 317-326.
PMID
27416635
Source
epmc
Published In
Archivos espanoles de urologia
Volume
69
Issue
6
Publish Date
2016
Start Page
317
End Page
326

Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation: Defining Success with Nadir Prostate-Specific Antigen.

Salvage prostate cryoablation is an effective treatment for patients with localized prostate cancer relapse following primary radiotherapy. The postsalvage prostate-specific antigen (PSA) nadir that best predicts long-term biochemical progression-free survival (bPFS) is not yet defined. We sought to determine what nadir PSA best predicted success following salvage whole-gland cryoablation.We retrospectively reviewed a cohort of 486 hormone-naive patients who underwent salvage whole-gland cryoablation from the Cryo On-Line Database (COLD). Studied variables were age, race, initial PSA, presalvage prostate-specific antigen (psPSA), initial Gleason score, Gleason score at presalvage biopsy, clinical stage, and follow-up PSA values. Kaplan-Meier (KM) analysis was used to calculate 5-year bPFS using the Phoenix criteria. Hazard ratio and relative risk were also analyzed. Differences among the KM estimates, at 5 years, were calculated using the log-rank test.Using group thresholds, KM analysis identified nadir PSA less than or greater than 0.4 ng/mL as the nadir PSA threshold, with the greatest difference in bPFS. The KM estimated 5-year bPFS was 75.5% and 22.1% for nadir PSA <0.4 and ≥0.4 ng/mL, respectively. Stratified by psPSA, the KM estimated 5-year bPFS comparing patients with PSA nadir <0.4 vs ≥0.4 ng/mL was 78.5% and 17.9% (p < 0.0001) for psPSA <4 ng/mL, 77.1% and 15.7% (p < 0.0001) for psPSA 4-10 ng/mL, and 77.8% and 16.8% (p < 0.0001) for psPSA >10 ng/mL, respectively.The best objective indicator of biochemical success following whole-gland salvage cryoablation of the prostate is PSA nadir <0.4 ng/mL.

Authors
Kovac, E; ElShafei, A; Tay, KJ; Mendez, M; Polascik, TJ; Jones, JS
MLA Citation
Kovac, E, ElShafei, A, Tay, KJ, Mendez, M, Polascik, TJ, and Jones, JS. "Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation: Defining Success with Nadir Prostate-Specific Antigen." Journal of endourology 30.6 (June 2016): 624-631.
PMID
26915721
Source
epmc
Published In
Journal of Endourology
Volume
30
Issue
6
Publish Date
2016
Start Page
624
End Page
631
DOI
10.1089/end.2015.0719

Identifying Clinically Significant Prostate Cancers using 3-D In Vivo Acoustic Radiation Force Impulse Imaging with Whole-Mount Histology Validation.

Overly aggressive prostate cancer (PCa) treatment adversely affects patients and places an unnecessary burden on our health care system. The inability to identify and grade clinically significant PCa lesions is a factor contributing to excessively aggressive PCa treatment, such as radical prostatectomy, instead of more focal, prostate-sparing procedures such as cryotherapy and high-dose radiation therapy. We have performed 3-D in vivo B-mode and acoustic radiation force impulse (ARFI) imaging using a mechanically rotated, side-fire endorectal imaging array to identify regions suspicious for PCa in 29 patients being treated with radical prostatectomies for biopsy-confirmed PCa. Whole-mount histopathology analyses were performed to identify regions of clinically significant/insignificant PCa lesions, atrophy and benign prostatic hyperplasia. Regions of suspicion for PCa were reader-identified in ARFI images based on boundary delineation, contrast, texture and location. These regions of suspicion were compared with histopathology identified lesions using a nearest-neighbor regional localization approach. Of all clinically significant lesions identified on histopathology, 71.4% were also identified using ARFI imaging, including 79.3% of posterior and 33.3% of anterior lesions. Among the ARFI-identified lesions, 79.3% corresponded to clinically significant PCa lesions, with these lesions having higher indices of suspicion than clinically insignificant PCa. ARFI imaging had greater sensitivity for posterior versus anterior lesions because of greater displacement signal-to-noise ratio and finer spatial sampling. Atrophy and benign prostatic hyperplasia can cause appreciable prostate anatomy distortion and heterogeneity that confounds ARFI PCa lesion identification; however, in general, ARFI regions of suspicion did not coincide with these benign pathologies.

Authors
Palmeri, ML; Glass, TJ; Miller, ZA; Rosenzweig, SJ; Buck, A; Polascik, TJ; Gupta, RT; Brown, AF; Madden, J; Nightingale, KR
MLA Citation
Palmeri, ML, Glass, TJ, Miller, ZA, Rosenzweig, SJ, Buck, A, Polascik, TJ, Gupta, RT, Brown, AF, Madden, J, and Nightingale, KR. "Identifying Clinically Significant Prostate Cancers using 3-D In Vivo Acoustic Radiation Force Impulse Imaging with Whole-Mount Histology Validation." Ultrasound in medicine & biology 42.6 (June 2016): 1251-1262.
PMID
26947445
Source
epmc
Published In
Ultrasound in Medicine & Biology
Volume
42
Issue
6
Publish Date
2016
Start Page
1251
End Page
1262
DOI
10.1016/j.ultrasmedbio.2016.01.004

Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results.

Cryoablation (CA) is a minimally invasive modality with low complication rates, but its use in urology is relatively recent.To summarize available evidence for CA for small renal masses (SRMs) and to assess the selection criteria, complications, and functional and oncologic results based on the latest CA literature.A systematic literature search of the Medline, Embase, and Scopus databases was performed in August 2014 using Medical Subject Headings and free-text protocol. The following search terms were included: kidney cryosurgery, renal cryosurgery, kidney cryoablation, renal cryoablation, kidney cryotherapy, and renal cryotherapy.Due to the relatively recent mainstream utilization of CA and lack of long-term efficacy data from large prospective or randomized studies, most of the data available on CA are limited to treatment of SRMs in patients who are often older or are poor surgical candidates. The rates of major complications across the CA literature remain relatively low. Studies assessing renal function after CA suggest a degree of functional decline following CA because proper application includes freezing of a tumor margin; however, often this is not clinically significant. Specific oncologic outcomes should be evaluated in patients with biopsy-proven renal cell carcinoma; when SRM series include benign or unbiopsied tumors, the results of these outcomes are skewed. Although earlier series were suggestive of a higher recurrence rate after CA, some studies have challenged this view reporting recurrence rates comparable with extirpative nephron-sparing surgery.CA represents an alternative approach to treatment for patients diagnosed with renal neoplasm. There is no consensus within the literature on the best patient selection criteria. Due to higher rates of treatment failure, it is often not offered to patients with minimal comorbidities and good life expectancy. In terms of functional outcomes, CA signifies a modality with minimum impact on renal function; however, well-designed studies precisely assessing this factor are lacking. CA is a minimally invasive modality with suitably low rates of complications, particularly if delivered via the percutaneous route.Cryoablation (CA) represents an alternative approach for treating renal neoplasm. Excellent functional outcomes and low rates of complications make CA an ideal minimally invasive modality. Patient selection criteria and oncologic outcomes require further study.

Authors
Zargar, H; Atwell, TD; Cadeddu, JA; de la Rosette, JJ; Janetschek, G; Kaouk, JH; Matin, SF; Polascik, TJ; Zargar-Shoshtari, K; Thompson, RH
MLA Citation
Zargar, H, Atwell, TD, Cadeddu, JA, de la Rosette, JJ, Janetschek, G, Kaouk, JH, Matin, SF, Polascik, TJ, Zargar-Shoshtari, K, and Thompson, RH. "Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results." European urology 69.1 (January 2016): 116-128.
PMID
25819723
Source
epmc
Published In
European Urology
Volume
69
Issue
1
Publish Date
2016
Start Page
116
End Page
128
DOI
10.1016/j.eururo.2015.03.027

Primary Cryotherapy for High-Grade Clinically Localized Prostate Cancer: Oncologic and Functional Outcomes from the COLD Registry.

To evaluate the oncological and functional outcomes of primary cryotherapy in men with clinically localized, high-grade prostate cancer.We included all men with biopsy Gleason score ≥8, localized (cT1-2) disease with a serum prostate-specific antigen (PSA) ≤50 ng/mL from the Cryo On-Line Data (COLD) registry. The primary outcome was biochemical progression free survival (BPFS) as defined by the Phoenix criteria (nadir PSA +2 ng/mL). Secondary outcomes of continence (defined as strictly no leak) and potency (able to have intercourse) were patient reported. Factors influencing BPFS were evaluated individually using Kaplan Meier and in a multivariate model using Cox regression.Altogether, 300 men were included for analysis. The median follow-up was 18.2 months (mean 28.4) and median BPFS was 69.8 months. Based on Kaplan-Meier analysis, the estimated 2- and 5-year BPFS rate was 77.2% and 59.1%, respectively. Neoadjuvant hormonal therapy was administered to 41% of men and this tended to occur in men with larger prostates, likely as a technical consideration for downsizing before cryosurgery. At multivariate analysis, the presence of Gleason score 9 or 10 (Hazard Ratio [HR] 1.9) and a posttreatment PSA nadir of ≥0.4 ng/mL (HR 5.7) were the only significant variables associated with biochemical progression using Cox regression. Complete continence was noted in 90.5% of men and potency in 17% of men at the 12-month follow-up. The incidence of rectourethral fistulae and urinary retention requiring intervention beyond temporary catheterization was 1.3% and 3.3%, respectively.Primary cryotherapy appears to be effective and safe in the community setting for high-grade, clinically localized prostate cancer in the short term.

Authors
Tay, KJ; Polascik, TJ; Elshafei, A; Cher, ML; Given, RW; Mouraviev, V; Ross, AE; Jones, JS
MLA Citation
Tay, KJ, Polascik, TJ, Elshafei, A, Cher, ML, Given, RW, Mouraviev, V, Ross, AE, and Jones, JS. "Primary Cryotherapy for High-Grade Clinically Localized Prostate Cancer: Oncologic and Functional Outcomes from the COLD Registry." Journal of endourology 30.1 (January 2016): 43-48.
PMID
26414656
Source
epmc
Published In
Journal of Endourology
Volume
30
Issue
1
Publish Date
2016
Start Page
43
End Page
48
DOI
10.1089/end.2015.0403

Navigating MRI-TRUS fusion biopsy: optimizing the process and avoiding technical pitfalls.

Multi-parametric MRI (mpMRI) is widely used in the detection and characterization of clinically- significant prostate cancer. MRI-TRUS (trans-rectal ultrasound) fusion biopsy is an in-office procedure that promises to empower urologists to successfully target these MRI-visible lesions for histological confirmation. We describe the moving parts in the process and discuss methods to optimize biopsy outcomes. mpMRI is highly technical and reader-dependent. The acquisition of US images to generate a valid 3D US model and subsequent registration and fusion requires the urologist to attain equilibrium of probe position and pressure to achieve maximum registration accuracy. Environmental, medical and engineering measures can be undertaken to improve targeting accuracy. The art and skill of 'hitting' a visual target involves real-time recognition and adjustment for potential errors/ mis-registration in the fusion guide. A multi-disciplinary team effort is critical to improve all steps of the procedure.

Authors
Tay, KJ; Gupta, RT; Rastinehad, AR; Tsivian, E; Freedland, SJ; Moul, JW; Polascik, TJ
MLA Citation
Tay, KJ, Gupta, RT, Rastinehad, AR, Tsivian, E, Freedland, SJ, Moul, JW, and Polascik, TJ. "Navigating MRI-TRUS fusion biopsy: optimizing the process and avoiding technical pitfalls." Expert review of anticancer therapy 16.3 (January 2016): 303-311.
PMID
26653079
Source
epmc
Published In
Expert Review of Anticancer Therapy
Volume
16
Issue
3
Publish Date
2016
Start Page
303
End Page
311
DOI
10.1586/14737140.2016.1131155

Keeping an Open Mind About Novel Concepts for Management of Prostate Cancer.

Authors
Polascik, TJ; Tay, KJ; Moul, JW
MLA Citation
Polascik, TJ, Tay, KJ, and Moul, JW. "Keeping an Open Mind About Novel Concepts for Management of Prostate Cancer." European urology 68.6 (December 2015): 937-938.
PMID
25770483
Source
epmc
Published In
European Urology
Volume
68
Issue
6
Publish Date
2015
Start Page
937
End Page
938
DOI
10.1016/j.eururo.2015.02.024

Comparison of Outcomes Between Preoperatively Potent Men Treated with Focal Versus Whole Gland Cryotherapy in a Matched Population.

The refinement in the localization of prostate cancer tumor foci through transperineal template-mapping biopsies and MRI has led to an increased interest in lesion-directed focal prostatic cryoablation. Data are lacking, however, that compare the outcomes of whole-gland (WG) to focal ablation therapy (FT). The aim of our study was to assess both oncologic and functional outcomes between WG and FT cryoablation of the prostate after having matched patients for preoperative characteristics.We matched with a 1:1 ratio 317 men who underwent FT with 317 who underwent WG treatment in the Cryo Online Data (COLD) registry between 2007 and 2013. All patients were low-risk according to the D'Amico risk groups and were matched according to age at surgery. We only included preoperatively potent men. Oncologic outcomes were biochemical recurrence (BCR) free-survival defined according to the American Society for Radiation Oncology (ASTRO) and Phoenix criteria and assessed by Kaplan-Meier curves. Only patients with prostate-specific antigen (PSA) nadir data were included in oncologic outcome analysis. Functional outcomes were assessed at 6, 12, and 24 months after the procedure for erectile function (defined as ability to have intercourse with or without erectile aids), urinary continence, urinary retention, and rates of fistula formation.Median age at the time of the procedure was 66.5 years (standard deviation [SD] 6.6 y), and median follow-up time was 58.3 months. After surgery, 30% (n=95) and 17% (n=55) of the men who received WG and FT, respectively, underwent biopsy, with positive biopsy rates of 11.6% and 14.5%, respectively. BCR-free survival rates at 60 months according to the Phoenix definition were 80.1% and 71.3% in the WG and FT cohorts, respectively, with a hazard ratio of 0.827; according to the ASTRO definition, they were 82.1% and 73%, respectively (all P ≥ 0.1). Erectile function data at 24 months was available for 172 WG and 160 FT treated men. Recovery of erection was achieved in 46.8% and 68.8% of patients in the WG and FT cohorts, respectively (P=0.001). Urinary function data at 24 months was available for 307 WG and 313 FT patients. Continence rates were 98.7% and 100% for WG and FT groups, respectively (P=0.02). Urinary retention at 6, 12, and 24 months was reported in 7.3%, 1.9%, and 0.6%, respectively, in the WG arm, and in 5%, 1.3%, and 0.9%, respectively, in the FT arm. Finally, only one fistula was reported in each group.Men with low-risk prostate cancer who underwent FT cryoablation had comparable BCR-survival rates at 60 months to patients treated with WG. However, FT patients had higher erectile function preservation rates at 24 months post-procedure. Urinary continence, retention and fistula rates were similar between the two treatment groups.

Authors
Mendez, MH; Passoni, NM; Pow-Sang, J; Jones, JS; Polascik, TJ
MLA Citation
Mendez, MH, Passoni, NM, Pow-Sang, J, Jones, JS, and Polascik, TJ. "Comparison of Outcomes Between Preoperatively Potent Men Treated with Focal Versus Whole Gland Cryotherapy in a Matched Population." Journal of endourology 29.10 (October 2015): 1193-1198.
PMID
26058496
Source
epmc
Published In
Journal of Endourology
Volume
29
Issue
10
Publish Date
2015
Start Page
1193
End Page
1198
DOI
10.1089/end.2014.0881

Follow-up modalities in focal therapy for prostate cancer: results from a Delphi consensus project.

Focal therapy can offer the middle ground for treatment between active surveillance and radical therapy in patients with low- and intermediate-risk prostate cancer. Factors that prohibit focal therapy from being standard of care are numerous. Several consensus projects have been conducted to position the utilization of imaging and trial design in focal therapy. However, the literature is still scarce on patient follow-up after focal therapy. For these reasons, an international multidisciplinary consensus project was established in order to reach consensus about a uniform follow-up protocol after focal therapy.To standardize patient follow-up after focal therapy.A literature study was performed, and a questionnaire was constructed. The questionnaire was sent out to 76 participants (70 % urologists, 28 % radiologists and 2 % biomedical engineers) in three consecutive rounds according to the Delphi method. In each round, the panelists were presented with the results of the previous round. Participants each had the opportunity to adapt, delete or add questions. The topics discussed pertaining to follow-up after focal therapy were as follows: (1) general,(2) biopsies, (3) PSA, (4) digital rectal examination (DRE), (5) imaging, (6) quality of life (QoL) and (7) registration and pooling of data. The project was concluded with a face-to-face meeting in which final conclusions were formulated.The follow-up after focal therapy should be a minimum of 5 years. The following modalities should be included in assessing post-treatment outcomes: multiparametric MRI (mpMRI), biopsies, assessment of erectile function, QoL, urinary symptoms and incontinence. A systematic 12-core TRUS biopsy combined with 4-6 targeted biopsy cores of the treated area and any suspicious lesion(s) should be performed after 1 year, and thereafter only when there is suspicion on imaging. The ideal way to perform targeted biopsies is to use TRUS-MRI fusion technology. PSA should be performed for research purposes, in the first year, every 3 months, and after the first year, every 6 months. mpMRI is the optimal imaging modality for follow-up after focal therapy. On a 1.5T scanner, an endorectal coil is strongly advised by the panel, whereas on a 3T machine, it is optional, however, it will improve image quality. The following sequences should be included: T2WI, DWI including high b values of >1,000 and ADC maps of DWI, DCE and T1WI. Imaging should be performed at 6 months and at 1 year following treatment; after the first year post-treatment, it should be performed every year until 5 years following treatment. All data should ideally be pooled in a common global database.Focal therapy is a relatively new form of treatment for prostate cancer. In order to include focal therapy as a standard of care treatment, consistent follow-up is necessary. By implementing the results of this consensus study, focal therapy users will be able to provide important and standardized outcome data.

Authors
Muller, BG; van den Bos, W; Brausi, M; Fütterer, JJ; Ghai, S; Pinto, PA; Popeneciu, IV; de Reijke, TM; Robertson, C; de la Rosette, JJMCH; Scionti, S; Turkbey, B; Wijkstra, H; Ukimura, O; Polascik, TJ
MLA Citation
Muller, BG, van den Bos, W, Brausi, M, Fütterer, JJ, Ghai, S, Pinto, PA, Popeneciu, IV, de Reijke, TM, Robertson, C, de la Rosette, JJMCH, Scionti, S, Turkbey, B, Wijkstra, H, Ukimura, O, and Polascik, TJ. "Follow-up modalities in focal therapy for prostate cancer: results from a Delphi consensus project." World journal of urology 33.10 (October 2015): 1503-1509.
PMID
25559111
Source
epmc
Published In
World Journal of Urology
Volume
33
Issue
10
Publish Date
2015
Start Page
1503
End Page
1509
DOI
10.1007/s00345-014-1475-2

A pretreatment nomogram for prediction of biochemical failure after primary cryoablation of the prostate.

To create a predictive nomogram for biochemical failure following primary whole-gland cryoablation of the prostate for localized prostate cancer (LPCa).We retrospectively analyzed 2,242 patients from the Cryo On-Line Database (COLD) who were treatment naive and had undergone primary whole gland cryoablation of the prostate for biopsy-confirmed LPCa. Kaplan-Meier (KM) curves estimating 5 year biochemical progression-free survival (bPFS) were generated. Multivariable Cox proportional hazards analysis (CoxPH) was performed in order to construct the nomogram. The nomogram was internally validated using the bootstrap technique.Overall, the KM estimated 5 year bPFS was 72.8%. Stratified by D'Amico risk, The KM estimated 5 year bPFS was 82.6%, 71.1%, and 57.8% for low-, intermediate-, and high-risk groups, respectively. Statistically significant predictors of biochemical outcomes from CoxPH analysis were pre-treatment prostate specific antigen (PTPSA) (P < 0.001), total prostate volume (P = 0.004), clinical stage (P = 0.034), and Gleason score (0.004). A nomogram for predicted 5 year biochemical progression free probability was constructed with a concordance index of 0.652. An online risk calculator was also generated.To the best of our knowledge, this is the first predictive nomogram for biochemical outcomes after primary whole gland cryoablation of the prostate using socio-demographic, pretreatment, clinical, and prostate biopsy data. Our nomogram and online risk calculator can guide both patients and urologists for shared decision making regarding definitive treatment options.

Authors
Elshafei, A; Kovac, E; Dhar, N; Levy, D; Polascik, T; Mouraviev, V; Yu, C; Jones, JS
MLA Citation
Elshafei, A, Kovac, E, Dhar, N, Levy, D, Polascik, T, Mouraviev, V, Yu, C, and Jones, JS. "A pretreatment nomogram for prediction of biochemical failure after primary cryoablation of the prostate." The Prostate 75.13 (September 2015): 1447-1453.
PMID
26172607
Source
epmc
Published In
The Prostate
Volume
75
Issue
13
Publish Date
2015
Start Page
1447
End Page
1453
DOI
10.1002/pros.23030

Apparent Diffusion Coefficient Values of the Benign Central Zone of the Prostate: Comparison With Low- and High-Grade Prostate Cancer.

The apparent diffusion coefficient (ADC) values for benign central zone (CZ) of the prostate were compared with ADC values of benign peripheral zone (PZ), benign transition zone (TZ), and prostate cancer, using histopathologic findings from radical prostatectomy as the reference standard.The study included 27 patients with prostate cancer (mean [± SD] age, 60.0 ± 7.6 years) who had 3-T endorectal coil MRI of the prostate performed before undergoing prostatectomy with whole-mount histopathologic assessment. Mean ADC values were recorded from the ROI within the index tumor and within benign CZ, PZ, and TZ, with the use of histopathologic findings as the reference standard. ADC values of the groups were compared using paired t tests and ROC curve analysis.The ADC of benign CZ in the right (1138 ± 123 × 10(-6) mm(2)/s) and left (1166 ± 141 × 10(-6) mm(2)/s) lobes was not significantly different (p = 0.217). However, the ADC of benign CZ (1154 ± 129 × 10(-6) mm(2)/s) was significantly lower (p < 0.001) than the ADCs of benign PZ (1579 ± 197 × 10(-6) mm(2)/s) and benign TZ (1429 ± 180 × 10(-6) mm(2)/s). Although the ADC of index tumors (1042 ± 134 × 10(-6) mm(2)/s) was significantly lower (p = 0.002) than the ADC of benign CZ there was no significant difference (p = 0.225) between benign CZ and tumors with a Gleason score of 6 (1119 ± 87 × 10(-6) mm(2)/s). In 22.2% of patients (6/27), including five patients who had tumors with a Gleason score greater than 6, the ADC was lower in benign CZ than in the index tumor. The AUC of ADC for the differentiation of benign CZ from index tumors was 72.4% (sensitivity, 70.4%; specificity, 51.9%), and the AUC of ADC for differentiation from tumors with a Gleason score greater than 6 was 76.7% (sensitivity, 75.0%; specificity, 65.0%).The ADC of benign CZ is lower than the ADC of other zones of the prostate and overlaps with the ADC of prostate cancer tissue, including high-grade tumors. Awareness of this potential diagnostic pitfall is important to avoid misinterpreting the normal CZ as suspicious for tumor.

Authors
Gupta, RT; Kauffman, CR; Garcia-Reyes, K; Palmeri, ML; Madden, JF; Polascik, TJ; Rosenkrantz, AB
MLA Citation
Gupta, RT, Kauffman, CR, Garcia-Reyes, K, Palmeri, ML, Madden, JF, Polascik, TJ, and Rosenkrantz, AB. "Apparent Diffusion Coefficient Values of the Benign Central Zone of the Prostate: Comparison With Low- and High-Grade Prostate Cancer." AJR. American journal of roentgenology 205.2 (August 2015): 331-336.
PMID
26204283
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
205
Issue
2
Publish Date
2015
Start Page
331
End Page
336
DOI
10.2214/ajr.14.14221

Re-purposing cryoablation: a combinatorial 'therapy' for the destruction of tissue.

It is now recognized that the tumor microenvironment creates a protective neo-tissue that isolates the tumor from the various defense strategies of the body. Evidence demonstrates that, with successive therapeutic attempts, cancer cells acquire resistance to individual treatment modalities. For example, exposure to cytotoxic drugs results in the survival of approximately 20-30% of the cancer cells as only dividing cells succumb to each toxic exposure. With follow-up treatments, each additional dose results in tumor-associated fibroblasts secreting surface-protective proteins, which enhance cancer cell resistance. Similar outcomes are reported following radiotherapy. These defensive strategies are indicative of evolved capabilities of cancer to assure successful tumor growth through well-established anti-tumor-protective adaptations. As such, successful cancer management requires the activation of multiple cellular 'kill switches' to prevent initiation of diverse protective adaptations. Thermal therapies are unique treatment modalities typically applied as monotherapies (without repetition) thereby denying cancer cells the opportunity to express defensive mutations. Further, the destructive mechanisms of action involved with cryoablation (CA) include both physical and molecular insults resulting in the disruption of multiple defensive strategies that are not cell cycle dependent and adds a damaging structural (physical) element. This review discusses the application and clinical outcomes of CA with an emphasis on the mechanisms of cell death induced by structural, metabolic, vascular and immune processes. The induction of diverse cell death cascades, resulting in the activation of apoptosis and necrosis, allows CA to be characterized as a combinatorial treatment modality. Our understanding of these mechanisms now supports adjunctive therapies that can augment cell death pathways.

Authors
Baust, JG; Bischof, JC; Jiang-Hughes, S; Polascik, TJ; Rukstalis, DB; Gage, AA; Baust, JM
MLA Citation
Baust, JG, Bischof, JC, Jiang-Hughes, S, Polascik, TJ, Rukstalis, DB, Gage, AA, and Baust, JM. "Re-purposing cryoablation: a combinatorial 'therapy' for the destruction of tissue." Prostate cancer and prostatic diseases 18.2 (June 2015): 87-95.
PMID
25622539
Source
epmc
Published In
Prostate Cancer and Prostatic Diseases
Volume
18
Issue
2
Publish Date
2015
Start Page
87
End Page
95
DOI
10.1038/pcan.2014.54

Current trends and new frontiers in focal therapy for localized prostate cancer.

Prostate cancer (PCa) care is an ever-evolving field. Research and technological developments continue to refine our definitions and management of this disease. Now, with a greater understanding of the natural history of PCa, the prevention of overtreatment has shaped a new era with the adoption of active surveillance (AS) and advancement of focal therapy (FT). Multiparametric magnetic resonance imaging (mpMRI) allows us to define, locate, and monitor cancers in a way never before possible. These capabilities combined with promising results from current prospective studies have changed the face of FT. This review presents the latest developments, current trends, and next steps in FT.

Authors
Mendez, MH; Joh, DY; Gupta, R; Polascik, TJ
MLA Citation
Mendez, MH, Joh, DY, Gupta, R, and Polascik, TJ. "Current trends and new frontiers in focal therapy for localized prostate cancer." Current urology reports 16.6 (June 2015): 35-.
PMID
25903803
Source
epmc
Published In
Current Urology Reports
Volume
16
Issue
6
Publish Date
2015
Start Page
35
DOI
10.1007/s11934-015-0513-y

Active surveillance for prostate cancer: can we modernize contemporary protocols to improve patient selection and outcomes in the focal therapy era?

In the absence of whole gland treatment for prostate cancer, both active surveillance and focal therapy share the common need of requiring a more thorough, detailed and precise analysis of the biological threats within the prostatic parenchyma if one chooses to monitor or selectively eradicate only specific neoplastic targets. In addition, focal therapy utilizes active surveillance post-treatment to monitor the untreated sectors of the prostate. We aim to evaluate the current modalities available to modernize active surveillance protocols in order to distinguish patients who may be safely observed from those who require intervention.Traditional active surveillance protocols by today's standards are rudimentary given the rapidly evolving technologies now available to clinicians. There is growing evidence for the adoption and use of multiparametric MRI and MRI-targeted biopsy to identify and localize prostate cancers of higher stage and grade. In addition, serum markers and prostate tissue DNA, RNA and methylation markers provide novel information that extends beyond Gleason grade to better characterize and define prostate cancer prognosis. Current active surveillance protocols should incorporate these modalities to improve patient stratification to surveillance, focal or whole gland interventions.Active surveillance protocols should be modernized to include cancer localization modalities and molecular prognostic markers to improve tumour characterization and better stratify men to surveillance, focal or radical intervention.

Authors
Tay, KJ; Mendez, M; Moul, JW; Polascik, TJ
MLA Citation
Tay, KJ, Mendez, M, Moul, JW, and Polascik, TJ. "Active surveillance for prostate cancer: can we modernize contemporary protocols to improve patient selection and outcomes in the focal therapy era?." Current opinion in urology 25.3 (May 2015): 185-190.
PMID
25768694
Source
epmc
Published In
Current Opinion in Urology
Volume
25
Issue
3
Publish Date
2015
Start Page
185
End Page
190
DOI
10.1097/mou.0000000000000168

Focal therapy of prostate cancer: making steady progress toward a first-line image-guided treatment modality.

Authors
Polascik, TJ
MLA Citation
Polascik, TJ. "Focal therapy of prostate cancer: making steady progress toward a first-line image-guided treatment modality." Current opinion in urology 25.3 (May 2015): 183-184.
PMID
25775366
Source
epmc
Published In
Current Opinion in Urology
Volume
25
Issue
3
Publish Date
2015
Start Page
183
End Page
184
DOI
10.1097/mou.0000000000000171

Focal therapy: patients, interventions, and outcomes--a report from a consensus meeting.

Focal therapy as a treatment option for localized prostate cancer (PCa) is an increasingly popular and rapidly evolving field.To gather expert opinion on patient selection, interventions, and meaningful outcome measures for focal therapy in clinical practice and trial design.Fifteen experts in focal therapy followed a modified two-stage RAND/University of California, Los Angeles (UCLA) Appropriateness Methodology process. All participants independently scored 246 statements prior to rescoring at a face-to-face meeting. The meeting occurred in June 2013 at the Royal Society of Medicine, London, supported by the Wellcome Trust and the UK Department of Health.Agreement, disagreement, or uncertainty were calculated as the median panel score. Consensus was derived from the interpercentile range adjusted for symmetry level.Of 246 statements, 154 (63%) reached consensus. Items of agreement included the following: patients with intermediate risk and patients with unifocal and multifocal PCa are eligible for focal treatment; magnetic resonance imaging-targeted or template-mapping biopsy should be used to plan treatment; planned treatment margins should be 5mm from the known tumor; prostate volume or age should not be a primary determinant of eligibility; foci of indolent cancer can be left untreated when treating the dominant index lesion; histologic outcomes should be defined by targeted biopsy at 1 yr; residual disease in the treated area of ≤3 mm of Gleason 3+3 did not need further treatment; and focal retreatment rates of ≤20% should be considered clinically acceptable but subsequent whole-gland therapy deemed a failure of focal therapy. All statements are expert opinion and therefore constitute level 5 evidence and may not reflect wider clinical consensus.The landscape of PCa treatment is rapidly evolving with new treatment technologies. This consensus meeting provides guidance to clinicians on current expert thinking in the field of focal therapy.In this report we present expert opinion on patient selection, interventions, and meaningful outcomes for clinicians working in focal therapy for prostate cancer.

Authors
Donaldson, IA; Alonzi, R; Barratt, D; Barret, E; Berge, V; Bott, S; Bottomley, D; Eggener, S; Ehdaie, B; Emberton, M; Hindley, R; Leslie, T; Miners, A; McCartan, N; Moore, CM; Pinto, P; Polascik, TJ; Simmons, L; van der Meulen, J; Villers, A; Willis, S; Ahmed, HU
MLA Citation
Donaldson, IA, Alonzi, R, Barratt, D, Barret, E, Berge, V, Bott, S, Bottomley, D, Eggener, S, Ehdaie, B, Emberton, M, Hindley, R, Leslie, T, Miners, A, McCartan, N, Moore, CM, Pinto, P, Polascik, TJ, Simmons, L, van der Meulen, J, Villers, A, Willis, S, and Ahmed, HU. "Focal therapy: patients, interventions, and outcomes--a report from a consensus meeting." European urology 67.4 (April 2015): 771-777.
PMID
25281389
Source
epmc
Published In
European Urology
Volume
67
Issue
4
Publish Date
2015
Start Page
771
End Page
777
DOI
10.1016/j.eururo.2014.09.018

Disparate results between proliferation rates of surgically excised prostate tumors and an in vitro bioassay using sera from a positive randomized controlled trial.

In vitro bioassay has been used extensively to test the effects of culturing cancer cells in sera from humans participating in dietary interventions, i.e, studies of modified intake of nutrients for the purpose of reducing cancer risk or progression. It has been hypothesized that cell proliferation rates determined by the in vitro bioassay indicate whether modification of dietary intake could decrease cancer cell growth in vivo. It has been suggested, however, that the in vitro bioassay may not correlate with tumor cell proliferation rates in prostate cancer. We investigated the concordance of cell proliferation rates from surgically excised prostate tumor tissue with the in vitro bioassay using sera from matched patients. We used samples from an earlier randomized clinical trial that showed that supplementation with flaxseed significantly inhibited prostate cancer cell proliferation rates in vivo as indicated by Ki67 staining in tumor specimens. Proliferation rates of LNCaP, DU145 and PC3 cell lines cultured in 10% human sera from participants in the flaxseed trial were determined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Spearman's Rho correlation coefficients (ρ) indicated no association between Ki67 staining in prostate tumors and the in vitro bioassay for the three cell lines. These disparate findings suggest that the in vitro bioassay may not provide an accurate assessment of the environment in vivo.

Authors
Azrad, M; Vollmer, RT; Madden, J; Polascik, TJ; Snyder, DC; Ruffin, MT; Moul, JW; Brenner, D; He, X; Demark-Wahnefried, W
MLA Citation
Azrad, M, Vollmer, RT, Madden, J, Polascik, TJ, Snyder, DC, Ruffin, MT, Moul, JW, Brenner, D, He, X, and Demark-Wahnefried, W. "Disparate results between proliferation rates of surgically excised prostate tumors and an in vitro bioassay using sera from a positive randomized controlled trial." Biotechnic & histochemistry : official publication of the Biological Stain Commission 90.3 (April 2015): 184-189.
PMID
25434394
Source
epmc
Published In
Biotechnic & Histochemistry
Volume
90
Issue
3
Publish Date
2015
Start Page
184
End Page
189
DOI
10.3109/10520295.2014.976840

Prostate elastography

© Springer Science+Business Media New York 2015.Conventional B-mode transrectal ultrasound (TRUS) generates images of the acoustic properties of tissues (density and sound speed). TRUS is used extensively to aid in visualizing the prostate gland and needle during biopsy. However, TRUS has limited sensitivity and specificity for prostate cancer (PCa) detection/visualization [1, 2], and therefore advanced ultrasonic methods are currently being investigated to improve PCa detection. One promising approach, called elastography, generates images of the elastic properties of tissues (i.e., tissue stiffness), providing complementary information to B-mode images. This approach has promise for PCa imaging due to the inherent differences in stiffness between normal and pathologic tissues in the prostate.

Authors
Rosenzweig, S; Miller, Z; Polascik, T; Nightingale, K
MLA Citation
Rosenzweig, S, Miller, Z, Polascik, T, and Nightingale, K. "Prostate elastography." Prostate Ultrasound: Current Practice and Future Directions. January 1, 2015. 163-172.
Source
scopus
Publish Date
2015
Start Page
163
End Page
172
DOI
10.1007/978-1-4939-1948-2_12

Definitions and principles of focal therapy

© Springer-Verlag France 2015.Focal therapy is a treatment concept that is quite broad in clinical application, encompassing the spectrum of precise laser ablation of a tumor target to near complete destruction of a large portion of thegland, as long as sexual and urinary function can be preserved. The index lesion, along with any other secondary lesions, needs to be identified and characterized as to itsclinically significance and whether it requires treatment. The target(s) need to be examined within the 3-dimensional space of the prostate, particularly in relation to important anatomical structures, such as theneurovascular bundles and urinary sphincter. Based on these factors, the surgeon then decides the number, location and boundariesofthe targeted ablation zones, weighing the perceived benefits and disadvantages oflesser or greater ablation volume on oncologic and functional outcomes. Applications that employ greater ablation volumes potentially diminish the likelihood of residual/denovotumor in the untreated area(s) but risk, to some degree, the loss of physiologic function depending on location of ablation zones near critical anatomical structures. This chapter outlines the more commonly utilized configurations of focal ablation, to provide a standard nomenclature for reporting andcomparison of clinical outcomes.

Authors
Mancini, JG; Polascik, TJ
MLA Citation
Mancini, JG, and Polascik, TJ. "Definitions and principles of focal therapy." Technical Aspects of Focal Therapy in Localized Prostate Cancer. January 1, 2015. 19-28.
Source
scopus
Publish Date
2015
Start Page
19
End Page
28
DOI
10.1007/978-2-8178-0484-2_3

Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis.

To evaluate the impact of dedicated reader education on accuracy/confidence of peripheral zone index cancer and anterior prostate cancer (PCa) diagnosis with mpMRI; secondary aim was to assess the ability of readers to differentiate low-grade cancer (Gleason 6 or below) from high-grade cancer (Gleason 7+).Five blinded radiology fellows evaluated 31 total prostate mpMRIs in this IRB-approved, HIPAA-compliant, retrospective study for index lesion detection, confidence in lesion diagnosis (1-5 scale), and Gleason grade (Gleason 6 or lower vs. Gleason 7+). Following a dedicated education program, readers reinterpreted cases after a memory extinction period, blinded to initial reads. Reference standard was established combining whole mount histopathology with mpMRI findings by a board-certified radiologist with 5 years of prostate mpMRI experience.Index cancer detection: pre-education accuracy 74.2%; post-education accuracy 87.7% (p = 0.003). Confidence in index lesion diagnosis: pre-education 4.22 ± 1.04; post-education 3.75 ± 1.41 (p = 0.0004). Anterior PCa detection: pre-education accuracy 54.3%; post-education accuracy 94.3% (p = 0.001). Confidence in anterior PCa diagnosis: pre-education 3.22 ± 1.54; post-education 4.29 ± 0.83 (p = 0.0003). Gleason score accuracy: pre-education 54.8%; post-education 73.5% (p = 0.0005).A dedicated reader education program on PCa detection with mpMRI was associated with a statistically significant increase in diagnostic accuracy of index cancer and anterior cancer detection as well as Gleason grade identification as compared to pre-education values. This was also associated with a significant increase in reader diagnostic confidence. This suggests that substantial interobserver variability in mpMRI interpretation can potentially be reduced with a focus on education and that this can occur over a fellowship training year.

Authors
Garcia-Reyes, K; Passoni, NM; Palmeri, ML; Kauffman, CR; Choudhury, KR; Polascik, TJ; Gupta, RT
MLA Citation
Garcia-Reyes, K, Passoni, NM, Palmeri, ML, Kauffman, CR, Choudhury, KR, Polascik, TJ, and Gupta, RT. "Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis." Abdominal imaging 40.1 (January 2015): 134-142.
PMID
25034558
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
1
Publish Date
2015
Start Page
134
End Page
142
DOI
10.1007/s00261-014-0197-7

B-mode and acoustic radiation force impulse (ARFI) imaging of prostate zonal anatomy: comparison with 3T T2-weighted MR imaging.

Prostate cancer (PCa) is the most common non-cutaneous malignancy among men in the United States and the second leading cause of cancer-related death. Multi-parametric magnetic resonance imaging (mpMRI) has gained recent popularity to characterize PCa. Acoustic Radiation Force Impulse (ARFI) imaging has the potential to aid PCa diagnosis and management by using tissue stiffness to evaluate prostate zonal anatomy and lesions. MR and B-mode/ARFI in vivo imaging datasets were compared with one another and with gross pathology measurements made immediately after radical prostatectomy. Images were manually segmented in 3D Slicer to delineate the central gland (CG) and prostate capsule, and 3D models were rendered to evaluate zonal anatomy dimensions and volumes. Both imaging modalities showed good correlation between estimated organ volume and gross pathologic weights. Ultrasound and MR total prostate volumes were well correlated (R(2) = 0.77), but B-mode images yielded prostate volumes that were larger (16.82% ± 22.45%) than MR images, due to overestimation of the lateral dimension (18.4% ± 13.9%), with less significant differences in the other dimensions (7.4% ± 17.6%, anterior-to-posterior, and -10.8% ± 13.9%, apex-to-base). ARFI and MR CG volumes were also well correlated (R(2) = 0.85). CG volume differences were attributed to ARFI underestimation of the apex-to-base axis (-28.8% ± 9.4%) and ARFI overestimation of the lateral dimension (21.5% ± 14.3%). B-mode/ARFI imaging yielded prostate volumes and dimensions that were well correlated with MR T2-weighted image (T2WI) estimates, with biases in the lateral dimension due to poor contrast caused by extraprostatic fat. B-mode combined with ARFI imaging is a promising low-cost, portable, real-time modality that can complement mpMRI for PCa diagnosis, treatment planning, and management.

Authors
Palmeri, ML; Miller, ZA; Glass, TJ; Garcia-Reyes, K; Gupta, RT; Rosenzweig, SJ; Kauffman, C; Polascik, TJ; Buck, A; Kulbacki, E; Madden, J; Lipman, SL; Rouze, NC; Nightingale, KR
MLA Citation
Palmeri, ML, Miller, ZA, Glass, TJ, Garcia-Reyes, K, Gupta, RT, Rosenzweig, SJ, Kauffman, C, Polascik, TJ, Buck, A, Kulbacki, E, Madden, J, Lipman, SL, Rouze, NC, and Nightingale, KR. "B-mode and acoustic radiation force impulse (ARFI) imaging of prostate zonal anatomy: comparison with 3T T2-weighted MR imaging." Ultrasonic imaging 37.1 (January 2015): 22-41.
PMID
25060914
Source
epmc
Published In
Ultrasonic Imaging
Volume
37
Issue
1
Publish Date
2015
Start Page
22
End Page
41
DOI
10.1177/0161734614542177

Does the multidisciplinary approach improve oncological outcomes in men undergoing surgical treatment for prostate cancer?

OBJECTIVES: To determine whether oncological outcomes are improved in prostate cancer patients by using a multidisciplinary strategy as compared with a standard clinic paradigm, and whether time to treatment is delayed when using a multidisciplinary approach. METHODS: We retrospectively analyzed patients who were evaluated and pursued radical prostatectomy as primary treatment, by the same surgeons, in the prostate cancer multidisciplinary clinic (n = 194) and standard urology clinic (n = 741) at Duke University Medical Center from 2005 to 2009. Comparisons of baseline characteristics were examined using rank sum and χ(2) -tests. Differences in time to radical prostatectomy and oncological outcomes were evaluated using multivariate linear and Cox regression, respectively. RESULTS: A greater proportion of high-risk patients (D'Amico criteria) were evaluated at the multidisciplinary clinic compared with the urology clinic (23.2% vs 15.6%, P = 0.014). Mean-adjusted time from biopsy to radical prostatectomy was shorter for multidisciplinary clinic patients (85.6 vs 96.8 days, P = 0.006). After a median follow up of 21 months, no significant difference was found between the multidisciplinary clinic and urology clinic in the risk of biochemical recurrence after radical prostatectomy, whether controlling for clinical (hazard ratio 0.71, P = 0.249) or pathological variables (hazard ratio 0.75, P = 0.349). CONCLUSIONS: Despite higher-risk disease, men evaluated using the multidisciplinary approach have similar oncological outcomes compared with men undergoing standard evaluation. Furthermore, time to radical prostatectomy is not delayed by the multidisciplinary management of these patients.

Authors
Stewart, SB; Moul, JW; Polascik, TJ; Koontz, BF; Robertson, CN; Freedland, SJ; George, DJ; Lee, WR; Armstrong, AJ; Bañez, LL
MLA Citation
Stewart, SB, Moul, JW, Polascik, TJ, Koontz, BF, Robertson, CN, Freedland, SJ, George, DJ, Lee, WR, Armstrong, AJ, and Bañez, LL. "Does the multidisciplinary approach improve oncological outcomes in men undergoing surgical treatment for prostate cancer?." International journal of urology : official journal of the Japanese Urological Association 21.12 (December 2014): 1215-1219.
PMID
25041422
Source
epmc
Published In
International Journal of Urology
Volume
21
Issue
12
Publish Date
2014
Start Page
1215
End Page
1219
DOI
10.1111/iju.12561

Modernizing the diagnostic and decision-making pathway for prostate cancer.

PSA has led to a drastic increase in the detection of prostate cancer, rendering this biomarker the gateway for the diagnostic pathway of prostatic neoplasms. However, the increase in incidence has not been mirrored by a similar reduction in mortality. Widespread PSA testing has facilitated the overdiagnosis and overtreatment of indolent disease. To reduce this phenomenon and avoid negative repercussions on the quality of life of men undergoing unnecessary therapies, the diagnostic pathway of prostate cancer needs to be improved. Multiparametric MRI (mp-MRI) can enhance the sensitivity and specificity of PSA, as well as the shortcomings of random biopsy sampling. This novel imaging technique has been proven to identify larger and more aggressive cancer foci, which should be targeted for treatment. New technological developments now allow for fusion of mp-MRI images with real-time ultrasound, opening the way to lesion-targeted biopsies. Furthermore, mp-MRI and targeted biopsies can also improve active surveillance protocols and permit more conservative focal therapy strategies. By implementing targeted biopsies, the diagnostic pathway will focus on clinically significant disease, consequently reducing overdiagnosis and overtreatment. Before this novel protocol becomes the new gold standard, mp-MRI acquisition and interpretation need to be standardized and targeted-biopsy strategies need to be further validated prior to abandoning random-sampling ones. Several multidisciplinary consortiums are already working on the standardization of prostate MRI, and there are ongoing prospective trials on targeted biopsies and MRI. Soon, imaging of prostatic lesions and selected biopsies will modify the diagnostic evaluation of prostate cancer, reducing overtreatment and therapy-derived complications that negatively affect quality of life.

Authors
Polascik, TJ; Passoni, NM; Villers, A; Choyke, PL
MLA Citation
Polascik, TJ, Passoni, NM, Villers, A, and Choyke, PL. "Modernizing the diagnostic and decision-making pathway for prostate cancer." Clinical cancer research : an official journal of the American Association for Cancer Research 20.24 (December 2014): 6254-6257.
PMID
25316814
Source
epmc
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
20
Issue
24
Publish Date
2014
Start Page
6254
End Page
6257
DOI
10.1158/1078-0432.ccr-14-0247

Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy.

OBJECTIVES: The purpose of our study was to test our hypothesis that multiparametric magnetic resonance imaging (mpMRI) may have a higher prognostic accuracy than the Partin tables in predicting organ-confined (OC) prostate cancer and extracapsular extension (ECE) after radical prostatectomy (RP). METHODS AND MATERIALS: After institutional review board approval, we retrospectively reviewed 60 patients who underwent 3-T mpMRI before RP. mpMRI was used to assess clinical stage and the updated version of the Partin tables was used to calculate the probability of each patient to harbor OC disease. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in detecting OC and ECE were calculated. Logistic regression models predicting OC pathology were created using either clinical stage at mpMRI or Partin tables probability. The area under the curve was used to calculate the predictive accuracy of each model. RESULTS: Median prostate-specific antigen level at diagnosis was 5 ng/ml (range: 4.1-6.7 ng/ml). Overall, 52 (86.7%) men had cT1 disease, 7 (11.7%) had cT2a/b, and 1 (1.6%) had cT3b at digital rectal examination. Biopsy Gleason score was 6, 3+4 = 7, 4+3 = 7, 8, and 9 to 10 in 28 (46.7%), 15 (25%), 3 (5%), 10 (16.7%), and 4 (6.6%) patients, respectively. At mpMRI, clinical stage was defined as cT2a/b, cT2c, cT3a, and cT3b in 11 (18.3%), 23 (38.3%), 21 (35%), and 5 (8.4%) patients, respectively. At final pathology, 38 men (63.3%) had OC disease, whereas 18 (30%) had ECE and 4 (6.7%) had seminal vesicle invasion. The sensitivity, specificity, PPV, and NPV of mpMRI in detecting OC disease were 81.6%, 86.4%, 91.2%, and 73.1%, respectively, whereas in detecting ECE were 77.8%, 83.4%, 66.7%, and 89.7%, respectively. At logistic regression, both the Partin tables-derived probability and the mpMRI clinical staging were significantly associated with OC disease (all P<0.01). The area under the curves of the model built using the Partin tables and that of the mpMRI model were 0.62 and 0.82, respectively (P = 0.04). CONCLUSIONS: The predictive accuracy of mpMRI in predicting OC disease on pathological analysis is significantly greater than that of the Partin tables. mpMRI had a high PPV (91.2%) when predicting OC disease and a high NPV (89.7%) with regard to ECE. mpMRI should be considered when planning prostate cancer treatment in addition to readily available clinical parameters.

Authors
Gupta, RT; Faridi, KF; Singh, AA; Passoni, NM; Garcia-Reyes, K; Madden, JF; Polascik, TJ
MLA Citation
Gupta, RT, Faridi, KF, Singh, AA, Passoni, NM, Garcia-Reyes, K, Madden, JF, and Polascik, TJ. "Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy." Urologic oncology 32.8 (November 2014): 1292-1299.
PMID
24863013
Source
epmc
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
32
Issue
8
Publish Date
2014
Start Page
1292
End Page
1299
DOI
10.1016/j.urolonc.2014.04.017

Low-risk and very-low-risk prostate cancer: is there a role for focal therapy in the era of active surveillance? Yes, the two approaches complement each other.

Authors
Klotz, L; Polascik, TJ
MLA Citation
Klotz, L, and Polascik, TJ. "Low-risk and very-low-risk prostate cancer: is there a role for focal therapy in the era of active surveillance? Yes, the two approaches complement each other." Oncology (Williston Park, N.Y.) 28.11 (November 2014): 950-9C3.
PMID
25741545
Source
epmc
Published In
Oncology
Volume
28
Issue
11
Publish Date
2014
Start Page
950
End Page
9C3

Role of multiparametric magnetic resonance imaging (MRI) in focal therapy for prostate cancer: a Delphi consensus project.

OBJECTIVE: To define the role of multiparametric MRI (mpMRI) for treatment planning, guidance and follow-up in focal therapy for prostate cancer based on a multidisciplinary Delphi consensus project. MATERIALS AND METHODS: An online consensus process based on a questionnaire was circulated according to the Delphi method. Discussion points were identified by literature research and were sent to the panel via an online questionnaire in three rounds. A face-to-face consensus meeting followed the three rounds of questions that were sent to a 48-participant expert panel consisting of urologists, radiologists and engineers. Participants were presented with the results of the previous rounds. Conclusions formulated from the results of the questionnaire were discussed in the final face-to-face meeting. RESULTS: Consensus was reached in 41% of all key items. Patients selected for focal therapy should have biopsy-proven prostate cancer. Biopsies should ideally be performed after mpMRI of the prostate. Standardization of imaging protocols is essential and mpMRIs should be read by an experienced radiologist. In the follow-up after focal therapy, mpMRI should be performed after 6 months, followed by a yearly mpMRI. mpMRI findings should be confirmed by targeted biopsies before re-treatment. No consensus was reached on whether mpMRI could replace transperineal template saturation biopsies to exclude significant lesions outside the target lesion. CONCLUSIONS: Consensus was reached on a number of areas related to the conduct, interpretation and reporting of mpMRI for use in treatment planning, guidance and follow-up of focal therapy for prostate cancer. Future studies, comparing mpMRI with transperineal saturation mapping biopsies, will confirm the importance of mpMRI for a variety of purposes in focal therapy for prostate cancer.

Authors
Muller, BG; van den Bos, W; Brausi, M; Cornud, F; Gontero, P; Kirkham, A; Pinto, PA; Polascik, TJ; Rastinehad, AR; de Reijke, TM; de la Rosette, JJ; Ukimura, O; Villers, A; Walz, J; Wijkstra, H; Marberger, M
MLA Citation
Muller, BG, van den Bos, W, Brausi, M, Cornud, F, Gontero, P, Kirkham, A, Pinto, PA, Polascik, TJ, Rastinehad, AR, de Reijke, TM, de la Rosette, JJ, Ukimura, O, Villers, A, Walz, J, Wijkstra, H, and Marberger, M. "Role of multiparametric magnetic resonance imaging (MRI) in focal therapy for prostate cancer: a Delphi consensus project." BJU Int 114.5 (November 2014): 698-707.
PMID
24180365
Source
pubmed
Published In
Bju International
Volume
114
Issue
5
Publish Date
2014
Start Page
698
End Page
707
DOI
10.1111/bju.12548

The role of focal therapy in the management of localised prostate cancer: a systematic review.

CONTEXT: The incidence of localised prostate cancer is increasing worldwide. In light of recent evidence, current, radical, whole-gland treatments for organ-confined disease have being questioned with respect to their side effects, cancer control, and cost. Focal therapy may be an effective alternative strategy. OBJECTIVE: To systematically review the existing literature on baseline characteristics of the target population; preoperative evaluation to localise disease; and perioperative, functional, and disease control outcomes following focal therapy. EVIDENCE ACQUISITION: Medline (through PubMed), Embase, Web of Science, and Cochrane Review databases were searched from inception to 31 October 2012. In addition, registered but not yet published trials were retrieved. Studies evaluating tissue-preserving therapies in men with biopsy-proven prostate cancer in the primary or salvage setting were included. EVIDENCE SYNTHESIS: A total of 2350 cases were treated to date across 30 studies. Most studies were retrospective with variable standards of reporting, although there was an increasing number of prospective registered trials. Focal therapy was mainly delivered to men with low and intermediate disease, although some high-risk cases were treated that had known, unilateral, significant cancer. In most of the cases, biopsy findings were correlated to specific preoperative imaging, such as multiparametric magnetic resonance imaging or Doppler ultrasound to determine eligibility. Follow-up varied between 0 and 11.1 yr. In treatment-naïve prostates, pad-free continence ranged from 95% to 100%, erectile function ranged from 54% to 100%, and absence of clinically significant cancer ranged from 83% to 100%. In focal salvage cases for radiotherapy failure, the same outcomes were achieved in 87.2-100%, 29-40%, and 92% of cases, respectively. Biochemical disease-free survival was reported using a number of definitions that were not validated in the focal-therapy setting. CONCLUSIONS: Our systematic review highlights that, when focal therapy is delivered with intention to treat, the perioperative, functional, and disease control outcomes are encouraging within a short- to medium-term follow-up. Focal therapy is a strategy by which the overtreatment burden of the current prostate cancer pathway could be reduced, but robust comparative effectiveness studies are now required.

Authors
Valerio, M; Ahmed, HU; Emberton, M; Lawrentschuk, N; Lazzeri, M; Montironi, R; Nguyen, PL; Trachtenberg, J; Polascik, TJ
MLA Citation
Valerio, M, Ahmed, HU, Emberton, M, Lawrentschuk, N, Lazzeri, M, Montironi, R, Nguyen, PL, Trachtenberg, J, and Polascik, TJ. "The role of focal therapy in the management of localised prostate cancer: a systematic review." Eur Urol 66.4 (October 2014): 732-751. (Review)
PMID
23769825
Source
pubmed
Published In
European Urology
Volume
66
Issue
4
Publish Date
2014
Start Page
732
End Page
751
DOI
10.1016/j.eururo.2013.05.048

Words of wisdom. Re: Tracking the clonal origin of lethal prostate cancer.

Authors
Passoni, NM; Polascik, TJ
MLA Citation
Passoni, NM, and Polascik, TJ. "Words of wisdom. Re: Tracking the clonal origin of lethal prostate cancer." European urology 66.2 (August 2014): 390-391.
PMID
25305788
Source
epmc
Published In
European Urology
Volume
66
Issue
2
Publish Date
2014
Start Page
390
End Page
391
DOI
10.1016/j.eururo.2014.05.022

Clinicopathological characteristics and outcomes of surgically excised renal masses in African Americans.

OBJECTIVES: In the present study, we report on the clinical and pathological characteristics of African American (AA) patients with surgically excised renal masses and assess the associations between race and oncological outcomes. METHODS AND MATERIALS: We conducted a retrospective review of patients who underwent partial or radical nephrectomy for renal masses at our institution between 2000 and 2010. Patients were divided into 2 groups based on self-reported race: AA and non-AA. Patient demographics and disease characteristics, and overall, cancer-specific, recurrence-free, distant, and local recurrence-free survival for localized renal cell carcinoma (RCC) were compared between AA and non-AA patients. Multivariable proportional hazard analyses were used to assess the associations of race with oncological outcomes. RESULTS: A total of 1,467 patients, of whom 359 (24.5%) were AA, were included. Rates of benign disease were comparable between AA patients and non-AA (18.2% vs. 17.6%, P = 0.556). AA patients presented with higher rates of localized disease (83% vs. 71%, P<0.001). Papillary subtype accounted for 40.8% of RCCs in AA patients compared with 11.6% in non-AA patients (P<0.001). The high proportion of papillary RCC in AA patients was maintained across disease stages. On univariable analyses, AA patients had better recurrence-free and cancer-specific survival. On multivariable analyses, AA race was not a significant predictor of oncological outcomes after adjusting for patient and disease characteristics. CONCLUSION: In this study, AA patients presented with more localized disease than non-AA patients, whereas rates of benign disease were comparable between the groups. Furthermore, AA patients had roughly 3 times higher rates of papillary RCC across disease stages. On univariable analyses, AA patients appeared to have more favorable oncological outcomes. However, this association is likely explained by tumor stage, grade, and histology as outcomes were similar across races when the analyses were adjusted for these and other characteristics.

Authors
Qi, P; Tsivian, M; Abern, MR; Passoni, NM; McGinley, KF; Polascik, TJ
MLA Citation
Qi, P, Tsivian, M, Abern, MR, Passoni, NM, McGinley, KF, and Polascik, TJ. "Clinicopathological characteristics and outcomes of surgically excised renal masses in African Americans." Urologic oncology 32.5 (July 2014): 555-560.
PMID
24495445
Source
epmc
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
32
Issue
5
Publish Date
2014
Start Page
555
End Page
560
DOI
10.1016/j.urolonc.2013.11.011

Targeted prostate biopsies: the complexity behind a simple concept.

Authors
Passoni, NM; Polascik, TJ
MLA Citation
Passoni, NM, and Polascik, TJ. "Targeted prostate biopsies: the complexity behind a simple concept." European urology 66.1 (July 2014): 30-31.
PMID
24731786
Source
epmc
Published In
European Urology
Volume
66
Issue
1
Publish Date
2014
Start Page
30
End Page
31
DOI
10.1016/j.eururo.2014.03.025

Psychosocial trajectories of men monitoring prostate-specific antigen levels following surgery for prostate cancer.

PURPOSE/OBJECTIVES: To describe the psychosocial trajectories of men treated surgically for prostate cancer after monitoring their prostate-specific antigen (PSA) levels until 24 months post-treatment. DESIGN: Descriptive longitudinal study. SETTING: Urology clinic at Duke University Health System. SAMPLE: 12 men diagnosed and treated for prostate cancer. METHODS: Men were interviewed in their homes at baseline and at 24 months and via telephone at 6, 12, and 18 months. Scores from the Profile of Mood States, Mishel Uncertainty in Illness Scale, Self-Control Schedule, and Cantril's Ladder were entered into a database for analysis. Graphs of individual participants' scores were plotted. MAIN RESEARCH VARIABLES: PSA values, mood state, cognitive reframing, impact of event, quality of life, illness uncertainty, and growth through uncertainty were measured. FINDINGS: Three trajectories were identified (i.e., stable, unstable, and mixed) and graphed using a typological or health pattern approach. CONCLUSIONS: Monitoring PSA levels is critical for men treated for prostate cancer. This study provides preliminary data on the psychological trajectories of men during the first 24 months postprostatectomy. IMPLICATIONS FOR NURSING: Rising PSA levels that are associated with the recurrence of disease can cause psychosocial distress among men with prostate cancer.

Authors
Bailey, DE; Wallace Kazer, M; Polascik, TJ; Robertson, C
MLA Citation
Bailey, DE, Wallace Kazer, M, Polascik, TJ, and Robertson, C. "Psychosocial trajectories of men monitoring prostate-specific antigen levels following surgery for prostate cancer." Oncology nursing forum 41.4 (July 2014): 361-368.
PMID
24969246
Source
epmc
Published In
Oncology Nursing Forum
Volume
41
Issue
4
Publish Date
2014
Start Page
361
End Page
368
DOI
10.1188/14.onf.361-368

Small renal mass biopsy--how, what and when: report from an international consensus panel.

To discuss the use of renal mass biopsy (RMB) for small renal masses (SRMs), formulate technical aspects, outline potential pitfalls and provide recommendations for the practicing clinician. The meeting was conducted as an informal consensus process and no scoring system was used to measure the levels of agreement on the different topics. A moderated general discussion was used as the basis for consensus and arising issues were resolved at this point. A consensus was established and lack of agreement to topics or specific items was noted at this point. Recommended biopsy technique: at least two cores, sampling different tumour regions with ultrasonography being the preferred method of image guidance. Pathological interpretation: 'non-diagnostic samples' should refer to insufficient material, inconclusive and normal renal parenchyma. For non-diagnostic samples, a repeat biopsy is recommended. Fine-needle aspiration may provide additional information but cannot substitute for core biopsy. Indications for RMB: biopsy is recommended in most cases except in patients with imaging or clinical characteristics indicative of pathology (syndromes, imaging characteristics) and cases whereby conservative management is not contemplated. RMB is recommended for active surveillance but not for watchful-waiting candidates. We report the results of an international consensus meeting on the use of RMB for SRMs, defining the technique, pathological interpretation and indications.

Authors
Tsivian, M; Rampersaud, EN; del Pilar Laguna Pes, M; Joniau, S; Leveillee, RJ; Shingleton, WB; Aron, M; Kim, CY; DeMarzo, AM; Desai, MM; Meler, JD; Donovan, JF; Klingler, HC; Sopko, DR; Madden, JF; Marberger, M; Ferrandino, MN; Polascik, TJ
MLA Citation
Tsivian, M, Rampersaud, EN, del Pilar Laguna Pes, M, Joniau, S, Leveillee, RJ, Shingleton, WB, Aron, M, Kim, CY, DeMarzo, AM, Desai, MM, Meler, JD, Donovan, JF, Klingler, HC, Sopko, DR, Madden, JF, Marberger, M, Ferrandino, MN, and Polascik, TJ. "Small renal mass biopsy--how, what and when: report from an international consensus panel." BJU Int 113.6 (June 2014): 854-863. (Review)
PMID
24119037
Source
pubmed
Published In
Bju International
Volume
113
Issue
6
Publish Date
2014
Start Page
854
End Page
863
DOI
10.1111/bju.12470

Metastatic ampullary adenocarcinoma presenting as a hydrocele: a case report.

CONTEXT: Metastases from ampullary malignancies are common, but spread to the testicle and paratesticular tissue is exceedingly rare with only 2 reported cases in the literature. CASE REPORT: We report a case of a 70 year-old male with a history of ampullary adenocarcinoma status post pancreaticoduodenectomy who presented with a symptomatic right-sided hydrocele. Subsequent pathology revealed metastatic ampullary adenocarcinoma. CONCLUSIONS: Metastasis to the testicle and paratesticular tissue from ampullary malignancies is rare, but must be considered in the evaluation of scrotal masses in patients with a history of ampullary malignancy.

Authors
Lane, WO; Bentley, RC; Hurwitz, HI; Howard, LA; Polascik, TJ; Anderson, MR; Blazer, DG
MLA Citation
Lane, WO, Bentley, RC, Hurwitz, HI, Howard, LA, Polascik, TJ, Anderson, MR, and Blazer, DG. "Metastatic ampullary adenocarcinoma presenting as a hydrocele: a case report." JOP : Journal of the pancreas 15.3 (May 27, 2014): 266-268.
PMID
24865540
Source
epmc
Published In
JOP : Journal of the pancreas
Volume
15
Issue
3
Publish Date
2014
Start Page
266
End Page
268
DOI
10.6092/1590-8577/2407

Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy: a randomized controlled trial.

OBJECTIVE: To compare acute normovolemic hemodilution versus low central venous pressure strategy versus conventional fluid management in reducing intraoperative estimated blood loss, hematocrit drop and need for blood transfusion in patients undergoing radical retropubic prostatectomy under general anesthesia. RESEARCH DESIGN AND METHODS: Patients undergoing radical retropubic prostatectomy under general anesthesia were randomized to conventional fluid management, acute normovolemic hemodilution or low central venous pressure (≤5 mmHg). Treatment effects on estimated blood loss and hematocrit change were tested in multivariable regression models accounting for surgeon, prostate size, and all two-way interactions. RESULTS: Ninety-two patients completed the study. Estimated blood loss (mean ± SD) was significantly lower with low central venous pressure (706 ± 362 ml) compared to acute normovolemic hemodilution (1103 ± 635 ml) and conventional (1051 ± 714 ml) groups (p = 0.0134). There was no difference between the groups in need for blood transfusion, or hematocrit drop from preoperative values. The multivariate model predicting estimated blood loss showed a significant effect of treatment (p = 0.0028) and prostate size (p = 0.0323), accounting for surgeon (p = 0.0013). In the model predicting hematocrit change, accounting for surgeon difference (p = 0.0037), the treatment effect depended on prostate size (p = 0.0007) with the slope of low central venous pressure differing from the other two groups. Hematocrit was predicted to drop more with increased prostate size in acute normovolemic hemodilution and conventional groups but not with low central venous pressure. KEY LIMITATIONS: Limitations include the inability to blind providers to group assignment, possible variability between providers in estimation of blood loss, and the relatively small sample size that was not powered to detect differences between the groups in need for blood transfusion. CONCLUSIONS: Maintaining low central venous pressure reduced estimated blood loss compared to conventional fluid management and acute normovolemic hemodilution in patients undergoing radical retropubic prostatectomy but there was no difference in allogeneic blood transfusion between the groups.

Authors
Habib, AS; Moul, JW; Polascik, TJ; Robertson, CN; Roche, AM; White, WD; Hill, SE; Nosnick, I; Gan, TJ; Duke Perioperative Outcome Study Group,
MLA Citation
Habib, AS, Moul, JW, Polascik, TJ, Robertson, CN, Roche, AM, White, WD, Hill, SE, Nosnick, I, Gan, TJ, and Duke Perioperative Outcome Study Group, . "Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy: a randomized controlled trial." Curr Med Res Opin 30.5 (May 2014): 937-943.
PMID
24351100
Source
pubmed
Published In
Current Medical Research and Opinion
Volume
30
Issue
5
Publish Date
2014
Start Page
937
End Page
943
DOI
10.1185/03007995.2013.877436

How to select the right patients for focal therapy of prostate cancer?

PURPOSE OF REVIEW: Just as lumpectomy for breast cancer aims at achieving oncological control with maximal tissue preservation, the concept of focal therapy for prostate cancer has evolved with the aim of controlling disease while preserving urinary and erectile function. Our review aims at describing the evolution of focal therapy in time and the resulting advances in patient selection. RECENT FINDINGS: Originally, focal therapy was developed as an alternative to active surveillance for men with low-risk disease and a minimal burden of cancer. However, with improvement of the diagnostic technologies, the entry criteria for this therapeutic approach are broadening. Since its introduction, focal therapy has evolved from ablation of half or three-quarters of the prostate in men with low-risk disease to only selected cancer foci even if they present with Gleason pattern 4. This development has become possible because of a better understanding of the biology of the index lesion(s) and the improvement of biopsy techniques. Candidates were selected at first with conventional transrectal random prostate biopsies. To overcome the sampling bias of standard techniques, a more thorough multicore sampling utilizing transperineal three-dimensional template mapping biopsies was developed. Today, advances in multiparametric MRI allow for detection and targeted biopsies of high-grade and high-volume lesions. SUMMARY: In light of the less stringent selection criteria, enrollment for focal therapy protocols should encourage patient education on the need of possible subsequent cycles of ablation as well as the need for surveillance of the untreated prostatic tissue, as prostate cancer is transformed into a chronic, manageable condition.

Authors
Passoni, NM; Polascik, TJ
MLA Citation
Passoni, NM, and Polascik, TJ. "How to select the right patients for focal therapy of prostate cancer?." Current opinion in urology 24.3 (May 2014): 203-208.
PMID
24625428
Source
epmc
Published In
Current Opinion in Urology
Volume
24
Issue
3
Publish Date
2014
Start Page
203
End Page
208
DOI
10.1097/mou.0000000000000045

Survival of patients undergoing cytoreductive surgery for metastatic renal cell carcinoma in the targeted-therapy era.

BACKGROUND/AIM: In the cytokine era, cytoreductive nephrectomy (CN) improves survival for patients with metastatic renal cell carcinoma (mRCC). We analyzed the effect of CN on the survival of patients diagnosed with mRCC in the era of tyrosine kinase inhibitors (2005-present). PATIENTS AND METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify adult patients diagnosed with mRCC between 2005 and 2009. The primary outcome was overall survival, analyzed with multivariable Cox models. RESULTS: Out of 7,143 incident mRCC cases reported to SEER between 2005-2009, 2,629 (37%) underwent CN. Patients undergoing CN were younger, and more likely to be white, male, and married. Patients with stage T3 tumors were most likely to undergo CN (64%). Patients that underwent CN had improved one-year survival (61% vs. 22%). On multivariable analysis, CN was associated with improved overall survival(hazard ratio[HR]=0.40 95% confidence interval [CI]=0.37-0.43). CONCLUSION: In the targeted-therapy era, patients with mRCC undergoing CN have improved survival after adjusting for tumor stage and demographic characteristics.

Authors
Abern, MR; Scosyrev, E; Tsivian, M; Messing, EM; Polascik, TJ; Dudek, AZ
MLA Citation
Abern, MR, Scosyrev, E, Tsivian, M, Messing, EM, Polascik, TJ, and Dudek, AZ. "Survival of patients undergoing cytoreductive surgery for metastatic renal cell carcinoma in the targeted-therapy era." Anticancer research 34.5 (May 2014): 2405-2411.
PMID
24778051
Source
epmc
Published In
Anticancer research
Volume
34
Issue
5
Publish Date
2014
Start Page
2405
End Page
2411

3D in vivo ARFI imaging: Prostate cancer sensitivity

© 2014 IEEE.Imaging tools that reliably visualize prostate cancer (PCa) are increasingly needed in the urological community. The objective of this research was to evaluate the ability of Acoustic Radiation Force Impulse (ARFI) imaging to localize PCa in 29 patients with biopsy-confirmed PCa who underwent radical prostatectomy and whole mount histopathology analysis. B-mode, ARFI imaging and whole mount histopathology volumes were acquired for each patient. Regions of suspicion (ROS) for PCa were reader-identified in ARFI images based on boundary delineation, contrast, texture and location, and compared to lesions identified in histopathology. ARFI imaging identified a total of 29 ROSs, 27 of which were correctly identified as cancer (PPV: 93%). ARFI imaging's overall sensitivity was 55%; however, there was significant variation in sensitivity depending on lesion type. We found that ARFI imaging was much more sensitive to posterior lesions (63%) than anterior lesions (12.5%). Posterior index lesions were identified with greater sensitivity (81%) than clinically-insignificant lesions (33%).

Authors
Miller, ZA; Palmeri, ML; Rosenzweig, SJ; Glass, TJ; Nightingale, KR; Polascik, TJ; Buck, A; Madden, J
MLA Citation
Miller, ZA, Palmeri, ML, Rosenzweig, SJ, Glass, TJ, Nightingale, KR, Polascik, TJ, Buck, A, and Madden, J. "3D in vivo ARFI imaging: Prostate cancer sensitivity." January 1, 2014.
Source
scopus
Published In
IEEE International Ultrasonics Symposium : [proceedings]. IEEE International Ultrasonics Symposium
Publish Date
2014
Start Page
209
End Page
212
DOI
10.1109/ULTSYM.2014.0053

Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy

Copyright © 2014 Elsevier Inc. All rights reserved.OBJECTIVES: The purpose of our study was to test our hypothesis that multiparametric magnetic resonance imaging (mpMRI) may have a higher prognostic accuracy than the Partin tables in predicting organ-confined (OC) prostate cancer and extracapsular extension (ECE) after radical prostatectomy (RP).METHODS AND MATERIALS: After institutional review board approval, we retrospectively reviewed 60 patients who underwent 3-T mpMRI before RP. mpMRI was used to assess clinical stage and the updated version of the Partin tables was used to calculate the probability of each patient to harbor OC disease. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in detecting OC and ECE were calculated. Logistic regression models predicting OC pathology were created using either clinical stage at mpMRI or Partin tables probability. The area under the curve was used to calculate the predictive accuracy of each model.RESULTS: Median prostate-specific antigen level at diagnosis was 5 ng/ml (range: 4.1-6.7 ng/ml). Overall, 52 (86.7%) men had cT1 disease, 7 (11.7%) had cT2a/b, and 1 (1.6%) had cT3b at digital rectal examination. Biopsy Gleason score was 6, 3+4 = 7, 4+3 = 7, 8, and 9 to 10 in 28 (46.7%), 15 (25%), 3 (5%), 10 (16.7%), and 4 (6.6%) patients, respectively. At mpMRI, clinical stage was defined as cT2a/b, cT2c, cT3a, and cT3b in 11 (18.3%), 23 (38.3%), 21 (35%), and 5 (8.4%) patients, respectively. At final pathology, 38 men (63.3%) had OC disease, whereas 18 (30%) had ECE and 4 (6.7%) had seminal vesicle invasion. The sensitivity, specificity, PPV, and NPV of mpMRI in detecting OC disease were 81.6%, 86.4%, 91.2%, and 73.1%, respectively, whereas in detecting ECE were 77.8%, 83.4%, 66.7%, and 89.7%, respectively. At logistic regression, both the Partin tables-derived probability and the mpMRI clinical staging were significantly associated with OC disease (all P<0.01). The area under the curves of the model built using the Partin tables and that of the mpMRI model were 0.62 and 0.82, respectively (P = 0.04).CONCLUSIONS: The predictive accuracy of mpMRI in predicting OC disease on pathological analysis is significantly greater than that of the Partin tables. mpMRI had a high PPV (91.2%) when predicting OC disease and a high NPV (89.7%) with regard to ECE. mpMRI should be considered when planning prostate cancer treatment in addition to readily available clinical parameters.

Authors
Gupta, RT; Faridi, KF; Singh, AA; Passoni, NM; Garcia-Reyes, K; Madden, JF; Polascik, TJ
MLA Citation
Gupta, RT, Faridi, KF, Singh, AA, Passoni, NM, Garcia-Reyes, K, Madden, JF, and Polascik, TJ. "Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy." Urologic oncology 32.8 (2014): 1292-1299.
Source
scival
Published In
Urologic Oncology: seminars and original investigations
Volume
32
Issue
8
Publish Date
2014
Start Page
1292
End Page
1299
DOI
10.1016/j.urolonc.2014.04.017

Bayesian shear wave speed estimation for in vivo 3D imaging of the prostate

Shear wave elasticity imaging (SWEI) has shown promise for visualizing structure and pathology within multiple organs; however, due to the assumptions of time of flight algorithms, artifacts caused by reflected waves at structural boundaries may be present in the images. The maximum a posteriori (MAP) estimator provides a framework for Bayesian estimation of the shear wave speed in order to reduce the artifacts and noise in SWEI images. Finite element method simulations and data acquired in a calibrated CIRS phantom show reductions in the bias and variance of the shear wave speed estimates compared to least squares linear regression. In vivo data are presented along with concurrently acquired acoustic radiation force impulse (ARFI) images demonstrating correlation between the elasticity imaging modalities. © 2013 IEEE.

Authors
Rosenzweig, S; Rouze, N; Byram, B; Palmeri, M; Polascik, T; Nightingale, K
MLA Citation
Rosenzweig, S, Rouze, N, Byram, B, Palmeri, M, Polascik, T, and Nightingale, K. "Bayesian shear wave speed estimation for in vivo 3D imaging of the prostate." December 1, 2013.
Source
scopus
Published In
IEEE International Ultrasonics Symposium : [proceedings]. IEEE International Ultrasonics Symposium
Publish Date
2013
Start Page
1260
End Page
1263
DOI
10.1109/ULTSYM.2013.0322

Long-term oncological outcomes of men undergoing radical prostatectomy with preoperative prostate-specific antigen <2.5 ng/ml and 2.5-4 ng/ml.

OBJECTIVES: Prostate-specific antigen (PSA) screening has increased the detection of small, organ-confined tumors, and studies suggest that these patients may have favorable outcomes following radical prostatectomy (RP). To date, there are limited data available on the outcomes of patients diagnosed with low PSA (≤ 4 ng/ml) who underwent RP. This study aimed to evaluate long-term oncological outcomes of patients undergoing RP with preoperative PSA <2.5 and 2.5-4 ng/ml compared with PSA 4.1-10 ng/ml. MATERIALS AND METHODS: Data were analyzed from 3,621 men who underwent RP between 1988 and 2010 at our institution. Patients were stratified into 3 PSA groups: <2.5 ng/ml (n = 280), 2.5-4 ng/ml (n = 563), and 4.1-10 ng/ml (n = 2,778). Patient and disease characteristics were compared. Overall, biochemical disease-free (bDFS), and PCa-specific survivals were analyzed and compared between the groups. Multivariable analyses were conducted using proportional hazards model. RESULTS: Compared with the 4.1-10 ng/ml PSA group, Gleason score >7, extracapsular extension, and non-organ-confined disease were less common in patients with PSA ≤ 4 ng/ml (all P < 0.001). The incidence of organ-confined disease was similar between the PSA < 2.5 and 2.5-4 ng/ml groups while perineural invasion (P = 0.050) and Gleason score ≥ 7 (P = 0.026) were more common in the 2.5-4 ng/ml PSA group. Estimated 10-year overall and PCa-specific survivals were comparable across all PSA groups, whereas bDFS was significantly lower in PSA 4.1-10 group (P < 0.001). bDFS was not statistically different between PSA <2.5 and 2.5-4 groups (P = 0.300). 10-year bDFS were 59.0%, 70.1%, and 76.4% in PSA 4.1-10, 2.5-4, and <2.5, respectively. For the PSA ≤ 4 ng/ml groups, age, race, margin status, pathologic stage, but not PSA were independent predictors of bDFS, whereas age, pathologic Gleason, and biochemical recurrence were associated with overall survival. CONCLUSIONS: Long-term oncological outcomes (overall, bDFS, PCa-specific survivals) of patients presenting with low PSA (≤ 4 ng/ml) were excellent in this study. Compared with PSA 4.1-10 ng/ml, patients presenting with PSA ≤ 4 ng/ml had better bDFS outcomes. However, there was no difference in long-term outcomes between PSA <2.5 and 2.5-4 ng/ml.

Authors
Qi, P; Tsivian, M; Abern, MR; Bañez, LL; Tang, P; Moul, JW; Polascik, TJ
MLA Citation
Qi, P, Tsivian, M, Abern, MR, Bañez, LL, Tang, P, Moul, JW, and Polascik, TJ. "Long-term oncological outcomes of men undergoing radical prostatectomy with preoperative prostate-specific antigen <2.5 ng/ml and 2.5-4 ng/ml." Urol Oncol 31.8 (November 2013): 1527-1532.
PMID
22795501
Source
pubmed
Published In
Urologic Oncology: seminars and original investigations
Volume
31
Issue
8
Publish Date
2013
Start Page
1527
End Page
1532
DOI
10.1016/j.urolonc.2012.06.003

Characteristics of patients diagnosed with both melanoma and renal cell cancer.

BACKGROUND: Patients with renal cell carcinoma (RCC) and malignant melanoma (MM) have an increased risk of additional malignancies. We identified characteristics of MM and RCC associated with a patient developing both cancers. METHODS: A total of 147,656 cases of RCC and 225,548 of MM submitted to the Surveillance, Epidemiology, and End Results database between 1973 and 2008 were analyzed. Standardized incidence ratios (SIR) with 95 % confidence intervals (CI) were calculated for MM after RCC and vice versa. Clinical and pathological characteristics were compared between patients with RCC or MM only and with both cancers using multivariable proportional hazards and competing risks regression models. RESULTS: Overall 1,241 patients developed both cancers. The crude incidence rates of RCC in patients with a prior MM diagnosis and vice versa were 5.2 and 9.4 per 10,000 person-years, respectively. There was an excess of MM in RCC patients (SIR 1.45, CI 1.34-1.57) and of RCC in MM patients (SIR 1.34, CI 1.25-1.43). Median years from RCC to MM diagnosis was 4.3 (2.0-7.8) and from MM to RCC 4.7(2.3-9.9). Patients with a history of MM had more papillary RCC (10.2 vs. 4.8 %, p = 0.01) and were more likely to be female (25.9 vs. 20.5 %, p < 0.001). On multivariable analyses, ocular MM was independently associated with subsequent RCC (HR 1.76 CI 1.24-2.49), as were increasing age, and male sex. CONCLUSIONS: We confirmed a bidirectional association between RCC and MM. A history of MM was found to be associated with papillary RCC and advanced RCC. Ocular MM predicted an increased risk of RCC diagnosis. Further research is warranted into the mechanisms responsible for the association between RCC and MM.

Authors
Abern, MR; Tsivian, M; Coogan, CL; Kaufman, HL; Polascik, TJ
MLA Citation
Abern, MR, Tsivian, M, Coogan, CL, Kaufman, HL, and Polascik, TJ. "Characteristics of patients diagnosed with both melanoma and renal cell cancer." Cancer Causes Control 24.11 (November 2013): 1925-1933.
PMID
23897487
Source
pubmed
Published In
Cancer Causes & Control
Volume
24
Issue
11
Publish Date
2013
Start Page
1925
End Page
1933
DOI
10.1007/s10552-013-0267-0

Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer.

PURPOSE: To evaluate, in a phase 1 study, the safety of neoadjuvant whole-pelvis radiation therapy (RT) administered immediately before radical prostatectomy in men with high-risk prostate cancer. METHODS AND MATERIALS: Twelve men enrolled and completed a phase 1 single-institution trial between 2006 and 2010. Eligibility required a previously untreated diagnosis of localized but high-risk prostate cancer. Median follow-up was 46 months (range, 14-74 months). Radiation therapy was dose-escalated in a 3 × 3 design with dose levels of 39.6, 45, 50.4, and 54 Gy. The pelvic lymph nodes were treated up to 45 Gy with any additional dose given to the prostate and seminal vesicles. Radical prostatectomy was performed 4-8 weeks after RT completion. Primary outcome measure was intraoperative and postoperative day-30 morbidity. Secondary measures included late morbidity and oncologic outcomes. RESULTS: No intraoperative morbidity was seen. Chronic urinary grade 2+ toxicity occurred in 42%; 2 patients (17%) developed a symptomatic urethral stricture requiring dilation. Two-year actuarial biochemical recurrence-free survival was 67% (95% confidence interval 34%-86%). Patients with pT3 or positive surgical margin treated with neoadjuvant RT had a trend for improved biochemical recurrence-free survival compared with a historical cohort with similar adverse factors. CONCLUSIONS: Neoadjuvant RT is feasible with moderate urinary morbidity. However, oncologic outcomes do not seem to be substantially different from those with selective postoperative RT. If this multimodal approach is further evaluated in a phase 2 setting, 54 Gy should be used in combination with neoadjuvant androgen deprivation therapy to improve biochemical outcomes.

Authors
Koontz, BF; Quaranta, BP; Pura, JA; Lee, WR; Vujaskovic, Z; Gerber, L; Haake, M; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Koontz, BF, Quaranta, BP, Pura, JA, Lee, WR, Vujaskovic, Z, Gerber, L, Haake, M, Anscher, MS, Robertson, CN, Polascik, TJ, and Moul, JW. "Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer." Int J Radiat Oncol Biol Phys 87.1 (September 1, 2013): 88-93.
PMID
23790772
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
87
Issue
1
Publish Date
2013
Start Page
88
End Page
93
DOI
10.1016/j.ijrobp.2013.05.014

Radiation exposure associated with dedicated renal mass computed tomography protocol: impact of patient characteristics.

BACKGROUND AND PURPOSE: Renal mass protocol CT (RMP-CT) using multiphase abdomen and pelvis CT imaging is the mainstay for diagnosis, characterization, and follow-up for renal masses; however, it is associated with ionizing radiation to the patient. We sought to quantify the effective dose associated with RMP-CT and to determine how patient factors affect radiation exposure. MATERIAL AND METHODS: We retrospectively reviewed the records of 247 patients undergoing management of a small renal mass (cT1a) between 2005 and 2011 at our institution. Body mass index (BMI) was categorized as normal weight, overweight, obese, and morbidly obese (≤25, 25.1-30, 30.1-35 and >35, respectively). Effective dose of RMP-CT was calculated through the dose-length-product multiplied by a factor coefficient (0.015). Effective doses in milliSieverts (mSv) were correlated to patient characteristics. RESULTS: Patients' median age was 61 years, and median BMI was 28.7 kg/m(2); 72% were Caucasian and 56% were male. Median effective dose was 26.1 mSv (interquartile range 20.6-35.3). When stratified by BMI, the median effective doses were 18.9, 25.2, 27.7, and 36.2mSv for normal weight, overweight, obese, and morbidly obese patients, respectively. On multivariable analyses, BMI and male sex were significantly associated with increased radiation dose. CONCLUSIONS: In this series, the median effective dose for RMP-CT was 26.1 mSv. Obesity was independently associated with markedly increased radiation exposure, with morbidly obese patients being exposed to almost twice the amount of radiation compared with normal weight persons. These findings should be considered when devising management strategies in patients with a renal mass and strategies should be developed to reduce medical ionizing radiation exposure.

Authors
Tsivian, M; Abern, MR; Yoo, JJ; Evans, P; Qi, P; Kim, CY; Lipkin, ME; Polascik, TJ; Ferrandino, MN
MLA Citation
Tsivian, M, Abern, MR, Yoo, JJ, Evans, P, Qi, P, Kim, CY, Lipkin, ME, Polascik, TJ, and Ferrandino, MN. "Radiation exposure associated with dedicated renal mass computed tomography protocol: impact of patient characteristics." J Endourol 27.9 (September 2013): 1102-1106.
PMID
23682980
Source
pubmed
Published In
Journal of Endourology
Volume
27
Issue
9
Publish Date
2013
Start Page
1102
End Page
1106
DOI
10.1089/end.2013.0111

The use of mannitol in partial and live donor nephrectomy: an international survey.

PURPOSE: Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol has never been performed. The aim of this study is to document patterns of mannitol use during PN and LDN. MATERIALS AND METHODS: A survey on the use of mannitol during PN and LDN was sent to 92 high surgical volume urological centers. Questions included use of mannitol, indications for use, physician responsible for administration, dosage, timing and other renoprotective measures. RESULTS: Mannitol was used in 78 and 64 % of centers performing PN and LDN, respectively. The indication for use was as antioxidant (21 %), as diuretic (5 %) and as a combination of the two (74 %). For PN, the most common dosages were 12.5 g (30 %) and 25 g (49 %). For LDN, the most common doses were 12.5 g (36.3 %) and 25 g (63.7 %). Overall, 83 % of centers utilized mannitol, and two (percent or centers??) utilized furosemide for renoprotection. CONCLUSIONS: A large majority of high-volume centers performing PN and LDN use mannitol for renoprotection. Since there are no data proving its value nor standardized indication and usage, this survey may provide information for a randomized prospective study.

Authors
Cosentino, M; Breda, A; Sanguedolce, F; Landman, J; Stolzenburg, J-U; Verze, P; Rassweiler, J; Van Poppel, H; Klingler, HC; Janetschek, G; Celia, A; Kim, FJ; Thalmann, G; Nagele, U; Mogorovich, A; Bolenz, C; Knoll, T; Porpiglia, F; Alvarez-Maestro, M; Francesca, F; Deho, F; Eggener, S; Abbou, C; Meng, MV; Aron, M; Laguna, P; Mladenov, D; D'Addessi, A; Bove, P; Schiavina, R; De Cobelli, O; Merseburger, AS; Dalpiaz, O; D'Ancona, FCH; Polascik, TJ; Muschter, R; Leppert, TJ; Villavicencio, H
MLA Citation
Cosentino, M, Breda, A, Sanguedolce, F, Landman, J, Stolzenburg, J-U, Verze, P, Rassweiler, J, Van Poppel, H, Klingler, HC, Janetschek, G, Celia, A, Kim, FJ, Thalmann, G, Nagele, U, Mogorovich, A, Bolenz, C, Knoll, T, Porpiglia, F, Alvarez-Maestro, M, Francesca, F, Deho, F, Eggener, S, Abbou, C, Meng, MV, Aron, M, Laguna, P, Mladenov, D, D'Addessi, A, Bove, P, Schiavina, R, De Cobelli, O, Merseburger, AS, Dalpiaz, O, D'Ancona, FCH, Polascik, TJ, Muschter, R, Leppert, TJ, and Villavicencio, H. "The use of mannitol in partial and live donor nephrectomy: an international survey." World J Urol 31.4 (August 2013): 977-982.
PMID
23242033
Source
pubmed
Published In
World Journal of Urology
Volume
31
Issue
4
Publish Date
2013
Start Page
977
End Page
982
DOI
10.1007/s00345-012-1003-1

Bilateral focal ablation of prostate tissue using low-energy direct current (LEDC): a preclinical canine study.

OBJECTIVE: To evaluate side-effects, erectile function and capability to preserve adjacent tissues of bilateral focal prostate ablation using low-energy direct current (LEDC) in a canine model. MATERIALS AND METHODS: In all, 12 male Beagle dogs underwent bilateral focal prostate ablation using the NanoKnife™ LEDC system. Three 19 G monopolar electrodes were transperineally placed on each side of the prostate under transrectal ultrasonographic (TRUS) guidance using a triangular probe array. Intra- and postoperative side-effects were recorded. Erectile function was evaluated at baseline and 4-5 and 26-27 days after ablation. The dogs were killed humanely at 7 (six) and 30 days (six) for gross and microscopic evaluation of the prostate and adjacent organs. RESULTS: The median (range) prostate volume on TRUS was 12.1 (8.9-17.2) mL. The electrodes were placed at a median distance of 0.55-0.66 cm from the capsule, urethra and rectum. All procedures were completed successfully and recovery was uneventful. There were no episodes of urinary retention. All the dogs were able to achieve erections after ablation. Pathological analyses revealed inflammatory changes in the ablation zone at 7 days and replacement by fibrosis at 30 days. On microscopic examination no histological injury to the capsule, urethra, rectal wall or nervous structures was identified. CONCLUSIONS: In this study, bilateral focal prostate ablation using LEDC was safe and had a favourable side-effects profile limited to transient minor events. LEDC ablation effectively spared adjacent structures as well as physiological functions in all the dogs.

Authors
Tsivian, M; Polascik, TJ
MLA Citation
Tsivian, M, and Polascik, TJ. "Bilateral focal ablation of prostate tissue using low-energy direct current (LEDC): a preclinical canine study." BJU Int 112.4 (August 2013): 526-530.
PMID
23879907
Source
pubmed
Published In
Bju International
Volume
112
Issue
4
Publish Date
2013
Start Page
526
End Page
530
DOI
10.1111/bju.12227

Short-term functional outcomes and complications associated with transperineal template prostate mapping biopsy.

OBJECTIVE: To assess the complications and erectile and urinary functional outcomes of transperineal template mapping biopsy (TTMB) of the prostate. METHODS: We retrospectively reviewed the records of 84 patients undergoing TTMB at our institution and recorded complications and functional outcomes. Erectile and urinary functions were measured at baseline, 2 weeks, and 6 ± 2 weeks after TTMB using the International Index of Erectile Function short version (IIEF-5) and International Prostate Symptom Score questionnaires. Erectile and urinary function parameters were compared between baseline and 2 and 6 weeks after TTMB in a paired fashion. A subanalysis of erectile function was performed in preoperatively potent men (IIEF-5 >17). RESULTS: Sixteen patients (19%) experienced complications. The most common events were transient urinary retention (6%), prostatitis (4%) and local events, including perineal hematoma, bruising, or perineal pain (5%). One patient with hematuria required intervention. IIEF-5 scores at baseline, 2 weeks, and 6 weeks were 20 (interquartile range [IQR], 16-23), 18 (IQR, 12-22), and 18 (IQR, 12-22), respectively (P = .096 and P = .034). Among preoperatively potent men, IIEF-5 scores at baseline, 2 weeks, and 6 weeks were 22 (IQR, 20-24), 21 (IQR, 18-24), and 22 (IQR, 18-24), respectively (P = .011 and P = .018). International Prostate Symptom Scores were 6 (IQR, 3.5-11) at baseline, rose to 10 (IQR, 4.8-15) at 2 weeks (P = .012), and returned to 7 (IQR, 3.5-13) at 6 weeks (P = .628). CONCLUSION: TTMB has a favorable morbidity profile, with mostly mild and transient complications. Urinary retention occurred in 6%, and only 1 patient required intervention with bladder irrigation. Despite a statistically significant decline in erectile function from baseline, the median change in IIEF-5 score was 1 point. Urinary symptoms worsened initially but returned to baseline within 6 weeks.

Authors
Tsivian, M; Abern, MR; Qi, P; Polascik, TJ
MLA Citation
Tsivian, M, Abern, MR, Qi, P, and Polascik, TJ. "Short-term functional outcomes and complications associated with transperineal template prostate mapping biopsy." Urology 82.1 (July 2013): 166-170.
PMID
23697794
Source
pubmed
Published In
Urology
Volume
82
Issue
1
Publish Date
2013
Start Page
166
End Page
170
DOI
10.1016/j.urology.2013.01.071

Refining treatment for the men who need it: lessons from the PIVOT trial.

Authors
Abern, MR; Tsivian, M; Polascik, TJ
MLA Citation
Abern, MR, Tsivian, M, and Polascik, TJ. "Refining treatment for the men who need it: lessons from the PIVOT trial." Translational andrology and urology 2.2 (June 2013): 82-84.
PMID
26816728
Source
epmc
Published In
Translational Andrology and Urology
Volume
2
Issue
2
Publish Date
2013
Start Page
82
End Page
84
DOI
10.3978/j.issn.2223-4683.2012.09.05

Flaxseed-derived enterolactone is inversely associated with tumor cell proliferation in men with localized prostate cancer.

Enterolactone and enterodiol, mammalian lignans derived from dietary sources such as flaxseed, sesame seeds, kale, broccoli, and apricots, may impede tumor proliferation by inhibiting activation of nuclear factor kappa B (NFκB) and vascular endothelial growth factor (VEGF). We examined the associations between urinary enterolactone and enterodiol with prostatic tumor expression of NFκB, VEGF, and Ki67 among 147 patients with prostate cancer who participated in a presurgical trial of flaxseed supplementation (30 g/day) for ~30 days. Urinary enterolignans and tissue biomarkers were determined by high-performance liquid chromatography and immunohistochemistry, respectively. After supplementation, we observed significant correlations between intakes of plant lignan and urinary concentrations of total enterolignans (ρ=0.677, P<.0001), enterolactone (ρ=0.676, P<.0001), and enterodiol (ρ=0.628, P<.0001). Importantly, we observed that total urinary enterolignans and enterolactone were significantly and inversely correlated with Ki67 in the tumor tissue (ρ=-0.217, P=.011, and ρ=-0.230, P=.007, respectively), and a near-significant inverse association was observed for enterodiol (ρ=-0.159, P=.064). An inverse association was observed between enterolactone and VEGF (ρ=-0.143, P=.141), although this did not reach statistical significance. We did not observe an association between enterolignans and NFκB. In conclusion, flaxseed-derived enterolignans may hinder cancer cell proliferation via VEGF-associated pathways.

Authors
Azrad, M; Vollmer, RT; Madden, J; Dewhirst, M; Polascik, TJ; Snyder, DC; Ruffin, MT; Moul, JW; Brenner, DE; Demark-Wahnefried, W
MLA Citation
Azrad, M, Vollmer, RT, Madden, J, Dewhirst, M, Polascik, TJ, Snyder, DC, Ruffin, MT, Moul, JW, Brenner, DE, and Demark-Wahnefried, W. "Flaxseed-derived enterolactone is inversely associated with tumor cell proliferation in men with localized prostate cancer." J Med Food 16.4 (April 2013): 357-360.
PMID
23566060
Source
pubmed
Published In
Journal of Medicinal Food
Volume
16
Issue
4
Publish Date
2013
Start Page
357
End Page
360
DOI
10.1089/jmf.2012.0159

The State of Prostate MRI in 2013

Authors
Gupta, RT; Kauffman, CR; Polascik, TJ; Taneja, SS; Rosenkrantz, AB
MLA Citation
Gupta, RT, Kauffman, CR, Polascik, TJ, Taneja, SS, and Rosenkrantz, AB. "The State of Prostate MRI in 2013." ONCOLOGY-NEW YORK 27.4 (April 2013): 262-270.
PMID
23781689
Source
wos-lite
Published In
Oncology
Volume
27
Issue
4
Publish Date
2013
Start Page
262
End Page
270

Race is associated with discontinuation of active surveillance of low-risk prostate cancer: results from the Duke Prostate Center.

BACKGROUND: Active surveillance (AS) is increasingly utilized in low-risk prostate cancer (PC) patients. Although black race has traditionally been associated with adverse PC characteristics, its prognostic value for patients managed with AS is unclear. METHODS: A retrospective review identified 145 patients managed with AS at the Duke Prostate Center from January 2005 to September 2011. Race was patient-reported and categorized as black, white or other. Inclusion criteria included PSA <10 ng ml(-1), Gleason sum ≤ 6, and ≤ 33% of cores with cancer on diagnostic biopsy. The primary outcome was discontinuation of AS for treatment due to PC progression. In men who proceeded to treatment after AS, the trigger for treatment, follow-up PSA and biopsy characteristics were analyzed. Time to treatment was analyzed with univariable and multivariable Cox proportional hazards models and also stratified by race. RESULTS: In our AS cohort, 105 (72%) were white, 32 (22%) black and 8 (6%) another race. Median follow-up was 23.0 months, during which 23% percent of men proceeded to treatment. The demographic, clinical and follow-up characteristics did not differ by race. There was a trend toward more uninsured black men (15.6% black, 3.8% white, 0% other, P = 0.06). Black race was associated with treatment (hazard ratio (HR) 2.93, P = 0.01) as compared with white. When the analysis was adjusted for socioeconomic and clinical parameters at the time of PC diagnosis, black race remained the sole predictor of treatment (HR 3.08, P = 0.01). Among men undergoing treatment, the trigger was less often patient driven in black men (8 black, 33 white, 67% other, P = 0.05). CONCLUSIONS: Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters.

Authors
Abern, MR; Bassett, MR; Tsivian, M; Bañez, LL; Polascik, TJ; Ferrandino, MN; Robertson, CN; Freedland, SJ; Moul, JW
MLA Citation
Abern, MR, Bassett, MR, Tsivian, M, Bañez, LL, Polascik, TJ, Ferrandino, MN, Robertson, CN, Freedland, SJ, and Moul, JW. "Race is associated with discontinuation of active surveillance of low-risk prostate cancer: results from the Duke Prostate Center." Prostate Cancer Prostatic Dis 16.1 (March 2013): 85-90.
PMID
23069729
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
16
Issue
1
Publish Date
2013
Start Page
85
End Page
90
DOI
10.1038/pcan.2012.38

Preoperative predictors of pathologic stage T2a and pathologic Gleason score ≤ 6 in men with clinical low-risk prostate cancer treated with radical prostatectomy: reference for active surveillance.

To assess preoperative parameters that may be predictive of pathologic stage T2a (pT2a) and pathologic Gleason score (pGS) ≤ 6 disease in low-risk prostate cancer patients considering active surveillance. A cohort of 1,495 men with low-risk prostate cancer between 1993 and 2009 was utilized. Preoperative assessment focused on patient age, race, diagnostic PSA level, clinical stage, diagnostic biopsy Gleason score, and prostate cancer laterality. Kaplan-Meier curves and a Cox regression model were used for analysis of PSA recurrence. Preoperative parameters were analyzed by univariate and multivariate logistic regression methods. Of 1,495 patients, 187 (12.5 %) were identified with pT2a and pGS ≤ 6 disease. Of the 187 men with pT2a and pGS ≤ 6 disease, only 6 (3.2 %) cases had PSA recurrence. Kaplan-Meier PSA recurrence-free survival curves identified a difference between prostate cancers with pT2a and pGS ≤ 6 and prostate cancers with >pT2a or pGS ≥ 7 disease (p = 0.002). Only biopsy tumor unilaterality (OR, 10.452; p ≤ 0.001) and low diagnostic PSA levels (OR, 0.887; p = 0.003) were independent predictors of prostate cancers with pT2a and pGS ≤ 6 disease on univariate and multivariate logistic regression. Biopsy tumor unilaterality and low diagnostic PSA levels are the independent predictors of pT2a and pGS ≤ 6 disease in low-risk prostate cancer patients. Unilateral cancer by prostate biopsy and low diagnostic PSA level may be the reference to improving the selection of appropriate candidates for active surveillance within a low-risk prostate cancer cohort.

Authors
Fu, Q; Moul, JW; Bañez, L; Sun, L; Mouraviev, V; Xie, D; Polascik, TJ
MLA Citation
Fu, Q, Moul, JW, Bañez, L, Sun, L, Mouraviev, V, Xie, D, and Polascik, TJ. "Preoperative predictors of pathologic stage T2a and pathologic Gleason score ≤ 6 in men with clinical low-risk prostate cancer treated with radical prostatectomy: reference for active surveillance." Med Oncol 30.1 (March 2013): 326-.
PMID
23263824
Source
pubmed
Published In
Medical Oncology
Volume
30
Issue
1
Publish Date
2013
Start Page
326
DOI
10.1007/s12032-012-0326-5

African-American men with low-grade prostate cancer have higher tumor burdens: results from the Duke Prostate Center.

BACKGROUND: To investigate racial differences in tumor burden (cancer volume, cancer percentage and cancer to PSA ratios) in a large cohort of men undergoing radical prostatectomy (RP). METHODS: Demographic, clinical and pathological data of patients undergoing RP between 1993-2010 were reviewed and compared between African-American (AA) and non African-American (nAA) men. Further assessments of pathological tumor burden (estimated tumor volume, percent of cancer involvement, and estimated tumor volume/PSA ratios) were performed across Gleason score categories. RESULTS: Of 4157 patients in the analysis, 604 (14.5%) were AA. Overall, AA patients were younger, had higher Gleason scores, PSA levels and incidence of palpable disease (all P < 0.001). Despite comparable prostate weights (39.4 vs. 39.6 g), AA men had higher percent cancer involvement and estimated tumor volume (all P < 0.001) but similar estimated tumor volume/PSA ratios ( P> 0.05). When stratified by Gleason scores, prostate weights were comparable; however, estimated tumor volume, percent cancer involvement and estimated tumor volume/PSA ratios were higher in AA men with low grade (≤ 6) prostate cancer (PCa), similar in intermediate grade (7-8) and lower in high grade (9-10) PCa compared to nAA men. CONCLUSIONS: In this large series, AA patients had higher disease burden (estimated tumor volume, percent cancer involvement, estimated tumor volume/PSA ratios) compared to nAA but this association was especially pronounced in low grade (Gleason ≤ 6) cancers. These data depict a complex picture of relations between race and tumor burden across the spectrum of PCa aggressiveness. Further investigation is warranted to understand the mechanisms of racial disparities in PCa.

Authors
Tsivian, M; Bañez, LL; Keto, CJ; Abern, MR; Qi, P; Gerber, L; Moul, JW; Polascik, TJ
MLA Citation
Tsivian, M, Bañez, LL, Keto, CJ, Abern, MR, Qi, P, Gerber, L, Moul, JW, and Polascik, TJ. "African-American men with low-grade prostate cancer have higher tumor burdens: results from the Duke Prostate Center." Prostate Cancer Prostatic Dis 16.1 (March 2013): 91-94.
PMID
23032361
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
16
Issue
1
Publish Date
2013
Start Page
91
End Page
94
DOI
10.1038/pcan.2012.39

Sexual bother and function after radical prostatectomy: predictors of sexual bother recovery in men despite persistent post-operative sexual dysfunction.

Changes in sexual bother (SB) following radical prostatectomy (RP) negatively affect health-related quality of life (HRQoL) of prostate cancer survivors. However, post-operative SB tends to be neglected whereas sexual function (SF) is thoroughly assessed in clinical practice and few studies have focused on and evaluated patients' SB. We retrospectively reviewed 2 345 consecutive patients who underwent RP between 2001 and 2009 at a single institution. SF and SB were assessed using Expanded Prostate Cancer Index Composite (EPIC) questionnaires. We stratified our cohort by SB recovery and post-operative SF status, including a subset of men who recovered SB despite persistent post-RP sexual dysfunction. Multivariable logistic regression analyses were conducted to identify factors for men who have SB recovery. Of 319 eligible patients, 133 (41.7%) recovered their SB at a mean of 20 months after RP. Among the 133 men who demonstrated SB recovery, 109 had post-operative sexual dysfunction. Patients with SB recovery despite post-RP sexual dysfunction were more likely to be old (p = 0.004), to have higher clinical T stage (p < 0.001), to have more non-nerve-sparing RP (p < 0.001), to have lower pre-operative EPIC-SF/SB scores (p < 0.001), to have more extracapsular extension (p = 0.031) and to be PDE5i non-users after surgery (p < 0.001). In multivariable analysis, predictors for this subset were lower comorbidity (OR 0.62, p = 0.043), higher clinical cancer stage (OR 2.35, p = 0.026), worse pre-operative SF (OR 0.98, p = 0.010), SB (OR 0.98, p < 0.010) and no PDE5i use (OR 0.37, p = 0.002); age was not related (OR 0.99, p = 0.555). As SB can influence patients' overall HRQoL, expectations of SB recovery should be provided to patients in the same way that SF recovery is presented. This study may help clinicians to discuss SB with patients and assess their potential for SB recovery following RP.

Authors
Kimura, M; Bañez, LL; Polascik, TJ; Bernal, RM; Gerber, L; Robertson, CN; Donatucci, CF; Moul, JW
MLA Citation
Kimura, M, Bañez, LL, Polascik, TJ, Bernal, RM, Gerber, L, Robertson, CN, Donatucci, CF, and Moul, JW. "Sexual bother and function after radical prostatectomy: predictors of sexual bother recovery in men despite persistent post-operative sexual dysfunction." Andrology 1.2 (March 2013): 256-261.
PMID
23413138
Source
pubmed
Published In
Andrology
Volume
1
Issue
2
Publish Date
2013
Start Page
256
End Page
261
DOI
10.1111/j.2047-2927.2012.00036.x

Renal tumors in solid organ recipients: clinical and pathologic features.

OBJECTIVES: Solid organ recipients are several times more likely to develop renal cell carcinoma (RCC) compared with the general population, but little is known about the features of these tumors. The aim of this study is to report on the characteristics of renal tumors in solid organ recipients compared with the general population. MATERIALS AND METHODS: Patients undergoing surgery for a localized renal mass between 2000 and 2008 were studied. Demographic, clinical, radiographic, and pathologic characteristics were compared between patients with and without a history of organ transplant. A subanalysis focused on the features of a kidney compared with another non-renal organ transplant. RESULTS: Of 950 patients identified, 19 were organ recipients. Transplant recipients were younger and had lower body mass indices. Most organ recipients (94.7%) were asymptomatic at presentation. Transplant recipients had higher incidence of malignant pathology (88.2% vs. 78.7%), but had smaller masses, of lower stage and grade, and a higher proportion of papillary histology (35.3% vs. 19.8%). Papillary subtype accounted for almost one-half of the RCCs in kidney recipients compared with 20% in other organ recipients. Over a median follow-up of 4 years, 1 (5.9%) local recurrence, no metastatic progressions, and no RCC-related deaths occurred in the transplant cohort. CONCLUSIONS: Organ recipients typically present with incidental renal masses of smaller size. However, these are twice more likely to be malignant compared with the general population. RCC arising in transplant recipients tend to be of lower stage and grade, contributing to the apparently excellent oncologic outcomes of surgical treatment.

Authors
Tsivian, M; Caso, JR; Kimura, M; Polascik, TJ
MLA Citation
Tsivian, M, Caso, JR, Kimura, M, and Polascik, TJ. "Renal tumors in solid organ recipients: clinical and pathologic features." Urol Oncol 31.2 (February 2013): 255-258.
PMID
21719326
Source
pubmed
Published In
Urologic Oncology: seminars and original investigations
Volume
31
Issue
2
Publish Date
2013
Start Page
255
End Page
258
DOI
10.1016/j.urolonc.2010.11.006

Evolution of the concept of focal therapy for prostate cancer.

The landscape of prostate cancer has been rapidly evolving, and technological advances in imaging and biopsy tools offer novel approaches to focal therapy. In this dynamic environment, the role of focal therapy for prostate cancer is being shaped both by advances in technology and by reconsidering the epidemiological and outcomes data for available treatments. Here we focus on the evolution of the concept of focal therapy and its potential roles in the management of prostate cancer.

Authors
Tsivian, M; Abern, MR; Polascik, TJ
MLA Citation
Tsivian, M, Abern, MR, and Polascik, TJ. "Evolution of the concept of focal therapy for prostate cancer." Oncology (Williston Park) 27.1 (January 2013): 64-70. (Review)
PMID
23461042
Source
pubmed
Published In
Oncology
Volume
27
Issue
1
Publish Date
2013
Start Page
64
End Page
70

Evolution of the concept of focal therapy for prostate cancer.

The landscape of prostate cancer has been rapidly evolving, and technological advances in imaging and biopsy tools offer novel approaches to focal therapy. In this dynamic environment, the role of focal therapy for prostate cancer is being shaped both by advances in technology and by reconsidering the epidemiological and outcomes data for available treatments. Here we focus on the evolution of the concept of focal therapy and its potential roles in the management of prostate cancer.

Authors
Tsivian, M; Abern, MR; Polascik, TJ
MLA Citation
Tsivian, M, Abern, MR, and Polascik, TJ. "Evolution of the concept of focal therapy for prostate cancer." Oncology (Williston Park, N.Y.) 27.1 (2013): 64-70.
Source
scival
Published In
Oncology
Volume
27
Issue
1
Publish Date
2013
Start Page
64
End Page
70

Preoperative predictors of pathologic stage T2a and pathologic Gleason score ≤ 6 in men with clinical low-risk prostate cancer treated with radical prostatectomy: reference for active surveillance.

To assess preoperative parameters that may be predictive of pathologic stage T2a (pT2a) and pathologic Gleason score (pGS) ≤ 6 disease in low-risk prostate cancer patients considering active surveillance. A cohort of 1,495 men with low-risk prostate cancer between 1993 and 2009 was utilized. Preoperative assessment focused on patient age, race, diagnostic PSA level, clinical stage, diagnostic biopsy Gleason score, and prostate cancer laterality. Kaplan-Meier curves and a Cox regression model were used for analysis of PSA recurrence. Preoperative parameters were analyzed by univariate and multivariate logistic regression methods. Of 1,495 patients, 187 (12.5 %) were identified with pT2a and pGS ≤ 6 disease. Of the 187 men with pT2a and pGS ≤ 6 disease, only 6 (3.2 %) cases had PSA recurrence. Kaplan-Meier PSA recurrence-free survival curves identified a difference between prostate cancers with pT2a and pGS ≤ 6 and prostate cancers with >pT2a or pGS ≥ 7 disease (p = 0.002). Only biopsy tumor unilaterality (OR, 10.452; p ≤ 0.001) and low diagnostic PSA levels (OR, 0.887; p = 0.003) were independent predictors of prostate cancers with pT2a and pGS ≤ 6 disease on univariate and multivariate logistic regression. Biopsy tumor unilaterality and low diagnostic PSA levels are the independent predictors of pT2a and pGS ≤ 6 disease in low-risk prostate cancer patients. Unilateral cancer by prostate biopsy and low diagnostic PSA level may be the reference to improving the selection of appropriate candidates for active surveillance within a low-risk prostate cancer cohort.

Authors
Fu, Q; Moul, JW; Bañez, L; Sun, L; Mouraviev, V; Xie, D; Polascik, TJ
MLA Citation
Fu, Q, Moul, JW, Bañez, L, Sun, L, Mouraviev, V, Xie, D, and Polascik, TJ. "Preoperative predictors of pathologic stage T2a and pathologic Gleason score ≤ 6 in men with clinical low-risk prostate cancer treated with radical prostatectomy: reference for active surveillance." Medical oncology (Northwood, London, England) 30.1 (2013): 326--.
Source
scival
Published In
Medical Oncology
Volume
30
Issue
1
Publish Date
2013
Start Page
326-
DOI
10.1007/s12032-012-0326-5

Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy.

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The role of the vacuum erection device (VED) has increased with its use in combined therapy with a phosphodiesterase type 5 inhibitor (PDE5i) for penile rehabilitation after radical prostatectomy (RP) and radiotherapy. The advantages of the VED are non-invasive, cost-effective, and a possibility of preventing shrinkage of penis length. Albeit current widespread use of penile rehabilitation programmes for post-RP erectile dysfunction, independent predictors for the rehabilitation participants, as well as for its treatment success have not been fully investigated. In the present study, we have added several new predictors for rehabilitation participation, e.g. African-Americans and higher preoperative sexual function. Conversely, higher preoperative PSA concentrations and the presence of positive surgical margins were predictors for avoidance of rehabilitation. Notably, there was a primary surgeon difference, which had a trend for predicting outcome of the rehabilitation among the participants, implying their surgical technique and follow-up might influence success of the rehabilitation. OBJECTIVES: • To investigate baseline demographic and clinicopathological characteristics of men who participate in our penile rehabilitation programme after radical prostatectomy (RP). • To determine predictors for participation in rehabilitation, as well as successful rehabilitation outcome using multivariable logistic regression analyses. PATIENTS AND METHODS: • We analysed data on 2345 consecutive patients who underwent RP between 2001 and 2009 in our institution. • The decision to participate in penile rehabilitation using phosphodiesterase type 5 inhibitor (PDE5i) with a vacuum erection device (VED) was based on the patient's choice after post-RP discussions. • Rehabilitation success was defined using the following criteria: (i) patients who continued the penile rehabilitation programme and did not switch treatment from PDE5i to other erectile aids, (ii) success was noted in men who had an Expanded Prostate Cancer Index Composite (EPIC) sexual function (SF) score of >75% of the patient's baseline EPIC score, and (iii) patients who answered that they achieved adequate erections with a PDE5i. • Logistic regression analysis was used to identify factors associated with treatment participation and its success. RESULTS: • Of 676 patients, 354 (53.2%) men participated in a penile rehabilitation programme. Among 329 rehabilitation participants with available data, 96 (29.2%) had treatment success. • In multivariable regression analysis, African-Americans (odds ratio [OR] 3.47, P < 0.001), and higher preoperative SF (OR 1.02, P < 0.001) were associated with participation in rehabilitation. • Higher preoperative PSA concentration (OR 0.50, P = 0.004) and presence of positive surgical margins (OR 0.68, P = 0.042) were found to be independent predictors for non-participation in the rehabilitation. • For rehabilitation outcomes, being older at surgery (OR 0.93, P = 0.001) and adjuvant therapy (OR 0.34, P = 0.047) had a negative association with successful outcome. • There was a trend in the relationship between primary surgeon and rehabilitation success (OR 1.05, P = 0.053) CONCLUSIONS: • Those patients who have risk factors, e.g. adverse prostate cancer features, need to be carefully counselled and encouraged to participate in the penile rehabilitation programme. • Clinicians could lead patients toward successful outcomes if appropriate surgical techniques and rehabilitation are provided.

Authors
Kimura, M; Caso, JR; Bañez, LL; Koontz, BF; Gerber, L; Senocak, C; Donatucci, CF; Vujaskovic, Z; Moul, JW; Polascik, TJ
MLA Citation
Kimura, M, Caso, JR, Bañez, LL, Koontz, BF, Gerber, L, Senocak, C, Donatucci, CF, Vujaskovic, Z, Moul, JW, and Polascik, TJ. "Predicting participation in and successful outcome of a penile rehabilitation programme using a phosphodiesterase type 5 inhibitor with a vacuum erection device after radical prostatectomy." BJU international 110.11 Pt C (December 2012): E931-E938.
PMID
22520165
Source
epmc
Published In
Bju International
Volume
110
Issue
11 Pt C
Publish Date
2012
Start Page
E931
End Page
E938
DOI
10.1111/j.1464-410x.2012.11168.x

Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer.

To find the predictors of Gleason score upgrading in a cohort of low-risk prostate cancer patients, data were analyzed comprising 1,632 consecutive men with low-risk prostate cancer who underwent radical prostatectomy between 1993 and 2009. Assessment focused on preoperative parameters including patient age, race, diagnostic prostate-specific antigen (PSA) levels, clinical stage and biopsy Gleason score, along with pathological parameters including percentage of tumor involvement (PTI), tumor laterality, pathological stage, extra-capsular extension, seminal vesicle invasion, and surgical margins. These parameters were analyzed using univariate and multivariate methods. Kaplan-Meier curves compared differences in biochemical disease-free survival in men having cancers with and without Gleason score upgrading. Cases involving pathological Gleason score upgrading were identified in 723 (44.3 %) of 1,632 patients. Kaplan-Meier PSA recurrence-free survival curves showed a difference in outcome between men with and without Gleason score upgrading (p < 0.001). Of Gleason score upgraded patients, 35 (4.8 %) men had PTI of <5 %, 237 (32.8 %) had PTI of 5-9.9 %, 177 (24.5 %) had PTI of 10-14.9 %, and 274 (37.9 %) had PTI ≥ 15 % (p < 0.001). PTI (p < 0.001) along with diagnostic PSA, patient age, diagnostic biopsy Gleason score, pathologic stage, and surgical margin status were independent predictors of pathological Gleason score upgrading on multivariate logistic regression. PTI correlates closely with Gleason score upgrading in a low-risk prostate cancer cohort. Low-risk prostate cancer patients with clinical findings suggestive of high PTI or large volume cancers should not benefit from active surveillance strategies.

Authors
Fu, Q; Moul, JW; Bañez, LL; Sun, L; Mouraviev, V; Xie, D; Polascik, TJ
MLA Citation
Fu, Q, Moul, JW, Bañez, LL, Sun, L, Mouraviev, V, Xie, D, and Polascik, TJ. "Association between percentage of tumor involvement and Gleason score upgrading in low-risk prostate cancer." Med Oncol 29.5 (December 2012): 3339-3344.
PMID
22688447
Source
pubmed
Published In
Medical Oncology
Volume
29
Issue
5
Publish Date
2012
Start Page
3339
End Page
3344
DOI
10.1007/s12032-012-0270-4

Mn porphyrins as novel molecular magnetic resonance imaging contrast agents.

BACKGROUND AND PURPOSE: In this study, we investigated the potential of a new class of therapeutic Mn porphyrins as molecular MRI probes for prostate cancer imaging. Two compounds of different bioavailibility were investigated: Mn(III) meso-tetrakis(N-ethylpyridinium-2-yl)porphyrin (MnTE-2-PyP(5+)) and Mn(III) meso-tetrakis(N-n-hexylpyridinium-2-yl)porphyrin (MnTnHex-2-PyP(5+)). These compounds have previously been shown to have adjunctive antineoplastic activity through their actions as powerful superoxide dismutase mimics, peroxynitrite scavengers, and modulators of cellular redox-based signaling pathways. Strong paramagnetic MRI contrast properties and affinity for cancer cells suggest their potential application as novel diagnostic imaging agents. MATERIALS AND METHODS: MRI experiments were performed at 7.0T on a Bruker Biospec horizontal bore scanner. All in-vivo experiments were performed on 12 C57 black mice implanted with RM-9 prostate cancer cells on the hind limb. Two mg/kg of MnTnHex-2-PyP(5+) (n=6) and 8 mg/kg MnTE-2-PyP(5+) (n=6) were administered intraperitoneally 90 minutes before imaging. All the images were collected using a volume coil and processed using Paravision 4.0. RESULTS: Phantom studies reveal remarkably high T1 relaxivity changes for both metalloporphyrins, which are twofold to threefold higher than commercially available gadolinium chelates. Observable detection limits using conventional T1-weighted MRI are in the low micromolar range for both compounds. In vivo, MR relaxation changes in prostate tumor xenografts were readily observed after a single injection of either MnTE-2-PyP(5+)or MnTnHex-2-PyP(5+), with tumor contrast to background ratio greatest after MnTE-2-PyP(5+) administration. CONCLUSION: After a single dose of MnTE-2-PyP(5+), contrast changes in prostate tumors are up to sixfold greater than in surrounding, noncancerous tissues, suggesting the potential use of this metalloporphyrin as a novel diagnostic probe for detecting prostate malignancy using MRI.

Authors
Mouraviev, V; Venkatraman, TN; Tovmasyan, A; Kimura, M; Tsivian, M; Mouravieva, V; Polascik, TJ; Wang, H; Amrhein, TJ; Batinic-Haberle, I; Lascola, C
MLA Citation
Mouraviev, V, Venkatraman, TN, Tovmasyan, A, Kimura, M, Tsivian, M, Mouravieva, V, Polascik, TJ, Wang, H, Amrhein, TJ, Batinic-Haberle, I, and Lascola, C. "Mn porphyrins as novel molecular magnetic resonance imaging contrast agents." J Endourol 26.11 (November 2012): 1420-1424.
PMID
22783812
Source
pubmed
Published In
Journal of Endourology
Volume
26
Issue
11
Publish Date
2012
Start Page
1420
End Page
1424
DOI
10.1089/end.2012.0171

Radical prostatectomy vs radiation therapy and androgen-suppression therapy in high-risk prostate cancer.

UNLABELLED: What's known on the subject? and What does the study add? Prostate cancer is generally considered to be high risk when the prostate-specific antigen (PSA) concentration is >20 ng/mL, the Gleason score is ≥8 or the American Joint Commission on Cancer (AJCC) tumour (T) category is ≥2c. There is no consensus on the best treatment for men with prostate cancer that includes these high-risk features. Options include external beam radiation therapy (EBRT) with androgen suppression therapy (AST), treatment with a combination of brachytherapy, EBRT and AST termed combined-modality therapy (CMT) or radical prostatectomy (RP) followed by adjuvant RT in cases where there are unfavourable pathological features, e.g. positive surgical margin, extracapsular extension and seminal vesicle invasion. While outcomes for both approaches have been published independently these treatments have not been compared in the setting of a prospective RCT where confounding factors related to patient selection for RP or CMT would be minimised. These factors include age, known prostate cancer prognostic factors and comorbidity. RCTs that compare RP to radiation-based regimens have been attempted but failed to accrue. OBJECTIVE: To assess the risk of prostate cancer-specific mortality after therapy with radical prostatectomy (RP) or combined-modality therapy (CMT) with brachytherapy, external beam radiation therapy (EBRT) and androgen-suppression therapy (AST) in men with Gleason score 8-10 prostate cancer. PATIENTS AND METHODS: Men with localised high-risk prostate cancer based on a Gleason score of 8-10 were selected for study from Duke University (285 men), treated between January 1988 and October 2008 with RP or from the Chicago Prostate Cancer Center or within the 21st Century Oncology establishment (372) treated between August 1991 and November 2005 with CMT. Fine and Gray multivariable regression was used to assess whether the risk of prostate cancer-specific mortality differed after RP as compared with CMT adjusting for age, cardiac comorbidity and year of treatment, and known prostate cancer prognostic factors. RESULTS: As of January 2009, with a median (interquartile range) follow-up of 4.62 (2.4-8.2) years, there were 21 prostate cancer-specific deaths. Treatment with RP was not associated with an increased risk of prostate cancer-specific mortality compared with CMT (adjusted hazard ratio [HR] 1.8, 95% confidence interval [CI] 0.6-5.6, P = 0.3). Factors associated with an increased risk of prostate cancer-specific mortality were a PSA concentration of <4 ng/mL (adjusted HR 6.1, 95% CI 2.3-16, P < 0.001) as compared with ≥4 ng/mL, and clinical category T2b, c (adjusted HR 2.9; 95% CI 1.1-7.2; P = 0.03) as compared with T1c, 2a. CONCLUSION: Initial treatment with RP as compared with CMT was not associated with an increased risk of prostate cancer-specific mortality in men with Gleason score 8-10 prostate cancer.

Authors
Westover, K; Chen, M-H; Moul, J; Robertson, C; Polascik, T; Dosoretz, D; Katin, M; Salenius, S; D'Amico, AV
MLA Citation
Westover, K, Chen, M-H, Moul, J, Robertson, C, Polascik, T, Dosoretz, D, Katin, M, Salenius, S, and D'Amico, AV. "Radical prostatectomy vs radiation therapy and androgen-suppression therapy in high-risk prostate cancer." BJU Int 110.8 (October 2012): 1116-1121.
PMID
22540922
Source
pubmed
Published In
Bju International
Volume
110
Issue
8
Publish Date
2012
Start Page
1116
End Page
1121
DOI
10.1111/j.1464-410X.2012.11012.x

Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney: a multicenter experience.

BACKGROUND AND PURPOSE: Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes. PATIENTS AND METHODS: A multicenter study was performed from 12 institutions. All patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were included. Tumor size, complications, and recurrence rates were recorded. Renal function was assessed with serum creatinine level and estimated glomerular filtration rate. RESULTS: Ninety-eight patients underwent 105 ablations, and 100 patients underwent partial nephrectomy (PN). Preoperative estimated glomerular filtration rate (eGFR) was similar between the groups. Tumors managed with PN were significantly larger than those managed with ablation (P<0.001). Ablations were associated with a lower overall complication rate (9.5% vs 24%, P=0.01) and higher local recurrence rate (6.7% vs 3%, P=0.04). Eighty-four patients had a preoperative eGFR ≥60 mL/min/1.73 m(2). Among these patients, 19 (23%) fell below this threshold after 3 months and 15 (18%) at 12 months. Postoperatively, there was no significant difference in eGFR between the groups. CONCLUSIONS: Extirpation and ablation are both reasonable options for treatment. Ablation is more minimally invasive, albeit with higher recurrence rates compared with PN. Postoperative renal function is similar in both groups and is not affected by surgical approach.

Authors
Mues, AC; Korets, R; Graversen, JA; Badani, KK; Bird, VG; Best, SL; Cadeddu, JA; Clayman, RV; McDougall, E; Barwari, K; Laguna, P; de la Rosette, J; Kavoussi, L; Okhunov, Z; Munver, R; Patel, SR; Nakada, S; Tsivian, M; Polascik, TJ; Shalhav, A; Shingleton, WB; Johnson, EK; Wolf, JS; Landman, J
MLA Citation
Mues, AC, Korets, R, Graversen, JA, Badani, KK, Bird, VG, Best, SL, Cadeddu, JA, Clayman, RV, McDougall, E, Barwari, K, Laguna, P, de la Rosette, J, Kavoussi, L, Okhunov, Z, Munver, R, Patel, SR, Nakada, S, Tsivian, M, Polascik, TJ, Shalhav, A, Shingleton, WB, Johnson, EK, Wolf, JS, and Landman, J. "Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney: a multicenter experience." J Endourol 26.10 (October 2012): 1361-1366.
PMID
22667344
Source
pubmed
Published In
Journal of Endourology
Volume
26
Issue
10
Publish Date
2012
Start Page
1361
End Page
1366
DOI
10.1089/end.2012.0114

Rationale for percutaneous biopsy and histologic characterisation of renal tumours.

CONTEXT: The use of percutaneous biopsy of renal tumours has been traditionally reserved for selected cases because of uncertainties regarding its safety, accuracy, and clinical utility. With the adoption of modern biopsy techniques and increasing expertise in interpreting biopsy specimens, renal tumour biopsy today has limited morbidity and allows histologic diagnosis in the majority of cases in centres with expertise. OBJECTIVE: To review the current rationale, indications, and outcomes of percutaneous biopsies and histologic characterisation of renal tumours. EVIDENCE ACQUISITION: We conducted a systematic review of English-language articles on percutaneous biopsies of renal tumours published between January 1999 and December 2011 using the Medline, Embase, and Web of Science databases. One hundred twelve articles were selected with the consensus of all authors and analysed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria. EVIDENCE SYNTHESIS: In recent years, the increasing incidence of incidental small renal masses (SRMs), the development of conservative and minimally invasive treatments for low-risk renal cell carcinoma (RCC), and the discovery of novel targeted treatments for metastatic disease have provided the rationale for expanding the indications for renal tumour biopsy. Percutaneous biopsy for diagnostic assessment of SRMs can avoid unnecessary surgeries and support treatment decisions, especially in patients at high surgical risk. Biopsies can confirm histologic success after thermal ablation of SRMs and support the selection of the appropriate systemic therapy for metastatic RCC. There is increasing evidence that further diagnostic and prognostic information can be obtained from renal tumour biopsies with the use of immunohistochemistry, cytogenetic and molecular analysis, and high-throughput gene expression profiling. CONCLUSIONS: Percutaneous biopsies have increasing indications and can significantly contribute to clinical management of renal tumours but are still underutilised in clinical practice. Further research is needed to define optimal and standardised patterns of biopsy and improve the accuracy of biopsies to determine tumour histology. Molecular and genetic analysis of biopsy specimens can provide additional information to support patient counselling and treatment decision making.

Authors
Volpe, A; Finelli, A; Gill, IS; Jewett, MAS; Martignoni, G; Polascik, TJ; Remzi, M; Uzzo, RG
MLA Citation
Volpe, A, Finelli, A, Gill, IS, Jewett, MAS, Martignoni, G, Polascik, TJ, Remzi, M, and Uzzo, RG. "Rationale for percutaneous biopsy and histologic characterisation of renal tumours." Eur Urol 62.3 (September 2012): 491-504. (Review)
PMID
22633318
Source
pubmed
Published In
European Urology
Volume
62
Issue
3
Publish Date
2012
Start Page
491
End Page
504
DOI
10.1016/j.eururo.2012.05.009

Predicting biopsy-proven prostate cancer recurrence following cryosurgery.

OBJECTIVES: Prostate cancer (CaP) cryosurgery utilizes PSA nadir level and radiotherapy criteria as surrogates for success. We attempted to correlate PSA doubling time (PSAdt) and time of undetectable PSA (TUPSA) with biopsy-proven cancer recurrence (BPR) in men treated with primary third-generation cryotherapy for clinically localized CaP. MATERIALS AND METHODS: Demographic, clinical, and pathologic data was retrieved including age, race, use of preoperative hormones or 5-α reductase inhibitors (5-ARIs), initial biopsy PSA, biopsy Gleason score, cT stage, prostate volume, presence/absence median lobe, and follow-up. Post-cryotherapy biopsy was considered for PSA levels ≥ 0.5 ng/ml. PSAdt was determined by the log-slope method. TUPSA was defined as time from surgery to a PSA value ≥ 0.2 ng/ml or most recent follow-up if undetectable. RESULTS: Ninety-seven patients were identified. Preoperative hormonal manipulation was used in 25 (26%); 5 (5%) were using a 5-ARI. Twenty-seven (29%) underwent post-cryotherapy biopsy, 12 (12%) had a BPR. In 41 (42%), PSAdt was calculated (median 11.9 months, IQR 6.6-34.8); no significant difference between patients with BPR and without CaP was found (P = 0.46). TUPSA was a median of 4.9 months (IQR 3.2-9.9) vs. 15.6 months (IQR 6.1-30.3) for BPR or no CaP, respectively (P = 0.005). On proportional hazards regression, TUPSA was the only independent predictor of BPR (P = 0.03, OR 0.91). CONCLUSIONS: Post-cryosurgery PSAdt does not appear to be associated with BPR risk, whereas TUPSA reduces the risk of BPR by 9% per month. This may help guide management if local failure is suspected.

Authors
Caso, JR; Tsivian, M; Mouraviev, V; Polascik, TJ
MLA Citation
Caso, JR, Tsivian, M, Mouraviev, V, and Polascik, TJ. "Predicting biopsy-proven prostate cancer recurrence following cryosurgery." Urol Oncol 30.4 (July 2012): 391-395.
PMID
20826095
Source
pubmed
Published In
Urologic Oncology: seminars and original investigations
Volume
30
Issue
4
Publish Date
2012
Start Page
391
End Page
395
DOI
10.1016/j.urolonc.2010.04.001

Characteristics and outcomes of tumors arising from the distal nephron.

OBJECTIVE: To compare the characteristics and predictors of cancer-specific survival (CSS) of 2 rare distal nephron tumors--medullary renal cell carcinoma (MRCC) and collecting duct carcinoma (CDC). METHODS: All cases of histologically verified MRCC and CDC reported to The Surveillance, Epidemiology and End Results (SEER) database between 1995 and 2007 were considered. A number of characteristics were compared by tumor histology. Subset analyses were performed for metastatic patients and those managed surgically. CSS was analyzed using Cox proportional hazard models. RESULTS: Overall, 21 cases of MRCC and 227 cases of CDC met the criteria for analysis. Patients with MRCC were younger (median 24 vs 63 years, P < .001), more often black (71.4% vs 22.7%, P < .001), metastatic at presentation (71.4% vs 27.8%, P < .001), and less likely to undergo surgery (61.9% vs 85.6%, P = .015) compared with patients with CDC. Tumor size was similar between MRCC and CDC (median 6 vs 5 cm, P = .70). Median survival was 5 months for MRCC and 30 months for CDC (P < .001). In metastatic MRCC and CDC patients, surgery predicted CSS (HR 4.61 and 2.24, both P ≤.05) despite having larger primary tumors than those managed nonsurgically (median 7.5 vs 5.0 cm, P < .01). CONCLUSION: Patients with MRCC present younger, at a later stage, and are more often black than patients with CDC. The stage migration toward localized kidney cancer is not apparent for these tumors. Although both cancers have a poor prognosis, the clinical and survival characteristics are distinct. Patients selected for cytoreductive surgery have improved survival.

Authors
Abern, MR; Tsivian, M; Polascik, TJ; Coogan, CL
MLA Citation
Abern, MR, Tsivian, M, Polascik, TJ, and Coogan, CL. "Characteristics and outcomes of tumors arising from the distal nephron." Urology 80.1 (July 2012): 140-146.
PMID
22626576
Source
pubmed
Published In
Urology
Volume
80
Issue
1
Publish Date
2012
Start Page
140
End Page
146
DOI
10.1016/j.urology.2012.03.034

Transatlantic Consensus Group on active surveillance and focal therapy for prostate cancer.

UNLABELLED: What's known on the subject? and What does the study add? Active surveillance for prostate cancer is gaining increasing acceptance for low risk prostate cancer. Focal therapy is an emerging tissue preservation strategy that aims for treat only areas of cancer. Early phase trials have shown that side-effects can be significantly reduced using focal therapy. There is significant uncertainty in both active surveillance and focal therapy. This consensus group paper provides a road-map for clinical practice and research for both tissue-preserving strategies in the areas of patient population, tools for risk stratification and cancer localisation, treatment interventions as well as comparators and outcome measures in future comparative trials. OBJECTIVE: To reach consensus on key issues for clinical practice and future research in active surveillance and focal therapy in managing localized prostate cancer. PATIENTS AND METHODS: A group of expert urologists, oncologists, radiologists, pathologists and computer scientists from North America and Europe met to discuss issues in patient population, interventions, comparators and outcome measures to use in both tissue-preserving strategies of active surveillance and focal therapy. Break-out sessions were formed to provide agreement or highlight areas of disagreement on individual topics which were then collated by a writing group into statements that formed the basis of this report and agreed upon by the whole Transatlantic Consensus Group. RESULTS: The Transatlantic group propose that emerging diagnostic tools such as precision imaging and transperineal prostate mapping biopsy can improve prostate cancer care. These tools should be integrated into prostate cancer management and research so that better risk stratification and more effective treatment allocation can be applied. The group envisaged a process of care in which active surveillance, focal therapy, and radical treatments lie on a continuum of complementary therapies for men with a range of disease grades and burdens, rather than being applied in the mutually exclusive and competitive way they are now. CONCLUSION: The changing landscape of prostate cancer epidemiology requires the medical community to re-evaluate the entire prostate cancer diagnostic and treatment pathway in order to minimize harms resulting from over-diagnosis and over-treatment. Precise risk stratification at every point in this pathway is required alongside paradigm shifts in our thinking about what constitutes cancer in the prostate.

Authors
Ahmed, HU; Akin, O; Coleman, JA; Crane, S; Emberton, M; Goldenberg, L; Hricak, H; Kattan, MW; Kurhanewicz, J; Moore, CM; Parker, C; Polascik, TJ; Scardino, P; van As, N; Villers, A; Transatlantic Consensus Group on Active Surveillance and Focal Therapy for Prostate Cancer (appendix),
MLA Citation
Ahmed, HU, Akin, O, Coleman, JA, Crane, S, Emberton, M, Goldenberg, L, Hricak, H, Kattan, MW, Kurhanewicz, J, Moore, CM, Parker, C, Polascik, TJ, Scardino, P, van As, N, Villers, A, and Transatlantic Consensus Group on Active Surveillance and Focal Therapy for Prostate Cancer (appendix), . "Transatlantic Consensus Group on active surveillance and focal therapy for prostate cancer." BJU Int 109.11 (June 2012): 1636-1647.
PMID
22077593
Source
pubmed
Published In
Bju International
Volume
109
Issue
11
Publish Date
2012
Start Page
1636
End Page
1647
DOI
10.1111/j.1464-410X.2011.10633.x

Role of oxidative stress in a rat model of radiation-induced erectile dysfunction.

INTRODUCTION: Chronic oxidative stress is one of the major factors playing an important role in radiation-induced normal tissue injury. However, the role of oxidative stress in radiation-induced erectile dysfunction (ED) has not been fully investigated. Aims.  To investigate role of oxidative stress after prostate-confined irradiation in a rat model of radiation-induced ED. METHODS: Fifty-four young adult male rats (10-12 weeks of age) were divided into age-matched sham radiotherapy (RT) and RT groups. Irradiated animals received prostate-confined radiation in a single 20 Gy fraction. MAIN OUTCOME MEASURES: Intracavernous pressure (ICP) measurements with cavernous nerve electrical stimulation were conducted at 2, 4, and 9 weeks following RT. The protein expression of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunits (Nox4 and gp91(phox)), markers of oxidative DNA damage (8-hydroxy-2'-deoxyguanosine [8-OHdG]), lipid peroxidation (4-hydroxynonenal [4HNE]), and inflammatory response including inducible nitric oxide synthase, macrophage activation (ED-1), and nitrotyrosine, and endogenous antioxidant defense by nuclear factor erythroid 2-related factor (Nrf2) were evaluated in irradiated prostate tissue and corpora cavernosa (CC). In addition, we investigated the relationships between results of ICP/mean arterial pressure (MAP) ratios and expression level of oxidative stress markers. RESULTS: In the RT group, hemodynamic functional studies demonstrated a significant time-dependent decrease in ICP. Increased expression of Nox4, gp91(phox), 8-OHdG, and 4HNE were observed in the prostate and CC after RT. Similarly, expressions of inflammatory markers were significantly increased. There was a trend for increased Nrf2 after 4 weeks. ICP/MAP ratio negatively correlated with higher expression level of oxidative markers. CONCLUSION: NADPH oxidase activation and chronic oxidative stress were observed in irradiated prostate tissue and CC, which correlated with lower ICP/MAP ratio. Persistent inflammatory responses were also found in both tissues after RT. These findings suggest that oxidative stress plays a crucial role in the development of radiation-induced ED.

Authors
Kimura, M; Rabbani, ZN; Zodda, AR; Yan, H; Jackson, IL; Polascik, TJ; Donatucci, CF; Moul, JW; Vujaskovic, Z; Koontz, BF
MLA Citation
Kimura, M, Rabbani, ZN, Zodda, AR, Yan, H, Jackson, IL, Polascik, TJ, Donatucci, CF, Moul, JW, Vujaskovic, Z, and Koontz, BF. "Role of oxidative stress in a rat model of radiation-induced erectile dysfunction." J Sex Med 9.6 (June 2012): 1535-1549.
PMID
22489731
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
9
Issue
6
Publish Date
2012
Start Page
1535
End Page
1549
DOI
10.1111/j.1743-6109.2012.02716.x

Prostate cancer treatment unblinded.

Authors
Tsivian, M; Abern, MR; Polascik, TJ
MLA Citation
Tsivian, M, Abern, MR, and Polascik, TJ. "Prostate cancer treatment unblinded." Lancet Oncol 13.6 (June 2012): 567-568.
PMID
22512845
Source
pubmed
Published In
The Lancet Oncology
Volume
13
Issue
6
Publish Date
2012
Start Page
567
End Page
568
DOI
10.1016/S1470-2045(12)70136-5

The number of high-risk factors and the risk of prostate cancer-specific mortality after brachytherapy: implications for treatment selection.

PURPOSE: To determine whether an increasing number of high-risk factors is associated with higher prostate cancer-specific mortality (PCSM) among men treated with brachytherapy (BT)-based treatment, and whether supplemental therapy has an impact on this risk. METHODS AND MATERIALS: We analyzed the cases of 2234 men with localized prostate cancer treated between 1991 and 2007 with low-dose rate BT monotherapy (n = 457) or BT with supplemental external-beam radiotherapy (EBRT, n = 229), androgen suppression therapy (AST, n = 424), or both (n = 1124). All men had at least one high-risk factor (prostate-specific antigen >20 ng/mL, biopsy Gleason score 8-10, or clinical stage ≥T2c). Competing-risks multivariable regressions were performed to determine whether the presence of at least two high-risk factors was associated with an increased risk of PCSM, with adjustment for age, comorbidity, and the type of supplemental treatment. RESULTS: The median follow-up time was 4.3 years. The number of men with at least two high-risk factors was highest in the group treated with BT, EBRT, and AST (21%), followed by BT plus EBRT or AST (13%), and BT alone (8%) (p(trend) < 0.001). The adjusted hazard ratio (AHR) for PCSM for those with at least two high-risk factors (as compared with one) was 4.8 (95% confidence interval [CI], 2.8-8.0; p < 0.001). The use of both supplemental EBRT and AST was associated with a decreased risk of PCSM (AHR 0.5; 95% CI, 0.2-0.9; p = 0.03) compared with BT alone. When the high-risk factors were analyzed separately, Gleason score 8-10 was most significantly associated with increased PCSM (AHR 6.2; 95% CI, 3.5-11.2; p < 0.001). CONCLUSIONS: Men with high-risk prostate adenocarcinoma treated with BT have decreased PCSM if they receive trimodailty therapy that includes EBRT and AST. This benefit is likely most important in men with multiple determinants of high risk.

Authors
Wattson, DA; Chen, M-H; Moran, BJ; Dosoretz, DE; Braccioforte, MH; Salenius, SA; D'Amico, AV
MLA Citation
Wattson, DA, Chen, M-H, Moran, BJ, Dosoretz, DE, Braccioforte, MH, Salenius, SA, and D'Amico, AV. "The number of high-risk factors and the risk of prostate cancer-specific mortality after brachytherapy: implications for treatment selection." Int J Radiat Oncol Biol Phys 82.5 (April 1, 2012): e773-e779.
PMID
22300573
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
5
Publish Date
2012
Start Page
e773
End Page
e779
DOI
10.1016/j.ijrobp.2011.11.023

Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure?

BACKGROUND AND PURPOSE: Renal cryoablation has gained popularity as a treatment option for localized renal masses. Treatment success is typically defined by the absence of contrast enhancement on follow-up imaging. We investigate the evolution of lesions that demonstrate contrast enhancement on CT after renal cryoablation. PATIENTS AND METHODS: Retrospective review of records of laparoscopic and percutaneous cryoablation (LCA and PCA) was performed, identifying records with postoperative radiographic enhancement. Imaging studies were reviewed and radiographic (pre- and post-contrast Hounsfield units, pattern and location of enhancement) and clinical data including follow up were collected. RESULTS: One hundred and seventy-two cryoablation procedures were analyzed. Of these, 30 (17.4%) showed enhancement on follow-up CT. In 28 cases, contrast enhancement was demonstrated on the first postoperative study. Seven patients underwent salvage treatments. Spontaneous resolution of enhancement was noted in 17 (56.7%) cases. No association was found between enhancement pattern (diffuse/nodular/rim) and resolution. Of lesions enhancing >35 HU, only 14.3% resolved spontaneously. Delayed enhancement (after negative imaging studies) occurred in two patients; both underwent salvage treatments. CONCLUSIONS: Most of the time, contrast-enhancements after cryoablation are evident on the first follow-up imaging study. More than 50% of these resolve spontaneously, and only one of four patients need salvage treatment. Delayed appearance of enhancement after previously negative imaging and highly enhancing lesions (>35 HU) are unlikely to resolve and should be considered suspicious for local recurrence or incomplete ablation. Further investigation is warranted to reach a consensus on a radiographic definition of local recurrence after renal cryoablation.

Authors
Tsivian, M; Kim, CY; Caso, JR; Rosenberg, MD; Nelson, RC; Polascik, TJ
MLA Citation
Tsivian, M, Kim, CY, Caso, JR, Rosenberg, MD, Nelson, RC, and Polascik, TJ. "Contrast enhancement on computed tomography after renal cryoablation: an evidence of treatment failure?." J Endourol 26.4 (April 2012): 330-335.
PMID
22070179
Source
pubmed
Published In
Journal of Endourology
Volume
26
Issue
4
Publish Date
2012
Start Page
330
End Page
335
DOI
10.1089/end.2011.0337

Focal therapy of prostate cancer: evidence-based analysis for modern selection criteria.

Focal therapy for prostate cancer has been increasingly utilized with the goal of effective disease control while maximizing patient functional outcomes. The optimal patient selection criteria are not known and therefore are not standardized. This review compares the available expert panel consensus guidelines with the selection criteria utilized in recently published focal therapy trials. Because the data from focal trials are still maturing, the currently enrolling clinical trials are reviewed as well. In addition, the recent literature regarding technological advances in prostate biopsy and imaging strategies are added to the current guidelines to recommend a rationale for patient selection.

Authors
Abern, MR; Tsivian, M; Polascik, TJ
MLA Citation
Abern, MR, Tsivian, M, and Polascik, TJ. "Focal therapy of prostate cancer: evidence-based analysis for modern selection criteria." Curr Urol Rep 13.2 (April 2012): 160-169. (Review)
PMID
22298223
Source
pubmed
Published In
Current Urology Reports
Volume
13
Issue
2
Publish Date
2012
Start Page
160
End Page
169
DOI
10.1007/s11934-012-0241-5

Association between preoperative erectile dysfunction and prostate cancer features--an analysis from the Duke Prostate Center Database.

INTRODUCTION: Erectile dysfunction (ED) is related to several co-morbidities including obesity, metabolic syndrome, cigarette smoking, and low testosterone, all of which have been reported to be associated with adverse prostate cancer features. AIM: To examine whether preoperative ED has a relationship with adverse prostate cancer features in patients who underwent radical prostatectomy (RP). METHODS: We analyzed data from our institution on 676 patients who underwent RP between 2001 and 2010. Crude and adjusted logistic regression models were used to investigate the association between preoperative ED and several pathological parameters. The log-rank test and multivariate proportional hazards model were conducted to determine the association of preoperative ED with biochemical recurrence (BCR). MAIN OUTCOME MEASURES: The expanded prostate cancer index composite (EPIC) instrument was used to evaluate preoperative erectile function (EF). Preoperative normal EF was defined as EPIC-SF ≥ 60 points while ED was defined as preoperative EPIC-SF lower than 60 points. RESULTS: Preoperatively, a total of 343 (50.7%) men had normal EF and 333 (49.3%) men had ED. After adjusting for covariates, preoperative ED was identified a risk factor for positive extracapsular extension (OR 1.57; P = 0.029) and high percentage of tumor involvement (OR 1.56; P = 0.047). In a Kaplan-Meier curve, a trend was identified that patients with ED had higher incidence of BCR than men with normal EF (P = 0.091). Moreover, using a multivariate Cox model, higher preoperative EF was negatively associated with BCR (HR 0.99; P = 0.014). CONCLUSIONS: These results suggest that the likelihood for adverse pathological outcomes as well as BCR following prostatectomy is higher among men with preoperative ED, though these results require validation in larger datasets. The present study indicates that preoperative ED might be a surrogate for adverse prostate cancer outcomes following RP.

Authors
Kimura, M; Bañez, LL; Gerber, L; Qi, J; Tsivian, M; Freedland, SJ; Satoh, T; Polascik, TJ; Baba, S; Moul, JW
MLA Citation
Kimura, M, Bañez, LL, Gerber, L, Qi, J, Tsivian, M, Freedland, SJ, Satoh, T, Polascik, TJ, Baba, S, and Moul, JW. "Association between preoperative erectile dysfunction and prostate cancer features--an analysis from the Duke Prostate Center Database." J Sex Med 9.4 (April 2012): 1174-1181.
PMID
22188861
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
9
Issue
4
Publish Date
2012
Start Page
1174
End Page
1181
DOI
10.1111/j.1743-6109.2011.02547.x

111-In-capromab pendetide imaging using hybrid-γ camera-computer tomography technology is not reliable in detecting seminal vesicle invasion in patients with prostate cancer.

OBJECTIVES: In this study, we evaluate the diagnostic utility of a hybrid γ-camera-computer tomography (SPECT-CT) indium-111 (111-In)-capromab pendetide scan in detecting seminal vesicle invasion (SVI) in select patients evaluated for primary surgical treatment of prostate cancer (CaP). METHODS AND MATERIALS: We retrospectively analyzed a prospective database of patients who underwent preoperative SPECT-CT imaging with 111-In-capromab-pendetide as part of a staging evaluation who were subsequently treated with radical surgery in our center. Only patients with clinically localized disease were included. We calculated diagnostic properties of the hybrid scan in detecting SVI compared with final pathology. Regression analyses were performed, including scan and preoperative variables to predict SVI. RESULTS: We retrieved 50 medical records matching our criteria. Median patient age was 61 years (range 45-74). Most patients had a clinical T1c CaP and biopsy Gleason score of 7 or higher. On final pathology, SVI was found in 12 (24%) specimens and radiotracer signal in the seminal vesicle region was reported in 15 (30%) imaging studies. Hybrid SPECT-CT imaging had a sensitivity of 25%, specificity of 61.9%, positive and negative predictive values of 20% and 74.3%, respectively, for detecting SVI. SPECT-CT results did not contribute significantly to SVI prediction on univariate (P = 0.627) or multivariate (P = 0.754) analyses. CONCLUSIONS: SPECT-CT imaging with 111-In-capromab-pendetide is not reliable in detecting or excluding SVI in this select cohort. High rates of positive radiotracer signals from healthy seminal vesicles raise concerns regarding pharmacologic properties of this radiotracer molecule.

Authors
Tsivian, M; Wright, T; Price, M; Mouraviev, V; Madden, JF; Kimura, M; Wong, T; Polascik, TJ
MLA Citation
Tsivian, M, Wright, T, Price, M, Mouraviev, V, Madden, JF, Kimura, M, Wong, T, and Polascik, TJ. "111-In-capromab pendetide imaging using hybrid-γ camera-computer tomography technology is not reliable in detecting seminal vesicle invasion in patients with prostate cancer." Urol Oncol 30.2 (March 2012): 150-154.
PMID
20189846
Source
pubmed
Published In
Urologic Oncology: seminars and original investigations
Volume
30
Issue
2
Publish Date
2012
Start Page
150
End Page
154
DOI
10.1016/j.urolonc.2009.12.005

Complications and postoperative events after cryosurgery for prostate cancer.

OBJECTIVES: There has been a call in the urological literature for standardized reporting of complications. To use strict criteria aiming to report our complications and other postoperative events in a cohort of men undergoing third-generation prostate cryosurgery. PATIENTS AND METHODS: Demographic, clinical and pathological data were collected on men undergoing primary cryosurgery from 2002-2010, excluding those who had received neoadjuvant or adjuvant radiotherapy. Complications and events were broadly defined as any deviation from the expected postoperative course and any subjective complaint expressed during a follow-up visit. Descriptive statistics were generated and compared between groups using chi-squared and rank sum tests as appropriate. Logistic regression analyses were performed to assess the potential predictors of any complication or event. RESULTS: In total, 106 consecutive patients were identified.   There were no intra-operative complications or instances of equipment failure. We observed 42 early complications, with 48 delayed and 10 late postoperative events. A total of five (4.7%) patients had persistent urge and/or stress incontinence. Thirty-one patients had International Prostate Symptom Score (IPSS) and bother index scores available before and after surgery; median scores decreased from 7 and 2 to 6 and 1, for IPSS and bother index, respectively. Twenty-four patients had Sexual Health Inventory for Men scores available before surgery and at 2-year follow-up; median scores decreased from 11 to 2. On multivariate analysis, there were no significant associations. CONCLUSIONS: Modern cryosurgery is safe, and most of the complications and postoperative events are transient. Erectile function, however, has marked deterioration. We were unable to identify significant risk factors for complications or postoperative events.

Authors
Caso, JR; Tsivian, M; Mouraviev, V; Kimura, M; Polascik, TJ
MLA Citation
Caso, JR, Tsivian, M, Mouraviev, V, Kimura, M, and Polascik, TJ. "Complications and postoperative events after cryosurgery for prostate cancer." BJU Int 109.6 (March 2012): 840-845.
PMID
21883827
Source
pubmed
Published In
Bju International
Volume
109
Issue
6
Publish Date
2012
Start Page
840
End Page
845
DOI
10.1111/j.1464-410X.2011.10423.x

Vitamin D(3) cryosensitization increases prostate cancer susceptibility to cryoablation via mitochondrial-mediated apoptosis and necrosis.

OBJECTIVES: To investigate the effect and molecular mechanisms of action of Vitamin D(3) (VD(3) ) as a neo-adjunctive agent before cryosurgery in an effort to increase treatment efficacy for prostate cancer (CaP). To eliminate the potential for disease recurrence that exists at the periphery of the freeze lesion, where temperatures may be insufficient to destroy both androgen-sensitive (AS) and androgen-insensitive (AI) CaP. METHODS: Human CaP cells, LNCaP, were each genetically altered to express the AS and AI phenotypes and subjected to VD(3) treatment and freezing in an in vitro and tissue-engineered model. Cell viability, caspase inhibitor and western blot studies were used to determine the basis of the different responses of AI and AS cells to VD(3) cryosensitization. RESULTS: VD(3) was found to be a highly effective cryosensitizer, resulting in a >50% overall increase in cell death after -15 °C freezing. Fluorescence microscopy, western blot analysis and caspase protease assays confirmed that the increased activation of apoptosis was modulated through a mitochondrial-mediated pathway. Caspase inhibition studies showed that apoptosis played an integral role in cell death, with VD(3) cryosensitivation-induced apoptotic events responsible for >30% of the overall cell death after -15 °C freezing. CONCLUSIONS: The present study suggests that the use of VD(3) as a cryosensitizer increases cryoablation efficacy through the increased activity of apoptosis as well as through necrosis. The data show that through VD(3) treatment the overall level of AI CaP cell tolerance to freezing is reduced to a level similar to that of AS CaP. VD(3) pre-treatment in conjunction with cryoablation may increase treatment efficacy and reduce disease recurrence for CaP patients.

Authors
Baust, JM; Klossner, DP; Robilotto, A; Vanbuskirk, RG; Gage, AA; Mouraviev, V; Polascik, TJ; Baust, JG
MLA Citation
Baust, JM, Klossner, DP, Robilotto, A, Vanbuskirk, RG, Gage, AA, Mouraviev, V, Polascik, TJ, and Baust, JG. "Vitamin D(3) cryosensitization increases prostate cancer susceptibility to cryoablation via mitochondrial-mediated apoptosis and necrosis." BJU Int 109.6 (March 2012): 949-958.
PMID
21883825
Source
pubmed
Published In
Bju International
Volume
109
Issue
6
Publish Date
2012
Start Page
949
End Page
958
DOI
10.1111/j.1464-410X.2011.10408.x

Cryotherapy of the Prostate

Cryosurgery represents a recognized option for the treatment of prostate cancer. Herein we discuss the principles of cryobiology and their implications in modern cryosurgery, review the indications for primary and salvage cryotherapy, as well as summarize perioperative, functional, and oncologic outcomes of the procedure. In the primary setting cryoablation achieves biochemical disease-free survival (bDFS) rates as high as 89.9%, whereas in the salvage setting long-term data show a consistent bDFS rate of over 50%. Cryosurgery is a minimally invasive procedure and complications are typically minor and transient in both the primary and salvage settings. Future developments involve targeted focal therapy whereby healthy prostate tissue is spared with potential reduced morbidity and better preservation of quality of life. © 2012 Blackwell Publishing Ltd.

Authors
Tsivian, M; Polascik, TJ
MLA Citation
Tsivian, M, and Polascik, TJ. "Cryotherapy of the Prostate." Smith's Textbook of Endourology: 3rd Edition. January 5, 2012. 1406-1415.
Source
scopus
Volume
2
Publish Date
2012
Start Page
1406
End Page
1415
DOI
10.1002/9781444345148.ch116

Cryotherapy

© Springer-Verlag Berlin Heidelberg 2012.Cryotherapy is a recognized treatment option for prostate cancer both in the primary and salvage settings. Herein, we summarize the current knowledge on cryotherapy for prostate cancer including elements of cryobiology, complications, and oncological outcomes of primary and salvage cryoablation of the prostate. Cryotherapy in the primary setting appears to have a low morbidity profile with most complications being transient and self-limiting. In the salvage setting, the rates of some adverse events are higher than in the primary setting but compare favorably with alternative salvage treatments. Biochemical disease-free outcomes remain challenging to summarize for both primary and salvage cryoablation due to widespread variability in the definitions used. However, as long-term outcomes (cancer-specific, metastasis-free, and overall survival) begin to mature, promising results emerge. Yet, there is significant work to be done to standardize the definitions, candidate selection criteria, and refine the outcome measures. Cryotherapy for prostate cancer is an established technique, supported by favorable results, but in need for further high-quality data.

Authors
Tsivian, M; Polascik, TJ
MLA Citation
Tsivian, M, and Polascik, TJ. "Cryotherapy." Management of Prostate Cancer: A Multidisciplinary Approach. January 1, 2012. 213-223.
Source
scopus
Publish Date
2012
Start Page
213
End Page
223
DOI
10.1007/978-3-642-27597-5_16

Biopsy accuracy in identifying unilateral prostate cancer depends on prostate weight.

OBJECTIVE: To evaluate the association between prostate weight and the diagnostic performance of routine biopsy schemes in detecting unilateral prostate cancer (PCa) that may be amenable to focal therapy. METHODS AND MATERIALS: Retrospective analysis of patients undergoing radical prostatectomy at Duke University Medical Center from 1990 to 2007. The cohort was dichotomized according to prostate weight (≤40 and >40 g) and further divided by biopsy scheme: 6-9 (sextant) and 10-20 cores (extended). Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were calculated within each prostate weight group and compared between biopsy schemes. RESULTS: A total of 859 patients were included in the study. Patients with prostates >40 g were generally older and had higher PSA levels (P < 0.0001 and P = 0.036, respectively). Unilateral disease was more common in prostates >40 g both on biopsy (69% vs. 60%, P = 0.009) and on final pathology (21% vs. 14%, P = 0.017) despite larger total tumor volume (6.1 vs. 4.8 cc, P < 0.001). Low grade PCa was also more common in larger glands (P = 0.003). Overall, extended biopsy schemes performed better than sextant but the benefit was statistically significant only in prostates >40 g. CONCLUSIONS: Despite having higher tumor volumes, men with prostate weight >40 g were more likely to have unilateral PCa than those with smaller prostates. In prostates >40 g, increasing the number of cores harvested at biopsy increased the diagnostic performance for detecting cancer laterality. Therefore, our results suggest that the benefit of more extensive tissue sampling may be higher in larger prostates compared with smaller ones when selecting candidates for prostate hemiablation.

Authors
Tsivian, M; Moreira, DM; Sun, L; Mouraviev, V; Kimura, M; Moul, JW; Polascik, TJ
MLA Citation
Tsivian, M, Moreira, DM, Sun, L, Mouraviev, V, Kimura, M, Moul, JW, and Polascik, TJ. "Biopsy accuracy in identifying unilateral prostate cancer depends on prostate weight." Urol Oncol 30.1 (January 2012): 21-25.
PMID
20056457
Source
pubmed
Published In
Urologic Oncology: seminars and original investigations
Volume
30
Issue
1
Publish Date
2012
Start Page
21
End Page
25
DOI
10.1016/j.urolonc.2009.11.001

Acoustic radiation force impulse imaging of human prostates: initial in vivo demonstration.

Reliably detecting prostate cancer (PCa) has been a challenge for current imaging modalities. Acoustic radiation force impulse (ARFI) imaging is an elasticity imaging method that uses remotely generated, focused acoustic beams to probe tissue stiffness. A previous study on excised human prostates demonstrated ARFI images portray various prostatic structures and has the potential to guide prostate needle biopsy with improved sampling accuracy. The goal of this study is to demonstrate the feasibility of ARFI imaging to portray internal structures and PCa in the human prostate in vivo. Custom ARFI imaging sequences were designed and implemented using a modified Siemens Antares™ scanner with a three-dimensional (3-D) wobbler, end-firing, trans-cavity transducer, EV9F4. Nineteen patients were consented and imaged immediately preceding surgical prostatectomy. Pathologies and anatomic structures were identified in histologic slides by a pathologist blinded to ARFI data and were then registered with structures found in ARFI images. The results demonstrated that when PCa is visible, it generally appears as bilaterally asymmetric stiff structures; benign prostatic hyperplasia (BPH) appears heterogeneous with a nodular texture; the verumontanum and ejaculatory ducts appears softer compared with surrounding tissue, which form a unique 'V' shape; and the boundary of the transitional zone (TZ) forms a stiff rim separating the TZ from the peripheral zone (PZ). These characteristic appearances of prostatic structures are consistent with those found in our previous study of prostate ARFI imaging on excised human prostates. Compared with the matched B-mode images, ARFI images, in general, portray prostate structures with higher contrast. With the end-firing transducer used for this study, ARFI depth penetration was limited to 22 mm. Image contrast and resolution were decreased as compared with the previous ex vivo study due to the small transducer aperture. Even with these limitations, this study suggests ARFI imaging holds promise for guidance of targeted prostate needle biopsy and focal therapy, as well as aiding assessment of changes during watchful waiting/active surveillance.

Authors
Zhai, L; Polascik, TJ; Foo, W-C; Rosenzweig, S; Palmeri, ML; Madden, J; Nightingale, KR
MLA Citation
Zhai, L, Polascik, TJ, Foo, W-C, Rosenzweig, S, Palmeri, ML, Madden, J, and Nightingale, KR. "Acoustic radiation force impulse imaging of human prostates: initial in vivo demonstration." Ultrasound Med Biol 38.1 (January 2012): 50-61.
PMID
22104533
Source
pubmed
Published In
Ultrasound in Medicine and Biology
Volume
38
Issue
1
Publish Date
2012
Start Page
50
End Page
61
DOI
10.1016/j.ultrasmedbio.2011.10.002

The effect of noise-cancelling headphones or music on pain perception and anxiety in men undergoing transrectal prostate biopsy.

OBJECTIVE: To assess the effect of noise-cancelling headphones with or without music on patient pain and anxiety associated with routine, office-based transrectal ultrasound (TRUS)-guided prostate biopsy in a prospective randomized study. METHODS: Patients scheduled for prostate biopsy as a result of elevated prostate-specific antigen and/or abnormal digital rectal examination were prospectively enrolled and randomized into a control, noise-cancelling headphones, or music-headphones group. Patients completed pain and anxiety questionnaires and had their physiological parameters assessed before and after the procedure and compared across groups. RESULTS: Eighty-eight patients were enrolled. Pain scores increased from baseline across all study groups, with the lowest mean score in the music group. No appreciable change was noted in anxiety scores after the procedure between groups (P>.05). Although postbiopsy systolic blood pressure values remained comparable with baseline levels in all groups, postbiopsy diastolic blood pressure increased in the control and headphones groups (P=.062 and .088, respectively) but remained stable in the music group (P=.552) after biopsy, indicating lesser physiological response to anxiety and pain in this group. CONCLUSION: Music-induced attention shift during prostate biopsy may have a beneficial impact on procedural anxiety and pain perception, but no apparent effect was noted for use of headphones alone. Further studies are necessary to explore strategies to reduce perceived anxiety and pain in men undergoing prostate biopsy.

Authors
Tsivian, M; Qi, P; Kimura, M; Chen, VH; Chen, SH; Gan, TJ; Polascik, TJ
MLA Citation
Tsivian, M, Qi, P, Kimura, M, Chen, VH, Chen, SH, Gan, TJ, and Polascik, TJ. "The effect of noise-cancelling headphones or music on pain perception and anxiety in men undergoing transrectal prostate biopsy." Urology 79.1 (January 2012): 32-36.
PMID
22202544
Source
pubmed
Published In
Urology
Volume
79
Issue
1
Publish Date
2012
Start Page
32
End Page
36
DOI
10.1016/j.urology.2011.09.037

Utilization trends at a multidisciplinary prostate cancer clinic: initial 5-year experience from the Duke Prostate Center.

PURPOSE: The multidisciplinary approach is becoming increasingly encouraged but little is known about the multidisciplinary experience compared to routine care. For patients with prostate cancer the goal is to provide evaluations by urologists, medical and radiation oncologists at a single visit. Although additional resources are required, this strategy may enhance the overall health care experience. We compared utilization determinants between a multidisciplinary and a urology prostate cancer clinic at Duke University Medical Center and identified factors associated with pursuing treatment at the university medical center for multidisciplinary clinic patients. MATERIALS AND METHODS: We retrospectively analyzed data on patients referred for primary prostate cancer treatment evaluation at Duke University Medical Center from 2005 to 2009. Comparisons between 701 multidisciplinary clinic and 1,318 urology prostate cancer clinic patients were examined with the rank sum and chi-square tests. Predictive factors for pursuing treatment at the university medical center were assessed using multivariate adjusted logistic regression. RESULTS: Compared to patients at the urology prostate cancer clinic those at the multidisciplinary clinic were more likely to be younger and white, have a higher income and travel a longer distance for evaluation. Of multidisciplinary clinic patients 58% pursued primary treatment at the university medical center. They were more likely to be younger, black and physician referred, have a lower income and reside closer to the medical center. Factors predictive of pursuing treatment at the medical center included high risk disease and physician referral. Factors predictive of not receiving care at the university medical center were income greater than $40,000 and a distance traveled of greater than 100 miles. CONCLUSIONS: A different patient demographic is using the multidisciplinary approach. However, when treatment is pursued at the institution providing multidisciplinary services, the patient demographic resembles that of the treating institution.

Authors
Stewart, SB; Bañez, LL; Robertson, CN; Freedland, SJ; Polascik, TJ; Xie, D; Koontz, BF; Vujaskovic, Z; Lee, WR; Armstrong, AJ; Febbo, PG; George, DJ; Moul, JW
MLA Citation
Stewart, SB, Bañez, LL, Robertson, CN, Freedland, SJ, Polascik, TJ, Xie, D, Koontz, BF, Vujaskovic, Z, Lee, WR, Armstrong, AJ, Febbo, PG, George, DJ, and Moul, JW. "Utilization trends at a multidisciplinary prostate cancer clinic: initial 5-year experience from the Duke Prostate Center." J Urol 187.1 (January 2012): 103-108.
PMID
22088334
Source
pubmed
Published In
The Journal of Urology
Volume
187
Issue
1
Publish Date
2012
Start Page
103
End Page
108
DOI
10.1016/j.juro.2011.09.040

Preoperative predictors of pathologic stage T2a in low-risk prostate cancer: implications for focal therapy.

OBJECTIVE: To assess preoperative parameters that may be predictive of pathologic stage T2a disease in low-risk prostate cancer patients. METHODS: Data from a cohort of 1,495 consecutive men with low-risk prostate cancer who underwent a radical prostatectomy between 1993 and 2009 were evaluated. Preoperative parameter assessment focused on age, race, clinical stage, diagnostic PSA level, biopsy tumor laterality and diagnostic Gleason score. Preoperative parameters were analyzed by univariate and multivariate methods. Kaplan-Meier method was used to evaluate the biochemical disease-free survival. RESULTS: Among the 1,495 men, 236 (15.8%) had pT2a disease. In univariate analysis, biopsy tumor unilaterality (p < 0.001), diagnostic PSA ≤ 4 ng/ml (p < 0.001) and non-African-American race (p = 0.009) were significant variables. In multivariate analysis, biopsy tumor laterality (OR 0.377; p < 0.001), diagnostic PSA ≤ 4 ng/ml (OR 0.621; p = 0.002) and race (OR 0.583; p = 0.029) were independent predictors. Low-risk patients with pT2a disease showed a better PSA recurrence-free survival rate, compared with men with >pT2a diseases (p = 0.012). CONCLUSIONS: Biopsy tumor unilaterality, diagnostic PSA ≤ 4 ng/ml and race are independent predictors of pT2a in low-risk prostate cancer. These three preclinical variables may be a useful reference to begin the selection process for focal therapy in men with low-risk prostate cancer.

Authors
Fu, Q; Moul, JW; Bañez, LL; Sun, L; Mouraviev, V; Xie, D; Polascik, TJ
MLA Citation
Fu, Q, Moul, JW, Bañez, LL, Sun, L, Mouraviev, V, Xie, D, and Polascik, TJ. "Preoperative predictors of pathologic stage T2a in low-risk prostate cancer: implications for focal therapy." Urol Int 89.3 (2012): 296-300.
PMID
22964539
Source
pubmed
Published In
Urologia internationalis
Volume
89
Issue
3
Publish Date
2012
Start Page
296
End Page
300
DOI
10.1159/000341556

Role of transrectal ultrasonography (TRUS) in focal therapy of prostate cancer: Report from a Consensus Panel

What's known on the subject? and What does the study add? Focal therapy techniques are emerging in prostate cancer treatment. However, several key questions about patient selection, treatment and monitoring still have to be addressed. The concept of focal therapy is barely discussed in current urological guidelines. In the present manuscript, we report the results of a consensus meeting focused on ultrasonography, the most common used urological imaging method, in relation to focal therapy of prostate cancer. To establish a consensus on the utility of ultrasonography (US) to select patients for focal therapy. Topics were the current status of US to determine focality of prostate cancer, to monitor and assess outcome of focal therapy and the diagnostic advantages of new US methods. In addition, the biopsy techniques required to identify focal lesions were discussed. Urological surgeons, radiation oncologists, radiologists, and basic researchers from Europe and North America participated in a consensus meeting on the use of transrectal US (TRUS) in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. TRUS is commonly used and essential for diagnosing men with prostate cancer. It is particularly useful for targeting specific anatomical regions or visible lesions. However, it has several limitations and there is a need for improvement. Newer visualisation techniques, e.g. colour Doppler US, contrast-enhanced US and elastography, are being developed but currently there is no US technique that can accurately characterise a cancer suitable for focal therapy. Systematic biopsy is the only known procedure that allows the identification of prostate cancers suitable for focal therapy. Scarce data exist about the role of US for monitoring patients during or after ablative therapy. Consensus was reached on all key aspects of the meeting. US cannot reliably identify focal prostate cancer. New US methods show promising results in identifying prostate cancer focality. Currently selecting appropriate candidates for focal therapy should be performed using dedicated protocols and biopsy schemes. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

Authors
Smeenge, M; Barentsz, J; Cosgrove, D; Rosette, JDL; Reijke, TD; Eggener, S; Frauscher, F; Kovacs, G; Matin, SF; Mischi, M; al, E
MLA Citation
Smeenge, M, Barentsz, J, Cosgrove, D, Rosette, JDL, Reijke, TD, Eggener, S, Frauscher, F, Kovacs, G, Matin, SF, Mischi, M, and al, E. "Role of transrectal ultrasonography (TRUS) in focal therapy of prostate cancer: Report from a Consensus Panel." BJU International (2012).
PMID
22462566
Source
scival
Published In
Bju International
Publish Date
2012
DOI
10.1111/j.1464-410X.2012.11072.x

Prostatic alpha-linolenic acid (ALA) is positively associated with aggressive prostate cancer: a relationship which may depend on genetic variation in ALA metabolism.

Previous observational studies have reported associations between prostate cancer and alpha-linolenic acid (ALA). However, few investigations have been able to study this relationship prospectively and in well-controlled settings. Moreover, no studies have determined whether single nucleotide polymorphisms (SNPs) that influence ALA metabolism are associated with this common cancer. The purpose of this study was to explore associations between prostatic levels of ALA, SNPs and prostate cancer-specific biomarkers in samples collected from a previous randomized clinical trial conducted using a presurgical model and which tested the effects of flaxseed supplementation, a rich source of ALA, prior to prostatectomy (n = 134). Serum prostate-specific antigen (PSA) was determined and immunohistochemistry was used to assess tumor proliferation rate (Ki67). Prostatic ALA was determined with gas chromatography. Seven previously identified SNPs associated with delta-6 desaturase activity (rs99780, rs174537, rs174545, rs174572, rs498793, rs3834458 and rs968567) were tested for associations with prostatic ALA, PSA and Ki67. Despite consuming seven times more ALA per day, men in the flaxseed arm had similar amounts of prostatic ALA relative to men not consuming flaxseed. In unadjusted analysis, there were significant positive associations between prostatic ALA and PSA (ρ = 0.191, p = 0.028) and Ki67 (ρ = 0.186, p = 0.037). After adjusting for covariates (flaxseed, age, race, BMI and statin-use) the association between ALA and PSA remained (p = 0.004) but was slightly attenuated for Ki67 (p = 0.051). We did not observe associations between any of the SNPs studied and prostatic ALA; however, in models for PSA there was a significant interaction between rs498793 and ALA and for Ki67 there were significant interactions with ALA and rs99780 and rs174545. Independent and inverse associations were observed between rs174572 and Ki67. This study provides evidence that prostatic ALA, independent of the amount of ALA consumed, is positively associated with biomarkers of aggressive prostate cancer and that genetic variation may modify this relationship.

Authors
Azrad, M; Zhang, K; Vollmer, RT; Madden, J; Polascik, TJ; Snyder, DC; Ruffin, MT; Moul, JW; Brenner, D; Hardy, RW; Demark-Wahnefried, W
MLA Citation
Azrad, M, Zhang, K, Vollmer, RT, Madden, J, Polascik, TJ, Snyder, DC, Ruffin, MT, Moul, JW, Brenner, D, Hardy, RW, and Demark-Wahnefried, W. "Prostatic alpha-linolenic acid (ALA) is positively associated with aggressive prostate cancer: a relationship which may depend on genetic variation in ALA metabolism." PLoS One 7.12 (2012): e53104-.
Website
http://hdl.handle.net/10161/11293
PMID
23285256
Source
pubmed
Published In
PloS one
Volume
7
Issue
12
Publish Date
2012
Start Page
e53104
DOI
10.1371/journal.pone.0053104

Role of transrectal ultrasonography (TRUS) in focal therapy of prostate cancer: Report from a Consensus Panel

What's known on the subject? and What does the study add? Focal therapy techniques are emerging in prostate cancer treatment. However, several key questions about patient selection, treatment and monitoring still have to be addressed. The concept of focal therapy is barely discussed in current urological guidelines. In the present manuscript, we report the results of a consensus meeting focused on ultrasonography, the most common used urological imaging method, in relation to focal therapy of prostate cancer. To establish a consensus on the utility of ultrasonography (US) to select patients for focal therapy. Topics were the current status of US to determine focality of prostate cancer, to monitor and assess outcome of focal therapy and the diagnostic advantages of new US methods. In addition, the biopsy techniques required to identify focal lesions were discussed. Urological surgeons, radiation oncologists, radiologists, and basic researchers from Europe and North America participated in a consensus meeting on the use of transrectal US (TRUS) in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. TRUS is commonly used and essential for diagnosing men with prostate cancer. It is particularly useful for targeting specific anatomical regions or visible lesions. However, it has several limitations and there is a need for improvement. Newer visualisation techniques, e.g. colour Doppler US, contrast-enhanced US and elastography, are being developed but currently there is no US technique that can accurately characterise a cancer suitable for focal therapy. Systematic biopsy is the only known procedure that allows the identification of prostate cancers suitable for focal therapy. Scarce data exist about the role of US for monitoring patients during or after ablative therapy. Consensus was reached on all key aspects of the meeting. US cannot reliably identify focal prostate cancer. New US methods show promising results in identifying prostate cancer focality. Currently selecting appropriate candidates for focal therapy should be performed using dedicated protocols and biopsy schemes. © 2012 BJU International.

Authors
Smeenge, M; Barentsz, J; Cosgrove, D; Rosette, JDL; Reijke, TD; Eggener, S; Frauscher, F; Kovacs, G; Matin, SF; Mischi, M; Pinto, P; Rastinehad, A; Rouviere, O; Salomon, G; Polascik, T; Walz, J; Wijkstra, H; Marberger, M
MLA Citation
Smeenge, M, Barentsz, J, Cosgrove, D, Rosette, JDL, Reijke, TD, Eggener, S, Frauscher, F, Kovacs, G, Matin, SF, Mischi, M, Pinto, P, Rastinehad, A, Rouviere, O, Salomon, G, Polascik, T, Walz, J, Wijkstra, H, and Marberger, M. "Role of transrectal ultrasonography (TRUS) in focal therapy of prostate cancer: Report from a Consensus Panel." BJU International 110.7 (2012): 942-948.
Source
scival
Published In
Bju International
Volume
110
Issue
7
Publish Date
2012
Start Page
942
End Page
948
DOI
10.1111/j.1464-410X.2012.11072.x

Comparison of concurrently acquired in vivo 3D ARFI and SWEI images of the prostate

In the prostate, ARFI and SWEI imaging methods have reported that cancer and other pathologies as being stiffer than the surrounding tissue. A three-dimensional in vivo prostatic imaging system capable of concurrently acquiring ARFI and SWEI data was developed to compare the information available in the two image types. Data were acquired in a calibrated CIRS phantom to analyze the contrast, contrast to noise ratio (CNR), and resolution between the ARFI and SWEI images; SWEI images provided improved contrast and CNR, but lower spatial resolution than ARFI images. Challenges and potential artifacts in both the ARFI and SWEI images have been identified and reduced by viewing coronal sections and maximum value SWEI images, resulting in high correlation between the normalized ARFI displacement magnitude and the estimated shear wave speed. We have demonstrated that this combined ARFI and SWEI imaging system can image the anatomy of the prostate. © 2012 IEEE.

Authors
Rosenzweig, S; Palmeri, M; Rouze, N; Lipman, S; Kulbacki, E; Madden, J; Polascik, T; Nightingale, K
MLA Citation
Rosenzweig, S, Palmeri, M, Rouze, N, Lipman, S, Kulbacki, E, Madden, J, Polascik, T, and Nightingale, K. "Comparison of concurrently acquired in vivo 3D ARFI and SWEI images of the prostate." 2012.
Source
scival
Published In
IEEE International Ultrasonics Symposium : [proceedings]. IEEE International Ultrasonics Symposium
Publish Date
2012
Start Page
97
End Page
100
DOI
10.1109/ULTSYM.2012.0024

Prostate cancer: ideal candidates for focal therapy.

Authors
Tsivian, M; Polascik, TJ
MLA Citation
Tsivian, M, and Polascik, TJ. "Prostate cancer: ideal candidates for focal therapy. (Published online)" Nat Rev Urol 9.1 (December 13, 2011): 12-13.
PMID
22158594
Source
pubmed
Published In
Nature Reviews Urology
Volume
9
Issue
1
Publish Date
2011
Start Page
12
End Page
13
DOI
10.1038/nrurol.2011.206

Histological Trends and the Index Lesion in Localized Prostate Cancer

Authors
Mouraviev, V; Wheeler, TM; Polascik, TJ
MLA Citation
Mouraviev, V, Wheeler, TM, and Polascik, TJ. "Histological Trends and the Index Lesion in Localized Prostate Cancer." Focal Therapy in Prostate Cancer. November 10, 2011. 17-28.
Source
scopus
Publish Date
2011
Start Page
17
End Page
28
DOI
10.1002/9781444346893.ch3

Mn-Porphyrins as Novel Molecular MRI Contrast Agents.

Introduction: In these experiments, we investigated a new class of therapeutic metalloporphyrins and their potential as molecular MR imaging probes for prostate cancer (PCa). Mn(III)TE-2-Pyp5+ (meso-tetrakis(N-ethyl-2-prydil)porphyrin) and Mn(III)TnHex-2-PYP5+ (meso-tetrakis(N-n-hexyl-2-pyridyl)porphyrin are powerful superoxide dismutase mimics with low toxicity and antineoplastic activity. Methods: MR imaging experiments were performed at 7.0T on a Bruker Biospec horizontal bore scanner. All in vivo experiments were performed on twelve C57 black mice implanted with RM-9 PCa cells on the hind-limb location. 10 mg/kg of MnTn-Hex-2-PyP (n=6) and 2 mg/kg MnTE-2-PyP (n=6) were administered intraperitoneally 60 and 120 minutes prior to imaging. All the images were collected using a volume coil and processed using Paravision 4.0. Results: Phantom studies reveal remarkably high T1 relaxivity changes for both hexyl and ethyl analogues, which are several-fold higher than commercially available gadolinium chelates. Observable detection limits were in the low micromolar range, 1-2 orders of magnitude lower than conventional chelates. In vivo, we readily observed MR relaxation changes in prostate tumor xenografts after a single injection of either ethyl and hexyl analogues, although T1 shortening was highest after hexyl administration. Conclusion: Following a single dose of Mn-Porphyrins, relaxation changes in prostate tumors measured 10-11 folds greater than in surrounding tissues, suggesting these probes may be particularly effective in imaging PCa foci in vivo.

Authors
Mouraviev, V; Kimura, M; Venkatraman, T; Tsivian, M; Mouravieva, V; Batinic Haberle, I; Polascik, TJ; Wang, H; Lascola, C
MLA Citation
Mouraviev, V, Kimura, M, Venkatraman, T, Tsivian, M, Mouravieva, V, Batinic Haberle, I, Polascik, TJ, Wang, H, and Lascola, C. "Mn-Porphyrins as Novel Molecular MRI Contrast Agents." Journal of endourology / Endourological Society (November 2011). (Academic Article)
PMID
22050509
Source
manual
Published In
Journal of Endourology
Publish Date
2011
DOI
10.1089/end.2011.0133

Treatment of localised renal cell carcinoma.

CONTEXT: The increasing incidence of localised renal cell carcinoma (RCC) over the last 3 decades and controversy over mortality rates have prompted reassessment of current treatment. OBJECTIVE: To critically review the recent data on the management of localised RCC to arrive at a general consensus. EVIDENCE ACQUISITION: A Medline search was performed from January 1, 2004, to May 3, 2011, using renal cell carcinoma, nephrectomy (Medical Subject Heading [MeSH] major topic), surgical procedures, minimally invasive (MeSH major topic), nephron-sparing surgery, cryoablation, radiofrequency ablation, surveillance, and watchful waiting. EVIDENCE SYNTHESIS: Initial active surveillance (AS) should be a first treatment option for small renal masses (SRMs) <4 cm in unfit patients or those with limited life expectancy. SRMs that show fast growth or reach 4 cm in diameter while on AS should be considered for treatment. Partial nephrectomy (PN) is the established treatment for T1a tumours (<4 cm) and an emerging standard treatment for T1b tumours (4-7 cm) provided that the operation is technically feasible and the tumour can be completely removed. Radical nephrectomy (RN) should be limited to those cases where the tumour is not amenable to nephron-sparing surgery (NSS). Laparoscopic radical nephrectomy (LRN) has benefits over open RN in terms of morbidity and should be the standard of care for T1 and T2 tumours, provided that it is performed in an advanced laparoscopic centre and NSS is not applicable. Open PN, not LRN, should be performed if minimally invasive expertise is not available. At this time, there is insufficient long-term data available to adequately compare ablative techniques with surgical options. Therefore ablative therapies should be reserved for carefully selected high surgical risk patients with SRMs <4 cm. CONCLUSIONS: The choice of treatment for the patient with localised RCC needs to be individualised. Preservation of renal function without compromising the oncologic outcome should be the most important goal in the decision-making process.

Authors
Van Poppel, H; Becker, F; Cadeddu, JA; Gill, IS; Janetschek, G; Jewett, MAS; Laguna, MP; Marberger, M; Montorsi, F; Polascik, TJ; Ukimura, O; Zhu, G
MLA Citation
Van Poppel, H, Becker, F, Cadeddu, JA, Gill, IS, Janetschek, G, Jewett, MAS, Laguna, MP, Marberger, M, Montorsi, F, Polascik, TJ, Ukimura, O, and Zhu, G. "Treatment of localised renal cell carcinoma." Eur Urol 60.4 (October 2011): 662-672. (Review)
PMID
21726933
Source
pubmed
Published In
European Urology
Volume
60
Issue
4
Publish Date
2011
Start Page
662
End Page
672
DOI
10.1016/j.eururo.2011.06.040

Understanding the pathological features of focality, grade and tumour volume of early-stage prostate cancer as a foundation for parenchyma-sparing prostate cancer therapies: active surveillance and focal targeted therapy.

OBJECTIVE: • To better understand the biology and incidence of the cancer foci within the prostate through a comprehensive literature review and a review of our own data, to establish the current level of knowledge regarding the pathological foundation for active surveillance (AS) or focal therapy (FT). PATIENTS AND METHODS: • A systematic review of the literature was performed, searching PubMed® from January 1994 to July 2009. • Electronic searches were limited to the English language using the keywords 'prostate cancer', 'histopathology', 'radical prostatectomy', 'pathological stage' and 'focal therapy'. • The authors' own data were also analysed and are presented. RESULTS: • Recent data have shown a significant pathological stage migration towards earlier disease comprising unilateral pT2a/b prostate cancer (PCa). • The cancer volume of the clinically significant tumour (index lesion) has been proposed as a driving force of PCa progression and therefore should be identified and treated at an early stage. • In general, most satellite lesions do not appear to be life-threatening. • Other pathological features, such as Gleason score, extraprostatic extension and the spatial distribution of PCa within the prostate, remain important selective criteria for AS or FT. CONCLUSION: • The present study reviews the current knowledge of cancer focality, aggression and tumour volume. Further research is needed to better understand the biologic behaviour of each of the tumour foci within a cancerous prostate, and to employ this information to selected patients for no therapy (AS), parenchyma-preserving approaches (FT) or whole gland radical therapy.

Authors
Mouraviev, V; Villers, A; Bostwick, DG; Wheeler, TM; Montironi, R; Polascik, TJ
MLA Citation
Mouraviev, V, Villers, A, Bostwick, DG, Wheeler, TM, Montironi, R, and Polascik, TJ. "Understanding the pathological features of focality, grade and tumour volume of early-stage prostate cancer as a foundation for parenchyma-sparing prostate cancer therapies: active surveillance and focal targeted therapy." BJU Int 108.7 (October 2011): 1074-1085. (Review)
PMID
21489116
Source
pubmed
Published In
Bju International
Volume
108
Issue
7
Publish Date
2011
Start Page
1074
End Page
1085
DOI
10.1111/j.1464-410X.2010.10039.x

Effect of low-fat diets on plasma levels of NF-κB-regulated inflammatory cytokines and angiogenic factors in men with prostate cancer.

Diet, nutritional status, and certain dietary supplements are postulated to influence the development and progression of prostate cancer. Angiogenesis and inflammation are central to tumor growth and progression, but the effect of diet on these processes remains uncertain. We explored changes in 50 plasma cytokines and angiogenic factors (CAF) in 145 men with prostate cancer enrolled in a preoperative, randomized controlled phase II trial with four arms: control (usual diet), low-fat (LF) diet, flaxseed-supplemented (FS) diet, and FS+LS diet. The mean duration of dietary intervention was 30 to 31 days. Among the individual arms, the largest number of significant changes (baseline vs. preoperative follow-up) was observed in the LF arm, with 19 CAFs decreasing and one increasing (P < 0.05). Compared with the control arm, 6 CAFs-including proangiogenic factors (stromal-cell derived-1α) and myeloid factors (granulocyte-colony-stimulating factor, macrophage colony-stimulating factor)-all decreased in the LF arm compared with controls; three and four CAFs changed in the FS and FS+LF arms, respectively. Weight loss occurred in the LF arms and significantly correlated with VEGF decreases (P < 0.001). The CAFs that changed in the LF arm are all known to be regulated by NF-κB, and a pathway analysis identified NF-κB as the most likely regulatory network associated with these changes in the LF arm but not in the FS-containing arms. These results suggest that a LF diet without flaxseed may reduce levels of specific inflammatory CAFs and suggests that the NF-κB pathway may be a mediator of these changes.

Authors
Heymach, JV; Shackleford, TJ; Tran, HT; Yoo, S-Y; Do, K-A; Wergin, M; Saintigny, P; Vollmer, RT; Polascik, TJ; Snyder, DC; Ruffin, MT; Yan, S; Dewhirst, M; Kunnumakkara, AB; Aggarwal, BB; Demark-Wahnefried, W
MLA Citation
Heymach, JV, Shackleford, TJ, Tran, HT, Yoo, S-Y, Do, K-A, Wergin, M, Saintigny, P, Vollmer, RT, Polascik, TJ, Snyder, DC, Ruffin, MT, Yan, S, Dewhirst, M, Kunnumakkara, AB, Aggarwal, BB, and Demark-Wahnefried, W. "Effect of low-fat diets on plasma levels of NF-κB-regulated inflammatory cytokines and angiogenic factors in men with prostate cancer." Cancer Prev Res (Phila) 4.10 (October 2011): 1590-1598.
PMID
21764858
Source
pubmed
Published In
Cancer Prevention Research
Volume
4
Issue
10
Publish Date
2011
Start Page
1590
End Page
1598
DOI
10.1158/1940-6207.CAPR-10-0136

Factors predicting early and late phase decline of sexual health-related quality of life following radical prostatectomy.

INTRODUCTION: The association between early and late phase sexual health-related quality of life (HRQoL) following radical prostatectomy (RP) is unclear. Moreover, factors that predict either early or late sexual HRQoL decline have not been fully investigated. AIM: The aim of this study was to evaluate the correlation between early and late phase sexual HRQoL decline, and identify clinical parameters that predict substantial sexual HRQoL decline after surgery in the early phase (3 months) and late phase (20 months) following RP. METHODS: We analyzed data on 2,345 consecutive patients who underwent radical retropubic prostatectomy, radical perineal prostatectomy, or robotic-assisted laparoscopic prostatectomy between 2001 and 2009 from the Duke Prostate Center database. MAIN OUTCOME MEASURE: Sexual HRQoL was assessed using the Expanded Prostate Cancer Index Composite instrument at baseline, early and late phase after surgery. The Spearman rank test was used to calculate correlation coefficients between early and late phase sexual HRQoL decline. Logistic regression analysis was performed to identify factors associated with substantial sexual HRQoL decline during both phases. RESULTS: Of 406 men who met our criteria, 217 (53.5%) men had normal erectile function, whereas 189 (46.5%) men had erectile dysfunction at baseline. Declines of sexual HRQoL during early phase had a significant association with that of a decline during late phase (r = 0.48, P < 0.001). In logistic regression, older age at surgery (odds ratio [OR], 1.06; P = 0.007 and OR, 1.08; P = 0.001), African-American race (OR, 4.32; P = 0.001 and OR, 3.13; P = 0.017), and overall comorbidity (OR, 1.43; P = 0.072 and OR, 1.72; P = 0.010) were consistently associated with substantial decline of sexual HRQoL in both early and late phases. CONCLUSIONS: Sexual HRQoL at early and late phases after RP were strongly correlated. Additionally, several factors were identified to be a predictor for decline of sexual HRQoL. Our findings may be used to advise patients who possess aforementioned risk factors during both phases.

Authors
Kimura, M; Bañez, LL; Schroeck, FR; Gerber, L; Qi, J; Satoh, T; Baba, S; Robertson, CN; Walther, PJ; Donatucci, CF; Moul, JW; Polascik, TJ
MLA Citation
Kimura, M, Bañez, LL, Schroeck, FR, Gerber, L, Qi, J, Satoh, T, Baba, S, Robertson, CN, Walther, PJ, Donatucci, CF, Moul, JW, and Polascik, TJ. "Factors predicting early and late phase decline of sexual health-related quality of life following radical prostatectomy." J Sex Med 8.10 (October 2011): 2935-2943.
PMID
21771284
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
8
Issue
10
Publish Date
2011
Start Page
2935
End Page
2943
DOI
10.1111/j.1743-6109.2011.02387.x

Salvage radiation in men after prostate-specific antigen failure and the risk of death.

BACKGROUND: A survival benefit has been observed with salvage radiation therapy (RT) for prostate-specific antigen (PSA) failure after radical prostatectomy (RP) in men with rapid rises in PSA doubling time (DT, < 6 months). Whether such a benefit exits in men with a protracted PSA rise in DT (≥ 6 months) is unclear and was examined in the current study. METHODS: Of 4036 men who underwent RP at Duke University between 1988 and 2008, 519 experienced a PSA failure, had complete data, and were the subjects of this study. Univariate and multivariate Cox regression analyses were performed to evaluate whether salvage RT in men with either a rapid (< 6 months) or a protracted (≥ 6 months) PSA DT was associated with the risk of all-cause mortality adjusting for age at the time of PSA failure, known prostate cancer prognostic factors, and cardiac comorbidity. RESULTS: After a median follow-up of 11.3 years after PSA failure, 195 men died. Salvage RT was associated with a significant reduction in all-cause mortality for men with either a PSA DT of < 6 months (adjusted hazard ratio [AHR], 0.53; P = .02) or a PSA DT of ≥ 6 months (AHR, 0.52; P = .003). In a subset of patients with comorbidity data at the time of PSA failure, salvage RT remained associated with a significant reduction in all-cause mortality for both men with a PSA DT of < 6 months (AHR, 0.35; P = .042) or a PSA DT of ≥ 6 months (AHR, 0.60; P = .04). CONCLUSIONS: Salvage RT for PSA DTs less than or in excess of 6 months is associated with a decreased risk in all-cause mortality.

Authors
Cotter, SE; Chen, MH; Moul, JW; Lee, WR; Koontz, BF; Anscher, MS; Robertson, CN; Walther, PJ; Polascik, TJ; D'Amico, AV
MLA Citation
Cotter, SE, Chen, MH, Moul, JW, Lee, WR, Koontz, BF, Anscher, MS, Robertson, CN, Walther, PJ, Polascik, TJ, and D'Amico, AV. "Salvage radiation in men after prostate-specific antigen failure and the risk of death." Cancer 117.17 (September 1, 2011): 3925-3932.
PMID
21437885
Source
pubmed
Published In
Cancer
Volume
117
Issue
17
Publish Date
2011
Start Page
3925
End Page
3932
DOI
10.1002/cncr.25993

The role of transrectal saturation biopsy in tumour localization: pathological correlation after retropubic radical prostatectomy and implication for focal ablative therapy.

Authors
Tsivian, M; Polascik, TJ
MLA Citation
Tsivian, M, and Polascik, TJ. "The role of transrectal saturation biopsy in tumour localization: pathological correlation after retropubic radical prostatectomy and implication for focal ablative therapy." BJU Int 108.3 (August 2011): 371-.
PMID
21771242
Source
pubmed
Published In
Bju International
Volume
108
Issue
3
Publish Date
2011
Start Page
371
DOI
10.1111/j.1464-410X.2011.10496.x

Renal function outcomes after laparoscopic renal cryoablation.

BACKGROUND AND PURPOSE: Laparoscopic cryoablation (LCA) has emerged as an alternative to conventional surgery for the management of a T(1) renal mass; however, only few data are available on its functional outcomes. We assessed renal function changes after LCA in patients with normal renal function (NRF) and preexisting chronic renal insufficiency (CRI). PATIENTS AND METHODS: Data of consecutive patients who were undergoing LCA between 2000 and 2008 at Duke University Medical Center were analyzed. Renal function parameters were obtained preoperatively, at discharge, and at 6, 12, and 24 months postoperatively. Serum creatinine (sCr) levels and estimated glomerular filtration rates (eGFR) were compared over a 2-year follow-up. RESULTS: Of 67 patients, 22 (33%) had CRI at baseline. These patients were older, had larger tumors (2.5 vs 2.0 cm, P=0.039), and a higher incidence of multiple lesions (22.7% vs 4.4%, P=0.034). Compared with baseline, sCr was significantly increased and eGFR declined at discharge, 6, 12, and 24 months in both NRF and CRI groups. Median sCr increase was 0.1 mg/mL, eGFR declined by 4.2 mg/mL/1.73 m(2) in the CRI cohort and up to 8.8 mg/mL/1.73m(2) in NRF patients (all P<0.05) during the follow-up. Compared with baseline, however, no significant changes were noted in the distribution of CRI categories at any time (all P>0.05). CONCLUSIONS: A minimal decline in renal function can be appreciated in patients undergoing LCA at midterm follow-up. This decline is no higher in CRI than in NRF patients. LCA offers excellent renal function outcomes at 2 years follow-up. Specifically, in patients with CRI, LCA offers excellent preservation of renal function.

Authors
Tsivian, M; Caso, J; Kimura, M; Polascik, TJ
MLA Citation
Tsivian, M, Caso, J, Kimura, M, and Polascik, TJ. "Renal function outcomes after laparoscopic renal cryoablation." J Endourol 25.8 (August 2011): 1287-1291.
PMID
21740194
Source
pubmed
Published In
Journal of Endourology
Volume
25
Issue
8
Publish Date
2011
Start Page
1287
End Page
1291
DOI
10.1089/end.2011.0017

Radiation-induced erectile dysfunction using prostate-confined modern radiotherapy in a rat model.

INTRODUCTION: The mechanisms of radiation-induced erectile dysfunction (ED) are unclear, as clinical studies are limited, and previous animal models were based on wide-field irradiation, which does not model current radiotherapy (RT) techniques. AIMS: To perform functional and morphological analyses of erectile function (EF) utilizing image-guided stereotactic prostate-confined RT in a rat model. METHODS: Sixty young adult male rats aged 10-12 weeks old were divided into age-matched sham and RT groups. A single 20-Gy fraction to the prostate was delivered to RT animals. Penile bulb, shaft, and testes were excluded from treatment fields. MAIN OUTCOME MEASURES: Bioassay and intracavernous pressure (ICP) measurements were conducted at 2, 4, and 9 weeks following RT. Perfusion analysis of the corpora cavernosa (CC) was conducted using Hoechst injected prior to sacrifice. Penile shaft and cavernous nerve (CN) were evaluated by immunohistochemistry. Plasma testosterone level was analyzed using a testosterone enzyme-linked immunosorbent assay (ELISA) assay kit. RESULTS: Irradiated animals demonstrated statistically significant time-dependent functional impairment of EF by bioassay and ICP measurement from 4 weeks. Neuronal nitric oxide synthase (NOS) expression was decreased in CN by 4 weeks. In CC, expression levels of anti-alpha smooth muscle actin and endothelial NOS were significantly decreased at 9 weeks. In penile dorsal vessels, smooth muscle/collagen ratio was significantly decreased at 4 and 9 weeks. Additionally, Hoechst perfusion showed time-dependent decrease in CC of RT animals, whereas CD31 expression was not affected. No toxicities were noted; testosterone levels were similar in both groups. CONCLUSION: We demonstrated time-dependent ED following image-guided stereotactic RT. Our results imply that reduction of neuronal NOS expression in cavernous nerve could trigger consecutive reduction of smooth muscle content as well as blood perfusion in CC that resulted in corporal veno-occlusive dysfunction. Present study could be a cornerstone to future research that may bring comprehensive scientific understanding of radiation-induced ED.

Authors
Kimura, M; Yan, H; Rabbani, Z; Satoh, T; Baba, S; Yin, F-F; Polascik, TJ; Donatucci, CF; Vujaskovic, Z; Koontz, BF
MLA Citation
Kimura, M, Yan, H, Rabbani, Z, Satoh, T, Baba, S, Yin, F-F, Polascik, TJ, Donatucci, CF, Vujaskovic, Z, and Koontz, BF. "Radiation-induced erectile dysfunction using prostate-confined modern radiotherapy in a rat model." J Sex Med 8.8 (August 2011): 2215-2226.
PMID
21679303
Source
pubmed
Published In
The Journal of Sexual Medicine
Volume
8
Issue
8
Publish Date
2011
Start Page
2215
End Page
2226
DOI
10.1111/j.1743-6109.2011.02351.x

Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men.

OBJECTIVE: • To evaluate weather prostate-specific antigen (PSA) velocity could be used to stratify patients at risk of death from prostate cancer (PCa) and be useful in aiding decision making regarding PSA screening in elderly men, as previous studies have shown that PSA velocity can predict PCa risk. PATIENTS AND METHODS: • The cohort included 3,525 patients aged ≥ 75 years with two or more PSA tests before a diagnosis of PCa. Cox proportional hazard model was used to evaluate which variables at time of last PSA measurement were associated with death from PCa. • The rates of death from PCa after diagnosis in different PSA velocity groups were calculated. Kaplan-Meier and log rank test were used to assess the significant difference in death from PCa after diagnosis, stratified by PSA velocity cutoff. RESULTS: • On multivariate analysis, men with a PSA velocity of PSA velocity ≥ 0.45 ng/mL/year had a 4.8-fold higher risk of death from PCa as compared to men with a PSA velocity of < 0.45 ng/mL/year (p value = 0.013). After a median 6.5 (up to 16.9) years of follow-up from diagnosis, 1.4% of the men with a PSA velocity < 0.45 ng/mL/year had died of PCa as compared to 8.7% of those with a PSA velocity ≥ 0.45 ng/mL/year. • The cumulative rate of death from PCa after diagnosis, stratified by a PSA velocity of 0.45 ng/mL/year, was statistically different (log rank test, P < 0.001). CONCLUSION: • Men age ≥ 75 years old with a PSA velocity of <0.45 ng/mL/year are unlikely to die of PCa. It may be safe to discontinue PSA screening in these men.

Authors
Tang, P; Sun, L; Uhlman, MA; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Robertson, CN, Polascik, TJ, and Moul, JW. "Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men." BJU Int 108.1 (July 2011): 44-48.
PMID
21050357
Source
pubmed
Published In
Bju International
Volume
108
Issue
1
Publish Date
2011
Start Page
44
End Page
48
DOI
10.1111/j.1464-410X.2010.09812.x

Use of 1,25α dihydroxyvitamin D3 as a cryosensitizing agent in a murine prostate cancer model.

Cryotherapy has emerged as a primary treatment option for prostate cancer (CaP); however, incomplete ablation in the periphery of the cryogenic lesion can lead to recurrence. Accordingly, we investigated the use of a non-toxic adjunctive agent, vitamin D3 (VD3), with cryotherapy to sensitize CaP to low temperature-induced, non-ice rupture-related cell death. VD3 (calcitriol) has been identified as a possible adjunct in the treatment of cancer because of its antiproliferative and antitumorigenic properties. This study aimed to identify the cellular responses and molecular pathways activated when VD3 (calcitriol) is combined with cryotherapy in a murine CaP model. Single freeze-thaw events above -15 °C had little effect on cancer cell viability; however, pretreatment with calcitriol in conjunction with cryo significantly increased cell death. The -15 °C calcitriol combination increased cell death to 55% following a single freeze compared with negligible cell loss by freezing or calcitriol alone. Repeated cryo combination yielded 90% cell death compared with 65% in dual freeze-only cycles. Western blot analysis following calcitriol cryosensitization regimes confirmed the activation of apoptosis. Specifically, proapoptotic Bid and procaspase-3 were found to decrease at 1 h following combination treatment, indicating cleavage to the active forms. A parallel in vivo study confirmed the increased cell death when combining cryotherapy with calcitriol pretreatment. The development of an adjunctive therapy combining calcitriol and cryotherapy represents a potentially highly effective, less toxic, minimally invasive treatment option. These results suggest a role for calcitriol and cryo as a combinatorial treatment for CaP, with the potential for clinical translation.

Authors
Santucci, KL; Snyder, KK; Baust, JM; Van Buskirk, RG; Mouraviev, V; Polascik, TJ; Gage, AA; Baust, JG
MLA Citation
Santucci, KL, Snyder, KK, Baust, JM, Van Buskirk, RG, Mouraviev, V, Polascik, TJ, Gage, AA, and Baust, JG. "Use of 1,25α dihydroxyvitamin D3 as a cryosensitizing agent in a murine prostate cancer model." Prostate Cancer Prostatic Dis 14.2 (June 2011): 97-104.
PMID
21221127
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
14
Issue
2
Publish Date
2011
Start Page
97
End Page
104
DOI
10.1038/pcan.2010.52

Cigarette smoking is associated with advanced renal cell carcinoma.

PURPOSE: Cigarette smoking is a recognized risk factor for renal cell carcinoma (RCC), but little data are available on the association between smoking and RCC biology. We investigated the association between cigarette smoking and RCC stage in a large contemporary multiethnic surgical cohort. PATIENTS AND METHODS: We retrospectively reviewed the demographic, clinical, and pathologic data of patients undergoing surgery for RCC between 2000 and 2009. Advanced RCC was defined as metastatic disease, pathologic stage ≥ T3, and/or lymph node involvement. Self-reported smoking history included smoking status, duration, intensity, cumulative exposure, and cessation. Patient and tumor characteristics were compared between the groups in univariate and multivariate analyses. RESULTS: Of the 845 eligible patients, 19.4% and 29.1% were current and former smokers, respectively, and 207 patients (24.5%) had advanced disease. In both univariate and multivariate analyses, smoking was consistently associated with advanced RCC, and cessation reversed the risk. Current and former smokers had 1.5- and 1.6-fold increased odds of advanced disease, respectively. Heavier smoking (longer duration and exposure) was associated with increased risk of advanced RCC, whereas durable cessation reduced the odds of advanced disease. CONCLUSION: Cigarette smoking is an independent risk factor for advanced RCC. Heavier smoking increases the likelihood of advanced disease. Durable smoking cessation attenuated the risk of advanced disease. Given that cigarette smoking is among the few modifiable risk factors for RCC, our results reinforce the importance of smoking cessation and encourage further investigation of the association between smoking and RCC biology.

Authors
Tsivian, M; Moreira, DM; Caso, JR; Mouraviev, V; Polascik, TJ
MLA Citation
Tsivian, M, Moreira, DM, Caso, JR, Mouraviev, V, and Polascik, TJ. "Cigarette smoking is associated with advanced renal cell carcinoma." J Clin Oncol 29.15 (May 20, 2011): 2027-2031.
PMID
21502558
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
29
Issue
15
Publish Date
2011
Start Page
2027
End Page
2031
DOI
10.1200/JCO.2010.30.9484

Editorial comment.

Authors
Matvey, T; Polascik, TJ
MLA Citation
Matvey, T, and Polascik, TJ. "Editorial comment." Urology 77.5 (May 2011): 1152-1153.
PMID
21539966
Source
pubmed
Published In
Urology
Volume
77
Issue
5
Publish Date
2011
Start Page
1152
End Page
1153
DOI
10.1016/j.urology.2010.12.050

HEIGHT AND THE RISK FOR AGGRESSIVE PROSTATE CANCER AT THE TIME OF BIOPSY-RESULTS FROM THE DUKE PROSTATE CENTER DATABASE

Authors
Calloway, EE; Chu, DI; Gerber, L; II, TJ-A; Robertson, CN; Polascik, TJ; Moul, JW; Banez, LL
MLA Citation
Calloway, EE, Chu, DI, Gerber, L, II, TJ-A, Robertson, CN, Polascik, TJ, Moul, JW, and Banez, LL. "HEIGHT AND THE RISK FOR AGGRESSIVE PROSTATE CANCER AT THE TIME OF BIOPSY-RESULTS FROM THE DUKE PROSTATE CENTER DATABASE." April 2011.
Source
wos-lite
Published In
The Journal of Urology
Volume
185
Issue
4
Publish Date
2011
Start Page
E483
End Page
E483

DIABETES MELLITUS AND THE RISK OF HIGH-GRADE PROSTATE CANCER: RESULTS FROM THE DUKE PROSTATE CENTER

Authors
Gerber, L; Banez, LL; Freedland, SJ; Xie, D; Qi, JJ; Polascik, TJ; Robertson, CN; Moul, JW
MLA Citation
Gerber, L, Banez, LL, Freedland, SJ, Xie, D, Qi, JJ, Polascik, TJ, Robertson, CN, and Moul, JW. "DIABETES MELLITUS AND THE RISK OF HIGH-GRADE PROSTATE CANCER: RESULTS FROM THE DUKE PROSTATE CENTER." April 2011.
Source
wos-lite
Published In
The Journal of Urology
Volume
185
Issue
4
Publish Date
2011
Start Page
E135
End Page
E135

Percutaneous cryoablation of renal lesions with radiographic ice ball involvement of the renal sinus: analysis of hemorrhagic and collecting system complications.

OBJECTIVE: The purpose of this study was to determine the incidence of collecting system and hemorrhagic complications resulting from CT-guided percutaneous cryoablation of renal tumors in which the radiographic ice ball abuts or involves the renal sinus. MATERIALS AND METHODS: From November 2005 through July 2009 at our institution, we performed 129 CT-guided percutaneous cryoablation procedures on 107 patients (mean age, 64 years) with renal masses suspicious of being renal cell carcinoma. Radiographic ice balls that abutted or overlapped the renal sinus were classified as central; the other lesions were classified as noncentral. Medical records and follow-up images were retrospectively reviewed for hemorrhage requiring intervention and for evidence of collecting system injury. The mean follow-up period was 9.3 months. RESULTS: The radiographic ice ball was classified as central in 67 cases. In these central ablations, the mean sinus involvement was 6.2 mm (range, 0-19 mm), 41 ice balls overlapping the renal sinus by 6 mm or more (mean, 9.4 mm). No cases of collecting system injury were identified for any ablation. Overall, there was only one hemorrhagic complication requiring intervention, and it occurred in a noncentral ablation. CONCLUSION: CT-guided percutaneous cryoablation of renal masses with ice ball overlap of the renal sinus resulted in no cases of collecting system injury or serious hemorrhagic complications in our series.

Authors
Rosenberg, MD; Kim, CY; Tsivian, M; Suberlak, MN; Sopko, DR; Polascik, TJ; Nelson, RC
MLA Citation
Rosenberg, MD, Kim, CY, Tsivian, M, Suberlak, MN, Sopko, DR, Polascik, TJ, and Nelson, RC. "Percutaneous cryoablation of renal lesions with radiographic ice ball involvement of the renal sinus: analysis of hemorrhagic and collecting system complications." AJR Am J Roentgenol 196.4 (April 2011): 935-939.
PMID
21427348
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
196
Issue
4
Publish Date
2011
Start Page
935
End Page
939
DOI
10.2214/AJR.10.5182

Can the conventional sextant prostate biopsy accurately predict unilateral prostate cancer in low-risk, localized, prostate cancer?

We evaluate the reliability of routine sextant prostate biopsy to detect unilateral lesions. A total of 365 men with complete records including all clinical and pathologic variables who underwent a preoperative sextant biopsy and subsequent radical prostatectomy (RP) for clinically localized prostate cancer at our medical center between January 1996 and December 2006 were identified. When the sextant biopsy detects unilateral disease, according to RP results, the NPV is high (91%) with a low false negative rate (9%). However, the sextant biopsy has a PPV of 28% with a high false positive rate (72%). Therefore, a routine sextant prostate biopsy cannot provide reliable, accurate information about the unilaterality of tumor lesion(s).

Authors
Mayes, JM; Mouraviev, V; Sun, L; Tsivian, M; Madden, JF; Polascik, TJ
MLA Citation
Mayes, JM, Mouraviev, V, Sun, L, Tsivian, M, Madden, JF, and Polascik, TJ. "Can the conventional sextant prostate biopsy accurately predict unilateral prostate cancer in low-risk, localized, prostate cancer?." Urol Oncol 29.2 (March 2011): 166-170.
PMID
19451000
Source
pubmed
Published In
Urologic Oncology: seminars and original investigations
Volume
29
Issue
2
Publish Date
2011
Start Page
166
End Page
170
DOI
10.1016/j.urolonc.2009.03.011

On-demand use of erectile aids in men with preoperative erectile dysfunction treated by whole gland prostate cryoablation.

Prostate cryoablation is an established minimally invasive treatment for localized prostate cancer (PCa). However, the impairment of erectile function (EF) is considered a serious complication of the procedure. To investigate the efficacy of erectile aids following cryotherapy, 93 patients who underwent whole gland prostate cryoablation with required complete medical records were analyzed. The changes in postoperative EF were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. Additionally, independent factors that could have a correlation to the postoperative IIEF-5 score or postoperative Expanded Prostate Cancer Index Composite (EPIC) score were assessed. In the entire cohort, the mean preoperative IIEF-5 score was 7.0 ± 6.2. A total of 72 (77.4%) patients had moderate-to-severe preoperative erectile dysfunction. In longitudinal investigation, the patients using erectile aids showed the ability to recover to baseline after 24 months from cryoablation compared with the patients not using erectile aids. There were significant differences of IIEF-5 scores between these groups at 24 months (7.5 vs 3.0; P = 0.025) and 36 months (8.5 vs 3.5; P = 0.010). In multivariate analysis, the use of erectile aids correlated with restoration of IIEF-5 scores (odds ratio, 5.11; confidence interval (CI), 1.87-13.96; P < 0.001) and lower EPIC sexual bother (coef, 19.61; CI, 0.32-38.89; P = 0.046). Our data indicate that on-demand use of erectile aids could help restore EF and reduce sexual bother after whole gland prostate cryoablation. Although, erectile aids could not play a role as an adequate treatment for ED after whole gland prostate cryoablation, these results may aid in the decision-making process for PCa patients with preoperative and postoperative ED who have concern about sexual health-related quality of life.

Authors
Kimura, M; Donatucci, CF; Tsivian, M; Caso, JR; Moreira, DM; Mouraviev, V; Satoh, T; Baba, S; Polascik, TJ
MLA Citation
Kimura, M, Donatucci, CF, Tsivian, M, Caso, JR, Moreira, DM, Mouraviev, V, Satoh, T, Baba, S, and Polascik, TJ. "On-demand use of erectile aids in men with preoperative erectile dysfunction treated by whole gland prostate cryoablation." Int J Impot Res 23.2 (March 2011): 49-55.
PMID
21368768
Source
pubmed
Published In
International Journal of Impotence Research
Volume
23
Issue
2
Publish Date
2011
Start Page
49
End Page
55
DOI
10.1038/ijir.2011.3

Clinical predictors of renal mass pathological features.

OBJECTIVE: • To evaluate the influence of radiographic tumour size and other preoperative variables on the pathological characteristics of the lesion to determine the distribution of pathological features and assess preoperative risk factors for potentially aggressive versus probably indolent renal lesions. PATIENTS AND METHODS: • Retrospective review of records for 768 patients who underwent surgery for single, sporadic renal mass between 2000 and 2008 in a tertiary academic institution. • Demographic, radiographic and pathological variables were recorded and analysed with regression analyses for risk factors for potentially aggressive pathological features (malignant pathology, high Fuhrman grade, lymphovascular invasion and extracapsular extension). RESULTS: • Malignancy was pathologically confirmed in 628 (81.8%) specimens. • Radiographic size was significantly associated with malignancy (versus benign pathology; OR = 1.13, P= 0.001), high Fuhrman grade (OR = 1.21, P < 0.0001), vascular invasion (OR = 1.19, P < 0.0001) and extracapsular extension (OR = 1.23, P < 0.0001). • Age, symptomatic presentation, solid appearance and radiographic size were independent predictors of potentially aggressive disease, whereas for male gender (OR = 1.43, P= 0.062) a trend toward statistical significance was noted. CONCLUSIONS: • Age, male gender, radiographic size and appearance, as well as symptomatic presentation, are associated with an increased risk of malignant, potentially aggressive disease. • These factors should be considered when evaluating management options for a solitary enhancing renal mass.

Authors
Tsivian, M; Mouraviev, V; Albala, DM; Caso, JR; Robertson, CN; Madden, JF; Polascik, TJ
MLA Citation
Tsivian, M, Mouraviev, V, Albala, DM, Caso, JR, Robertson, CN, Madden, JF, and Polascik, TJ. "Clinical predictors of renal mass pathological features." BJU Int 107.5 (March 2011): 735-740.
PMID
21054752
Source
pubmed
Published In
Bju International
Volume
107
Issue
5
Publish Date
2011
Start Page
735
End Page
740
DOI
10.1111/j.1464-410X.2010.09629.x

ON-DEMAND USE OF ERECTILE AIDS IN MEN WITH SEVERE PREOPERATIVE ERECTILE FUNCTION TREATED BY PROSTATE CRYOABLATION

Authors
Kimura, M; Tsivian, M; Caso, J; Moreira, DM; Mouraviev, V; Donatucci, CF; Polascik, TJ
MLA Citation
Kimura, M, Tsivian, M, Caso, J, Moreira, DM, Mouraviev, V, Donatucci, CF, and Polascik, TJ. "ON-DEMAND USE OF ERECTILE AIDS IN MEN WITH SEVERE PREOPERATIVE ERECTILE FUNCTION TREATED BY PROSTATE CRYOABLATION." January 2011.
Source
wos-lite
Published In
The Journal of Sexual Medicine
Volume
8
Publish Date
2011
Start Page
37
End Page
37

New Frontiers in Imaging and Focal Therapy: Highlights From the Third International Symposium on Focal Therapy and Imaging of Prostate and Kidney Cancer, February 24-27, 2010, Washington, DC.

Authors
Mouraviev, V; Polascik, TJ
MLA Citation
Mouraviev, V, and Polascik, TJ. "New Frontiers in Imaging and Focal Therapy: Highlights From the Third International Symposium on Focal Therapy and Imaging of Prostate and Kidney Cancer, February 24-27, 2010, Washington, DC." Rev Urol 13.2 (2011): 104-111.
PMID
21935343
Source
pubmed
Volume
13
Issue
2
Publish Date
2011
Start Page
104
End Page
111

Methodology to register prostate B-mode and ARFI images to MR and histology

Acoustic Radiation Force Impulse (ARFI) imaging is being developed for guiding needle biopsy and focal therapy of Prostate cancer (PCa). In vivo ARFI images portray internal structures in the prostate with higher contrast than matched B-mode images. Given the heterogeneity of the prostate and the poor visualization provided by B-mode, another gold standard for determining what is being visualized in ARFI images is necessary. In this study, we present image registration techniques that facilitate correlation of in vivo ARFI, B-mode ultrasound (US), and Magnetic Resonance (MR) images obtained prior to radical prostatectomy with whole mount histology data. Pathology and structures were identified and segmented in the different datasets. The segmented datasets were used to form 3D mesh models of the prostate and the node and element information was extrapolated into a 3D image matrix of equivalent size for all modalities. Non-rigid registration of the different models was performed and the registered images were evaluated for co-localization of confirmed pathology. The methodology was validated using simulated prostate anatomy and finite-element techniques and found to improve the average displacement of registration markers by 76% in the MR simulation and 58% in the US simulation. When implemented on the patient data, the registration methodology was found to simplify multi-modality image comparison and analysis. Confirmed pathology was found to align with similarly suspicious regions in both ARFI and MR images. With its improved anatomical visualization over traditional B-mode imaging, ARFI holds promise for providing targeted image guidance of prostate focal therapy and needle biopsy. © 2011 IEEE.

Authors
Hsu, CML; Polascik, TJ; Davenport, MS; Kauffman, C; Gupta, RT; Kulbacki, E; Madden, J; Lipman, SL; Palmeri, ML; Nightingale, KR
MLA Citation
Hsu, CML, Polascik, TJ, Davenport, MS, Kauffman, C, Gupta, RT, Kulbacki, E, Madden, J, Lipman, SL, Palmeri, ML, and Nightingale, KR. "Methodology to register prostate B-mode and ARFI images to MR and histology." 2011.
Source
scival
Published In
IEEE International Ultrasonics Symposium : [proceedings]. IEEE International Ultrasonics Symposium
Publish Date
2011
Start Page
1866
End Page
1869
DOI
10.1109/ULTSYM.2011.0466

Re: Salvage radiation in men after prostate-specific antigen failure and the risk of death

Authors
Cotter, SE; Chen, MH; Moul, JW; Lee, WR; Koontz, BF; Anscher, MS; Robertson, CN; Walther, PJ; Polascik, TJ; D'Amico, AV
MLA Citation
Cotter, SE, Chen, MH, Moul, JW, Lee, WR, Koontz, BF, Anscher, MS, Robertson, CN, Walther, PJ, Polascik, TJ, and D'Amico, AV. "Re: Salvage radiation in men after prostate-specific antigen failure and the risk of death." Journal of Urology 186.5 (2011): 1876--.
Source
scival
Published In
The Journal of Urology
Volume
186
Issue
5
Publish Date
2011
Start Page
1876-
DOI
10.1016/j.juro.2011.08.056

Re: Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men

Authors
Tang, P; Sun, L; Uhlman, MA; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Robertson, CN, Polascik, TJ, and Moul, JW. "Re: Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men." Journal of Urology 186.5 (2011): 1880-1881.
Source
scival
Published In
The Journal of Urology
Volume
186
Issue
5
Publish Date
2011
Start Page
1880
End Page
1881
DOI
10.1016/j.juro.2011.07.063

Renal function outcomes after laparoscopic renal cryoablation

Background and Purpose: Laparoscopic cryoablation (LCA) has emerged as an alternative to conventional surgery for the management of a T(1) renal mass; however, only few data are available on its functional outcomes. We assessed renal function changes after LCA in patients with normal renal function (NRF) and preexisting chronic renal insufficiency (CRI). Patients and Methods: Data of consecutive patients who were undergoing LCA between 2000 and 2008 at Duke University Medical Center were analyzed. Renal function parameters were obtained preoperatively, at discharge, and at 6, 12, and 24 months postoperatively. Serum creatinine (sCr) levels and estimated glomerular filtration rates (eGFR) were compared over a 2-year follow-up. Results: Of 67 patients, 22 (33%) had CRI at baseline. These patients were older, had larger tumors (2.5 vs 2.0 cm, P = 0.039), and a higher incidence of multiple lesions (22.7% vs 4.4%, P=0.034). Compared with baseline, sCr was significantly increased and eGFR declined at discharge, 6, 12, and 24 months in both NRF and CRI groups. Median sCr increase was 0.1 mg/mL, eGFR declined by 4.2 mg/mL/1.73 m(2) in the CRI cohort and up to 8.8 mg/mL/1.73m(2) in NRF patients (all P < 0.05) during the follow-up. Compared with baseline, however, no significant changes were noted in the distribution of CRI categories at any time (all P > 0.05). Conclusions: A minimal decline in renal function can be appreciated in patients undergoing LCA at midterm follow-up. This decline is no higher in CRI than in NRF patients. LCA offers excellent renal function outcomes at 2 years follow-up. Specifically, in patients with CRI, LCA offers excellent preservation of renal function.

Authors
Tsivian, M; Caso, J; Kimura, M; Polascik, TJ
MLA Citation
Tsivian, M, Caso, J, Kimura, M, and Polascik, TJ. "Renal function outcomes after laparoscopic renal cryoablation." International Braz J Urol 37.4 (2011): 539--.
Source
scival
Published In
International braz j urol : official journal of the Brazilian Society of Urology
Volume
37
Issue
4
Publish Date
2011
Start Page
539-
DOI
10.1590/S1677-55382011000400016

3D Conformal and Intensity Modulated Radiotherapy to the Prostate Bed have Similar Biochemical Outcomes

Authors
Koontz, BF; Gerber, L; Banez, LL; Degirmenci, IT; Vujaskovic, Z; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW; Lee, WR
MLA Citation
Koontz, BF, Gerber, L, Banez, LL, Degirmenci, IT, Vujaskovic, Z, Anscher, MS, Robertson, CN, Polascik, TJ, Moul, JW, and Lee, WR. "3D Conformal and Intensity Modulated Radiotherapy to the Prostate Bed have Similar Biochemical Outcomes." 2011.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S406
End Page
S407

Neoadjuvant Radiotherapy plus Prostatectomy for High Risk Prostate Cancer

Authors
Koontz, BF; Lee, WR; Vujaskovic, Z; Carroll, M; Quaranta, BP; Anscher, MS; Robertson, CN; Polascik, TJ; Moul, JW
MLA Citation
Koontz, BF, Lee, WR, Vujaskovic, Z, Carroll, M, Quaranta, BP, Anscher, MS, Robertson, CN, Polascik, TJ, and Moul, JW. "Neoadjuvant Radiotherapy plus Prostatectomy for High Risk Prostate Cancer." 2011.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S397
End Page
S397

The Number of High-Risk Factors and the Risk of Prostate Cancer-Specific Mortality Following Radical Prostatectomy or Brachytherapy

Authors
Wattson, DA; Chen, M; Moul, JW; Moran, BJ; Dosoretz, DE; Robertson, CN; Polascik, TJ; Braccioforte, MH; Salenius, SA; D'Amico, AV
MLA Citation
Wattson, DA, Chen, M, Moul, JW, Moran, BJ, Dosoretz, DE, Robertson, CN, Polascik, TJ, Braccioforte, MH, Salenius, SA, and D'Amico, AV. "The Number of High-Risk Factors and the Risk of Prostate Cancer-Specific Mortality Following Radical Prostatectomy or Brachytherapy." 2011.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S434
End Page
S434

Pathological T2 sub-divisions as a prognostic factor in the biochemical recurrence of prostate cancer.

OBJECTIVE: To determine the adequacy of T2 prostate cancer (PCa) sub-staging as an independent Predictor of biochemical disease-free survival (bDFS) after radical prostatectomy. MATERIALS AND METHODS: The Duke Prostate Center database was queried for patients who underwent radical prostatectomy between 1988 and 2007 and had pT2 PCa, identifying 1990 cases. Prostate-specific antigen (PSA) recurrence was defined as a single value ≥0.2 ng/mL. Kaplan-Meier curves compared differences in bDFS between T2 sub-divisions. Multivariate analysis was performed, adjusting for age, pathological Gleason sum, surgical margin status, preoperative PSA, race, total tumour percentage and prostate weight on biochemical recurrence. RESULTS: The mean age at surgery was 62 years, and 16% of patients were African-American. Median prostate weight was 40 g [interquartile range (IQR) 31-52] and median preoperative PSA was 5.6 (IQR 4.2-7.8). Pathological Gleason score was ≤6 in 57%, 7 in 38%, and ≥8 in 5%; pathological T stage distribution was 18% T2a, 6% T2b, and 76% T2c; and percentage tumour involvement was ≤5% in 43%, between 5.1 and 10% in 24%, between 10.1 and 15% in 10%, and >15% in 19%. 366 (18.4%) patients had a biochemical recurrence after a median of 4.6 years (IQR 2.1-8.2) follow-up. bDFS was significantly (P= 0.006) higher for pT2a disease than for pT2b and pT2c, which were comparable. Adjusting for demographic and other pathological variables, T2 sub-divisions lost statistical significance. CONCLUSIONS: Pathological T2a prostate cancer has significantly higher bDFS than the pT2b or pT2c sub-groups in univariate but not multivariate analyses. Different pathological features should be explored to create more meaningfully predictive pathological T2 sub-divisions.

Authors
Caso, JR; Tsivian, M; Mouraviev, V; Polascik, TJ; Moul, JW
MLA Citation
Caso, JR, Tsivian, M, Mouraviev, V, Polascik, TJ, and Moul, JW. "Pathological T2 sub-divisions as a prognostic factor in the biochemical recurrence of prostate cancer." BJU Int 106.11 (December 2010): 1623-1627.
PMID
20553260
Source
pubmed
Published In
Bju International
Volume
106
Issue
11
Publish Date
2010
Start Page
1623
End Page
1627
DOI
10.1111/j.1464-410X.2010.09439.x

Adjuvant versus salvage radiation therapy for prostate cancer and the risk of death.

OBJECTIVE: To investigate whether salvage radiation therapy (RT) for prostate-specific antigen (PSA) failure can provide the same result as adjuvant RT, which decreases the risk of all-cause mortality (ACM) for men with positive margins (R1), or extra-capsular or seminal vesicle extension (pT3). METHODS: We studied 1638 men at Duke University who underwent radical prostatectomy for unfavourable-risk prostate cancer and whose postoperative PSA was undetectable. Cox regression was used to evaluate whether salvage vs adjuvant RT in men with a rapid (<10 months) or slow (≥10 months) PSA doubling time (DT) was associated with the risk of ACM, adjusting for adverse features (pT3, R1, Gleason score 8-10), age, preoperative PSA level, comorbidity and hormonal therapy use. RESULTS: Despite fewer men with two or more adverse features (61 vs 82%; P=0.016), salvage for a rapid PSA DT vs adjuvant RT increased the risk of ACM [adjusted hazard ratio (AHR)=3.42; 95% confidence interval (CI)=1.27-9.20; P=0.015]. There was no difference (AHR=1.39; 95% CI=0.50-3.90; P=0.53) in the risk of ACM among men who received salvage for a slow PSA DT or adjuvant RT. Nearly all (90%) men with a slow PSA DT had Gleason score ≤7 and the majority (59%) had at most pT3 or R1 disease. CONCLUSION: Radiation therapy after PSA failure as compared with adjuvant RT was not associated with an increased risk of ACM in men with Gleason score ≤7 and pT3R0 or pT2R1 disease.

Authors
D'Amico, AV; Chen, M-H; Sun, L; Lee, WR; Mouraviev, V; Robertson, CN; Walther, PJ; Polascik, TJ; Albala, DM; Moul, JW
MLA Citation
D'Amico, AV, Chen, M-H, Sun, L, Lee, WR, Mouraviev, V, Robertson, CN, Walther, PJ, Polascik, TJ, Albala, DM, and Moul, JW. "Adjuvant versus salvage radiation therapy for prostate cancer and the risk of death." BJU Int 106.11 (December 2010): 1618-1622.
PMID
20553253
Source
pubmed
Published In
Bju International
Volume
106
Issue
11
Publish Date
2010
Start Page
1618
End Page
1622
DOI
10.1111/j.1464-410X.2010.09447.x

Analysis of urinary function using validated instruments and uroflowmetry after primary and salvage prostate cryoablation.

OBJECTIVES: To evaluate changes in urinary function after cryoablation for clinically localized prostate cancer and to investigate risk factors that predict changes in urinary function after surgery. METHODS: Among the patients who underwent primary or salvage cryoablation between January 2002 and May 2008, 74 patients (50 primary and 24 salvage) with both a preoperative and postoperative urinary function domain score and uroflowmetry were included in this study. The mean age was 66.8 ± 7.5 years and the mean follow-up period was 42.5 ± 20.3 months. The changes in postoperative urinary function were evaluated on the basis of several categorized groups, including surgical method, preoperative urinary symptoms, and prostate volume. RESULTS: Of 74 patients, 2 (2.7%) presented with mild stress incontinence after cryoablation. No patient presented with persistent urinary retention or urethral fistula. When comparing postoperative International Prostate Symptom Score (IPSS) and bother index scores with preoperative scores, it was found that on average IPSS and bother index recovered 12 and 18 months after cryoablation, respectively, and continued to improve after recovery. Only salvage cryoablation correlated with deteriorating urinary function in a logistic regression model (P = .032). However, it was noted that the patients with preoperative moderate to severe urinary symptoms and larger prostate volume showed improvement of urinary function after cryoablation. No associations were found between worsened urinary function and prostate volume, comorbidities (hypertension, obesity, and diabetes), or sexual function. CONCLUSIONS: Cryoablation is a minimally invasive surgery for localized prostate cancer. This study is the first to demonstrate the ability of cryoablation in terms of maintaining and potentially improving urinary function using validated instruments and uroflowmetry assessments.

Authors
Kimura, M; Mouraviev, V; Tsivian, M; Moreira, DM; Mayes, JM; Polascik, TJ
MLA Citation
Kimura, M, Mouraviev, V, Tsivian, M, Moreira, DM, Mayes, JM, and Polascik, TJ. "Analysis of urinary function using validated instruments and uroflowmetry after primary and salvage prostate cryoablation." Urology 76.5 (November 2010): 1258-1265.
PMID
19963257
Source
pubmed
Published In
Urology
Volume
76
Issue
5
Publish Date
2010
Start Page
1258
End Page
1265
DOI
10.1016/j.urology.2009.09.062

Prostate-specific antigen-based risk-adapted discontinuation of prostate cancer screening in elderly African American and Caucasian American men.

OBJECTIVES: To evaluate the relationship between initial prostate-specific antigen (PSA) and prostate cancer (PCa) risk in elderly African American (AA) and Caucasian American (CA) men. METHODS: A total of 408 AA and 1720 CA men whose initial PSA measurement was performed between 75 and 80 years of age were retrieved from Duke Prostate Center database. Patients were stratified by race and initial PSA value. The relative risk (RR) of PCa detection was estimated. The rates of high risk PCa, and death from PCa stratified by initial PSA groups were compared using the chi-square test. RESULTS: The age-adjusted RR of PCa detection in CA men with PSA 3.0-5.9 ng/mL was 1.9-fold higher when compared with that of men with PSA 0.0-2.9 ng/mL (P < .001), but it did not change significantly in AA men (P = .270). PSA 6.0-9.9 ng/mL was associated with age-adjusted RR of PCa 9.3-fold in AA men and 4.1-fold in CA men (both P values < .001). A low rate of high-risk PCa and death from PCa was indicated with PSA < 6.0 ng/mL and < 3.0 ng/mL and follow-up of a maximum of 19.2 years and 17.6 years, respectively, in AA and CA men. CONCLUSIONS: AA men with initial PSA < 6.0 ng/mL and CA men with initial PSA < 3.0 ng/mL between 75 and 80 years of age are unlikely to be diagnosed with high risk PCa or death from PCa. It may be safe to discontinue PSA screening in these men.

Authors
Tang, P; Sun, L; Uhlman, MA; Robertson, CN; Polascik, TJ; Albala, DM; Donatucci, CF; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Robertson, CN, Polascik, TJ, Albala, DM, Donatucci, CF, and Moul, JW. "Prostate-specific antigen-based risk-adapted discontinuation of prostate cancer screening in elderly African American and Caucasian American men." Urology 76.5 (November 2010): 1058-1062.
PMID
20035982
Source
pubmed
Published In
Urology
Volume
76
Issue
5
Publish Date
2010
Start Page
1058
End Page
1062
DOI
10.1016/j.urology.2009.09.049

Baseline PSA as a predictor of prostate cancer-specific mortality over the past 2 decades: Duke University experience.

BACKGROUND: A diagnosis of prostate cancer is not often predictive of death from prostate cancer because of competing causes of mortality. Identification of the risk of death from prostate cancer and death from all causes using information available at the time of baseline prostate-specific antigen (PSA) measurement appears to be particularly pertinent. METHODS: The Duke Prostate Center database was used to identify men who had their PSA level measured over the past 20 years. The Cox proportional hazards model was used to assess whether baseline PSA, race, and age at baseline PSA could predict death from prostate cancer and death from all causes after baseline PSA measurement. The receiver operating characteristic (ROC) curve was performed to analyze the accuracy of baseline PSA as a continuous variable in predicting death from prostate cancer. RESULTS: A total of 4568 men diagnosed with prostate cancer after baseline PSA measurement were included. On multivariate analysis, baseline PSA levels of 4.0 to 9.9 ng/mL and ≥10 ng/mL were associated with significantly higher rates of death from prostate cancer compared with PSA levels <2.5 ng/mL. An advanced age at baseline PSA and African American race were associated with a higher death rate from prostate cancer and death from all causes. The area under the ROC curve for baseline PSA predicting death was 0.839. When a baseline PSA of 10 ng/mL was chosen to predict death from prostate cancer, the corresponding sensitivity and specificity were 77% and of 78%, respectively. CONCLUSIONS: Baseline PSA appears to be a reliable and independent predictor of death from prostate cancer. A baseline PSA of ≥4 ng/mL has been associated with higher risk of death from prostate cancer.

Authors
Tang, P; Sun, L; Uhlman, MA; Polascik, TJ; Freedland, SJ; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Polascik, TJ, Freedland, SJ, and Moul, JW. "Baseline PSA as a predictor of prostate cancer-specific mortality over the past 2 decades: Duke University experience." Cancer 116.20 (October 15, 2010): 4711-4717.
PMID
20589748
Source
pubmed
Published In
Cancer
Volume
116
Issue
20
Publish Date
2010
Start Page
4711
End Page
4717
DOI
10.1002/cncr.25447

Obese African-Americans with prostate cancer (T1c and a prostate-specific antigen, PSA, level of <10 ng/mL) have higher-risk pathological features and a greater risk of PSA recurrence than non-African-Americans.

OBJECTIVE: to analyse the relationship between African American (AA) race and obesity in men with prostate cancer. PATIENTS AND METHODS: in all, 4196 patients who underwent radical prostatectomy from 1988 to 2008 were identified in the Duke Prostate Center database. A subset of 389 (AA 20.9% and non-AA 79.1%) patients with a body mass index (BMI) of ≥30 kg/m(2) , T1c disease and a prostate-specific antigen (PSA) level of <10 ng/mL were stratified by race and analysed. Age at surgery, race, surgical margin status, pathological tumour stage (pT2, pT3/4), pathological Gleason sum (<7, 3 + 4, 4 + 3, >7), extracapsular extension (ECE), seminal vesicle invasion and tumour percentage were assessed by univariate analysis followed by Cox regression analysis. RESULTS: in the entire cohort, 143 (38.1%) AA men were obese, compared to 509 (25.0%) of the non-AA men. AA men had a significantly higher tumour percentage (15% vs 10%, P= 0.002), and a greater proportion of pT3/4 disease (45.1% vs 26.2%, P= 0.039), pathological Gleason sum ≥ 7 (70.7% vs 50.5%, P= 0.003), positive ECE (37.8% vs 23.1%, P= 0.007), and positive surgical margin (52.4% vs 36.8%, P= 0.010) than non-AA men. AA men had a greater risk of PSA recurrence on Kaplan Meier (P= 0.004) and Cox regression analysis (P= 0.040, hazard ratio 1.72) CONCLUSION: a greater proportion of AA men was obese in this cohort. Obese AA with impalpable cancer and a PSA level of <10 ng/mL have a higher risk of pathological features than obese non-AA men, as well as a higher risk of PSA recurrence. Obesity might be responsible for the racial disparity seen in prostate cancer.

Authors
Caire, AA; Sun, L; Polascik, TJ; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Polascik, TJ, Albala, DM, and Moul, JW. "Obese African-Americans with prostate cancer (T1c and a prostate-specific antigen, PSA, level of <10 ng/mL) have higher-risk pathological features and a greater risk of PSA recurrence than non-African-Americans." BJU Int 106.8 (October 2010): 1157-1160.
PMID
20367635
Source
pubmed
Published In
Bju International
Volume
106
Issue
8
Publish Date
2010
Start Page
1157
End Page
1160
DOI
10.1111/j.1464-410X.2010.09340.x

Characterizing stiffness of human prostates using acoustic radiation force.

Acoustic Radiation Force Impulse (ARFI) imaging has been previously reported to portray normal anatomic structures and pathologies in ex vivo human prostates with good contrast and resolution. These findings were based on comparison with histological slides and McNeal's zonal anatomy. In ARFI images, the central zone (CZ) appears darker (smaller displacement) than other anatomic zones and prostate cancer (PCa) is darker than normal tissue in the peripheral zone (PZ). Since displacement amplitudes in ARFI images are determined by both the underlying tissue stiffness and the amplitude of acoustic radiation force that varies with acoustic attenuation, one question that arises is how the relative displacements in prostate ARFI images are related to the underlying prostatic tissue stiffness. In linear, isotropic elastic materials and in tissues that are relatively uniform in acoustic attenuation (e.g., liver), relative displacement in ARFI images has been shown to be correlated with underlying tissue stiffness. However, the prostate is known to be heterogeneous. Variations in acoustic attenuation of prostatic structures could confound the interpretation of ARFI images due to the associated variations in the applied acoustic radiation force. Therefore, in this study, co-registered three-dimensional (3D) ARFI datasets and quantitative shear wave elasticity imaging (SWEI) datasets were acquired in freshly-excised human prostates to investigate the relationship between displacement amplitudes in ARFI prostate images and the matched reconstructed shear moduli. The lateral time-to-peak (LTTP) algorithm was applied to the SWEI data to compute the shear-wave speed and reconstruct the shear moduli. Five types of prostatic tissue (PZ, CZ, transition zone (TZ) and benign prostatic hyperplasia (BPH), PCa and atrophy) were identified, whose shear moduli were quantified to be 4.1 +/- 0.8 kPa, 9.9 +/- 0.9 kPa, 4.8 +/- 0.6 kPa, 10.0 +/- 1.0 kPa and 8.0 kPa, respectively. Linear regression was performed to compare ARFI displacement amplitudes and the inverse of the corresponding reconstructed shear moduli at multiple depths. The results indicate an inverse relation between ARFI displacement amplitude and reconstructed shear modulus at all depths. These findings support the conclusion that ARFI prostate images portray underlying tissue stiffness variations.

Authors
Zhai, L; Madden, J; Foo, W-C; Mouraviev, V; Polascik, TJ; Palmeri, ML; Nightingale, KR
MLA Citation
Zhai, L, Madden, J, Foo, W-C, Mouraviev, V, Polascik, TJ, Palmeri, ML, and Nightingale, KR. "Characterizing stiffness of human prostates using acoustic radiation force." Ultrason Imaging 32.4 (October 2010): 201-213.
PMID
21213566
Source
pubmed
Published In
Ultrasonic Imaging
Volume
32
Issue
4
Publish Date
2010
Start Page
201
End Page
213
DOI
10.1177/016173461003200401

Editorial comment.

Authors
Tsivian, M; Polascik, TJ
MLA Citation
Tsivian, M, and Polascik, TJ. "Editorial comment." Urology 76.3 (September 2010): 687-.
PMID
20832627
Source
pubmed
Published In
Urology
Volume
76
Issue
3
Publish Date
2010
Start Page
687
DOI
10.1016/j.urology.2009.12.024

Role of vitamin D(3) as a sensitizer to cryoablation in a murine prostate cancer model: preliminary in vivo study.

OBJECTIVES: Calcitriol has been reported to have antitumor efficacy in several cancers. In this study, we hypothesized that calcitriol may potentially function as a cryosensitizer that can enhance cryoablation, and we investigated several molecular marker changes in a murine model of prostate cancer. METHODS: Murine prostate tumors (RM-9) were grown in male C57BL/6J mice subcutaneously with neoadjuvant intratumoral injection of calcitriol followed by cryoablation. The microenvironmental changes after cryoablation alone and in combination with calcitriol were analyzed in a comparative fashion using immunohistochemistry and Western blot analyses. RESULTS: Both cryoablation and the combination group could suppress tumor growth after treatment compared with the control. At final pathologic assessment, a larger necrotic area was seen in the combination group (P = .026). Although microvessel density (CD31) and the area of hypoxia (pimonidazole) was not different between the control and combination groups, cell proliferation (Ki-67) significantly decreased in the combination treatment (P = .035). In Western blot analyses, several markers for apoptosis were expressed significantly higher with the combination treatment. CONCLUSIONS: The synergistic effect of calcitriol with cryoablation was demonstrated because of enhanced antitumor efficacy by increasing necrosis and apoptosis and reduced cell proliferation. This study suggests that calcitriol is a potentially applicable reagent as a freeze sensitizer to cryoablation.

Authors
Kimura, M; Rabbani, Z; Mouraviev, V; Tsivian, M; Caso, J; Satoh, T; Baba, S; Vujaskovic, Z; Baust, JM; Baust, JG; Polascik, TJ
MLA Citation
Kimura, M, Rabbani, Z, Mouraviev, V, Tsivian, M, Caso, J, Satoh, T, Baba, S, Vujaskovic, Z, Baust, JM, Baust, JG, and Polascik, TJ. "Role of vitamin D(3) as a sensitizer to cryoablation in a murine prostate cancer model: preliminary in vivo study." Urology 76.3 (September 2010): 764.e14-764.e20.
PMID
20599255
Source
pubmed
Published In
Urology
Volume
76
Issue
3
Publish Date
2010
Start Page
764.e14
End Page
764.e20
DOI
10.1016/j.urology.2010.03.041

Predicting non-organ-confined prostate cancer in men diagnosed after 2000.

The objective of this study was to preoperatively predict non-organ-confined disease in patients considering radical prostatectomy. To account for the stage migration seen in prostate cancer, we included only those patients who underwent prostatectomy after the year 2000. Information on a cohort of 1895 patients who underwent radical prostatectomy from 2000 to 2008 was retrieved from the Duke Prostate Center database. Race (African American, non-African American), body mass index, age at surgery, PSA, biopsy Gleason sum (<7, 7 and >7) and clinical tumor stage (cT1, cT2/3) were analyzed by univariate analysis followed by logistic regression analysis. The Duke Interactive Clinical Equation for staging (DICE-S score) was calculated from the logistic regression model. The model was then internally validated using a bootstrapping technique. Biopsy Gleason sums 7 and >7 were more likely to have non-organ-confined disease compared with <7 (OR=2.97, Gleason sum=7; OR=3.25, Gleason sum>7). Clinical tumor stage, cT2/3, predicted non-organ-confined disease (OR=1.58). Older age was associated with non-organ-confined disease (OR=1.02), as was greater PSA (OR=1.12). DICE-S equation x=ln (p/1-p)=-3.627+0.019 (age)+0.109 (PSA)+1.087 (bGleason=7)+1.180 (bGleason >7)+0.459 (clinical T stage >T1), where p=(e(x))/(1+e(x)). A concordance index (prediction accuracy) of 0.73 was reached on internal validation. Using the DICE-S score, age, PSA, biopsy Gleason sum and clinical tumor stage, we can predict non-organ-confined disease in radical prostatectomy at an acceptable accuracy. Preoperative information on disease stage may aid in treatment decisions and surgical approach.

Authors
Caire, AA; Sun, L; Lack, BD; Lum, K; Tang, P; Stackhouse, DA; Robertson, CN; Mouraviev, V; Polascik, TJ; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Lack, BD, Lum, K, Tang, P, Stackhouse, DA, Robertson, CN, Mouraviev, V, Polascik, TJ, Albala, DM, and Moul, JW. "Predicting non-organ-confined prostate cancer in men diagnosed after 2000." Prostate Cancer Prostatic Dis 13.3 (September 2010): 248-251.
PMID
20514082
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
13
Issue
3
Publish Date
2010
Start Page
248
End Page
251
DOI
10.1038/pcan.2010.15

CONTRAST ENHANCEMENT AFTER RENAL CRYOABLATION: AN EVIDENCE OF TREATMENT FAILURE?

Authors
Tsivian, M; Kim, CY; Caso, JR; Rosenberg, M; Mouraviev, V; Albala, DM; Nelson, R; Polascik, TJ
MLA Citation
Tsivian, M, Kim, CY, Caso, JR, Rosenberg, M, Mouraviev, V, Albala, DM, Nelson, R, and Polascik, TJ. "CONTRAST ENHANCEMENT AFTER RENAL CRYOABLATION: AN EVIDENCE OF TREATMENT FAILURE?." September 2010.
Source
wos-lite
Published In
Journal of Endourology
Volume
24
Publish Date
2010
Start Page
A236
End Page
A237

A NOVEL CO2-LASER PARTIAL NEPHRECTOMY: PILOT STUDY IN A PORCINE MODEL

Authors
Tsivian, M; Caso, JR; Kimura, M; Madden, JF; Polascik, TJ; Mouraviev, V
MLA Citation
Tsivian, M, Caso, JR, Kimura, M, Madden, JF, Polascik, TJ, and Mouraviev, V. "A NOVEL CO2-LASER PARTIAL NEPHRECTOMY: PILOT STUDY IN A PORCINE MODEL." September 2010.
Source
wos-lite
Published In
Journal of Endourology
Volume
24
Publish Date
2010
Start Page
A13
End Page
A13

Morphology of hypoxia following cryoablation in a prostate cancer murine model: its relationship to necrosis, apoptosis and, microvessel density.

The aim of this study is to investigate the tumor tissue changes in terms of hypoxia and demonstrate its relationship to vascularity and apoptosis following therapeutic cryoablation in a prostate tumor murine model. Total 67 male C57BL/J6 mice were assigned into sham-operation group and cryoablation group. Murine prostate tumors (RM-9) were inoculated subcutaneously in a right hind leg and treated with cryotherapy. Of 30 mice, tumor volumes were measured for 12 days following operation. Of 37 mice, tumor tissues were harvested in 24h following operation, and histological/molecular changes were analyzed. Hematoxylin and eosin or immunohistochemical staining were utilized to quantify tumor necrosis, hypoxia (pimonidazole), vascularization (CD31), and apoptosis (cleaved caspase-3). The results showed that cryoablated tumors demonstrated significant delayed growth following treatment compared to controls. Pathological analysis revealed that the severity of hypoxia increased in the cryoablation arm compared to controls. Necrotic and apoptotic populations were also found to be increased in the cryoablation arm (P=0.028 and 0.021). Hypoxia demonstrated a positive correlation with necrosis (r=0.520, P=0.001) and apoptosis (r=0.474, P=0.003), while showing negative correlation with microvessel density (MVD) (r=-0.361, P=0.021). We concluded that in the peripheral areas from the cryoneedle impact site, strong hypoxic responses were found, which may play important role in tumor freezing injury. To our knowledge, this is the first report describing cryoablation-mediated changes of hypoxia at a molecular level in the prostate cancer murine model.

Authors
Kimura, M; Rabbani, Z; Mouraviev, V; Tsivian, M; Vujaskovic, Z; Satoh, T; Baba, S; Baust, JM; Baust, JG; Polascik, TJ
MLA Citation
Kimura, M, Rabbani, Z, Mouraviev, V, Tsivian, M, Vujaskovic, Z, Satoh, T, Baba, S, Baust, JM, Baust, JG, and Polascik, TJ. "Morphology of hypoxia following cryoablation in a prostate cancer murine model: its relationship to necrosis, apoptosis and, microvessel density." Cryobiology 61.1 (August 2010): 148-154.
PMID
20599882
Source
pubmed
Published In
Cryobiology
Volume
61
Issue
1
Publish Date
2010
Start Page
148
End Page
154
DOI
10.1016/j.cryobiol.2010.06.010

Complications of laparoscopic and percutaneous renal cryoablation in a single tertiary referral center.

BACKGROUND: Laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) of small renal masses have gained popularity, but only limited data exist on the complication rates. OBJECTIVES: In this study, we report on postoperative complications associated with LCA and PCA in a single tertiary center experience. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective review of electronic medical records for patients undergoing LCA or PCA between 2001 and 2008 at our institution. INTERVENTIONS: All patients underwent LCA or PCA. MEASUREMENTS: Demographics, radiographic variables, and complication rates were compared between the two groups. Complications were classified according to the modified Clavien system. RESULTS AND LIMITATIONS: Of a total of 195 patients included in this study, 72 underwent LCA and 123 underwent PCA. There were no differences in demographics between the groups. We observed complications in 10 LCA procedures (13.9%) and 26 PCA procedures (21.1%) (p=0.253). The distribution of the complications differed significantly between the groups with mild complications (grades 1 and 2) more common in the PCA group (20.3% vs 5.6%, respectively; p=0.001), whereas severe events (grades 3 and 4) were more frequent in the LCA group (8.3% vs 0.8%, respectively; p=0.011). On multivariate analysis, age and body mass index were inversely associated with complications, whereas female gender, multiple tumors, and preexisting comorbidities showed a trend toward increased risk. CONCLUSIONS: LCA and PCA, although minimally invasive, are not void of complications. Most of the complications encountered are mild; however, severe (grade 3 or 4) events may occur in up to 3.6% of patients. PCA may be associated with a higher rate of complications, although most of these are mild and transient. However, on multivariate analysis, the chosen ablative approach (laparoscopic or percutaneous) is not associated with the risk of complications.

Authors
Tsivian, M; Chen, VH; Kim, CY; Zilberman, DE; Mouraviev, V; Nelson, RC; Albala, DM; Polascik, TJ
MLA Citation
Tsivian, M, Chen, VH, Kim, CY, Zilberman, DE, Mouraviev, V, Nelson, RC, Albala, DM, and Polascik, TJ. "Complications of laparoscopic and percutaneous renal cryoablation in a single tertiary referral center." Eur Urol 58.1 (July 2010): 142-147.
PMID
20363550
Source
pubmed
Published In
European Urology
Volume
58
Issue
1
Publish Date
2010
Start Page
142
End Page
147
DOI
10.1016/j.eururo.2010.03.035

Focal therapy for prostate cancer: possibilities and limitations.

CONTEXT: A significant proportion of patients diagnosed with prostate cancer have well-differentiated, low-volume tumors at minimal risk of impacting their quality of life or longevity. The selection of a treatment strategy, among the multitude of options, has enormous implications for individuals and health care systems. OBJECTIVE: Our aim was to review the rationale, patient selection criteria, diagnostic imaging, biopsy schemes, and treatment modalities available for the focal therapy of localized prostate cancer. We gave particular emphasis to the conceptual possibilities and limitations. EVIDENCE ACQUISITION: A National Center for Biotechnology Information PubMed search (www.pubmed.gov) was performed from 1995 to 2009 using medical subject headings "focal therapy" or "ablative" and "prostate cancer." Additional articles were extracted based on recommendations from an expert panel of authors. EVIDENCE SYNTHESIS: Focal therapy of the prostate in patients with low-risk cancer characteristics is a proposed treatment approach in development that aims to eradicate all known foci of cancer while minimizing damage to adjacent structures necessary for the preservation of urinary, sexual, and bowel function. Conceptually, focal therapy has the potential to minimize treatment-related toxicity without compromising cancer-specific outcome. Limitations include the inability to stage or grade the cancer(s) accurately, suboptimal imaging capabilities, uncertainty regarding the natural history of untreated cancer foci, challenges with posttreatment monitoring, and the lack of quality-of-life data compared with alternative treatment strategies. Early clinical experiences with modest follow-up evaluating a variety of modalities are encouraging but hampered by study design limitations and small sample sizes. CONCLUSIONS: Prostate focal therapy is a promising and emerging treatment strategy for men with a low risk of cancer progression or metastasis. Evaluation in formal prospective clinical trials is essential before this new strategy is accepted in clinical practice. Adequate trials must include appropriate end points, whether absence of cancer on biopsy or reduction in progression of cancer, along with assessments of safety and longitudinal alterations in quality of life.

Authors
Eggener, S; Salomon, G; Scardino, PT; De la Rosette, J; Polascik, TJ; Brewster, S
MLA Citation
Eggener, S, Salomon, G, Scardino, PT, De la Rosette, J, Polascik, TJ, and Brewster, S. "Focal therapy for prostate cancer: possibilities and limitations." Eur Urol 58.1 (July 2010): 57-64. (Review)
PMID
20378241
Source
pubmed
Published In
European Urology
Volume
58
Issue
1
Publish Date
2010
Start Page
57
End Page
64
DOI
10.1016/j.eururo.2010.03.034

Predicting occult multifocality of renal cell carcinoma.

BACKGROUND: Multifocal renal cell carcinoma (RCC) has been reported in up to 25% of all radical nephrectomy specimens. Modern imaging tends to underestimate the rate of multifocality. Recognition of multifocality before treatment may guide physicians and patients to the type of intervention and tailor long-term follow-up. OBJECTIVE: Our aim was to develop and assess preoperative nomograms to predict occult multifocal RCC. DESIGN, SETTING, AND PARTICIPANTS: We evaluated 560 consecutive patients undergoing radical nephrectomy for clinically localized suspected sporadic RCC between 2000 and 2008 in a tertiary center. Clinically manifest multifocal lesions were excluded. Logistic regression models were used to assess the potential risk factors of occult multifocality with and without pathologic variables that may be available with preoperative biopsy. Nomograms were developed and assessed for diagnostic properties. INTERVENTIONS: All patients underwent radical nephrectomy. MEASUREMENTS: Assessments of risk factors for occult multifocal RCC were obtained using regression models and nomograms. RESULTS AND LIMITATIONS: The incidence of occult multifocality was 7.9%. Significantly associated predictors of multifocality were male gender, family history of malignancy other than RCC, radiographic size of the lesion, histologic subtype other than clear cell, and Fuhrman grade IV. The two designed nomograms had 0.75 and 0.82 concordance indices, respectively. CONCLUSIONS: Our data suggest that occult multifocal RCC is more frequently associated with small (2-4 cm) renal lesions. Male gender, family history of kidney cancer, histologic subtype, and grade are strongly associated with an increased risk of occult multifocal RCC. The developed nomograms had good predictive accuracy that was enhanced when combined with pathologic variables.

Authors
Tsivian, M; Moreira, DM; Caso, JR; Mouraviev, V; Madden, JF; Bratslavsky, G; Robertson, CN; Albala, DM; Polascik, TJ
MLA Citation
Tsivian, M, Moreira, DM, Caso, JR, Mouraviev, V, Madden, JF, Bratslavsky, G, Robertson, CN, Albala, DM, and Polascik, TJ. "Predicting occult multifocality of renal cell carcinoma." Eur Urol 58.1 (July 2010): 118-126.
PMID
20346577
Source
pubmed
Published In
European Urology
Volume
58
Issue
1
Publish Date
2010
Start Page
118
End Page
126
DOI
10.1016/j.eururo.2010.03.011

Integrin involvement in freeze resistance of androgen-insensitive prostate cancer.

Cryoablation has emerged as a primary therapy to treat prostate cancer. Although effective, the assumption that freezing serves as a ubiquitous lethal stress is challenged by clinical experience and experimental evidence demonstrating time-temperature-related cell-death dependence. The age-related transformation from an androgen-sensitive (AS) to an androgen-insensitive (AI) phenotype is a major challenge in the management of prostate cancer. AI cells exhibit morphological changes and treatment resistance to many therapies. As this resistance has been linked with alpha6beta4 integrin overexpression as a result of androgen receptor (AR) loss, we investigated whether alpha6beta4 integrin expression, as a result AR loss, contributes to the reported increased freeze tolerance of AI prostate cancer. A series of studies using AS (LNCaP LP and PC-3 AR) and AI (LNCaP HP and PC-3) cell lines were designed to investigate the cellular mechanisms contributing to variations in freezing response. Investigation into alpha6beta4 integrin expression revealed that AI cell lines overexpressed this protein, thereby altering morphological characteristics and increasing adhesion characteristics. Molecular investigations revealed a significant decrease in caspases-8, -9, and -3 levels in AI cells after freezing. Inhibition of alpha6beta4 integrin resulted in increased caspase activity after freezing (similar to AS cells) and enhanced cell death. These data show that AI cells show an increase in post-freeze susceptibility after inhibition of alpha6beta4 integrin function. Further understanding the role of androgen receptor-related alpha6beta4 integrin expression in prostate cancer cells responses to freezing might lead to novel options for neo-adjunctive treatments targeting the AR signaling pathway.

Authors
Baust, JG; Klossner, DP; Vanbuskirk, RG; Gage, AA; Mouraviev, V; Polascik, TJ; Baust, JM
MLA Citation
Baust, JG, Klossner, DP, Vanbuskirk, RG, Gage, AA, Mouraviev, V, Polascik, TJ, and Baust, JM. "Integrin involvement in freeze resistance of androgen-insensitive prostate cancer." Prostate Cancer Prostatic Dis 13.2 (June 2010): 151-161.
PMID
20066006
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
13
Issue
2
Publish Date
2010
Start Page
151
End Page
161
DOI
10.1038/pcan.2009.59

Prostate biopsy in selecting candidates for hemiablative focal therapy.

Focal therapy (FT) for the management of clinically localized prostate cancer (PCa) is growing from a concept to reality because of increased interest of both patients and physicians. Selection protocols, however, are yet to be established. We discuss the role of prostate biopsy in candidate selection for FT and highlight the different strategies and technical aspects of the use of prostate biopsy in this setting. In our opinion, prostate biopsy plays a major role in the selection process and tailoring appropriate treatment strategy to the patient. FT necessitates dedicated biopsy schemes that would reliably predict the extent, nature, and location of PCa in selected patients. Currently, there is insufficient scientific evidence to propose a specific biopsy scheme that could fit every candidate, providing accurate characterization of the disease in the individual patient. Further research is necessary to establish solid selection protocols that would reliably identify appropriate candidates for FT of PCa.

Authors
Tsivian, M; Hruza, M; Mouraviev, V; Rassweiler, J; Polascik, TJ
MLA Citation
Tsivian, M, Hruza, M, Mouraviev, V, Rassweiler, J, and Polascik, TJ. "Prostate biopsy in selecting candidates for hemiablative focal therapy." J Endourol 24.5 (May 2010): 849-853.
Website
http://hdl.handle.net/10161/3314
PMID
20370327
Source
pubmed
Published In
Journal of Endourology
Volume
24
Issue
5
Publish Date
2010
Start Page
849
End Page
853
DOI
10.1089/end.2009.0473

Focal cryotherapy for prostate cancer.

Focal therapy for prostate cancer has emerged an interesting concept as a less morbid option for the treatment of localized low-risk disease. Despite the growing interest in focal therapy, this approach has not yet gained sufficient popularity nor provided enough data to be discussed outside the experimental application. Herein we summarize the available data on focal cryotherapy and focus on the targets to be achieved in order to increase the applicability of focal cryotherapy to clinical practice. A cautious approach to candidate selection and generation of solid scientific data that would result in wide consensus on patient selection strategies and follow-up schemes would provide the tools necessary to take the path of focal therapy. Currently available focal cryotherapy data demonstrate excellent short-term results and a favorable quality-of-life profile. Although the future role of focal treatment is debated, a growing amount of science is generated in support of this minimally invasive approach.

Authors
Tsivian, M; Polascik, TJ
MLA Citation
Tsivian, M, and Polascik, TJ. "Focal cryotherapy for prostate cancer." Curr Urol Rep 11.3 (May 2010): 147-151. (Review)
PMID
20425620
Source
pubmed
Published In
Current Urology Reports
Volume
11
Issue
3
Publish Date
2010
Start Page
147
End Page
151
DOI
10.1007/s11934-010-0100-1

Contemporary results of focal therapy for prostate cancer using cryoablation.

The concept of focal therapy is rapidly evolving and gaining popularity from both physician and patient perspectives. We review the rationale, candidate selection, and results of the first clinical studies of focal cryoablation for selected patients with low volume and low- to low-moderate-risk features of prostate cancer as an alternative to whole-gland treatment. In spite of improved understanding of the tumor biology of early stage disease, we currently have limited tools to select appropriate patients with low- to low-moderate risk unifocal or unilateral prostate cancer who may be amenable to focal therapy. From a technical point, a number of ablative treatment options for focal therapy are available, with cryoablation having the most clinical experience. Recently, several reports have been published from single and multi-institutional studies that discuss focal therapy as a reasonable balance between cancer control and quality-of-life outcomes. Retrospective pathologic data from large prostatectomy series, however, do not clearly reveal valid and reproducible criteria to select appropriate candidates for focal cryoablation because of the complexity of tumorigenesis in early stage disease. At this time, a more feasible option remains hemiablation of the prostate with reasonable certainty about the absence of clinically significant cancer lesion(s) on the contralateral side of the prostate based on three-dimensional transperineal prostate biopsy mapping studies. Minimally invasive, parenchyma-preserving cryoablation can be considered as a potential feasible option in the treatment armamentarium of early stage, localized prostate cancer in appropriately selected candidates. There is a need to further test this technique in randomized, multicenter clinical trials.

Authors
Mouraviev, V; Johansen, TEB; Polascik, TJ
MLA Citation
Mouraviev, V, Johansen, TEB, and Polascik, TJ. "Contemporary results of focal therapy for prostate cancer using cryoablation." J Endourol 24.5 (May 2010): 827-834. (Review)
Website
http://hdl.handle.net/10161/3235
PMID
20443724
Source
pubmed
Published In
Journal of Endourology
Volume
24
Issue
5
Publish Date
2010
Start Page
827
End Page
834
DOI
10.1089/end.2009.0546

Prostate cancer: an evolving paradigm.

Since at least the early 1990s, stage and risk migration have been seen in patients with prostate cancer, likely corresponding to the institution of prostate specific antigen (PSA) screening in health systems. Preoperative risk factors, including PSA level and clinical stage, have decreased significantly. These improved prognostic variables have led to a larger portion of men being stratified with low-risk disease, as per the classification of D'Amico and associates. This, in turn, has corresponded with more favorable postoperative variables, including decreased extraprostatic tumor extension and prolonged biochemical-free recurrence rates. The advent of focal therapy is bolstered by findings of increased unilateral disease with decreased tumor volume. Increasingly, targeted or delayed therapies may be possible within the current era of lower risk disease.

Authors
Caso, JR; Mouraviev, V; Tsivian, M; Polascik, TJ; Moul, JW
MLA Citation
Caso, JR, Mouraviev, V, Tsivian, M, Polascik, TJ, and Moul, JW. "Prostate cancer: an evolving paradigm." J Endourol 24.5 (May 2010): 805-809.
Website
http://hdl.handle.net/10161/3242
PMID
20367442
Source
pubmed
Published In
Journal of Endourology
Volume
24
Issue
5
Publish Date
2010
Start Page
805
End Page
809
DOI
10.1089/end.2009.0539

Public survey and survival data do not support recommendations to discontinue prostate-specific antigen screening in men at age 75.

OBJECTIVES: To evaluate the US Preventative Services Task Force (USPSTF) recommendation to discontinue prostate-specific antigen (PSA) screening at age 75. METHODS: Public survey: A cohort of 340 patients was surveyed at our PSA screening clinic and stratified by awareness of the recommendation and education level. Age (< 75, >or= 75), race, health insurance status, knowledge of prostate cancer, and opinion on screening discontinuation at age 75 was evaluated between groups. Disease risk and survival analysis: A cohort of 4196 men who underwent radical prostatectomy between 1988 and 2008 was stratified into age groups: < 65, 65-74, and >or= 75. Associations between clinicopathologic variables, disease risk, and survival were compared between age groups using univariate and multivariate analysis. RESULTS: Approximately 78% of men surveyed disagreed with the USPSTF recommendation. The number of men who disagreed was not significantly different between awareness groups (P = .962). Awareness of new screening guidelines showed a significant difference (P = .006) between education groups. Age >or= 75 years was predictive of high-risk disease based on D'Amico's criteria (odds ratio = 2.72, P = .003). Kaplan-Meier and Cox regression analyses showed an association of men aged >or= 75 years with higher rate of PSA recurrence, distant metastasis, and disease specific death compared with the age groups of < 65 and 65-74 (P <.05). CONCLUSIONS: Men presenting to our PSA screening clinic disagreed with discontinuation of screening at age 75. Men aged >or= 75 years had higher risk disease and poorer survival. The USPSTF recommendation was supported neither by public opinion nor disease risk and survival results.

Authors
Caire, AA; Sun, L; Robertson, CN; Polascik, TJ; Maloney, KE; George, DJ; Price, MM; Stackhouse, DA; Lack, BD; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Robertson, CN, Polascik, TJ, Maloney, KE, George, DJ, Price, MM, Stackhouse, DA, Lack, BD, Albala, DM, and Moul, JW. "Public survey and survival data do not support recommendations to discontinue prostate-specific antigen screening in men at age 75." Urology 75.5 (May 2010): 1122-1127.
PMID
19815259
Source
pubmed
Published In
Urology
Volume
75
Issue
5
Publish Date
2010
Start Page
1122
End Page
1127
DOI
10.1016/j.urology.2009.06.091

Impact of postoperative prostate-specific antigen disease recurrence and the use of salvage therapy on the risk of death.

BACKGROUND: This report evaluated whether biochemical recurrence (BCR) as a time-dependent covariate (t) after radical prostatectomy (RP) for prostate cancer was associated with the risk of death and whether salvage therapy with radiotherapy (RT) and/or hormonal therapy (HT) can lessen this risk METHODS: This was a retrospective cohort study of 3071 men who underwent RP at Duke University between 1988 and 2008 and had complete follow-up data. A Cox regression multivariable analysis was used to determine whether BCR (t) was associated with the risk of death in men after adjusting for age, prostatectomy findings, and the use of salvage RT and/or HT. RESULTS: After a median follow-up of 7.4 years, 546 (17.8%) men experienced BCR and 454 (14.8%) died. The median follow-up after prostate-specific antigen (PSA) failure was 11.2 years (interquartile range, 5.8-16.0 years). BCR (t) was associated with an increased risk of death (adjusted hazards ratio [AHR], 1.03; 95% confidence interval [95% CI], 1.004-1.06 [P = .025]). In men who experienced BCR, a PSA doubling time <6 months was associated with an increased risk of death (AHR, 1.55; 95% CI, 1.15-2.1 [P = .004]); whereas a decrease in the risk of death was observed in men who received RT (AHR, 0.58; 95% CI, 0.40-0.58 [P = .002]) or HT (AHR, 0.56; 95% CI, 0.37-0.84 [P = .005]) after BCR. CONCLUSIONS: The occurrence of BCR was found to increase the risk of death in men undergoing RP for prostate cancer, and this risk appeared to increase as the time to BCR shortened. However, the addition of RT and/or HT in men with BCR significantly lowered this risk.

Authors
Choueiri, TK; Chen, M-H; D'Amico, AV; Sun, L; Nguyen, PL; Hayes, JH; Robertson, CN; Walther, PJ; Polascik, TJ; Albala, DM; Moul, JW
MLA Citation
Choueiri, TK, Chen, M-H, D'Amico, AV, Sun, L, Nguyen, PL, Hayes, JH, Robertson, CN, Walther, PJ, Polascik, TJ, Albala, DM, and Moul, JW. "Impact of postoperative prostate-specific antigen disease recurrence and the use of salvage therapy on the risk of death." Cancer 116.8 (April 15, 2010): 1887-1892.
PMID
20162710
Source
pubmed
Published In
Cancer
Volume
116
Issue
8
Publish Date
2010
Start Page
1887
End Page
1892
DOI
10.1002/cncr.25013

Acoustic radiation force impulse imaging of human prostates ex vivo.

It has been challenging for clinicians using current imaging modalities to visualize internal structures and detect lesions inside human prostates. Lack of contrast among prostatic tissues and high false positive or negative detection rates of prostate lesions have limited the use of current imaging modalities in the diagnosis of prostate cancer. In this study, acoustic radiation force impulse (ARFI) imaging is introduced to visualize the anatomical and abnormal structures in freshly excised human prostates. A modified Siemens Antares ultrasound scanner (Siemens Medical Solutions USA Inc., Malvern, PA) and a Siemens VF10-5 linear array were used to acquire ARFI images. The transducer was attached to a three-dimensional (3-D) translation stage, which was programmed to automate volumetric data acquisition. A depth dependent gain (DDG) method was developed and applied to 3-D ARFI datasets to compensate for the displacement gradients associated with spatially varying radiation force magnitudes as a function of depth. Nine human prostate specimens were collected and imaged immediately after surgical excision. Prostate anatomical structures such as seminal vesicles, ejaculatory ducts, peripheral zone, central zone, transition zone and verumontanum were visualized with high spatial resolution and in good agreement with McNeal's zonal anatomy. The characteristic appearance of prostate pathologies, such as prostate cancerous lesions, benign prostatic hyperplasia, calcified tissues and atrophy were identified in ARFI images based upon correlation with the corresponding histologic slides. This study demonstrates that ARFI imaging can be used to visualize internal structures and detecting suspicious lesions in the prostate and appears promising for image guidance of prostate biopsy.

Authors
Zhai, L; Madden, J; Foo, W-C; Palmeri, ML; Mouraviev, V; Polascik, TJ; Nightingale, KR
MLA Citation
Zhai, L, Madden, J, Foo, W-C, Palmeri, ML, Mouraviev, V, Polascik, TJ, and Nightingale, KR. "Acoustic radiation force impulse imaging of human prostates ex vivo." Ultrasound Med Biol 36.4 (April 2010): 576-588.
PMID
20350685
Source
pubmed
Published In
Ultrasound in Medicine and Biology
Volume
36
Issue
4
Publish Date
2010
Start Page
576
End Page
588
DOI
10.1016/j.ultrasmedbio.2009.12.006

Predicting unilateral prostate cancer on routine diagnostic biopsy: sextant vs extended.

OBJECTIVE: To compare the diagnostic properties of routine office-based sextant and extended biopsies for unilateral prostate cancer, as validated by final pathology, because focal therapy of prostate cancer is gaining acceptance as a viable treatment option and thus patient selection is of paramount consideration. PATIENTS AND METHODS: We retrospectively analysed records of patients who had a radical prostatectomy (RP) for biopsy confirmed prostate cancer at our institution between 1990 and 2007. Records with incomplete data were excluded. Diagnostic properties for sextant and extended biopsies were calculated and compared for diagnostic accuracy, sensitivity, specificity, positive and negative predictive values (PPV, NPV) and false-positive and -negative rates. RESULTS: We identified 882 records (729 sextant, 153 extended biopsies) matching our criteria. Overall, unilateral prostate cancer was confirmed in 151 (16%) of pathological RP specimens. The sensitivity improved from 84.1% to 88.0% on sextant and extended biopsy, respectively. Similarly, the PPV increased from 21.9% to 27.2%, specificity from 37.1% to 53.9% (P < 0.05), and NPV from 91.8% to 95.8% (P < 0.05). These changes are reflected in the decrease in false-positive rates (from 62.9% to 46.1%) and false-negative rates (from 15.9% to 12.0%). The overall diagnostic accuracy increased from 49% on sextant to 59% on extended biopsy (P < 0.05). CONCLUSIONS: Taking more prostate biopsy cores improves the diagnostic properties for identifying unilateral prostate cancer. However, a 12-core biopsy is not an ideal diagnostic test to select patients for focal therapy, and should be interpreted in conjunction with imaging and clinical variables. Additional research should investigate the diagnostic gain associated with a further increase in the number of biopsy cores.

Authors
Tsivian, M; Kimura, M; Sun, L; Mouraviev, V; Mayes, JM; Polascik, TJ
MLA Citation
Tsivian, M, Kimura, M, Sun, L, Mouraviev, V, Mayes, JM, and Polascik, TJ. "Predicting unilateral prostate cancer on routine diagnostic biopsy: sextant vs extended." BJU Int 105.8 (April 2010): 1089-1092.
PMID
19818078
Source
pubmed
Published In
Bju International
Volume
105
Issue
8
Publish Date
2010
Start Page
1089
End Page
1092
DOI
10.1111/j.1464-410X.2009.08904.x

Minimally invasive surgery using ablative modalities for the localized renal mass.

Due to a number of evolving devices and modalities to treat the small, localized renal mass, the physician and patient have the opportunity to choose an appropriate therapy from several treatment options. Minimally invasive surgery to ablate a localized renal tumor is an alternative strategy to nephron-sparing surgery for the small renal mass. Even though partial nephrectomy has been established as an optimal technique for nephron-sparing surgery, patients who have comorbidities and renal insufficiency would potentially benefit from less invasive treatment. With respect to those concerns, several articles are discussed here regarding thermal ablative therapy for the small renal mass along with oncological outcomes and complications among these modalities compared to conventional procedures. In this review, a comprehensive PubMed search was conducted. For the purposes of reviewing the current status of thermal ablative modalities for the small renal mass, only articles written in English published from 1992 to 2009 were considered. Cryoablation and radiofrequency ablation are the most utilized and potentially promising therapies that are evolving as nephron-sparing minimally invasive surgery for patients with a localized renal tumor. High-intensity focused ultrasound, a relatively new modality to treat the renal mass, needs further study. All modalities require long-term follow up with unified reporting methods in terms of patient selection, pre- and post-treatment evaluation, treatment description, and analysis of outcome.

Authors
Kimura, M; Baba, S; Polascik, TJ
MLA Citation
Kimura, M, Baba, S, and Polascik, TJ. "Minimally invasive surgery using ablative modalities for the localized renal mass." Int J Urol 17.3 (March 2010): 215-227. (Review)
PMID
20070411
Source
pubmed
Published In
International Journal of Urology
Volume
17
Issue
3
Publish Date
2010
Start Page
215
End Page
227
DOI
10.1111/j.1442-2042.2009.02445.x

Initial prostate specific antigen 1.5 ng/ml or greater in men 50 years old or younger predicts higher prostate cancer risk.

PURPOSE: Studies show that initial prostate specific antigen higher than the median in young men predicts a subsequent higher risk of prostate cancer. To our knowledge this relationship has not been studied in patients stratified by race. MATERIALS AND METHODS: A cohort of 3,530 black and 6,118 white men 50 years or younger with prostate specific antigen 4 ng/ml or less at the first prostate specific antigen screening was retrieved from the prostate center database at our institution. Patients were divided into groups based on initial prostate specific antigen 0.1 to 0.6, 0.7 to 1.4, 1.5 to 2.4 and 2.5 to 4.0 ng/ml. Univariate and age adjusted multivariate logistic regression was done to estimate the cancer RR in these prostate specific antigen groups. We calculated the prostate cancer rate at subsequent followups. RESULTS: Median prostate specific antigen in black and white men was 0.7 ng/ml at age 50 years or less. The prostate cancer rate was not significantly different in the groups with prostate specific antigen less than 0.6 and 0.7 to 1.4 ng/ml in black or white men. Black and white men with initial prostate specific antigen in the 1.5 to 2.4 ng/ml range had a 9.3 and 6.7-fold increase in the age adjusted prostate cancer RR, respectively. At up to 9 years of followup initial prostate specific antigen 1.5 ng/ml or greater was associated with gradually increased detection at followup in black and white men. CONCLUSIONS: An initial prostate specific antigen cutoff of 1.5 ng/ml may be better than median prostate specific antigen 0.7 ng/ml to determine the risk of prostate cancer in black and white men 50 years old or younger.

Authors
Tang, P; Sun, L; Uhlman, MA; Robertson, CN; Polascik, TJ; Albala, DM; Donatucci, CF; Moul, JW
MLA Citation
Tang, P, Sun, L, Uhlman, MA, Robertson, CN, Polascik, TJ, Albala, DM, Donatucci, CF, and Moul, JW. "Initial prostate specific antigen 1.5 ng/ml or greater in men 50 years old or younger predicts higher prostate cancer risk." J Urol 183.3 (March 2010): 946-950.
PMID
20083275
Source
pubmed
Published In
The Journal of Urology
Volume
183
Issue
3
Publish Date
2010
Start Page
946
End Page
950
DOI
10.1016/j.juro.2009.11.021

Tumor percent involvement predicts prostate specific antigen recurrence after radical prostatectomy only in men with smaller prostate.

PURPOSE: We determined the predictive power of tumor percent involvement on prostate specific antigen recurrence in patients when stratified by prostate weight. MATERIALS AND METHODS: Data on 3,057 patients who underwent radical prostatectomy between 1988 and 2008 was retrieved from our institutional prostate cancer database. Patients with data on tumor percent involvement, prostate volume and prostate specific antigen recurrence were included in analysis. Patients were divided into 3 groups based on prostate volume less than 35, 35 to 45 and greater than 45 cc. The variables tumor percent involvement, age at surgery, race, prostate specific antigen, pathological Gleason score, positive surgical margins, extraprostatic extension, seminal vesicle invasion and surgery year were analyzed using the chi-square and Mann-Whitney tests to determine individual effects on prostate specific antigen recurrence. Tumor percent involvement and prostate specific antigen were evaluated as continuous variables. Significant variables on univariate analysis were included in multivariate Cox regression analysis to compare their effects on prostate specific antigen recurrence. RESULTS: Tumor percent involvement significantly predicted prostate specific antigen recurrence in men with a small prostate (p = 0.006) but not in those with a prostate of greater than 35 cc. Black race was a marginally significant predictor of prostate specific antigen recurrence in men with a medium prostate (p = 0.055). Age at surgery was a predictor of prostate specific antigen recurrence in men with a larger prostate (p = 0.003). Prostate specific antigen, positive surgical margins, seminal vesicle invasion and pathological Gleason score 7 or greater predicted prostate specific antigen recurrence in men with all prostate sizes. CONCLUSIONS: In men with a prostate of less than 35 cc tumor percent involvement is an important variable when assessing the risk of prostate specific antigen recurrence. Tumor percent involvement and prostate volume should be considered when counseling patients and determining who may benefit from heightened surveillance after radical prostatectomy.

Authors
Uhlman, MA; Sun, L; Stackhouse, DA; Polascik, TJ; Mouraviev, V; Robertson, CN; Albala, DM; Moul, JW
MLA Citation
Uhlman, MA, Sun, L, Stackhouse, DA, Polascik, TJ, Mouraviev, V, Robertson, CN, Albala, DM, and Moul, JW. "Tumor percent involvement predicts prostate specific antigen recurrence after radical prostatectomy only in men with smaller prostate." J Urol 183.3 (March 2010): 997-1001.
PMID
20089281
Source
pubmed
Published In
The Journal of Urology
Volume
183
Issue
3
Publish Date
2010
Start Page
997
End Page
1001
DOI
10.1016/j.juro.2009.11.046

Tumor size and endophytic growth pattern affect recurrence rates after laparoscopic renal cryoablation.

OBJECTIVE: To analyze factors that may contribute to local relapse after laparoscopic cryoablation (LCA) of renal tumors. LCA has gained popularity in the treatment of small renal tumors, but local tumor control remains a concern. METHODS: We analyzed 163 patients who underwent LCA between 2001 and 2008 either at Allegheny General Hospital or Duke University Medical Center, with at least 6 months of follow-up. Demographics, perioperative variables, tumor characteristics (size, pattern of growth, and biopsy results), and follow-up were recorded. Growth pattern was categorized as exophytic, mesophytic, or endophytic. Regression analyses were performed to evaluate risk factors for local relapse after LCA. RESULTS: Median patient age was 66 (range, 33-90) years, with men comprising 60.1% of the cohort. Median tumor size was 2.4 cm (range, 0.5-5.0). Pathology was as follows: renal cell carcinoma in 118 (72.4%), other malignancies in 2 (1.2%), and no malignancy in 43 (26.4%) patients. A single lesion was treated in 95.1% patients and multiple tumors in 4.9%. Endophytic growth pattern was present in 22.8% patients. We observed 7 (4.3%) local recurrences over a median follow-up of 20 months (range, 6-79). Median time to recurrence was 15 months (range, 6-48). On proportional hazards regression, tumor size and endophytic growth pattern were significantly associated with local recurrence (P = .003 and .028; odds ratios [OR] = 4.1 and 11.4, respectively). CONCLUSIONS: LCA demonstrated good tumor control over a 5-year follow-up, with an acceptable recurrence rate. Larger tumors and those with endophytic growth pattern may be at increased risk of relapse after LCA.

Authors
Tsivian, M; Lyne, JC; Mayes, JM; Mouraviev, V; Kimura, M; Polascik, TJ
MLA Citation
Tsivian, M, Lyne, JC, Mayes, JM, Mouraviev, V, Kimura, M, and Polascik, TJ. "Tumor size and endophytic growth pattern affect recurrence rates after laparoscopic renal cryoablation." Urology 75.2 (February 2010): 307-310.
PMID
19942265
Source
pubmed
Published In
Urology
Volume
75
Issue
2
Publish Date
2010
Start Page
307
End Page
310
DOI
10.1016/j.urology.2009.09.039

Tumor volume, tumor percentage involvement, or prostate volume: which is predictive of prostate-specific antigen recurrence?

OBJECTIVES: To compare the effects of tumor volume (TV), tumor percentage involvement (TPI), and prostate volume (PV) on prostate-specific antigen (PSA) recurrence (PSAR) after radical prostatectomy (RP). METHODS: A cohort of 3528 patients receiving RP between 1988 and 2008 was retrieved from the Duke Prostate Center. Patients were stratified by TV (< 3, 3-6, > 6 cm(3)), TPI (< 10%, 10%-20%, > 20%), and PV (< 35, 35-45, > 45 cm(3)) and their effects on PSAR evaluated using Kaplan-Meier analysis. Clinicopathologic variables included in univariate analysis were age at surgery, race, year of surgery, PSA, pathologic Gleason score, pathologic tumor stage, margin status, extracapsular extension, and seminal vesicle invasion. The effects of TV, TPI, and PV (as continuous and categorical variables) on PSAR were compared using Cox analysis. RESULTS: TPI, TV, and PV were predictive of PSAR (P <.05) in Kaplan-Meier analysis. In multivariate analysis as continuous variables, TPI and PV were predictive of PSAR (hazard ratio [HR] = 1.16 and HR = 0.65, P <.05). As categorical variables, TPI > 20% and PV 10-35 cm(3) were predictive of PSAR (HR = 1.45 and OR = 1.25, P <.05). TV was not predictive of PSAR in either analysis. Pathologic Gleason score > or = 7, PSA, positive margins, seminal vesicle invasion, and tumor stage T3/T4 were found to be predictors of PSAR (P <.05). CONCLUSIONS: TV, TPI, and PV were predictive of PSAR in univariate analysis, but in multivariate analysis, only TPI and PV were predictive of PSAR. TPI and PV should be considered when evaluating, assessing, and counseling patients regarding PSAR risk.

Authors
Uhlman, MA; Sun, L; Stackhouse, DA; Caire, AA; Polascik, TJ; Robertson, CN; Madden, J; Vollmer, R; Albala, DM; Moul, JW
MLA Citation
Uhlman, MA, Sun, L, Stackhouse, DA, Caire, AA, Polascik, TJ, Robertson, CN, Madden, J, Vollmer, R, Albala, DM, and Moul, JW. "Tumor volume, tumor percentage involvement, or prostate volume: which is predictive of prostate-specific antigen recurrence?." Urology 75.2 (February 2010): 460-466.
PMID
19819532
Source
pubmed
Published In
Urology
Volume
75
Issue
2
Publish Date
2010
Start Page
460
End Page
466
DOI
10.1016/j.urology.2009.06.059

Tumor Volume, Tumor Percentage Involvement, or Prostate Volume: Which Is Predictive of Prostate-specific Antigen Recurrence?

Authors
Uhlman, MA; Sun, L; Stackhouse, DA; Caire, AA; Polascik, TJ; Robertson, CN; Madden, J; Vollmer, R; Albala, DM; Moul, JW
MLA Citation
Uhlman, MA, Sun, L, Stackhouse, DA, Caire, AA, Polascik, TJ, Robertson, CN, Madden, J, Vollmer, R, Albala, DM, and Moul, JW. "Tumor Volume, Tumor Percentage Involvement, or Prostate Volume: Which Is Predictive of Prostate-specific Antigen Recurrence?." UROLOGY 75.2 (February 2010): 460-466.
Source
wos-lite
Published In
Urology
Volume
75
Issue
2
Publish Date
2010
Start Page
460
End Page
466
DOI
10.1016/j.urology.2009.06.059

Recent advances in focal therapy of prostate and kidney cancer.

The concept of focal therapy in oncologic surgery refers to maximizing healthy tissue preservation while maintaining excellent cancer control outcomes. Herein, we address the recent advantages in the field of focal therapy for both kidney and prostate cancer, focusing on technological achievements and future perspectives.

Authors
Tsivian, M; Polascik, TJ
MLA Citation
Tsivian, M, and Polascik, TJ. "Recent advances in focal therapy of prostate and kidney cancer. (Published online)" F1000 Med Rep 2 (January 18, 2010).
PMID
20948877
Source
pubmed
Published In
F1000 Medicine Reports
Volume
2
Publish Date
2010
DOI
10.3410/M2-1

Current salvage methods for recurrent prostate cancer after failure of primary radiotherapy.

We reviewed the current salvage methods for patients with local recurrent prostate cancer after primary radiotherapy (RT), using a search of relevant Medline/PubMed articles published from 1982 to 2008, with the following search terms: 'radiorecurrent prostate cancer, local salvage treatment, salvage radical prostatectomy (RP), salvage cryoablation, salvage brachytherapy, salvage high-intensity focused ultrasound (HIFU)', and permutations of the above. Only articles written in English were included. The objectives of this review were to analyse the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. There are four whole-gland re-treatment options (salvage RP, salvage cryoablation, salvage brachytherapy, salvage HIFU) for RT failure, although others might be in development or investigations. Salvage RP has the longest follow-up with acceptable oncological results, but it is a challenging technique with a high complication rate. Salvage cryoablation is a feasible option, especially using third-generation technology, whereby the average biochemical disease-free survival rate is 50-70% and there are fewer occurrences of severe complications such as recto-urethral fistula. Salvage brachytherapy, with short-term cancer control, is comparable to other salvage methods but depends on cumulative dosage limitation to target tissues. HIFU is a relatively recent option in the salvage setting. Both salvage brachytherapy and HIFU require more detailed studies with intermediate and long-term follow-up. As these are not prospective, randomized studies and the definitions of biochemical failure varied, there are limited comparisons among these different salvage methods, including efficacy. In the focal therapy salvage setting, the increased use of thermoablative methods for eligible patients might contribute to reducing complications and maintaining quality of life. The problem to effectively salvage patients with locally recurrent disease after RT is the lack of diagnostic examinations with sufficient sensitivity and specificity to detect local recurrence at an early curable stage. Therefore, a more strict definition of biochemical failure, improved imaging techniques, and accurate specimen mapping are needed as diagnostic tools. Furthermore, universal selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological efficacy and least comorbidity.

Authors
Kimura, M; Mouraviev, V; Tsivian, M; Mayes, JM; Satoh, T; Polascik, TJ
MLA Citation
Kimura, M, Mouraviev, V, Tsivian, M, Mayes, JM, Satoh, T, and Polascik, TJ. "Current salvage methods for recurrent prostate cancer after failure of primary radiotherapy." BJU Int 105.2 (January 2010): 191-201. (Review)
PMID
19583717
Source
pubmed
Published In
Bju International
Volume
105
Issue
2
Publish Date
2010
Start Page
191
End Page
201
DOI
10.1111/j.1464-410X.2009.08715.x

Erratum: Focal therapy for prostate cancer: Possibilities and limitations (European Urology (2010) 58 (57-64))

Authors
Eggener, S; Salomon, G; Scardino, PT; Rosette, JDL; Polascik, TJ; Brewster, S
MLA Citation
Eggener, S, Salomon, G, Scardino, PT, Rosette, JDL, Polascik, TJ, and Brewster, S. "Erratum: Focal therapy for prostate cancer: Possibilities and limitations (European Urology (2010) 58 (57-64))." European Urology 58.4 (2010): 644--.
PMID
28065298
Source
scival
Published In
European Urology
Volume
58
Issue
4
Publish Date
2010
Start Page
644-
DOI
10.1016/j.eururo.2010.07.001

Focal therapy in prostate cancer-report from a consensus panel

Purpose: To establish a consensus in relation to case selection, conduct of therapy, and outcomes that are associated with focal therapy for men with localized prostate cancer. Material and Methods: Urologic surgeons, radiation oncologists, radiologists, and histopathologists from North America and Europe participated in a consensus workshop on focal therapy for prostate cancer. The consensus process was face to face within a structured meeting, in which pertinent clinical issues were raised, discussed, and agreement sought. Where no agreement was possible, this was acknowledged, and the nature of the disagreement noted. Results: Candidates for focal treatment should have unilateral low- to intermediate-risk disease with clinical stage ≤cT 2a. Prostate size and both tumor volume and tumor topography are important case selection criteria that depend on the ablative technology used. Currently, the best method to ascertain the key characteristics for men who are considering focal therapy is exposure to transperineal template mapping biopsies. MRI of the prostate using novel techniques such as dynamic contrast enhancement and diffusion weighed imaging are increasingly being used to diagnose and stage primary prostate cancer with excellent results. For general use, however, these new techniques require validation in prospective clinical trials. Until such are performed, MRI will, in most centers, continue to be an investigative tool in assessing eligibility of patients for focal therapy. Conclusions: Consensus was derived for most of the key aspects of case selection, conduct of treatment, and outcome measures for men who are undergoing focal therapy for localized prostate cancer. The level of agreement achieved will pave the way for future collaborative trials. © Copyright 2010, Mary Ann Liebert, Inc.

Authors
Rosette, JDL; Ahmed, H; Barentsz, J; Johansen, TB; Brausi, M; Emberton, M; Frauscher, F; Greene, D; Harisinghani, M; Haustermans, K; Heidenreich, A; Kovacs, G; Mason, M; Montironi, R; Mouraviev, V; Reijke, TD; Taneja, S; Thuroff, S; Tombal, B; Trachtenberg, J; Wijkstra, H; Polascik, T
MLA Citation
Rosette, JDL, Ahmed, H, Barentsz, J, Johansen, TB, Brausi, M, Emberton, M, Frauscher, F, Greene, D, Harisinghani, M, Haustermans, K, Heidenreich, A, Kovacs, G, Mason, M, Montironi, R, Mouraviev, V, Reijke, TD, Taneja, S, Thuroff, S, Tombal, B, Trachtenberg, J, Wijkstra, H, and Polascik, T. "Focal therapy in prostate cancer-report from a consensus panel." Journal of Endourology 24.5 (2010): 775-780.
Website
http://hdl.handle.net/10161/3299
PMID
20477543
Source
scival
Published In
Journal of Endourology
Volume
24
Issue
5
Publish Date
2010
Start Page
775
End Page
780
DOI
10.1089/end.2009.0596

Focal therapy for prostate and renal cancer - Are we ready for it?

Authors
Rosette, JDL; Gill, I; Polascik, T
MLA Citation
Rosette, JDL, Gill, I, and Polascik, T. "Focal therapy for prostate and renal cancer - Are we ready for it?." Journal of Endourology 24.5 (2010): 663--.
PMID
20477539
Source
scival
Published In
Journal of Endourology
Volume
24
Issue
5
Publish Date
2010
Start Page
663-
DOI
10.1089/end.2010.1504

A Modern Animal Model of Radiation-induced Erectile Dysfunction

Authors
Kimura, M; Koontz, BF; Yan, H; Rabbani, Z; Satoh, T; Baba, S; Yin, F; Donatucci, CF; Polascik, TJ; Vujaskovic, Z
MLA Citation
Kimura, M, Koontz, BF, Yan, H, Rabbani, Z, Satoh, T, Baba, S, Yin, F, Donatucci, CF, Polascik, TJ, and Vujaskovic, Z. "A Modern Animal Model of Radiation-induced Erectile Dysfunction." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S40
End Page
S40

Utilization of (111)In-Capromab pendetide SPECT-CT for detecting seminal vesicle invasion with recurrent prostate cancer after primary in situ therapy.

The aim of this study was to evaluate the diagnostic value of a hybrid (111)In-capromab pendetide fused computed tomography (CT) scan in detecting seminal vesicle invasion (SVI) in the setting of recurrent prostate cancer following primary in situ therapy. The study population comprised 59 patients, who biochemically failed primary in situ treatment based on American Society for Therapeutic Radiology and Oncology criteria. The patients underwent an (111)In-capromab pendetide/CT scan at the time of biochemical failure with a prostate (12-core) and seminal vesicle (SV) (8-core) biopsy. The diagnostic properties of the scan and magnetic resonance imaging (MRI) in detecting SVI compared to an SV biopsy were calculated. In total, eight (14%) patients had a positive SV biopsy after primary in situ prostate cancer treatment. Nine (15%) patients had positive uptake of the scan in the SV. When comparing the SV scan results to the SV biopsy, the sensitivity, specificity, positive predictive value, and negative predictive value were 37.5%, 88.2%, 33.3%, and 90.0% (95% confidence interval: 0.44-0.81), respectively. In contrast, the ability of MRI to detect SVI was 50.0%, 81.3%, 40.0%, and 86.7% (95% confidence interval: 0.46-0.85), respectively. Although the sensitivity and positive predictive value of the (111)In-capromab pendetide/CT scan are low, its specificity and negative predictive value are high. Based on these findings, the ability of the (111)In-capromab pendetide/CT scan to detect SVI seems to be comparable with MRI.

Authors
Kimura, M; Tsivian, M; Mouraviev, V; Mayes, JM; Price, MM; Bannister, MC; Madden, JF; Wong, TZ; Polascik, TJ
MLA Citation
Kimura, M, Tsivian, M, Mouraviev, V, Mayes, JM, Price, MM, Bannister, MC, Madden, JF, Wong, TZ, and Polascik, TJ. "Utilization of (111)In-Capromab pendetide SPECT-CT for detecting seminal vesicle invasion with recurrent prostate cancer after primary in situ therapy." Int J Urol 16.12 (December 2009): 971-975.
PMID
19843189
Source
pubmed
Published In
International Journal of Urology
Volume
16
Issue
12
Publish Date
2009
Start Page
971
End Page
975
DOI
10.1111/j.1442-2042.2009.02413.x

Altered male physiologic function after surgery for prostate cancer: couple perspective.

PURPOSE: Both the diagnosis of prostate cancer (PCa) and the physiologic outcomes of surgical treatment impact the male's psychological sphere. However, current research advocates a refocusing of outcomes directed to the PCa "couple". Herein we acquire insight into perspective and concordance regarding male physiological function from the standpoint of a couple recovering from PCa surgery. MATERIALS AND METHODS: Couples whereby the male partner had undergone primary surgical treatment for PCa were mailed a Retrospective Sexual Survey (RSS) packet consisting of male and female partner questionnaires. RSS questions surveyed physiological changes in libido, foreplay, erection and arousal, orgasm and ejaculation in addition to perceived psychological impact. Patients' and partners' scores were evaluated to determine the concordance of both individual items as well as domain sums. RESULTS: Twenty-eight couples completed the questionnaires. Only about 40% of men and women were happy with their levels of sexual interest with 82% concordance. Urine loss during orgasm was reported by 43% of men; the majority of participants were bothered by it. Ejaculation changes were observed by 96% of men (concordance 96%) with most reporting anejaculation. A change in orgasm experience was noted by 86% of men (and 36% of their female partners, p < 0.0001). Despite the change, the majority of men and women reported being satisfied with their ability to climax. CONCLUSION: Our results indicate that patients and their female partners may interpret differently the same physiological outcomes of PCa surgery. This information could be useful to better counsel the PCa couple and help patients and partners adjust after surgery.

Authors
Tsivian, M; Mayes, JM; Krupski, TL; Mouraviev, V; Donatucci, CF; Polascik, TJ
MLA Citation
Tsivian, M, Mayes, JM, Krupski, TL, Mouraviev, V, Donatucci, CF, and Polascik, TJ. "Altered male physiologic function after surgery for prostate cancer: couple perspective." Int Braz J Urol 35.6 (November 2009): 673-682.
PMID
20028573
Source
pubmed
Published In
International braz j urol : official journal of the Brazilian Society of Urology
Volume
35
Issue
6
Publish Date
2009
Start Page
673
End Page
682

Changes in Gleason score grading and their effect in predicting outcome after radical prostatectomy.

OBJECTIVES: To compare Gleason scores (GS) originally assigned in the mid 1990s with the current pathologic evaluation of the same prostatectomy slides, and to assess the GS migration effect on outcome in patients undergoing surgical treatment of prostate cancer. METHODS: We reviewed medical charts of consecutive patients who underwent a radical prostatectomy for T2-T3 prostate cancer at our Medical Center between 1995 and 1997. Prostate specimen slides of 204 patients were reviewed and GS was reassigned in a blinded fashion by a single uropathologist in 2008. GS distributions were compared, and original and re-evaluated GS were assessed for predictive ability in survival regression models. RESULTS: GS distribution differed significantly between the mid 1990s and the current evaluation (P < .001), with the average reevaluated GS higher than the initial one (6.14 vs 6.39, P < .001). The GS was upgraded in 63 cases (30.9%) and downgraded in 25 (12.3%) at reevaluation. The initial GS was predictive (P = .002) of prostate-specific antigen recurrence (PSAR), whereas the newly assigned GS was not (P = .393). However, grouping reassigned GS into risk groups (low < 7, moderate = 7 and high > 7) yielded a better PSAR definition. Survival curves of initial GS could not distinguish between moderate- and high-risk groups, although reassigned GS curves showed statistically significant differences between all risk groups. CONCLUSIONS: These results suggest that interpretation of pathologists played a significant role in the GS shift and propose that the contemporary GS remains a useful prognostic factor of PSAR when stratified in risk categories, although the single GS value may not be as important.

Authors
Tsivian, M; Sun, L; Mouraviev, V; Madden, JF; Mayes, JM; Moul, JW; Polascik, TJ
MLA Citation
Tsivian, M, Sun, L, Mouraviev, V, Madden, JF, Mayes, JM, Moul, JW, and Polascik, TJ. "Changes in Gleason score grading and their effect in predicting outcome after radical prostatectomy." Urology 74.5 (November 2009): 1090-1093.
PMID
19616835
Source
pubmed
Published In
Urology
Volume
74
Issue
5
Publish Date
2009
Start Page
1090
End Page
1093
DOI
10.1016/j.urology.2009.03.043

Men older than 70 years have higher risk prostate cancer and poorer survival in the early and late prostate specific antigen eras.

PURPOSE: We clarified whether men older than 70 years have a higher risk of prostate cancer and poorer survival in the early and late prostate specific antigen eras. MATERIALS AND METHODS: A cohort of 4,561 men who underwent radical prostatectomy were stratified into 3 age groups (younger than 60, 60 to 70 and older than 70 years), and early and late prostate specific antigen eras based on the year of surgery (before 2000 and 2000 or later). Race, body mass index, prostate specific antigen, prostate weight, tumor volume, pathological Gleason sum, pathological tumor stage, extracapsular extension, seminal vesicle invasion and surgical margin status were submitted for univariate and multivariable analyses against the previously mentioned groups. Survivals (prostate specific antigen recurrence, distant metastasis and disease specific death) were compared among the 3 age groups using univariate and multivariable methods. RESULTS: Compared with younger age groups (younger than 60, 60 to 70 years) men older than 70 years had a higher proportion of pathological tumor stage 3/4 (33.0 vs 44.3 vs 52.1%, p <0.001), pathological Gleason sum greater than 7 (9.5% vs 13.4% vs 17.2%, p <0.001) and larger tumor volume (3.7 vs 4.7 vs 5.2 cc, p <0.001). Pathological Gleason sum in men older than 70 years did not differ between the early and late prostate specific antigen eras (p = 0.071). Men older than 70 years had a higher risk of prostate specific antigen recurrence, distant metastasis and disease specific death on univariate (p <0.05) but not multivariable analysis. CONCLUSIONS: Men older than 70 years had higher risk disease and poorer survival in the early and late prostate specific antigen eras. Pathological Gleason sums did not change between the 2 eras. Patient age was an important variable in prostate specific antigen screening, biopsy, treatment and prognosis.

Authors
Sun, L; Caire, AA; Robertson, CN; George, DJ; Polascik, TJ; Maloney, KE; Walther, PJ; Stackhouse, DA; Lack, BD; Albala, DM; Moul, JW
MLA Citation
Sun, L, Caire, AA, Robertson, CN, George, DJ, Polascik, TJ, Maloney, KE, Walther, PJ, Stackhouse, DA, Lack, BD, Albala, DM, and Moul, JW. "Men older than 70 years have higher risk prostate cancer and poorer survival in the early and late prostate specific antigen eras." J Urol 182.5 (November 2009): 2242-2248.
PMID
19758616
Source
pubmed
Published In
The Journal of Urology
Volume
182
Issue
5
Publish Date
2009
Start Page
2242
End Page
2248
DOI
10.1016/j.juro.2009.07.034

Focal therapy for prostate cancer is a reasonable treatment option in properly selected patients.

Authors
Polascik, TJ; Mouraviev, V
MLA Citation
Polascik, TJ, and Mouraviev, V. "Focal therapy for prostate cancer is a reasonable treatment option in properly selected patients." Urology 74.4 (October 2009): 726-730.
PMID
19660791
Source
pubmed
Published In
Urology
Volume
74
Issue
4
Publish Date
2009
Start Page
726
End Page
730
DOI
10.1016/j.urology.2009.02.084

Bisphosphonates in oncology: evidence for the prevention of skeletal events in patients with bone metastases.

Bone metastases frequently occur in patients with advanced solid tumors, particularly breast and prostate cancers, and nearly all patients with multiple myeloma have some degree of skeletal involvement. The strides made in treating these primary tumors have extended median survival times and thereby increased patient risk for skeletal-related events (SREs), including pathologic fractures, spinal cord compression, need for palliative radiation therapy or surgery to bone, and hypercalcemia. Bisphosphonates, inhibitors of osteoclastic bone resorption that were first established as treatment of osteoporosis, have been shown to prevent and/or delay SREs related to malignancy. The results of a large, randomized phase 3 study comparing zoledronic acid and pamidronate in breast cancer or multiple myeloma patients with osteolytic lesions showed that the incidence of SREs, time to first SRE, and risk of developing a SRE were similar between treatment groups. However, in patients with solid tumors (excluding breast or prostate cancer) metastatic to the bone, only zoledronic acid has demonstrated clinical efficacy. Although bone turnover marker levels, such as N-telopeptide of type I collagen, have been shown to correlate with clinical response, additional studies are needed to validate their ability to predict response to bisphosphonate therapy.

Authors
Polascik, TJ
MLA Citation
Polascik, TJ. "Bisphosphonates in oncology: evidence for the prevention of skeletal events in patients with bone metastases. (Published online)" Drug Des Devel Ther 3 (September 21, 2009): 27-40.
PMID
19920919
Source
pubmed
Published In
Drug Design, Development and Therapy
Volume
3
Publish Date
2009
Start Page
27
End Page
40

Use of 111in-capromab pendetide immunoscintigraphy to image localized prostate cancer foci within the prostate gland.

PURPOSE: We compared the results of a preoperative (111)In-capromab pendetide scan co-registered with computerized tomography with pathological findings in the surgically excised prostate to determine whether the scan can efficiently detect cancer in the prostate. MATERIALS AND METHODS: This prospective trial included 25 hormone naïve men with clinically localized prostate cancer who underwent (111)In-capromab pendetide single photon emission computerized tomography/computerized tomography as part of the preoperative evaluation. In addition to routine histological analysis, representative prostate sections were stained for prostate specific membrane antigen using the same antibody used in the scan. A pathologist and a radiologist were blinded to pathology and imaging findings, respectively. Prostate specific membrane antigen immunohistochemistry was correlated with the 3-dimensional location of the prostate specific membrane antigen signal detected by scan. RESULTS: Scan sensitivity was 37% to 87% for 4 quadrants (right vs left and apical vs basal) with 0% to 50% specificity, as validated by final pathological assessment of the same quadrants. Stratifying positive scan signal strength did not statistically improve specificity (p = 0.35). There was no significant correlation between prostate specific membrane antigen over expression and tumor stage distribution (p = 0.23). CONCLUSIONS: The scan did not localize prostate cancer to a particular quadrant based on comparison with radical prostatectomy specimen pathology. The antibody used has affinity for benign and malignant prostatic glands in excised, formalin fixed prostate tissue, which may contribute to low scan specificity in vivo. The scan cannot be used to reliably detect or image cancer foci in the prostate.

Authors
Mouraviev, V; Madden, JF; Broadwater, G; Mayes, JM; Burchette, JL; Schneider, F; Smith, J; Tsivian, M; Wong, T; Polascik, TJ
MLA Citation
Mouraviev, V, Madden, JF, Broadwater, G, Mayes, JM, Burchette, JL, Schneider, F, Smith, J, Tsivian, M, Wong, T, and Polascik, TJ. "Use of 111in-capromab pendetide immunoscintigraphy to image localized prostate cancer foci within the prostate gland." J Urol 182.3 (September 2009): 938-947.
PMID
19616259
Source
pubmed
Published In
The Journal of Urology
Volume
182
Issue
3
Publish Date
2009
Start Page
938
End Page
947
DOI
10.1016/j.juro.2009.05.047

Delayed prostate-specific antigen recurrence after radical prostatectomy: how to identify and what are their clinical outcomes?

OBJECTIVES: To identify factors that predict delayed (> 5 years) prostate-specific antigen recurrence (PSAR) after radical prostatectomy (RP) and to analyze the associated clinical outcomes. METHODS: A cohort of 4561 men who underwent RP between 1988 and 2008 was retrieved from the Duke University Prostate Center database. Among them, 1207 (26.5%) had PSAR and were included in this study. The cohort was then divided into 2 groups; PSAR before 5 years (early PSAR) and PSAR after 5 years (delayed PSAR), and Kaplan Meier analysis was performed. Univariate and logistic regression analysis was carried out to determine significant predictors of delayed PSAR, using factors such as race, age, body mass index, PSA, surgical margin status, pathologic Gleason sum, pathologic tumor stage, and prostate weight. RESULTS: There was a marginal difference between the early and delayed PSAR groups with regard to metastasis-free survival (P = .062). A significant difference in disease-specific survival was found between the 2 groups (P = .025). Patients with pathologic Gleason sums < 7 were more likely to have delayed PSAR as compared to those with pathologic Gleason sums > 7 (OR = 2.38). Patients with a PSA < 10 ng/mL were more likely to have delayed PSAR in comparison to those with PSA > 20 ng/mL (OR = 2.38). CONCLUSIONS: Approximately 90% of PSAR occurred within 5 years after RP. Lower pathologic Gleason sums and lower PSA at diagnosis were associated with delayed PSAR. Patients with delayed PSAR have a disease-specific survival advantage as compared to men with early PSAR.

Authors
Caire, AA; Sun, L; Ode, O; Stackhouse, DA; Maloney, K; Donatucci, C; Mouraviev, V; Polascik, TJ; Robertson, CN; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Ode, O, Stackhouse, DA, Maloney, K, Donatucci, C, Mouraviev, V, Polascik, TJ, Robertson, CN, Albala, DM, and Moul, JW. "Delayed prostate-specific antigen recurrence after radical prostatectomy: how to identify and what are their clinical outcomes?." Urology 74.3 (September 2009): 643-647.
PMID
19501891
Source
pubmed
Published In
Urology
Volume
74
Issue
3
Publish Date
2009
Start Page
643
End Page
647
DOI
10.1016/j.urology.2009.02.049

Effect of age and pathologic Gleason score on PSA recurrence: analysis of 2911 patients undergoing radical prostatectomy.

OBJECTIVES: To clarify the relationship between age and pathologic Gleason score and their effect on prostate-specific antigen recurrence (PSAR). METHODS: The data from a cohort of 2911 men who had undergone radical prostatectomy from 1988 to 2006 were retrieved from the Duke Prostate Center database. Patient age was divided into 3 groups: <60, 60-64, and >or=65 years. The pathologic Gleason score was divided into 5 groups: 7. PSAR was defined as the prostate-specific antigen level increasing to >0.2 ng/mL >30 days after radical prostatectomy. The associations between age and pathologic Gleason score on PSAR and the time to PSAR were analyzed using parametric, nonparametric, Kaplan-Meier, and Cox regression techniques. RESULTS: Patient age and interval to PSAR had no significant association (P > .05). Kaplan-Meier analysis demonstrated a significant difference in PSAR among age groups. The pathologic Gleason scores of 3 + 3, 3 + 4, 4 + 3, and >7 were significant in determining the incidence of PSAR. Age was not significant for PSAR in patients with a pathologic Gleason score of 7, a statistically significant difference was observed among the age groups. Men <60 years old with a pathologic Gleason score >7 had a lower incidence of PSAR than did older men with a similar pathologic Gleason score. A pathologic Gleason score of >or=6 was significant in predicting PSAR. CONCLUSIONS: Age alone was an independent factor in predicting PSAR, but not in predicting the interval to PSAR. The pathologic Gleason score remained a predictor of PSAR, and patient age should be considered in patients with a pathologic Gleason score >7.

Authors
Xu, DD; Sun, SD; Wang, F; Sun, L; Stackhouse, D; Polascik, T; Albala, DM; Moul, JW; Caire, A; Robertson, CN
MLA Citation
Xu, DD, Sun, SD, Wang, F, Sun, L, Stackhouse, D, Polascik, T, Albala, DM, Moul, JW, Caire, A, and Robertson, CN. "Effect of age and pathologic Gleason score on PSA recurrence: analysis of 2911 patients undergoing radical prostatectomy." Urology 74.3 (September 2009): 654-658.
PMID
19628263
Source
pubmed
Published In
Urology
Volume
74
Issue
3
Publish Date
2009
Start Page
654
End Page
658
DOI
10.1016/j.urology.2008.12.063

A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy.

STUDY OBJECTIVE: To compare anesthetic management and postoperative outcomes in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) and radical retropubic prostatectomy (RRP) with general anesthesia. DESIGN: Retrospective database study of RALP and RRP patients at Duke University Medical Center from 6/2003 to 6/2006. SETTING: University teaching hospital. PATIENTS: 541 ASA physical status I, II, and III men, 280 of whom were RRP patients and 256 RALP patients. MEASUREMENTS: Patient demographics, intraoperative fluids and blood products, hemodynamic parameters, pain scores in the Postanesthesia Care Unit (PACU), intraoperative and postoperative analgesic consumption, need for rescue antiemetics in the PACU, and intraoperative use of vasopressors and antihypertensives, were all recorded. Additional data included postoperative transfusion data; clinical status of the patient's cancer preoperatively and postoperatively; hematocrit, platelet count, and creatinine levels; and length of hospital stay. MAIN RESULTS: Estimated blood loss (EBL) was higher for RRP than RALP patients (mean +/- SD; 1,087 +/- 853 mL vs. 287 +/- 317 mL; P < 0.0001). Likewise, 24% of RRP patients received red blood cell (RBC) transfusions intraoperatively, compared with 0.4% RALP patients (P < 0.0001). Intraoperatively, RALP patients received more antihypertensive agents (37% vs. 21%; P < 0.0001), and fewer vasopressors (63% vs. 78%; P < 0.0001) than did RRP patients. The two groups had similar morphine-equivalent opioid use intraoperatively, but in the PACU, RALP patients required fewer morphine equivalents (mean +/- SD; 11.4 +/- 7.7 mg vs. 14.9 +/- 9.8 mg; P < 0.0001). The RALP patients had longer surgical times (mean +/- SD; 296 +/- 76 vs.193 +/- 69 min; P < 0.0001) but shorter PACU stays (mean +/- SD; 113 +/- 55 min vs. 143 +/- 58 min; P < 0.0001) and shorter hospital stays (mean +/- SD; 44 +/- 77 hrs vs. 56 +/- 26 hrs; P = 0.009). CONCLUSIONS: Duration of surgery was greater with RALP, but it was associated with less EBL, fewer transfusions of blood products, and shorter PACU and hospital stays.

Authors
D'Alonzo, RC; Gan, TJ; Moul, JW; Albala, DM; Polascik, TJ; Robertson, CN; Sun, L; Dahm, P; Habib, AS
MLA Citation
D'Alonzo, RC, Gan, TJ, Moul, JW, Albala, DM, Polascik, TJ, Robertson, CN, Sun, L, Dahm, P, and Habib, AS. "A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy." J Clin Anesth 21.5 (August 2009): 322-328.
PMID
19700296
Source
pubmed
Published In
Journal of Clinical Anesthesia
Volume
21
Issue
5
Publish Date
2009
Start Page
322
End Page
328
DOI
10.1016/j.jclinane.2008.09.005

Concordance in the perception of couples recovering from primary surgical treatment of prostate cancer.

Although prostate cancer affects men, research shows effects on both members of the couple. We analyzed concordance in couples recovering from primary surgical treatment of prostate cancer when surveyed on psychological domains including emotional status, relationship, self-image, partnership quality and support. Retrospective Sexual Surveys were utilized to survey physiological changes as well as psychological effects. In total, 28 heterosexual couples (56 people) were enrolled. Patients were treated between February 2002 and March 2007 with a median follow-up of 26 (range: 4-59) months. When polled on psychological aspects that may have been affected by treatment, overall concordance was 75.0%. Partnership had the highest concordance (92.2%) with treatment satisfaction questions following in second (90.7%). Subcategories focused on self-image (77.5%), relationship (67.3%), support (66.4%) and emotional status (55.6%), were less concordant. Although couples report relationships as strong and team-like, misconception between partners is widespread. Further research with regards to the effect of such disparities in couples might provide additional insight into improving recovery.

Authors
Mayes, JM; Mouraviev, V; Tsivian, M; Krupski, TL; Donatucci, CF; Polascik, TJ
MLA Citation
Mayes, JM, Mouraviev, V, Tsivian, M, Krupski, TL, Donatucci, CF, and Polascik, TJ. "Concordance in the perception of couples recovering from primary surgical treatment of prostate cancer." Int J Impot Res 21.4 (July 2009): 253-260.
PMID
19516258
Source
pubmed
Published In
International Journal of Impotence Research
Volume
21
Issue
4
Publish Date
2009
Start Page
253
End Page
260
DOI
10.1038/ijir.2009.23

Factors predicting prostatic biopsy Gleason sum under grading.

PURPOSE: We determined clinical factors affecting the under grading of biopsy Gleason sum compared with prostatectomy pathology and developed a model predicting the probability of under grading. MATERIALS AND METHODS: We analyzed a cohort of 1,701 patients treated for prostate cancer at our institution between 1988 and 2007 with complete biopsy and pathological data available. Patients with a biopsy Gleason sum of 7 or less were included in our analysis. Cases were categorized as under graded or not under graded by comparing biopsy and radical prostatectomy Gleason sums. Logistic regression was used to determine the predictors of under grading based on clinical variables (race, age at diagnosis, body mass index, prostate weight, diagnostic prostate specific antigen, biopsy positive-to-total core ratio, maximal cancer percent in positive cores and time from diagnosis to surgery). A nomogram was developed to calculate the probability of under grading. Results were validated using bootstrapping. RESULTS: Under grading occurred in 46.6% of our cohort. Significant variables predicting under grading were age at diagnosis, biopsy Gleason sum, diagnostic prostate specific antigen, prostate weight, biopsy positive-to-total core ratio and maximal percent of cancer in cores (p <0.05). Nomogram predictive accuracy was 72.4%. CONCLUSIONS: The risk of Gleason sum under grading can be predicted to a satisfactory level using our nomogram. Predicting under grading would improve patient consulting and identify those who should consider repeat biopsy, ultimately enhancing the accuracy of prostate cancer diagnosis.

Authors
Stackhouse, DA; Sun, L; Schroeck, FR; Jayachandran, J; Caire, AA; Acholo, CO; Robertson, CN; Albala, DM; Polascik, TJ; Donatucci, CF; Maloney, KE; Moul, JW
MLA Citation
Stackhouse, DA, Sun, L, Schroeck, FR, Jayachandran, J, Caire, AA, Acholo, CO, Robertson, CN, Albala, DM, Polascik, TJ, Donatucci, CF, Maloney, KE, and Moul, JW. "Factors predicting prostatic biopsy Gleason sum under grading." J Urol 182.1 (July 2009): 118-122.
PMID
19447436
Source
pubmed
Published In
The Journal of Urology
Volume
182
Issue
1
Publish Date
2009
Start Page
118
End Page
122
DOI
10.1016/j.juro.2009.02.127

Lidocaine patch for postoperative analgesia after radical retropubic prostatectomy.

In a prospective, double-blind, placebo-controlled study, patients undergoing radical retropubic prostatectomy under general anesthesia were randomly assigned to receive a lidocaine patch or placebo applied on each side of the wound at the end of surgery. Data were collected for 24 h after surgery. Seventy patients completed the study (36 lidocaine group, 34 placebo group). Demographics and postoperative morphine consumption were not different between the groups. However, the lidocaine patch group reported significantly less pain on coughing (19%-33% reduction) over all time periods (treatment vs placebo P < 0.0001, time x treatment P = 0.3056) and at rest (17%-32% reduction) for up to 6 h (treatment vs placebo P = 0.0003, time x treatment P = 0.0130).

Authors
Habib, AS; Polascik, TJ; Weizer, AZ; White, WD; Moul, JW; ElGasim, MA; Gan, TJ
MLA Citation
Habib, AS, Polascik, TJ, Weizer, AZ, White, WD, Moul, JW, ElGasim, MA, and Gan, TJ. "Lidocaine patch for postoperative analgesia after radical retropubic prostatectomy." Anesth Analg 108.6 (June 2009): 1950-1953.
PMID
19448228
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
108
Issue
6
Publish Date
2009
Start Page
1950
End Page
1953
DOI
10.1213/ane.0b013e3181a21185

Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy.

BACKGROUND: The application of focal therapy for low-risk prostate cancer (PCa) depended on appropriate patient selection. No definitive criteria existed to characterize patients who may potentially benefit from an organ-sparing approach. We evaluated pretreatment clinical parameters that may predict unilateral PCa amenable to hemigland thermoablation. METHODS: In total, 538 patients with complete data from the Duke Prostate Center (DPC) Outcomes database with low- to low-intermediate-risk PCa (prostate-specific antigen<10 ng/mL, biopsy Gleason score < or =7, and clinical stage T1c-T2b) treated with radical prostatectomy (RP) were included in the dataset. Patients underwent diagnostic prostate biopsy (PBx) at Duke or community hospitals from 1996 to 2006. Clinical and biopsy parameters were assessed as to the ability to predict PCa unilaterality verified by RP pathology. RESULTS: The strongest predictor of pathologic unilaterality was PBx unilaterality. The sensitivity and specificity for biopsy unilaterality to predict pathologic unilaterality was 88.4% and 34%, with a positive predictive value of 28% and a negative predictive value of 91%. PBx unilaterality (odds ratio [OR] = 3.88; 95% confidence interval [CI], 2.14-7.05; P < .0005) and negative family history of PCa (OR = 1.83; 95% CI, 1.09-3.05; P = .21) was associated with a higher probability of unilateral disease by multivariate regression. CONCLUSIONS: Two pretreatment clinical variables were significantly predictive of unilateral PCa: negative family history of PCa and PBx unilaterality. These variables may be used to select men with low- to low-moderate-risk PCa for hemiablation. Further work is necessary to decrease the false-negative and false-positive rates associated with PBx to improve predictability for PCa laterality.

Authors
Polascik, TJ; Mayes, JM; Schroeck, FR; Sun, L; Madden, JF; Moul, JW; Mouraviev, V
MLA Citation
Polascik, TJ, Mayes, JM, Schroeck, FR, Sun, L, Madden, JF, Moul, JW, and Mouraviev, V. "Patient selection for hemiablative focal therapy of prostate cancer: variables predictive of tumor unilaterality based upon radical prostatectomy." Cancer 115.10 (May 15, 2009): 2104-2110.
PMID
19288576
Source
pubmed
Published In
Cancer
Volume
115
Issue
10
Publish Date
2009
Start Page
2104
End Page
2110
DOI
10.1002/cncr.24258

Urothelial Sloughing With Obstruction After Laparoscopic Cryoablation of Small Renal Carcinoma in Solitary Kidney Editoral Comment

Authors
Chen, VH; Mayes, JM; Mouraviev, V; Polascik, TJ; Cadeddu, JA
MLA Citation
Chen, VH, Mayes, JM, Mouraviev, V, Polascik, TJ, and Cadeddu, JA. "Urothelial Sloughing With Obstruction After Laparoscopic Cryoablation of Small Renal Carcinoma in Solitary Kidney Editoral Comment." JOURNAL OF UROLOGY 181.4 (April 2009): 1602-1602.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
1602
End Page
1602

Pathologic basis of focal therapy for early-stage prostate cancer.

The treatment paradigm for small-volume, low-grade unifocal or unilateral prostate cancer is shifting from a radical, whole-gland approach toward organ-sparing, focal ablation. The widely implemented screening program in the US has detected small-volume prostate lesions at early stages of carcinogenesis, which has enabled the shift in treatment paradigm. An image-guided approach to focal therapy has yet to be realized, and is dependent on the development of an imaging modality that detects cancer with high sensitivity and specificity. The future success of focal therapy will depend on adequate prostate sampling at biopsy, along with accurate characterization of the spatial distribution of tumor within the prostate. The pathologic evaluation of radical prostatectomy specimens remains of paramount importance, as this reference standard can validate all preoperative clinical, demographic, laboratory, imaging and prostate biopsy findings.

Authors
Mouraviev, V; Mayes, JM; Polascik, TJ
MLA Citation
Mouraviev, V, Mayes, JM, and Polascik, TJ. "Pathologic basis of focal therapy for early-stage prostate cancer." Nat Rev Urol 6.4 (April 2009): 205-215. (Review)
PMID
19352395
Source
pubmed
Published In
Nature Reviews Urology
Volume
6
Issue
4
Publish Date
2009
Start Page
205
End Page
215
DOI
10.1038/nrurol.2009.29

Utility of a 3-dimensional transrectal ultrasound-guided prostate biopsy system for prostate cancer detection.

The 3-D transrectal ultrasound (TRUS)-guided prostate biopsy system is a novel device that allows precise needle placement in a template fashion. We evaluate its utility for prostate cancer (PCa) detection. A retrospective analysis was performed evaluating 68 prospective patients at the Duke Prostate Center who underwent a prostate biopsy using a 3-D TRUS-guided system. After creation of a three-dimensional map of the prostate, a computer algorithm identified an ideal biopsy scheme based on the measured dimensions of the prostate. The system then used a fixed template that allowed prostate biopsy at specific locations with the ability to target the same region of the prostate in the future if needed. For all patients, a 12-core biopsy pattern was used to cover medial and lateral areas of the base, mid-gland, and apex. In total, 68 patients underwent 3-D TRUS-guided prostate biopsies between April 2006 and November 2007 for prostate cancer detection. The indication for prostate biopsy was PSA > or = 4.0 ng/ml in 47 (69%) patients, abnormal digital rectal examination (DRE) in 17 (25%), and atypia on previous biopsy in 4 (6%) patients. Prostate cancer was detected in 18 patients (26.5%) and 7 (10.3%) had atypical small acinar proliferation (ASAP). The highest frequency (55.5%) from all cases of cancer detected was identified when 3-D TRUS biopsy was used as the initial biopsy. This study demonstrates that a 3-D TRUS-guided biopsy system translates to a more frequent detection of prostate cancer among patients undergoing an initial prostate biopsy than a subsequent one. More comprehensive studies are warranted to corroborate and extend the results of this study.

Authors
Chen, VH; Mouraviev, V; Mayes, JM; Sun, L; Madden, JF; Moul, JW; Polascik, TJ
MLA Citation
Chen, VH, Mouraviev, V, Mayes, JM, Sun, L, Madden, JF, Moul, JW, and Polascik, TJ. "Utility of a 3-dimensional transrectal ultrasound-guided prostate biopsy system for prostate cancer detection." Technol Cancer Res Treat 8.2 (April 2009): 99-104.
PMID
19334790
Source
pubmed
Published In
Technology in cancer research & treatment
Volume
8
Issue
2
Publish Date
2009
Start Page
99
End Page
104
DOI
10.1177/153303460900800202

PHASE I TRIAL OF PROSTATECTOMY AFTER PLANNED PREOPERATIVE RADIOTHERAPY FOR HIGH RISK LOCALIZED PROSTATE CANCER: PRELIMINARY RESULTS

Authors
Koontz, BF; Quaranta, BP; Carroll, M; Vujaskovic, Z; Lee, WR; Robertson, CN; Polascik, TJ; Anscher, MS; Moul, JW
MLA Citation
Koontz, BF, Quaranta, BP, Carroll, M, Vujaskovic, Z, Lee, WR, Robertson, CN, Polascik, TJ, Anscher, MS, and Moul, JW. "PHASE I TRIAL OF PROSTATECTOMY AFTER PLANNED PREOPERATIVE RADIOTHERAPY FOR HIGH RISK LOCALIZED PROSTATE CANCER: PRELIMINARY RESULTS." April 2009.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
713
End Page
713

PREDICTING NON-ORGAN CONFINED PROSTATE CANCER AFTER THE YEAR 2000

Authors
Caire, AA; Sun, L; Polascik, TJ; Robertson, CN; Maloney, KE; Donatucci, CF; Albala, DM; Moul, JW
MLA Citation
Caire, AA, Sun, L, Polascik, TJ, Robertson, CN, Maloney, KE, Donatucci, CF, Albala, DM, and Moul, JW. "PREDICTING NON-ORGAN CONFINED PROSTATE CANCER AFTER THE YEAR 2000." JOURNAL OF UROLOGY 181.4 (April 2009): 609-609.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
609
End Page
609

PERINEAL RADICAL PROSTATECTOMY: WHAT ARE THE TEN YEAR OUTCOMES?

Authors
Stackhouse, DA; Sun, L; Dahm, P; Kavoussi, LR; Paulson, D; Donatucci, CF; Maloney, KE; Albala, DM; Polascik, TJ; Robertson, CN; Moul, JW
MLA Citation
Stackhouse, DA, Sun, L, Dahm, P, Kavoussi, LR, Paulson, D, Donatucci, CF, Maloney, KE, Albala, DM, Polascik, TJ, Robertson, CN, and Moul, JW. "PERINEAL RADICAL PROSTATECTOMY: WHAT ARE THE TEN YEAR OUTCOMES?." JOURNAL OF UROLOGY 181.4 (April 2009): 210-210.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
210
End Page
210

WHO DOES NOT NEED FOLLOW UP TWO YEARS AFTER PROSTATECTOMY? AN ANALYSIS OF 1739 PATIENTS AT DUKE UNIVERSITY MEDICAL CENTER

Authors
Lack, BD; Sun, L; Caire, AA; Donatucci, CF; Robertson, CN; Mouraviev, V; Polascik, TJ; Albala, DM; Maloney, KE; Walther, PJ; Moul, JW
MLA Citation
Lack, BD, Sun, L, Caire, AA, Donatucci, CF, Robertson, CN, Mouraviev, V, Polascik, TJ, Albala, DM, Maloney, KE, Walther, PJ, and Moul, JW. "WHO DOES NOT NEED FOLLOW UP TWO YEARS AFTER PROSTATECTOMY? AN ANALYSIS OF 1739 PATIENTS AT DUKE UNIVERSITY MEDICAL CENTER." JOURNAL OF UROLOGY 181.4 (April 2009): 759-759.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
759
End Page
759

SAY NO TO THE US PREVENTATIVE TASK FORCE RECOMMENDATION TO NO LONGER OFFER PROSTATE CANCER SCREENING AFTER AGE 75?

Authors
Moul, JW; Sun, L; Lack, BD; Robertson, CN; Polascik, TJ; Donatucci, CF; Maloney, KE; Price, M; Albala, DM; Caire, AA
MLA Citation
Moul, JW, Sun, L, Lack, BD, Robertson, CN, Polascik, TJ, Donatucci, CF, Maloney, KE, Price, M, Albala, DM, and Caire, AA. "SAY NO TO THE US PREVENTATIVE TASK FORCE RECOMMENDATION TO NO LONGER OFFER PROSTATE CANCER SCREENING AFTER AGE 75?." JOURNAL OF UROLOGY 181.4 (April 2009): 797-797.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
797
End Page
797

DELAYED PSA RECURRENCE AFTER RADICAL PROSTATECTOMY: HOW TO IDENTIFY PATIENTS AT RISK AND THEIR CLINICAL OUTCOMES?

Authors
Lack, BD; Sun, L; Caire, AA; Ode, O; Stackhouse, DA; Malone, KE; Donatucci, CF; Mouraviev, V; Polascik, TJ; Robertson, CN; Albala, DM; Moul, JW
MLA Citation
Lack, BD, Sun, L, Caire, AA, Ode, O, Stackhouse, DA, Malone, KE, Donatucci, CF, Mouraviev, V, Polascik, TJ, Robertson, CN, Albala, DM, and Moul, JW. "DELAYED PSA RECURRENCE AFTER RADICAL PROSTATECTOMY: HOW TO IDENTIFY PATIENTS AT RISK AND THEIR CLINICAL OUTCOMES?." JOURNAL OF UROLOGY 181.4 (April 2009): 457-457.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
457
End Page
457

LAPAROSCOPIC AND PERCUTANEOUS CRYOABLATION FOR RENAL TUMORS: A TWO-INSTITUTION EXPERIENCE

Authors
Shingleton, B; Wynia, B; Mayes, J; Tsivian, M; Mouraviev, V; Polascik, TJ
MLA Citation
Shingleton, B, Wynia, B, Mayes, J, Tsivian, M, Mouraviev, V, and Polascik, TJ. "LAPAROSCOPIC AND PERCUTANEOUS CRYOABLATION FOR RENAL TUMORS: A TWO-INSTITUTION EXPERIENCE." March 2009.
Source
wos-lite
Published In
European Urology Supplements
Volume
8
Issue
4
Publish Date
2009
Start Page
201
End Page
201

Prostate cancer: the new landscape.

PURPOSE OF REVIEW: This review highlights current features of the changing landscape of the US population with newly diagnosed prostate cancer and discusses new treatment options utilizing noninvasive or minimally invasive management. RECENT FINDINGS: Recent evidence of significant changes in the current prostate cancer landscape is based on clinical data and pathological specimens after radical prostatectomy that suggest a further increase of the low-risk patient population that may require reconsideration of treatment options. For a select cohort of patients with low-risk features, based on the D'Amico definition, active surveillance or focal ablative therapy may be a rational alternative to surgical prostatectomy or whole-gland radiation therapy that still dominate as the main treatment approaches for localized prostate cancer. SUMMARY: As the prostate-specific antigen era continues to mature, we continue to witness stage migration. A growing segment of the localized prostate cancer patient population has very low-volume, low-grade disease. Although active surveillance may be an appropriate approach for a selected group of patients, the progression requiring whole-gland therapy remains a challenge. Organ-sparing focal therapy might ideally fill the gap between a surveillance strategy and whole-gland treatment providing a reasonable balance between cancer control and quality of life.

Authors
Moul, JW; Mouraviev, V; Sun, L; Schroeck, FR; Polascik, TJ
MLA Citation
Moul, JW, Mouraviev, V, Sun, L, Schroeck, FR, and Polascik, TJ. "Prostate cancer: the new landscape." Curr Opin Urol 19.2 (March 2009): 154-160. (Review)
PMID
19195129
Source
pubmed
Published In
Current Opinion in Urology
Volume
19
Issue
2
Publish Date
2009
Start Page
154
End Page
160

Nerve-sparing focal cryoablation of prostate cancer.

PURPOSE OF REVIEW: We evaluate the rationale, candidate selection, and results of the first clinical studies of focal cryoablation for select patients with low volume and low-to-low - moderate risk features of prostate cancer as a possible alternative to whole gland treatment. RECENT FINDINGS: For a select cohort of patients with low-to-low - moderate risk unifocal or unilateral prostate cancer, a number of ablative treatment options for focal therapy are available with cryotherapy having the most clinical experience. However, retrospective pathological data from large prostatectomy series do not clearly reveal valid and reproducible criteria to select appropriate candidates for focal cryoablation due to the complexity of tumorigenesis in early stage disease. SUMMARY: The concept of focal therapy is evolving with the understanding of the biologic variability (clinically aggressive, significant, or insignificant) of prostate cancers that may require different treatment approaches. Minimally-invasive, parenchyma-preserving cryoablation can be considered as a potential feasible option in the treatment armamentarium of early stage, localized prostate cancer in appropriately selected candidates.

Authors
Polascik, TJ; Mayes, JM; Mouraviev, V
MLA Citation
Polascik, TJ, Mayes, JM, and Mouraviev, V. "Nerve-sparing focal cryoablation of prostate cancer." Curr Opin Urol 19.2 (March 2009): 182-187. (Review)
PMID
19188772
Source
pubmed
Published In
Current Opinion in Urology
Volume
19
Issue
2
Publish Date
2009
Start Page
182
End Page
187
DOI
10.1097/MOU.0b013e328323f603

Satisfaction and Regret After Open Retropubic or Robot-Assisted Laparoscopic Radical Prostatectomy

Authors
Schroeck, FR; Krupski, TL; Sun, L; Albala, DM; Price, MM; Polascik, TJ; Robertson, CN; Tewari, AK; Moul, JW
MLA Citation
Schroeck, FR, Krupski, TL, Sun, L, Albala, DM, Price, MM, Polascik, TJ, Robertson, CN, Tewari, AK, and Moul, JW. "Satisfaction and Regret After Open Retropubic or Robot-Assisted Laparoscopic Radical Prostatectomy." JOURNAL OF UROLOGY 181.2 (February 2009): 635-636.
Source
wos-lite
Published In
The Journal of Urology
Volume
181
Issue
2
Publish Date
2009
Start Page
635
End Page
636

Correlation between SWEI and ARFI image findings in ex vivo human prostates

Acoustic Radiation Force Impulse (ARFI) imaging has previously been used to visualize normal anatomic structures and pathologies in both ex vivo and in vivo human prostates. Based on the relative displacement amplitudes in ARFI images and comparison with histological slides and McNeal's zonal anatomy, it seems that the central zone (CZ) is stiffer than other anatomic zones, and prostate cancer (PCa) is stiffer than normal tissue in the peripheral zone and benign prostatic hyperplasia (BPH). Since displacement amplitudes in ARFI images are determined by both the underlying tissue stiffness and the amplitude of acoustic radiation force, one question that arises is: how are the relative displacements in ARFI images related to the underlying tissue stiffness? In this study, co-registered three-dimensional (3D) ARFI datasets and shear wave elasticity imaging (SWEI) datasets were acquired to investigate the relationship between displacement amplitudes in ARFI images and the underlying tissue stiffness. Six freshly excised human prostates were collected and imaged. The lateral time-to-peak (TTP) algorithm was used to reconstruct the tissue stiffness. Linear regression was performed between ARFI displacement amplitudes and the inverse of the corresponding reconstructed shear moduli. Five types of prostatic tissues were identified in ARFI images, and their stiffnesses were quantified. ©2009 IEEE.

Authors
Zhai, L; Madden, J; Mouraviev, V; Polascik, T; Nightingale, K
MLA Citation
Zhai, L, Madden, J, Mouraviev, V, Polascik, T, and Nightingale, K. "Correlation between SWEI and ARFI image findings in ex vivo human prostates." 2009.
Source
scival
Published In
Proceedings of the IEEE Ultrasonics Symposium
Publish Date
2009
DOI
10.1109/ULTSYM.2009.5441796

Evaluation of a novel precision template-guided biopsy system for detecting prostate cancer (BJU International (2008) 102 (546-50)

Authors
Megwalu, II; Ferguson, GG; Wei, JT; Mouraviev, V; Polascik, TJ; Taneja, S; Black, L; Andriole, GL; Kibel, AS
MLA Citation
Megwalu, II, Ferguson, GG, Wei, JT, Mouraviev, V, Polascik, TJ, Taneja, S, Black, L, Andriole, GL, and Kibel, AS. "Evaluation of a novel precision template-guided biopsy system for detecting prostate cancer (BJU International (2008) 102 (546-50)." BJU International 104.2 (2009): 284--.
Source
scival
Published In
Bju International
Volume
104
Issue
2
Publish Date
2009
Start Page
284-
DOI
10.1111/j.1464-410X.2009.08755.x

Focal Targeted Therapy Will Be a Future Treatment Modality for Early Stage Prostate Cancer

Context: Focal targeted therapy of early stage prostate cancer (PCa) can ideally facilitate the concept of personalized medicine in contemporary surgical oncology. Objective: To present indications and outcomes of subtotal glandular ablation. This treatment approach aims at the elimination of the cancer with preservation of uninvolved tissue in an attempt to maintain a patient's quality of life (QoL), including undisturbed erectile function as well as urinary and bowel control. Evidence acquisition: In 2002, the idea of a "lumpectomy" using an organ-sparing approach for very localized PCa was proposed in parallel with organ-sparing breast cancer treatment in women. Since then, a few pilot clinical studies have demonstrated an acceptable short-term cancer control while minimizing the complication rate. At the same time, progress in PCa screening has led to a significant stage and tumor volume migration toward early stage disease. In the past few years, a collection of accumulated data has created a scientific background for further development of this concept toward a wider implementation into clinical practice. In this paper, we review all available literature from PubMed of the past 15 yr-from 1994 to 2008-including the terms localized prostate cancer, focal therapy, organ preservation, and morbidity. Evidence synthesis: Several factors were identified that need to be taken into account to further develop an organ-sparing treatment approach for early stage localized PCa and turn this concept into clinical practice. First, novel thermoablative techniques such as third-generation cryosurgery, high-intensity focused ultrasound (HIFU), vascular photodynamic therapy and, electroporation can precisely target a tumor lesion within the prostate while maintaining the integrity of the surrounding tissues. Second, new ultrasound, magnetic resonance imaging (MRI) and molecular imaging techniques may provide new means to detect small PCa lesions. Third, extended image-guided biopsy protocols using a transperineal rather than a transrectal approach can provide a more exact spatial distribution of PCa lesions within the prostate. Fourth, careful patient selection using an individualized approach is a prerequisite for optimal preoperative planning and a successful treatment outcome. Conclusions: For patients with early stage localized PCa limited to one focus or lobe and who express a great desire not to jeopardize their QoL, targeted focal therapy will likely play a more significant role in the future as a tangible treatment option. Moreover, focal therapy may fill the gap between active surveillance for low-risk PCa and radical treatment for higher-risk forms. © 2009 European Association of Urology.

Authors
Rosette, JJMCHDL; Mouraviev, V; Polascik, TJ
MLA Citation
Rosette, JJMCHDL, Mouraviev, V, and Polascik, TJ. "Focal Targeted Therapy Will Be a Future Treatment Modality for Early Stage Prostate Cancer." European Urology, Supplements 8.5 (2009): 424-432.
Source
scival
Published In
European Urology Supplements
Volume
8
Issue
5
Publish Date
2009
Start Page
424
End Page
432
DOI
10.1016/j.eursup.2009.01.005

Flaxseed supplementation (not dietary fat restriction) reduces prostate cancer proliferation rates in men presurgery.

BACKGROUND: Prostate cancer affects one of six men during their lifetime. Dietary factors are postulated to influence the development and progression of prostate cancer. Low-fat diets and flaxseed supplementation may offer potentially protective strategies. METHODS: We undertook a multisite, randomized controlled trial to test the effects of low-fat and/or flaxseed-supplemented diets on the biology of the prostate and other biomarkers. Prostate cancer patients (n = 161) scheduled at least 21 days before prostatectomy were randomly assigned to one of the following arms: (a) control (usual diet), (b) flaxseed-supplemented diet (30 g/d), (c) low-fat diet (<20% total energy), or (d) flaxseed-supplemented, low-fat diet. Blood was drawn at baseline and before surgery and analyzed for prostate-specific antigen, sex hormone-binding globulin, testosterone, insulin-like growth factor-I and binding protein-3, C-reactive protein, and total and low-density lipoprotein cholesterol. Tumors were assessed for proliferation (Ki-67, the primary endpoint) and apoptosis. RESULTS: Men were on protocol an average of 30 days. Proliferation rates were significantly lower (P < 0.002) among men assigned to the flaxseed arms. Median Ki-67-positive cells/total nuclei ratios (x100) were 1.66 (flaxseed-supplemented diet) and 1.50 (flaxseed-supplemented, low-fat diet) versus 3.23 (control) and 2.56 (low-fat diet). No differences were observed between arms with regard to side effects, apoptosis, and most serologic endpoints; however, men on low-fat diets experienced significant decreases in serum cholesterol (P = 0.048). CONCLUSIONS: Findings suggest that flaxseed is safe and associated with biological alterations that may be protective for prostate cancer. Data also further support low-fat diets to manage serum cholesterol.

Authors
Demark-Wahnefried, W; Polascik, TJ; George, SL; Switzer, BR; Madden, JF; Ruffin, MT; Snyder, DC; Owzar, K; Hars, V; Albala, DM; Walther, PJ; Robertson, CN; Moul, JW; Dunn, BK; Brenner, D; Minasian, L; Stella, P; Vollmer, RT
MLA Citation
Demark-Wahnefried, W, Polascik, TJ, George, SL, Switzer, BR, Madden, JF, Ruffin, MT, Snyder, DC, Owzar, K, Hars, V, Albala, DM, Walther, PJ, Robertson, CN, Moul, JW, Dunn, BK, Brenner, D, Minasian, L, Stella, P, and Vollmer, RT. "Flaxseed supplementation (not dietary fat restriction) reduces prostate cancer proliferation rates in men presurgery." Cancer Epidemiol Biomarkers Prev 17.12 (December 2008): 3577-3587.
PMID
19064574
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
17
Issue
12
Publish Date
2008
Start Page
3577
End Page
3587
DOI
10.1158/1055-9965.EPI-08-0008

Defining potency: a comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite.

BACKGROUND: Both the 5-item short version of the International Index of Erectile Function (IIEF-5) and the Expanded Prostate Cancer Index Composite (EPIC) have been used to assess erectile function. In this study, the authors compared various definitions of potency according to the IIEF-5 and the EPIC. METHODS: Patients with prostate cancer who had completed the IIEF-5 and the EPIC within 7 days of each other were included. The Spearman correlation coefficient (rho) was calculated to assess the relation between IIEF-5 and EPIC sexual domain scores. Concordance of potency rates by IIEF-5 and EPIC was assessed in cross-tabulations. By calculating the area under the receiver operator characteristics (ROC) curve (AUC), the authors ascertained the discriminative ability of the IIEF-5 score to identify potent men as defined by the EPIC. RESULTS: Analyzing 102 questionnaire pairs, IIEF-5 and EPIC domain scores were found to be highly correlated (rho = 0.776). EPIC sexual domain scores > or =60 had high concordance with IIEF-5 scores > or =17 (98%) and with nearly all single-item definitions of potency (> or =71%). However, an EPIC sexual domain score > or =80 was a very strict definition of potency, and only 54% of patients with IIEF-5 scores > or =22 met this threshold. On the basis of ROC analysis (AUC = 0.90), an IIEF-5 score > or =20 was identified as the ideal cutoff for defining potency and corresponded with an EPIC sexual domain score > or =60. CONCLUSIONS: IIEF-5 and EPIC scores were highly correlated, but potency rates varied widely, depending on the definition of potency. The current results help with the interpretation of sexual function outcomes data in patients with prostate cancer.

Authors
Schroeck, FR; Donatucci, CF; Smathers, EC; Sun, L; Albala, DM; Polascik, TJ; Moul, JW; Krupski, TL
MLA Citation
Schroeck, FR, Donatucci, CF, Smathers, EC, Sun, L, Albala, DM, Polascik, TJ, Moul, JW, and Krupski, TL. "Defining potency: a comparison of the International Index of Erectile Function short version and the Expanded Prostate Cancer Index Composite." Cancer 113.10 (November 15, 2008): 2687-2694.
PMID
18816628
Source
pubmed
Published In
Cancer
Volume
113
Issue
10
Publish Date
2008
Start Page
2687
End Page
2694
DOI
10.1002/cncr.23887

Persistent contrast enhancement several months after laparoscopic cryoablation of the small renal mass may not indicate recurrent tumor.

PURPOSE: We evaluated the clinical implication of persistent contrast enhancement demonstrated several months after laparoscopic renal cryoablation of a small renal mass. PATIENTS AND METHODS: Between September 2000 and May 2007, 30 patients underwent laparoscopic cryosurgery for an organ-confined renal tumor measuring

Authors
Stein, AJ; Mayes, JM; Mouraviev, V; Chen, VH; Nelson, RC; Polascik, TJ
MLA Citation
Stein, AJ, Mayes, JM, Mouraviev, V, Chen, VH, Nelson, RC, and Polascik, TJ. "Persistent contrast enhancement several months after laparoscopic cryoablation of the small renal mass may not indicate recurrent tumor." J Endourol 22.11 (November 2008): 2433-2439.
PMID
18928388
Source
pubmed
Published In
Journal of Endourology
Volume
22
Issue
11
Publish Date
2008
Start Page
2433
End Page
2439
DOI
10.1089/end.2008.0261

Significant discrepancies between diagnostic and pathologic Gleason sums in prostate cancer: the predictive role of age and prostate-specific antigen.

OBJECTIVES: To assess the discrepancies between diagnostic and pathologic Gleason sums and the predictive role of age and prostate-specific antigen (PSA) level on Gleason sum discrepancies. METHODS: A total of 2963 patients receiving radical prostatectomy at Duke University from 1988 to 2006 were divided into two groups according to year of diagnosis: 1988 to 1999 and 2000 to 2006. The Gleason sum discrepancies were evaluated in the above groups. The predictive roles of diagnostic age (less than 50, 50 to 60, 60.1 to 70, and greater than 70 years), PSA level (less than 10, 10 to 20, and greater than 20 ng/mL), race, body mass index, and prostate weight on the discrepancies were analyzed. RESULTS: Overall, 55.8% of diagnostic Gleason sums differed from those on final surgical pathology (58.6% in the 1988 to 1999 and 49.3% in the 2000 to 2006 groups). Diagnostic Gleason sums were undergraded in 41.2% of cases and overgraded in 12.8% of cases. Men older than 60 years were more likely to have their diagnostic Gleason sums undergraded than men younger than 50 (odds ratio in age groups less than 50, 50 to 60, 60.1 to 70, and greater than 70 years: 1.00, 2.30, 4.03, and 3.96, respectively). Biopsy Gleason sums in men with a high PSA level were more likely to be undergraded compared with the PSA group less than 10 ng/mL (odds ratio in PSA groups less than 10, 10 to 20, and greater than 20 ng/mL: 1.00, 2.11, and 3.64, respectively). CONCLUSIONS: Significant discrepancies between diagnostic and pathologic Gleason sums remain in recent years. The rate of diagnostic Gleason sum undergrading was 3.2-fold that of overgrading. Advanced age and high PSA level were predictive of diagnostic Gleason sum undergrading, and caution should be exercised when recommending active surveillance in older men.

Authors
Isariyawongse, BK; Sun, L; Bañez, LL; Robertson, C; Polascik, TJ; Maloney, K; Donatucci, C; Albala, D; Mouraviev, V; Madden, JF; Moul, JW
MLA Citation
Isariyawongse, BK, Sun, L, Bañez, LL, Robertson, C, Polascik, TJ, Maloney, K, Donatucci, C, Albala, D, Mouraviev, V, Madden, JF, and Moul, JW. "Significant discrepancies between diagnostic and pathologic Gleason sums in prostate cancer: the predictive role of age and prostate-specific antigen." Urology 72.4 (October 2008): 882-886.
PMID
18384857
Source
pubmed
Published In
Urology
Volume
72
Issue
4
Publish Date
2008
Start Page
882
End Page
886
DOI
10.1016/j.urology.2008.02.021

Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy.

BACKGROUND: To counsel patients adequately, it is important to understand the variables influencing satisfaction and regret following prostatectomy. OBJECTIVE: To identify independent predictors for satisfaction and regret after radical prostatectomy. DESIGN, SETTING, AND PARTICIPANTS: Patients who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy (RALP) between 2000 and 2007 were mailed cross-sectional surveys composed of sociodemographic information, the Expanded Prostate Cancer Index Composite (EPIC), and questions regarding satisfaction and regret. MEASUREMENTS: Sociodemographic variables, perioperative complications, type of procedure, length of follow-up, and EPIC scores were evaluated as independent predictors of satisfaction and regret in multivariate logistic regression analysis. RESULTS AND LIMITATIONS: A total of 400 patients responded (response rate 61%) of whom 84% were satisfied and 19% regretted their treatment choice. In multivariate analysis, lower income (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.03-0.23), shorter follow-up (OR, 0.63; 95% CI, 0.41-0.98), having undergone RRP versus RALP (OR, 4.45; 95% CI, 1.90-10.4)], urinary domain scores (OR, 2.70; 95% CI, 1.60-4.54), and hormonal domain scores (OR, 2.01; 95% CI, 1.30-3.12) were independently associated with satisfaction (p< or =0.039). In terms of regret, RALP versus RRP (OR, 3.02; 95% CI, 1.50-6.07), lower urinary domain scores (OR, 0.58; 95% CI, 0.37-0.91) and hormonal domain scores (OR, 0.67; 95% CI, 0.45-0.98), and years since surgery (OR, 1.63; 95% CI, 1.13-2.36) were again predictive (p< or =0.041). African American race (OR, 3.58; 95% CI, 1.52-8.43) and lower bowel domain scores (OR, 0.73; 95% CI, 0.55-0.97) were also independently associated with regret (p< or =0.028). CONCLUSIONS: Sociodemographic variables and quality of life were important variables associated with satisfaction and regret. Patients who underwent RALP were more likely to be regretful and dissatisfied, possibly because of higher expectation of an "innovative" procedure. We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counseling to minimize regret and maximize satisfaction.

Authors
Schroeck, FR; Krupski, TL; Sun, L; Albala, DM; Price, MM; Polascik, TJ; Robertson, CN; Tewari, AK; Moul, JW
MLA Citation
Schroeck, FR, Krupski, TL, Sun, L, Albala, DM, Price, MM, Polascik, TJ, Robertson, CN, Tewari, AK, and Moul, JW. "Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy." Eur Urol 54.4 (October 2008): 785-793.
PMID
18585849
Source
pubmed
Published In
European Urology
Volume
54
Issue
4
Publish Date
2008
Start Page
785
End Page
793
DOI
10.1016/j.eururo.2008.06.063

Pathologic stage T2a and T2b prostate cancer in the recent prostate-specific antigen era: implications for unilateral ablative therapy.

BACKGROUND: Early detection of small volume prostate cancer (PCa) has led to the concept of focal therapy to treat in an organ-sparing manner. We evaluated trends in pathologic staging among patients with localized PCa undergoing radical prostatectomy (RP), defining the frequency of unilateral cancers during 1988-1995, 1996-2000 and 2001-2006. METHODS: Data were abstracted from the Duke Prostate Cancer Outcome database selecting 3,676 men with available pathology treated with RP. Based on surgical pathology, trends in as pathological T (pT) stage, pathological Gleason Score (pGS), and percent tumor involvement (PTI) were evaluated. RESULTS: pT2a increased from 2.8% of men undergoing RP in 1988-1995 to 13.0% during 2001-2006 (P < 0.0005). PTI analysis shifted towards low volume disease, e.g. PTI

Authors
Polascik, TJ; Mayes, JM; Sun, L; Madden, JF; Moul, JW; Mouraviev, V
MLA Citation
Polascik, TJ, Mayes, JM, Sun, L, Madden, JF, Moul, JW, and Mouraviev, V. "Pathologic stage T2a and T2b prostate cancer in the recent prostate-specific antigen era: implications for unilateral ablative therapy." Prostate 68.13 (September 15, 2008): 1380-1386.
PMID
18543281
Source
pubmed
Published In
The Prostate
Volume
68
Issue
13
Publish Date
2008
Start Page
1380
End Page
1386
DOI
10.1002/pros.20804

Urothelial sloughing with obstruction after laparoscopic cryoablation of small renal carcinoma in solitary kidney.

Laparoscopic cryoablation is a minimally invasive treatment that is currently used to treat small renal tumors. Despite its growing use and promising outcomes, complications can occur. We report the first clinical case of urothelial sloughing with obstruction after cryoablation of a small renal tumor in a solitary kidney.

Authors
Chen, VH; Mayes, JM; Mouraviev, V; Polascik, TJ
MLA Citation
Chen, VH, Mayes, JM, Mouraviev, V, and Polascik, TJ. "Urothelial sloughing with obstruction after laparoscopic cryoablation of small renal carcinoma in solitary kidney." Urology 72.3 (September 2008): 716.e1-716.e2.
PMID
18314162
Source
pubmed
Published In
Urology
Volume
72
Issue
3
Publish Date
2008
Start Page
716.e1
End Page
716.e2
DOI
10.1016/j.urology.2007.12.067

Transdermal nicotine for analgesia after radical retropubic prostatectomy.

BACKGROUND: Previous animal and human studies suggested that nicotine might have an antinociceptive effect. We hypothesized that the preoperative application of a 7 mg nicotine patch would result in reduced postoperative analgesic requirements in patients undergoing radical retropubic prostatectomy (RRP) under general anesthesia. METHODS: Nonsmokers undergoing RRP under general anesthesia were enrolled in this prospective, double-blind, placebo-controlled study. Patients were randomly assigned to receive a patch of 7 mg nicotine or placebo applied behind the ear 30-60 min before induction of anesthesia. The anesthetic technique was standardized. Postoperative analgesia was provided with a standardized morphine patient-controlled analgesia and 6 hourly ketorolac 15 mg IV. Data were collected in the postanesthesia care unit and at 6, 12, and 24 h after surgery. RESULTS: Ninety patients were included in the analysis: 44 in the nicotine group and 46 in the placebo group. The groups did not differ significantly with respect to age, height, weight, ASA class, length of surgery, or amounts of intraoperative fentanyl received. The nicotine group showed significantly lower cumulative morphine consumption at 24 h (mean +/- sd): 33.3 +/- 30.8 mg vs 44.7 +/- 26.4 mg (P = 0.0059, time x treatment P = 0.0031). However, the repeated measures tests found no difference in amount of pain reported on coughing or at rest, either as treatment effects or in interaction with time. In post hoc comparisons, there was no significant difference in amount of pain reported on coughing or at rest at any of the times assessed. There were also no significant differences between the groups in the incidence of postoperative nausea and vomiting or the need for rescue antiemetics. However, the maximum nausea verbal rating scale score was higher in the nicotine than in the placebo group (median, 25th to 75th percentiles = 4, 0-6 vs 0, 0-6, P = 0.0158). There was a significant negative correlation between the 24 h plasma nicotine levels and postoperative morphine consumption in the postanesthesia care unit (P = 0.049), as well as at 6, 12, and 24 h (P = 0.002). CONCLUSION: The preoperative application of a 7 mg nicotine patch resulted in a significant reduction in opioid consumption in patients undergoing RRP under general anesthesia. Despite this reduction in opioid use, there was no reduction in pain scores or postoperative nausea and vomiting with the use of transdermal nicotine.

Authors
Habib, AS; White, WD; El Gasim, MA; Saleh, G; Polascik, TJ; Moul, JW; Gan, TJ
MLA Citation
Habib, AS, White, WD, El Gasim, MA, Saleh, G, Polascik, TJ, Moul, JW, and Gan, TJ. "Transdermal nicotine for analgesia after radical retropubic prostatectomy." Anesth Analg 107.3 (September 2008): 999-1004.
PMID
18713920
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
107
Issue
3
Publish Date
2008
Start Page
999
End Page
1004
DOI
10.1213/ane.0b013e31816f2616

Evaluation of a novel precision template-guided biopsy system for detecting prostate cancer.

OBJECTIVE: To explore the ability of a novel transrectal ultrasonography (TRUS) device (TargetScan, Envisioneering Medical Technologies, St. Louis MO) that creates a three-dimensional map of the prostate and calculates an optimal biopsy scheme, to accurately sample the prostate and define the true extent of disease, as standard TRUS-guided prostate biopsy relies on the operator to distribute the biopsy sites, often resulting in under- and oversampling regions of the gland. PATIENTS AND METHODS: In a multicentre retrospective chart review evaluating patients who had a TargetScan prostate biopsy between January 2006 and June 2007, we determined the overall cancer detection rate in all patients and in subgroups based on prostate specific antigen level, digital rectal examination, and indication for biopsy. We assessed the pathological significance of cancer detected, defined as a Gleason score of > or = 7, positive margins, extracapsular disease or > 20% tumour volume in the prostatectomy specimen. We also evaluated the concordance in Gleason score between the biopsy and prostatectomy specimen. RESULTS: Cancer was detected in 50 (35.7%) of the 140 patients biopsied, including 39 (47.6%) with no previous biopsies. Of 23 prostatectomy specimens, 20 (87%) had pathologically significant disease. The biopsy predicted the prostatectomy Gleason score in 12 patients (52%), overestimated in two (9%), underestimated in eight (35%), and biopsy Gleason score could not be assigned in one (4%). CONCLUSIONS: Template-guided biopsy potentially produces a higher cancer detection rate and more accurate assessment of grade. Prostatectomy specimens did not have a high rate of pathologically insignificant disease.

Authors
Megwalu, II; Ferguson, GG; Wei, JT; Mouraviev, V; Polascik, TJ; Taneja, S; Black, L; Andriole, GL; Kibel, AS
MLA Citation
Megwalu, II, Ferguson, GG, Wei, JT, Mouraviev, V, Polascik, TJ, Taneja, S, Black, L, Andriole, GL, and Kibel, AS. "Evaluation of a novel precision template-guided biopsy system for detecting prostate cancer." BJU Int 102.5 (August 5, 2008): 546-550.
PMID
18694408
Source
pubmed
Published In
Bju International
Volume
102
Issue
5
Publish Date
2008
Start Page
546
End Page
550
DOI
10.1111/j.1464-410X.2008.07832.x

Impact of a cryotherapy training workshop on the adoption and utilization of cryotherapy in the community setting.

INTRODUCTION: Given the improved therapeutic efficacy and acceptable side effect profile with current cryotechnology, we wish to better understand the attitudes of community urologists expressing interest in this treatment modality toward the adoption of cryotherapy in their practice. METHODS: A retrospective survey was conducted with information gathered on 50 responding physicians who attended a cryosurgery workshop between February 2004 and September 2006. Specifics such as demographics and professional background, reasons for interest in cryosurgery, and the current status of cryosurgery in the physicians' practice were collected and analyzed using SPSS, version 14 (Chicago, IL). RESULTS: Of the responding 50 physicians who attended a cryotherapy training workshop, 33 (66%) had been in practice for >/= 15 years. The most frequently cited reasons for interest in cryosurgery were the intention to introduce cryosurgery into routine practice for treatment of primary (70%) and salvage (62%) prostate cancer and treatment of renal neoplasms (62%). Most physicians reported the learning curve to be short. Of the 22 (44%) physicians currently practicing cryotherapy, most are using the technique for treatment of primary prostate cancer and as a salvage procedure for radiorecurrent prostate cancer. Twenty-eight (56%) physicians reported that they were not practicing cryosurgery yet, mainly citing lack of patient interest/appropriate patients and/or a lack of institutional support. CONCLUSIONS: This study provides insight into the attitudes of community urologists to adopt cryotherapy into their practice following a training course. Although some surgeons successfully integrate cryotherapy into their practice, further efforts must be made to remove barriers to allow adoption of this technology in the community setting.

Authors
Mayes, JM; Mouraviev, V; Polascik, TJ
MLA Citation
Mayes, JM, Mouraviev, V, and Polascik, TJ. "Impact of a cryotherapy training workshop on the adoption and utilization of cryotherapy in the community setting." Can J Urol 15.4 (August 2008): 4147-4152.
PMID
18706140
Source
pubmed
Published In
Canadian Journal of Urology
Volume
15
Issue
4
Publish Date
2008
Start Page
4147
End Page
4152

The effect of cryoablation on the histologic interpretation of intraoperative biopsy of small clear cell renal carcinoma and renal oncocytoma.

BACKGROUND AND PURPOSE: We evaluated the effects of the first freeze-thaw cycle of cryoablation on Fuhrman grade, histology, and tumor architecture of small clear cell renal carcinomas and renal oncocytomas using an 18-gauge needle biopsy. PATIENTS AND METHODS: Between August 2006 and June 2007, 11 patients underwent cryoablation for 14 renal neoplasms. A laparoscopic approach was employed using third-generation argon/helium cryotechnology. Biopsies were taken prior to and following the first freeze-thaw cycle. Each biopsy sample was semiquantitively evaluated for cytoplasmic fraying, nuclear hyperchromasia, nuclear breakdown, and tissue discohesion as well as Fuhrman grade and interpretability by a single pathologist. RESULTS: Eighteen precryoablation and 15 post-first freeze biopsies were taken. A tissue diagnosis was rendered in 100% of 11 patients. Pathologic diagnosis following the first freeze-thaw cycle of cryotherapy, as compared with the pretreatment biopsy, was accurate in 10 (91%) cases. Neither of the two post-first freeze biopsies in the remaining patient rendered a diagnosis: one had an insufficient quantity of tissue and the second missed the tumor, abstracting benign renal tissue. There was no significant difference in cytoplasmic fraying (P = 0.30), nuclear hyperchromasia (P = 0.43), nuclear breakdown (P = 0.58), or tissue discohesion (P = 0.84) observed between biopsies taken before and after the first freeze-thaw cycle of cryoablation. In no case did we note a change in Fuhrman grade greater than 1. CONCLUSIONS: One cycle of cryoablation does not significantly alter the architecture or Fuhrman grade of biopsy tissue, thus allowing for another method to obtain sufficient histologic tissue when bleeding is minimal.

Authors
Chen, VH; Mayes, JM; Madden, JF; Stein, AJ; Mouraviev, V; Polascik, TJ
MLA Citation
Chen, VH, Mayes, JM, Madden, JF, Stein, AJ, Mouraviev, V, and Polascik, TJ. "The effect of cryoablation on the histologic interpretation of intraoperative biopsy of small clear cell renal carcinoma and renal oncocytoma." J Endourol 22.8 (August 2008): 1617-1621.
PMID
18620504
Source
pubmed
Published In
Journal of Endourology
Volume
22
Issue
8
Publish Date
2008
Start Page
1617
End Page
1621
DOI
10.1089/end.2008.0156

From whole-gland to targeted cryoablation for the treatment of unilateral or focal prostate cancer.

The intermediate and long-term results of primary full-gland cryoablation for localized prostate cancer with moderate- and high-risk patients suggests a cancer control rate similar to what can be achieved with radiotherapy and surgery, with an acceptable rate of complications. A recent shift in the treatment paradigm toward unilateral cryoablation (hemiablation) or ablation of unifocal lesion(s) in select patients suggests the ability of this approach to maintain a quality of life closer to the pretreatment level. However, trials with longer oncologic follow-up are needed. The development of more accurate imaging-based techniques-ie, image-guided prostate biopsy sampling and image-guided prostate cryoablation-is of paramount importance to selecting appropriate candidates for an organ-sparing procedure. To make this approach scientifically sound, further investigation to establish patient selection criteria, the development of molecular and imaging parameters of cryoablative efficacy, and regular careful follow-up of these patients is needed.

Authors
Polascik, TJ; Mayes, JM; Mouraviev, V
MLA Citation
Polascik, TJ, Mayes, JM, and Mouraviev, V. "From whole-gland to targeted cryoablation for the treatment of unilateral or focal prostate cancer." Oncology (Williston Park) 22.8 (July 2008): 900-906. (Review)
PMID
18709901
Source
pubmed
Published In
Oncology
Volume
22
Issue
8
Publish Date
2008
Start Page
900
End Page
906

Comparison of prostate-specific antigen recurrence-free survival in a contemporary cohort of patients undergoing either radical retropubic or robot-assisted laparoscopic radical prostatectomy.

OBJECTIVES: To compare the prostate-specific antigen (PSA) recurrence (PSAR) rates in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) or radical retropubic prostatectomy (RRP). PATIENTS AND METHODS: Data from 797 consecutive patients who had RALP or RRP between August 2003 and January 2007 were retrieved from our database. Age, race, body mass index, PSA level, estimated blood loss (EBL), clinical and pathological stage, biopsy and pathological Gleason score, lymph node involvement, positive surgical margin (PSM) status, and prostate weight were compared between the groups. Multivariate analysis (logistic and Cox regression) was used to adjust for differences in clinical and pathological features when comparing the risk for PSM and PSAR. RESULTS: In all, 362 men had RALP and 435 had RRP; the mean follow-up was 1.09 and 1.37 years, respectively. RALP patients had a significantly lower clinical stage, Gleason score and EBL (P < 0.001). There was no significant difference in PSM between RALP and RRP in univariate (P = 0.701) and multivariate analyses (P = 0.095). The risk of PSAR for patients undergoing RALP or RRP was not significantly different after adjusting for clinical (hazard ratio 0.82, 95% confidence interval 0.48-1.38; P = 0.448) and pathological differences (0.94, 0.55-1.61; P = 0.824). CONCLUSIONS: Patients undergoing RALP had a lower EBL and lower-risk disease. After adjusting for differences in clinical and pathological features, there was no significant difference in early PSAR between patients undergoing RALP or RRP.

Authors
Schroeck, FR; Sun, L; Freedland, SJ; Albala, DM; Mouraviev, V; Polascik, TJ; Moul, JW
MLA Citation
Schroeck, FR, Sun, L, Freedland, SJ, Albala, DM, Mouraviev, V, Polascik, TJ, and Moul, JW. "Comparison of prostate-specific antigen recurrence-free survival in a contemporary cohort of patients undergoing either radical retropubic or robot-assisted laparoscopic radical prostatectomy." BJU Int 102.1 (July 2008): 28-32.
PMID
18384634
Source
pubmed
Published In
Bju International
Volume
102
Issue
1
Publish Date
2008
Start Page
28
End Page
32
DOI
10.1111/j.1464-410X.2008.07607.x

Use of local (111)in-capromab pendetide scan results to predict outcome after salvage radiotherapy for prostate cancer.

PURPOSE: The (111)In-capromab pendetide scan (ProstaScint; Cytogen Corp., Princeton NJ) is approved by the Food and Drug Administration to evaluate increasing prostate-specific antigen (PSA) levels after radical prostatectomy. This study evaluated the role of prostate bed (111)In-capromab pendetide scan findings to predict response to salvage radiotherapy (RT). METHODS AND MATERIALS: Forty patients who had PSA recurrence after radical prostatectomy and a (111)In-capromab pendetide scan immediately before salvage prostate bed RT (median, 66 Gy) were identified from the Duke Prostate Center database. Patients with distant uptake of capromab pendetide or long-term androgen deprivation therapy were excluded. Median follow-up after salvage RT was 2.7 years. Patient demographic, clinical, and pathologic characteristics; PSA values; and (111)In-capromab pendetide scan results were retrospectively analyzed. A PSA failure after salvage RT was defined as PSA level greater than 0.2 ng/ml. Data were combined with other published results in a secondary pooled analysis of 106 patients. RESULTS: (111)In-Capromab pendetide findings included 20 patients with negative scan results and 20 with locally positive scan results. Two-year progression-free survival rates were 60% for patients with a negative scan result and 74% for those with a locally positive scan result (p = 0.49). Combined analysis did not show a difference in outcome based on local (111)In-capromab pendetide scan result. CONCLUSION: For patients without distant signal detected by using (111)In-capromab pendetide scan, patients with locally positive scan findings did not have statistically different progression-free survival than those with a negative scan result, suggesting that salvage RT may be successful in patients with either a locally positive or negative (111)In-capromab pendetide scan result.

Authors
Koontz, BF; Mouraviev, V; Johnson, JL; Mayes, J; Chen, SH; Wong, TZ; Anscher, MS; Sun, L; Moul, J; Polascik, TJ
MLA Citation
Koontz, BF, Mouraviev, V, Johnson, JL, Mayes, J, Chen, SH, Wong, TZ, Anscher, MS, Sun, L, Moul, J, and Polascik, TJ. "Use of local (111)in-capromab pendetide scan results to predict outcome after salvage radiotherapy for prostate cancer." Int J Radiat Oncol Biol Phys 71.2 (June 1, 2008): 358-361.
PMID
18164863
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
71
Issue
2
Publish Date
2008
Start Page
358
End Page
361
DOI
10.1016/j.ijrobp.2007.10.020

Residual tumor potentially left behind after local ablation therapy in prostate adenocarcinoma - Comment

Authors
Chin, JL; Keane, TE; Polascik, TJ
MLA Citation
Chin, JL, Keane, TE, and Polascik, TJ. "Residual tumor potentially left behind after local ablation therapy in prostate adenocarcinoma - Comment." JOURNAL OF UROLOGY 179.6 (June 2008): 2206-2206.
Source
wos-lite
Published In
The Journal of Urology
Volume
179
Issue
6
Publish Date
2008
Start Page
2206
End Page
2206
DOI
10.1016/j.juro.2008.01.248

Can prostate-specific antigen and prostate-specific antigen velocity be used for prostate cancer screening in men older than 70 years?

OBJECTIVES: We evaluated the lower threshold of prostate-specific antigen (PSA) and prostate-specific antigen velocity (PSAV) in a population of men over 70 years of age. METHODS: Between January 1988 and December 2005, 4038 men over 70 years of age including 605 African-American (AA) men and 3433 non-AA men from the Duke Prostate Center Outcomes database had determination of serum PSA and PSAV. We used receiver operating characteristic (ROC) curves to display the data graphically. RESULTS: The median age for all men on the study was 75 years. The area under the curve (AUC) for PSA in AA men and non-AA men was 0.84 and 0.76, respectively. For PSAV the AUC was 0.71 versus 0.54, respectively. The largest relative sensitivity and specificity in AA men was achieved at the established PSA cut-point of 4.0 ng/mL: 85% and 71%, respectively. The best cut-point in non-AA men was 3.4 ng/mL, which resulted in a sensitivity and specificity of 72% and 73%, respectively. The AUC of ROC curves within various age subgroups tends to be stable regardless of how the ages are grouped. In a multivariate logistic regression model age, PSA and PSAV were significant predictors of cancer status in the AA subset. Age and PSA were significant predictors in the non-AA subset. CONCLUSIONS: The AUC of ROC curves within various age subgroups tends to be stable; therefore, we are led to believe that a PSA or PSAV cutoff for safely commending discontinuation of PCa screening is not apparent from these data.

Authors
Mouraviev, V; Broadwater, G; Sun, L; Mayes, JM; Moul, JW; Polascik, TJ
MLA Citation
Mouraviev, V, Broadwater, G, Sun, L, Mayes, JM, Moul, JW, and Polascik, TJ. "Can prostate-specific antigen and prostate-specific antigen velocity be used for prostate cancer screening in men older than 70 years?." Urology 71.6 (June 2008): 1020-1023.
PMID
18267331
Source
pubmed
Published In
Urology
Volume
71
Issue
6
Publish Date
2008
Start Page
1020
End Page
1023
DOI
10.1016/j.urology.2007.11.016

WITHDRAWN: Can the conventional sextant prostate biopsy reliably diagnose unilateral prostate cancer in low-risk, localized, prostate cancer?

The authors hereby retract the e-publication dated 13 May 2008 and entitled, 'Can the conventional sextant prostate biopsy reliably diagnose unilateral prostate cancer in low-risk, localized, prostate cancer?' The authors are submitting a revised version with the same title. This article's statistics were performed for predicting bilateral prostate cancer outcomes. The article was written to help predict unilateral prostate cancer. Although the statistical numbers are correct, they are backwards. We apologize that the statistics indicate a contrary outcome (eg predicting bilateral cancer instead of unilateral disease).

Authors
Mayes, JM; Mouraviev, V; Sun, L; Madden, JF; Polascik, TJ
MLA Citation
Mayes, JM, Mouraviev, V, Sun, L, Madden, JF, and Polascik, TJ. "WITHDRAWN: Can the conventional sextant prostate biopsy reliably diagnose unilateral prostate cancer in low-risk, localized, prostate cancer? (Published online)." Prostate Cancer Prostatic Dis (May 13, 2008).
PMID
18475285
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Publish Date
2008
DOI
10.1038/pcan.2008.31

Focal therapy for prostate cancer.

PURPOSE OF REVIEW: Nowadays the treatment paradigm for localized prostate cancer is to distinguish patients with clinically relevant cancers who may benefit from radical treatment, or perhaps an organ-sparing approach, from the remainder who may not need intervention at the time of diagnosis. We review new concepts of parenchymal preservation as possible new frontiers in the treatment armamentarium for this malignancy. RECENT FINDINGS: For a select cohort of patients with low-risk unifocal or unilateral prostate cancer lesions, a number of ablative treatment options for focal therapy are available with cryotherapy having the most clinical experience. Technologies that have the ability to be utilized for focal therapy include high-intensity focused ultrasound, brachytherapy, interstitial laser thermotherapy, stereotactic radio surgery, and vascular-targeted photodynamic therapy. Further basic and animal research along with the conduction of large-scale randomized clinical trials demonstrating long-term disease-free survival and quality of life outcomes are necessary. SUMMARY: The concept of focal therapy is evolving with the understanding of the biologic variability (clinically aggressive, significant or insignificant) of various prostate cancer lesions that may require different treatment approaches. Minimally invasive, parenchyma-preserving therapies can assume a greater role in the treatment of unilateral or unifocal lesions, representing an alternative approach to the current treatment extremes of whole-gland treatment and watchful waiting.

Authors
Polascik, TJ; Mouraviev, V
MLA Citation
Polascik, TJ, and Mouraviev, V. "Focal therapy for prostate cancer." Curr Opin Urol 18.3 (May 2008): 269-274. (Review)
PMID
18382236
Source
pubmed
Published In
Current Opinion in Urology
Volume
18
Issue
3
Publish Date
2008
Start Page
269
End Page
274
DOI
10.1097/MOU.0b013e3282f9b3a5

Older men associated with advanced disease and poor outcome: An analysis of 14601 prostate cancer men in duke prostate center

Authors
Moul, JW; Sun, L; Robertson, CN; Donatucci, CF; Albala, DM; Walther, PJ; Mouraviev, V; Schroeck, FR; Polascik, TJ
MLA Citation
Moul, JW, Sun, L, Robertson, CN, Donatucci, CF, Albala, DM, Walther, PJ, Mouraviev, V, Schroeck, FR, and Polascik, TJ. "Older men associated with advanced disease and poor outcome: An analysis of 14601 prostate cancer men in duke prostate center." April 2008.
Source
wos-lite
Published In
The Journal of Urology
Volume
179
Issue
4
Publish Date
2008
Start Page
641
End Page
641
DOI
10.1016/S0022-5347(08)61875-3

Pre-treatment factors predictive of positive surgical margin in contemporary radical prostatectomies

Authors
Sun, L; Zorn, KC; Albala, DM; Shikanov, S; Zagaja, GP; Shalhav, AL; Robertson, CN; Donatucci, CF; Walther, PJ; Mouraviev, V; Schroeck, FR; Polascik, TJ; Moul, JW
MLA Citation
Sun, L, Zorn, KC, Albala, DM, Shikanov, S, Zagaja, GP, Shalhav, AL, Robertson, CN, Donatucci, CF, Walther, PJ, Mouraviev, V, Schroeck, FR, Polascik, TJ, and Moul, JW. "Pre-treatment factors predictive of positive surgical margin in contemporary radical prostatectomies." April 2008.
Source
wos-lite
Published In
The Journal of Urology
Volume
179
Issue
4
Publish Date
2008
Start Page
250
End Page
250
DOI
10.1016/S0022-5347(08)60724-7

Zoledronic acid in the management of metastatic bone disease.

Many patients with advanced cancer experience decreased bone strength due to metastatic foci, underlying osteoporosis and/or cancer treatment induced bone loss. The clinical consequences of metastatic disease involving the skeleton are widespread. This review focuses on the efficacy, pharmacology, and safety when using intravenous biphosphonate such a zoledronic acid for cancer bone metastases. Zoledronic acid is the gold standard for the medical management of metastatic bone disease. The indications for treatment include prevention of skeletal relevant events (SRE), osteoporotic complications, and palliation of bone pain, among others. Zoledronic acid is the only bisphosphonate effective in decreasing SREs associated with bone metastases from advanced renal cell carcinoma and prostate cancer. Regarding prostate cancer, zoledronic acid effectively prevents both bone loss in patients with locally advanced disease receiving androgen deprivation therapy and SREs in men with hormone-refractory or hormone-sensitive metastatic disease. Zoledronic acid has an acceptable safety profile and tolerability, and has been effective at significantly decreasing the incidence, delaying the onset, and reducing the overall risk of experiencing an SRE compared to placebo. It is the only bisphosphonate currently approved for the prevention and treatment of skeletal complications in patients with bone metastases due to all solid tumors.

Authors
Polascik, TJ; Mouraviev, V
MLA Citation
Polascik, TJ, and Mouraviev, V. "Zoledronic acid in the management of metastatic bone disease." Ther Clin Risk Manag 4.1 (February 2008): 261-268.
PMID
18728715
Source
pubmed
Published In
Therapeutics and clinical risk management
Volume
4
Issue
1
Publish Date
2008
Start Page
261
End Page
268

Bone health in prostate cancer patients receiving androgen-deprivation therapy: the role of bisphosphonates.

Androgen-deprivation therapy, a mainstay in the treatment of locally advanced and metastatic prostate cancer, is associated with significant bone loss and related complications, such as fracture. Bisphosphonates, osteoclast inhibitors, are effective in preventing skeletal-related events in patients with metastatic prostate cancer and also in preventing bone loss in patients with locally advanced disease. Understanding the management of bone health, including identifying patients at risk, the most appropriate therapy, and monitoring and managing side effects, is critical. This review provides the most recent bone health risk factor and bisphosphonate data available for prostate cancer patients.

Authors
Polascik, TJ
MLA Citation
Polascik, TJ. "Bone health in prostate cancer patients receiving androgen-deprivation therapy: the role of bisphosphonates." Prostate Cancer Prostatic Dis 11.1 (2008): 13-19. (Review)
PMID
17923854
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
11
Issue
1
Publish Date
2008
Start Page
13
End Page
19
DOI
10.1038/sj.pcan.4501019

Overcoming challenges in designing and implementing a phase II randomized controlled trial using a presurgical model to test a dietary intervention in prostate cancer.

BACKGROUND: The time between the diagnosis of cancer and a planned definitive surgical procedure offers a strong and direct approach for assessing the impact of interventions (including lifestyle interventions) on the biology of the target tissue and the tumor. Despite the many strengths of presurgical models, there are practical issues and challenges that arise when using this approach. PURPOSE/METHODS: We recently completed an NIH-funded phase II trial that utilized a presurgical model in testing the comparative effects of flaxseed supplementation and/or dietary fat restriction on the biology and biomarkers associated with prostatic carcinoma. Herein, we report the rationale for our original design, discuss modifications in strategy, and relay experiences in implementing this trial related to the following topics: (1) subject accrual; (2) subject retention; (3) intervention delivery; and (4) retrieval and completion rates regarding the collection of paraffin-embedded and fresh frozen prostate tissue, blood, urine, ejaculate, anthropometric measures and survey data. RESULTS: This trial achieved its accrual target, i.e., a racially-representative (70% white, 30% minority) sample of 161 participants, low rates of attrition (7%); and collection rates that exceeded 90% for almost all biospecimens and survey data. While the experience gained from pilot studies was invaluable in designing this trial, the complexity introduced by the collection of several biospecimens, inclusion of a team of pathologists (to provide validated readings), and shifts in practice patterns related to prostatectomy, made it necessary to revise our protocol; lessons from our experiences are offered within this article. CONCLUSIONS: While our experience specifically relates to the implementation of a presurgical model-based trial in prostate cancer aimed at testing flaxseed-supplemented and fat-restricted diets, many of the lessons learned have broad application to trials that utilize a presurgical model or dietary modification within various cancer populations.

Authors
Demark-Wahnefried, W; George, SL; Switzer, BR; Snyder, DC; Madden, JF; Polascik, TJ; Ruffin, MT; Vollmer, RT
MLA Citation
Demark-Wahnefried, W, George, SL, Switzer, BR, Snyder, DC, Madden, JF, Polascik, TJ, Ruffin, MT, and Vollmer, RT. "Overcoming challenges in designing and implementing a phase II randomized controlled trial using a presurgical model to test a dietary intervention in prostate cancer." Clin Trials 5.3 (2008): 262-272.
PMID
18559416
Source
pubmed
Published In
Clinical Trials
Volume
5
Issue
3
Publish Date
2008
Start Page
262
End Page
272
DOI
10.1177/1740774508091676

Avoiding surgery in prostate cancer patients with low-risk disease

At present, the treatment paradigm for localized prostate cancer (PCa) is to distinguish patients with clinically relevant cancers who require treatment either in the form of traditional radical therapy or a contemporary less aggressive, organ-preserving approach, from the remainder who do not need any intervention at the time of diagnosis. Recent research has proposed a rationale for an active surveillance (AS) strategy with deferred definitive therapy in a select cohort of patients with low-risk PCa; however, this approach requires careful patient selection, regular long-term follow-up and the possibility of altering treatment towards a more aggressive modality. For another select group of patients with unifocal or unilateral PCa, alternative treatment options may include focal therapy or subtotal glandular ablation with cryotherapy, for example, as a more established and proven technique. Other potential minimally invasive procedures that are nonsurgical in nature that can also be utilized in the clinical arena include high-intensity focused ultrasound, or vascular-targeted photodynamic therapy, which is currently undergoing clinical study. However, additional basic science research and large-scale randomized clinical trials with long-term oncologic follow-up and quality of life outcomes are necessary before any conclusions can be made about the sustained efficacy of these minimally invasive options. This perspective article evaluates the current trends for treating localized, low-risk PCa in a nonsurgical fashion, and in particular to discuss focal therapy as a means of targeting the known cancer in select low-risk cases, thus avoiding whole-gland therapy and its inherent potential complications regarding quality of life. Traditional surgical, radiotherapy or hormonal therapeutic modalities are beyond the scope of this perspective article. © 2008 Future Medicine Ltd.

Authors
Mouraviev, V; Polascik, TJ
MLA Citation
Mouraviev, V, and Polascik, TJ. "Avoiding surgery in prostate cancer patients with low-risk disease." Therapy 5.1 (2008): 25-36.
Source
scival
Published In
Therapy
Volume
5
Issue
1
Publish Date
2008
Start Page
25
End Page
36
DOI
10.2217/14750708.5.1.25

Three-dimensional acoustic radiation force impulse (ARFI) imaging of human prostates in vivo

We are investigating utilizing ARFI imaging to guide prostate needle biopsy. Our previous ex vivo study demonstrated that ARFI imaging using a VF10-5 linear array was able to visualize the internal anatomy and suspicious lesions in the prostate, which may help improve the diagnostic accuracy of prostate needle biopsy. The objective of this study is to implement ARFI techniques on a 3D wobbler rectal probe and image human prostates in vivo. Three patients were imaged. The initial in vivo results are reported. © 2008 IEEE.

Authors
Zhai, L; Dahl, J; Madden, J; Mouraviev, V; Polascik, T; Palmeri, M; Nightingale, K
MLA Citation
Zhai, L, Dahl, J, Madden, J, Mouraviev, V, Polascik, T, Palmeri, M, and Nightingale, K. "Three-dimensional acoustic radiation force impulse (ARFI) imaging of human prostates in vivo." 2008.
Source
scival
Published In
Proceedings of the IEEE Ultrasonics Symposium
Publish Date
2008
Start Page
540
End Page
543
DOI
10.ll09/ULTSYM.2008.0131

Editorial Comment

Authors
Polascik, TJ
MLA Citation
Polascik, TJ. "Editorial Comment." Journal of Urology 179.6 (2008): 2206--.
Source
scival
Published In
The Journal of Urology
Volume
179
Issue
6
Publish Date
2008
Start Page
2206-
DOI
10.1016/j.juro.2008.01.250

Short Term Clinical Outcome after Laparoscopic Cryoablation of the Renal Tumor < or = 3.5 cm.

Between September 2000 and September 2006, 26 patients underwent primary laparoscopic cryosurgical procedures (28) for an organ-confined renal tumor(s). In one case, cryosurgery was done sequentially on both kidneys. All patients had been carefully selected based on the following criteria: tumor size < or = 3.5 cm, the absence of local and systemic spread on cross-sectional computed tomography (CT) or magnetic resonance imaging (MRI), and the ability to tolerate general anesthesia. A pure laparoscopic approach was employed using third generation cryotechnology (Galil Medical Inc., Plymouth Meeting, USA). Patients were followed by serial CT or MRI scan, creatinine level, and physical examination at least every six months after cryotherapy. The mean patient age was 64 years (range: 44-79) and the mean follow-up was 20.9 +/- 17.2 months. The median tumor size was 2.0 cm (range: 1-3.5 cm). Only one patient required a blood transfusion and one patient developed a transient ileus. The median length of stay was 2.0 days (range: 0-9 days). The median change in creatinine was 0.1 mg/dl (range:-0.4 to 1.8). No patient was converted to open surgery. No evidence of recurrence or progression was found in all patients, and overall survival rate was 100%. Laparoscopic renal cryoablation of the small renal tumor is a safe procedure with minimal complications. Although there were no recurrences with short term follow-up, further long term study is needed to verify its efficacy.

Authors
Polascik, TJ; Nosnik, I; Mayes, JM; Mouraviev, V
MLA Citation
Polascik, TJ, Nosnik, I, Mayes, JM, and Mouraviev, V. "Short Term Clinical Outcome after Laparoscopic Cryoablation of the Renal Tumor < or = 3.5 cm." Technol Cancer Res Treat 6.6 (December 2007): 621-624.
PMID
17994792
Source
pubmed
Published In
Technology in cancer research & treatment
Volume
6
Issue
6
Publish Date
2007
Start Page
621
End Page
624
DOI
10.1177/153303460700600605

Prostate cancer laterality does not predict prostate-specific antigen recurrence after radical prostatectomy.

OBJECTIVES: To evaluate biologic behaviors of unilateral cancers compared with bilateral cancers on prostate-specific antigen (PSA) recurrence after radical prostatectomy. METHODS: Analysis included demographic, clinical, and pathologic parameters of 1184 men who underwent RP for clinically localized prostate cancer at our institution between 2002 and 2006. Final pathologic assessment was performed with particular attention to laterality and percentage of tumor involvement, along with other routine parameters. On the basis of percentage of tumor involvement, all cancer foci were ranked as 5% or less, 5.01% to 10%, 10.01% to 15%, or greater than 15%. Statistical analysis was performed with univariate and multivariate methods. RESULTS: Overall, 19.2% of 1184 patients had completely unilateral cancers. Prostate-specific antigen recurrence was revealed in 164 of 1184 patients (13.9%) at a mean (+/- standard deviation) follow-up of 2.7 +/- 2.4 years. Among men who had recurrence, 26 of 227 (11.5%) had unilateral tumors and 138 of 957 (14.4%) had bilateral disease (P = 0.25). The most common characteristics associated with PSA recurrence of unilateral tumors in the Cox model were diagnostic PSA level, prostate weight, and pathologic Gleason score (P <0.05). CONCLUSIONS: Unilateral or bilateral prostate cancer did not predict PSA recurrence in men receiving radical prostatectomy. In contrast, baseline PSA level and pathologic Gleason score strongly predicted PSA recurrence.

Authors
Mouraviev, V; Sun, L; Madden, JF; Mayes, JM; Moul, JW; Polascik, TJ
MLA Citation
Mouraviev, V, Sun, L, Madden, JF, Mayes, JM, Moul, JW, and Polascik, TJ. "Prostate cancer laterality does not predict prostate-specific antigen recurrence after radical prostatectomy." Urology 70.6 (December 2007): 1141-1145.
PMID
18158035
Source
pubmed
Published In
Urology
Volume
70
Issue
6
Publish Date
2007
Start Page
1141
End Page
1145
DOI
10.1016/j.urology.2007.07.066

The complication rate after cryosurgical ablation for clinically localized prostate cancer using third generation cryotechnology

Authors
Mayes, JM; Mouraviev, V; Nosnik, I; Polascik, TJ
MLA Citation
Mayes, JM, Mouraviev, V, Nosnik, I, and Polascik, TJ. "The complication rate after cryosurgical ablation for clinically localized prostate cancer using third generation cryotechnology." October 2007.
Source
wos-lite
Published In
Journal of Endourology
Volume
21
Publish Date
2007
Start Page
A148
End Page
A149

Short-term cancer control after primary cryosurgical ablation for clinically localized prostate cancer using third generation cryotechnology

Authors
Mouraviev, V; Mayes, JM; Nosnik, I; Polascik, TJ
MLA Citation
Mouraviev, V, Mayes, JM, Nosnik, I, and Polascik, TJ. "Short-term cancer control after primary cryosurgical ablation for clinically localized prostate cancer using third generation cryotechnology." October 2007.
Source
wos-lite
Published In
Journal of Endourology
Volume
21
Publish Date
2007
Start Page
A149
End Page
A149

Financial comparative analysis of minimally invasive surgery to open surgery for small renal tumors less than 3.5 cm: A single institutional experience

Authors
Polascik, TJ; Nosnik, I; Mayes, JM; Mouraviev, V
MLA Citation
Polascik, TJ, Nosnik, I, Mayes, JM, and Mouraviev, V. "Financial comparative analysis of minimally invasive surgery to open surgery for small renal tumors less than 3.5 cm: A single institutional experience." October 2007.
Source
wos-lite
Published In
Journal of Endourology
Volume
21
Publish Date
2007
Start Page
A115
End Page
A115

Tumor laterality does not predict biochemical prostate cancer recurrence after radical prostatectomy

Authors
Mouraviev, V; Sun, L; Madden, JF; Mayes, JM; Moul, JW; George, DJ; Febbo, PG; Polascik, TJ
MLA Citation
Mouraviev, V, Sun, L, Madden, JF, Mayes, JM, Moul, JW, George, DJ, Febbo, PG, and Polascik, TJ. "Tumor laterality does not predict biochemical prostate cancer recurrence after radical prostatectomy." October 2007.
Source
wos-lite
Published In
Journal of Endourology
Volume
21
Publish Date
2007
Start Page
A216
End Page
A216

Prostate cancer laterality as a rationale for the clinical application of focal ablative therapy: An analysis of 1184 prostatectomy specimens

Authors
Polascik, TJ; Sun, L; Madden, JF; Mayes, JM; George, DJ; Febbo, PG; Mouraviev, V
MLA Citation
Polascik, TJ, Sun, L, Madden, JF, Mayes, JM, George, DJ, Febbo, PG, and Mouraviev, V. "Prostate cancer laterality as a rationale for the clinical application of focal ablative therapy: An analysis of 1184 prostatectomy specimens." October 2007.
Source
wos-lite
Published In
Journal of Endourology
Volume
21
Publish Date
2007
Start Page
A216
End Page
A216

The rise of ablative technologies for treating the small renal mass.

Authors
Polascik, TJ; Mouraviev, V
MLA Citation
Polascik, TJ, and Mouraviev, V. "The rise of ablative technologies for treating the small renal mass." Eur Urol 52.3 (September 2007): 636-638.
PMID
17383084
Source
pubmed
Published In
European Urology
Volume
52
Issue
3
Publish Date
2007
Start Page
636
End Page
638
DOI
10.1016/j.eururo.2007.03.005

Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer.

BACKGROUND: Early detection of small-volume prostate cancer (PCa) has led to the concept of focal therapy to treat PCa as an organ-sparing, minimally invasive procedure. The authors sought to determine the frequency of unilateral cancers in the contemporary prostate-specific antigen (PSA) era to determine the percentage of patients who would be candidates for hemiablation of the prostate by using focal therapy while preserving the contralateral lobe. METHODS: Paraffin-embedded radical prostatectomy specimens (1184 specimens) from consecutive patients between 2002 and 2006 with pathologic organ confined PCa were analyzed. Pathologic assessment focused on tumor laterality and percentage of tumor involvement (PTI) along with other routine parameters such as pathological T-classification (pT), pathological Gleason Score (pGS), extracapsular extension (ECE), and surgical margins (SM). Clinical and pathologic parameters were analyzed by univariate and multivariate methods. RESULTS: Completely unilateral cancers were identified in 227 (19.2%) of 1184 patients. Of these patients, 164 (72.2%) had PTI of < or =5%, 40 (17.6%) had a PTI of 5.01%-10%, 9 (4.0%) had a PTI of 10.01%-15%, and 14 (6.2%) had a PTI of > 15%, respectively (P < .0005). African-American men had bilateral cancers more commonly that non-African-American men, eg, 90.8% versus 79.2%, respectively (P < .0005). Race, PTI, pGS, and SM were independent predictors by multivariate logistic regression (P < or = .05). CONCLUSIONS: This study suggests that 1 in 5 men diagnosed with PCa have small volume, completely unilateral cancers that may be amenable to hemiablation of the prostate. Further study is needed to develop predictive models to select candidates for focal therapy.

Authors
Mouraviev, V; Mayes, JM; Sun, L; Madden, JF; Moul, JW; Polascik, TJ
MLA Citation
Mouraviev, V, Mayes, JM, Sun, L, Madden, JF, Moul, JW, and Polascik, TJ. "Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer." Cancer 110.4 (August 15, 2007): 906-910.
PMID
17587207
Source
pubmed
Published In
Cancer
Volume
110
Issue
4
Publish Date
2007
Start Page
906
End Page
910
DOI
10.1002/cncr.22858

Prostatic abscess as a delayed complication following cryosurgery for primary prostate cancer.

Prostatic abscess is a rare and potentially life-threatening disease when left untreated. We report the first case of a man who developed a prostatic abscess as a long-term complication of cryoablation for primary prostate cancer. Timely diagnosis with non-contrast computed tomography (CT) scan, retrograde CT cystogram to ensure no bladder involvement, percutaneous drainage under CT-guidance, and antibiotic treatment sensitive to the causative organism were crucial for prompt recovery.

Authors
Chen, SH; Mouraviev, V; Mayes, JM; Polascik, TJ
MLA Citation
Chen, SH, Mouraviev, V, Mayes, JM, and Polascik, TJ. "Prostatic abscess as a delayed complication following cryosurgery for primary prostate cancer." Can J Urol 14.4 (August 2007): 3646-3648.
PMID
17784987
Source
pubmed
Published In
Canadian Journal of Urology
Volume
14
Issue
4
Publish Date
2007
Start Page
3646
End Page
3648

Short-term cancer control after primary cryosurgical ablation for clinically localized prostate cancer using third-generation cryotechnology.

OBJECTIVES: Percutaneous perineal cryoablation of the prostate is a promising technique in the treatment armamentarium for clinically localized prostate carcinoma. We report our initial experience using a transrectal ultrasound-guided, third-generation, argon/helium cryosurgical system. METHODS: From January 2002 to July 2005, 50 men underwent primary cryosurgery for clinically localized prostate carcinoma. The median patient age was 68 years (range 50 to 83), and the median follow-up period was 18 months (range 3 to 43). According to the D'Amico risk stratification system, 36 patients (72%) had low-risk, 9 (18%) had intermediate-risk, and 5 (10%) had high-risk prostate cancer. All patients underwent a dual freeze-thaw cycle using third-generation cryotechnology with ultrathin 17-gauge cryoneedles. RESULTS: The prostate-specific antigen (PSA) level for all patients at the last follow-up visit was less than 0.5 ng/mL in 45 patients (90%) and 0.5 ng/mL or more in 5 (10%). Two patients had persistent prostate cancer confirmed by prostate biopsy and were treated with salvage cryotherapy or external beam radiotherapy. Three other patients had an elevated PSA level after cryotherapy despite negative posttreatment biopsies and a metastatic evaluation. Of these 3 patients, 2 had their postcryotherapy PSA level normalize, and 1 patient, with intermediate-risk disease preoperatively, had a consistent increase in PSA up to 1.2 ng/mL. The overall survival rate was 100%. CONCLUSIONS: Cryoablation of the prostate is a feasible and safe treatment option in patients with organ-confined prostate cancer. Additional studies with longer follow-up are necessary to determine the sustained efficacy of this procedure.

Authors
Polascik, TJ; Nosnik, I; Mayes, JM; Mouraviev, V
MLA Citation
Polascik, TJ, Nosnik, I, Mayes, JM, and Mouraviev, V. "Short-term cancer control after primary cryosurgical ablation for clinically localized prostate cancer using third-generation cryotechnology." Urology 70.1 (July 2007): 117-121.
PMID
17656220
Source
pubmed
Published In
Urology
Volume
70
Issue
1
Publish Date
2007
Start Page
117
End Page
121
DOI
10.1016/j.urology.2007.03.027

Ureteropelvic junction obliteration resulting in nephrectomy after radiofrequency ablation of small renal cell carcinoma.

Percutaneous radiofrequency ablation is a minimally invasive treatment that is currently used to treat renal tumors. Despite its minimally invasive nature, potential serious complications can occur. We report the second case of ureteropelvic junction obstruction after radiofrequency ablation that resulted in nephrectomy. The use of radiofrequency ablation should be considered with caution, particularly when tumors are centrally located or abut the renal pelvis. Additional data are needed to better define the indications and contraindications to minimally invasive ablative technologies when used in the clinical setting.

Authors
Chen, SH; Mouraviev, V; Raj, GV; Marguet, CG; Polascik, TJ
MLA Citation
Chen, SH, Mouraviev, V, Raj, GV, Marguet, CG, and Polascik, TJ. "Ureteropelvic junction obliteration resulting in nephrectomy after radiofrequency ablation of small renal cell carcinoma." Urology 69.5 (May 2007): 982.e3-982.e5.
PMID
17482951
Source
pubmed
Published In
Urology
Volume
69
Issue
5
Publish Date
2007
Start Page
982.e3
End Page
982.e5
DOI
10.1016/j.urology.2007.02.031

Rectourethral fistula after combination radiotherapy for prostate cancer.

OBJECTIVES: To describe 6 cases of rectourethral fistula in patients treated with brachytherapy plus external beam radiotherapy for localized prostate cancer and subsequent rectal biopsies or rectal surgery. METHODS: A retrospective chart review was undertaken of patients with prostate cancer treated with brachytherapy who presented to our institution with the diagnosis of rectourethral fistula from February 1999 to June 2002. Potential contributing factors, including patient age, cancer grade and stage, cancer treatment, rectal procedure, and time to the complication, were evaluated. Potential approaches to rectourethral fistula treatment and their outcomes are reported. RESULTS: The mean patient age was 63.8 years. All 6 men underwent combination prostate brachytherapy and external beam radiotherapy with subsequent rectal biopsy/hemorrhoidectomy. All 6 patients developed a rectourethral fistula, with an average time between the end of radiotherapy and fistula development of 22.6 months. Four patients underwent hyperbaric oxygen therapy, which failed. Three patients underwent fecal diversion with gracilis interposition flaps, and two underwent pelvic exenteration. CONCLUSIONS: The results of our study have shown that rectourethral fistula development is a serious complication of combination radiotherapy, with definitive repair requiring major intraabdominal surgery. Biopsy of rectal ulcers in the clinical setting of combined radiotherapy should not be performed. In addition, elective rectal surgery should not be performed on irradiated tissue. In our series, hyperbaric oxygen therapy and conservative treatment did not obviate the need for definitive surgical management of the rectourethral fistula.

Authors
Marguet, C; Raj, GV; Brashears, JH; Anscher, MS; Ludwig, K; Mouraviev, V; Robertson, CN; Polascik, TJ
MLA Citation
Marguet, C, Raj, GV, Brashears, JH, Anscher, MS, Ludwig, K, Mouraviev, V, Robertson, CN, and Polascik, TJ. "Rectourethral fistula after combination radiotherapy for prostate cancer." Urology 69.5 (May 2007): 898-901.
PMID
17482930
Source
pubmed
Published In
Urology
Volume
69
Issue
5
Publish Date
2007
Start Page
898
End Page
901
DOI
10.1016/j.urology.2007.01.044

Analysis of laterality and percentage of tumor involvement in 1386 prostatectomized specimens for selection of unilateral focal cryotherapy.

In total, 1386 paraffin embedded radical prostatectomy specimens from patients with clinically localized prostate cancer (PCa) excised between 2002-06 were analyzed. Pathologic assessment paid particular attention to laterality and percentage of tumor involvement (PTI) along with pathologic Gleason Score (pGS). Completely unilateral cancers were identified in 254 (18.3%) patients, and in 39% cases of them the signs of clinically significant PCa were revealed. The majority of unilateral tumors (72%) were low volume with a PTI of < or =5. This study suggests that only a select group of men diagnosed with PCa have completely unilateral cancers that would be amenable to focal ablation therapy targeting 1 lobe. Further study is needed to develop predictive models for those patients likely to have small, unilateral cancers that may be amenable to focal therapy.

Authors
Mouraviev, V; Mayes, JM; Madden, JF; Sun, L; Polascik, TJ
MLA Citation
Mouraviev, V, Mayes, JM, Madden, JF, Sun, L, and Polascik, TJ. "Analysis of laterality and percentage of tumor involvement in 1386 prostatectomized specimens for selection of unilateral focal cryotherapy." Technol Cancer Res Treat 6.2 (April 2007): 91-95.
PMID
17375971
Source
pubmed
Published In
Technology in cancer research & treatment
Volume
6
Issue
2
Publish Date
2007
Start Page
91
End Page
95
DOI
10.1177/153303460700600205

The role of early adopter bias for new technologies in robot assisted laparoscopic prostatectomy.

PURPOSE: We determined the potential influence of an early adopter bias in patients undergoing robot assisted laparoscopic prostatectomy. MATERIALS AND METHODS: We compared baseline demographic, clinical and health related quality of life characteristics of patients undergoing 3 different surgical procedures for clinically localized prostate cancer following the introduction of robot assisted laparoscopic prostatectomy at our institution. Patients included in this analysis were participating in a prospective health related quality of life study using the SF-12(R) and Expanded Prostate Cancer Index Composite validated questionnaires. RESULTS: Of 402 patients 159 (39%) underwent robot assisted laparoscopic, 144 (36%) underwent radical perineal and 99 (25%) underwent radical retropubic prostatectomy. There were no statistically significant associations between procedure type and patient age (p = 0.267), race (p = 0.725), number of medical comorbidities (p = 0.490), income (p = 0.056) and level of education (p = 0.495). Mean prostate specific antigen was 5.9 +/- 3.3, 7.3 +/- 5.5 and 5.7 +/- 5.0 ng/ml for robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy, respectively (p = 0.030). The proportion of robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy patients with a final Gleason score of 4-6 was 55%, 45% and 39%, respectively (p = 0.037). The proportion of robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy patients with stage T2 disease was 91%, 68% and 80%, respectively (p = 0.001). Statistically significant associations of higher income and education with higher baseline health related quality of life scores were seen in the sexual and physical domains (each p <0.01). CONCLUSIONS: We failed to find evidence of an early adopter bias for patients undergoing robot assisted laparoscopic prostatectomy. Nevertheless, observational studies comparing robot assisted laparoscopic prostatectomy to radical perineal and radical retropubic prostatectomy should account carefully for patient baseline characteristics to allow meaningful comparisons of surgical outcomes.

Authors
Tseng, TY; Cancel, QV; Fesperman, SF; Kuebler, HR; Sun, L; Robertson, CN; Polascik, TJ; Moul, JW; Vieweg, J; Albala, DM; Dahm, P
MLA Citation
Tseng, TY, Cancel, QV, Fesperman, SF, Kuebler, HR, Sun, L, Robertson, CN, Polascik, TJ, Moul, JW, Vieweg, J, Albala, DM, and Dahm, P. "The role of early adopter bias for new technologies in robot assisted laparoscopic prostatectomy." J Urol 177.4 (April 2007): 1318-1323.
PMID
17382723
Source
pubmed
Published In
The Journal of Urology
Volume
177
Issue
4
Publish Date
2007
Start Page
1318
End Page
1323
DOI
10.1016/j.juro.2006.11.035

Prostate-specific antigen (PSA) and PSA velocity for prostate cancer detection in men aged <50 years.

OBJECTIVE: To identify threshold values of prostate-specific antigen (PSA) levels and PSA velocity (PSAV) to optimize the assessment of the risk of prostate cancer in young men, as prostate cancer is detected increasingly in men aged <50 years. PATIENTS AND METHODS: Data for a group of 12 078 men, including 1622 with prostate cancer, were retrieved from the Duke Prostate Center Database. Based on the latest date for a PSA assay, these men were divided into two age groups of <50 and >/= 50 years, with 904 and 11 174 men in each group, respectively. Receiver operating characteristic curves (ROC) of PSA and PSAV were calculated and the cancer risk was assessed. RESULTS: The prevalence of prostate cancer was 4.4% (40 men) for men aged <50 years and 14.2% (1582 men) for men aged >/= 50 years. For the group with cancer the median PSA in men aged <50 years was significantly lower than that in men aged >/= 50 (1.3 vs 6.3 ng/mL, P < 0.001). ROC curves of PSA and PSAV showed a breakpoint at a PSA level of 2.3 ng/mL and a PSAV of 0.60 ng/mL/year for men aged <50 years. Both the sensitivity and specificity in the younger group at a PSA level of 2.5 ng/mL were higher than in the older group. CONCLUSIONS: In men aged <50 years the operating characteristics of PSA are more sensitive and specific than in older men. Diagnostic PSA levels in men aged <50 years are significantly lower than suggested by guidelines. Using a 2.0-2.5 ng/mL PSA level threshold for biopsy in men aged <50 years and a PSAV threshold lower than the traditional 0.75 ng/mL/year is reasonable in contemporary practice. Further studies are warranted to validate these thresholds.

Authors
Sun, L; Moul, JW; Hotaling, JM; Rampersaud, E; Dahm, P; Robertson, C; Fitzsimons, N; Albala, D; Polascik, TJ
MLA Citation
Sun, L, Moul, JW, Hotaling, JM, Rampersaud, E, Dahm, P, Robertson, C, Fitzsimons, N, Albala, D, and Polascik, TJ. "Prostate-specific antigen (PSA) and PSA velocity for prostate cancer detection in men aged <50 years." BJU Int 99.4 (April 2007): 753-757.
PMID
17244286
Source
pubmed
Published In
Bju International
Volume
99
Issue
4
Publish Date
2007
Start Page
753
End Page
757
DOI
10.1111/j.1464-410X.2006.06682.x

Comparative financial analysis of minimally invasive surgery to open surgery for small renal tumours < or =3.5 cm: a single institutional experience.

OBJECTIVE: We analysed total hospital costs by comparing minimally invasive surgery (MIS) procedures, such as laparoscopic cryoablation (LCA), laparoscopic partial nephrectomy (LPN), and hand-assisted laparoscopic nephrectomy (HALN), with conventional surgery. METHODS: Between March 2000 and July 2005, 184 consecutive patients underwent surgery for a small, organ-confined renal tumour < or =3.5 cm in diameter. The distribution of patients among the surgical procedures was: HALN (n=53); LPN (n=20); open radical nephrectomy (ORN; n=20); open partial nephrectomy (OPN; n=71); and LCA (n=20). Total hospital costs were analysed for each procedure. RESULTS: Patients undergoing OPN at a mean age of 58+/-13 yr were significantly younger those undergoing HALN, ORN, and LCA. The mean hospital length of stay in the LCA group (2.0+/-1.2 d) was shorter than all other groups (p<0.05). Higher surgical costs occurred with LCA, LPN, and HALN compared (p<0.05) with ORN and OPN. However, total financial costs were lower for LCA and HALN with more obvious differences between LCA and the other four groups. CONCLUSIONS: The costs of MIS remain competitive with traditional surgery. Although the surgical costs were higher, LCA had the lowest total hospital costs for the renal tumour < or =3.5 cm at our institution. Long-term oncologic efficacy studies will be needed to fully appreciate the cost-efficacy ratio of MIS.

Authors
Mouraviev, V; Nosnik, I; Robertson, C; Albala, D; Walther, P; Polascik, TJ
MLA Citation
Mouraviev, V, Nosnik, I, Robertson, C, Albala, D, Walther, P, and Polascik, TJ. "Comparative financial analysis of minimally invasive surgery to open surgery for small renal tumours < or =3.5 cm: a single institutional experience." Eur Urol 51.3 (March 2007): 715-720.
PMID
16904255
Source
pubmed
Published In
European Urology
Volume
51
Issue
3
Publish Date
2007
Start Page
715
End Page
720
DOI
10.1016/j.eururo.2006.06.050

Current status of minimally invasive ablative techniques in the treatment of small renal tumours.

OBJECTIVES: In the current era, minimally invasive surgery using ablative techniques for the treatment of small renal tumours has become a more common and feasible treatment option. In this review, we present recent data regarding the utility of needle ablative techniques in the experimental and clinical settings. METHODS: We performed a comprehensive evaluation of available published data from 1997 to 2006 that were identified with PubMed. Official proceedings of internationally known scientific societies held in the same time period were also assessed. RESULTS: Two main thermoablative techniques, cryoablation (CA) and radiofrequency ablation (RFA), represent the current available minimally invasive treatments for renal cell carcinoma (RCC). CA has been more extensively studied and has gained acceptance from patients and physicians. The procedure is well tolerated by patients even with serious concomitant diseases. RFA is delivered with a monopolar alternating current. Morbidity rates for this modality remain slightly higher than those for cryotherapy. Both techniques are associated with highly successful cancer control rates at short-to-medium follow-up in patients with tumour size <3 cm. Multiple lesions can be treated simultaneously and the procedures can be repeated. However, long-term follow-up data are still lacking. CONCLUSION: Minimally invasive ablative approaches seem to represent an attractive alternative to extirpative surgery for the treatment of small renal neoplasms in select patients. Potential developments include concepts to improve the accuracy of thermal ablation using novel imaging modalities with reduction in side-effects and optimised selection and follow-up of patients to provide at least equivalent cancer control to conventional surgery.

Authors
Mouraviev, V; Joniau, S; Van Poppel, H; Polascik, TJ
MLA Citation
Mouraviev, V, Joniau, S, Van Poppel, H, and Polascik, TJ. "Current status of minimally invasive ablative techniques in the treatment of small renal tumours." Eur Urol 51.2 (February 2007): 328-336. (Review)
PMID
17069964
Source
pubmed
Published In
European Urology
Volume
51
Issue
2
Publish Date
2007
Start Page
328
End Page
336
DOI
10.1016/j.eururo.2006.09.024

Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience.

OBJECTIVES: To evaluate the financial implications of how the costs of new minimally invasive surgery such as laparoscopic robotic prostatectomy (LRP) and cryosurgical ablation of the prostate (CAP) technologies compare with those of conventional surgery. METHODS: From January 2002 to July 2005, 452 consecutive patients underwent surgical treatment for clinically localized (Stage T1-T2) prostate cancer. The distribution of patients among the surgical procedures was as follows: group 1, radical retropubic prostatectomy (RRP) (n = 197); group 2, radical perineal prostatectomy (RPP) (n = 60); group 3, LRP (n = 137); and group 4, CAP (n = 58). The total direct hospital costs and grand total hospital costs were analyzed for each type of surgery. RESULTS: The mean length of stay in the CAP group was significantly lower (0.16 +/- 0.14 days) than that for RRP (2.79 +/- 1.46 days), RPP (2.87 +/- 1.43 days), and LRP (2.15 +/- 1.48 days; P <0.0005). The direct surgical costs were less for the RRP (2471 dollars +/- 636 dollars) and RPP (2788 dollars +/- 762 dollars) groups than for the technology-dependent procedures: LRP (3441 dollars +/- 545 dollars) and CAP (5702 dollars +/- 1606 dollars; P <0.0005). The total hospital cost differences, including pathologic assessment costs, were less for LRP (10,047 dollars +/- 107 dollars, median 9343 dollars) and CAP (9195 dollars +/- 1511 dollars, median 8796 dollars) than for RRP (10,704 dollars +/- 3468 dollars, median 9724 dollars) or RPP (10,536 dollars +/- 3088 dollars, median 9251 dollars), with significant differences (P <0.05) between the minimally invasive technique and open surgery groups. CONCLUSIONS: In our study, despite the relatively increased surgical expense of CAP compared with conventional surgical prostatectomy (RRP or RPP) and LRP, the overall direct costs were offset by the significantly lower nonoperative hospital costs. The cost advantages associated with CAP included a shorter length of stay in the hospital and the absence of pathologic costs and the need for blood transfusion.

Authors
Mouraviev, V; Nosnik, I; Sun, L; Robertson, CN; Walther, P; Albala, D; Moul, JW; Polascik, TJ
MLA Citation
Mouraviev, V, Nosnik, I, Sun, L, Robertson, CN, Walther, P, Albala, D, Moul, JW, and Polascik, TJ. "Financial comparative analysis of minimally invasive surgery to open surgery for localized prostate cancer: a single-institution experience." Urology 69.2 (February 2007): 311-314.
PMID
17320670
Source
pubmed
Published In
Urology
Volume
69
Issue
2
Publish Date
2007
Start Page
311
End Page
314
DOI
10.1016/j.urology.2006.10.025

Age adjusted prostate specific antigen and prostate specific antigen velocity cut points in prostate cancer screening.

PURPOSE: We identified age adjusted prostate specific antigen and prostate specific antigen velocity cut points for prostate cancer biopsy. MATERIALS AND METHODS: A cohort of 33,643 men was retrieved from the Duke Prostate Center database. Of this group 11,861 men with 2 or more prostate specific antigen values within 2 years were analyzed for age adjusted prostate specific antigen and prostate specific antigen velocity performance in cancer risk assessment using a receiver operating characteristic curve. RESULTS: In the 11,861 men prostate cancer prevalence was 273 (8.0%), 659 (14.9%) and 722 (17.9%) in the groups of men 50 to 59 years old, 60 to 69 and 70 years old or older. In prostate cancer groups median prostate specific antigen and prostate specific antigen velocity in men 50 to 59 vs 70 years old or older were 5.6 vs 8.1 ng/ml and 1.37 vs 1.89 ng/ml per year (<0.0001). In men 50 to 59 years old the sensitivity and specificity were 82.1% and 80.7% at prostate specific antigen 2.5 ng/ml, and 84.3% and 72.4% at prostate specific antigen velocity 0.40 ng/ml per year, higher than those in men 70 years old or older at prostate specific antigen 4.0 ng/ml or prostate specific antigen velocity 0.75 ng/ml per year. Decreasing the prostate specific antigen cut point to 2.0 ng/ml and the prostate specific antigen velocity cut point to 0.40 ng/ml per year in men 50 to 59 years old improved the cancer detection rate but decreased the positive predictive value. CONCLUSIONS: Current biopsy guidelines (prostate specific antigen 4.0 ng/ml or greater, or prostate specific antigen velocity 0.75 ng/ml or greater per year) underestimated cancer risk in men 50 to 59 years old. Prostate specific antigen and prostate specific antigen velocity cut points should be age adjusted. In men 50 to 59 years old prostate specific antigen and prostate specific antigen velocity cut points could be decreased to 2.0 ng/ml and 0.40 ng/ml per year, respectively. Factors of age, sensitivity, specificity, positive predictive value and cancer prevalence are critical for obtaining the desired balance between cancer detection and negative biopsy.

Authors
Moul, JW; Sun, L; Hotaling, JM; Fitzsimons, NJ; Polascik, TJ; Robertson, CN; Dahm, P; Anscher, MS; Mouraviev, V; Pappas, PA; Albala, DM
MLA Citation
Moul, JW, Sun, L, Hotaling, JM, Fitzsimons, NJ, Polascik, TJ, Robertson, CN, Dahm, P, Anscher, MS, Mouraviev, V, Pappas, PA, and Albala, DM. "Age adjusted prostate specific antigen and prostate specific antigen velocity cut points in prostate cancer screening." J Urol 177.2 (February 2007): 499-503.
PMID
17222618
Source
pubmed
Published In
The Journal of Urology
Volume
177
Issue
2
Publish Date
2007
Start Page
499
End Page
503
DOI
10.1016/j.juro.2006.09.063

Issues critical to the successful application of cryosurgical ablation of the prostate

The techniques of present-day cryosurgery performed with multiprobe freezing apparatus and advanced imaging techniques yield predictable and encouraging results in the treatment of prostatic and renal cancers. Nevertheless, and not unique to cryosurgical treatment, the rates of persistent disease demonstrate the need for improvement in technique and emphasize the need for proper management of the therapeutic margin. The causes of persistent disease often relate to a range of factors including selection of patients, understanding of the extent of the tumor, limitations of the imaging techniques, and failure to freeze the tumor periphery in an efficacious manner. Of these diverse factors, the one most readily managed, but subject to therapeutic error, is the technique of freezing the tumor and appropriate margin to a lethal temperature [Baust, J. G., Gage, A. A. The Molecular Basis of Cryosurgery. BJU Int 95, 1187-1191 (2005)]. This article describes the recent experiments that examine the molecular basis of cryosurgery, clarifies the actions of the components of the freeze-thaw cycle, and defines the resultant effect on the cryogenic lesion from a clinical perspective. Further, this review addresses the important issue of management of the margin of the tumor through adjunctive therapy. Accordingly, a goal of this review is to identify the technical and future adjunctive therapeutic practices that should improve the efficacy of cryoablative techniques for the treatment of malignant lesions. ©Adenine Press (2007).

Authors
Baust, JG; Gage, AA; Klossner, D; Clarke, D; Miller, R; Cohen, J; Katz, A; Polascik, T; Clarke, H; Baust, JM
MLA Citation
Baust, JG, Gage, AA, Klossner, D, Clarke, D, Miller, R, Cohen, J, Katz, A, Polascik, T, Clarke, H, and Baust, JM. "Issues critical to the successful application of cryosurgical ablation of the prostate." Technology in Cancer Research and Treatment 6.2 (2007): 97-109.
PMID
17375972
Source
scival
Published In
Technology in cancer research & treatment
Volume
6
Issue
2
Publish Date
2007
Start Page
97
End Page
109

Visualizing the anatomic structures of human prostates using Acoustic Radiation Force Impulse (ARFI) imaging

McNeal's zonal anatomy for prostate has been the standard anatomical model for human prostate for about 30 years. It divides a human prostate into one non-glandular zone (the anterior flbromuscular stroma), and three glandular zones (central zone (CZ), transitional zone (TZ) and peripheral zone (PZ)). Visualizing these zones is of great importance for diagnosing prostate diseases. However, they are not well visualized by current ultrasound techniques. In this study, 3D Acoustic Radiation Force Impulse (ARFI) imaging has been implemented in order to visualize anatomic structures of excised human prostates. Prostate specimens were obtained immediately after radical prostatectomy and put in an isotonic saline bath at room temperature. ARFI data were acquired from the posterior side of the prostate using a Siemens Antares scanner and a VF10-5 linear array, whose imaging plane is the axial/lateral view in the normal anatomy. The position of the imaging transducer was controlled by a 3D translation stage. The scanner and the translation stage were programmed to scan the entire prostate specimen automatically with 1 mm spacing between elevation planes. 3D ARFI images with high spatial resolution were acquired for each specimen. Different zones and structures within the prostates have been well visualized in 3D ARFI images, which are in agreement with McNeal's zonal anatomy. Prostate lesions and benign prostatic hyperplasia were also detected and correlated with histopathological results. This study demonstrated that ARFI imaging is capable of visualizing internal structures and detecting suspicious lesions in the prostate.

Authors
Zhai, L; Madden, J; Mouraviev, V; Polascik, T; Nightingale, K
MLA Citation
Zhai, L, Madden, J, Mouraviev, V, Polascik, T, and Nightingale, K. "Visualizing the anatomic structures of human prostates using Acoustic Radiation Force Impulse (ARFI) imaging." 2007.
Source
scival
Published In
Proceedings of the IEEE Ultrasonics Symposium
Publish Date
2007
Start Page
432
End Page
435
DOI
10.1109/ULTSYM.2007.117

Malignant cystic nephroma.

AIM: To describe a malignant cystic nephroma in an asymptomatic man. METHODS: Case report and review of the literature. RESULTS: A 60 year old white male presented with an incidentally discovered right perirenal mass. An MRI demonstrated a large perinephric encapsulated mass with diffuse heterogeneity. Patient underwent a radical nephrectomy and retroperitoneal node dissection. Histopathological analyses of the resected specimen revealed malignant cystic nephroma. CONCLUSION: This represents the first published report of this rare tumor in an adult patient.

Authors
Raj, GV; Yowell, C; Madden, JF; Nosnik, I; Mouraviev, V; Polascik, TJ
MLA Citation
Raj, GV, Yowell, C, Madden, JF, Nosnik, I, Mouraviev, V, and Polascik, TJ. "Malignant cystic nephroma." Can J Urol 13.6 (December 2006): 3348-3350. (Review)
PMID
17187700
Source
pubmed
Published In
Canadian Journal of Urology
Volume
13
Issue
6
Publish Date
2006
Start Page
3348
End Page
3350

Multiple nephron-sparing procedures in solitary kidney with recurrent, metachronous, nonfamilial renal cell carcinoma.

Patients with metachronous bilateral renal cell carcinoma pose a significant challenge given the high mortality of renal cell carcinoma and the poor quality of life should dialysis become necessary. In addition, patients may be subject to morbidity due to potential multiple treatments of the multifocal renal tumors. We present the case of a 71-year-old woman with multifocal, bilateral clear cell carcinoma who maintained a minimal change in serum creatinine after undergoing unilateral radical nephrectomy, subsequent percutaneous radiofrequency ablation, percutaneous cryoablation, laparoscopic cryoablation, and open partial nephrectomy for recurrent renal cell carcinoma in a solitary kidney.

Authors
Nosnik, IP; Mouraviev, V; Nelson, R; Polascik, TJ
MLA Citation
Nosnik, IP, Mouraviev, V, Nelson, R, and Polascik, TJ. "Multiple nephron-sparing procedures in solitary kidney with recurrent, metachronous, nonfamilial renal cell carcinoma." Urology 68.6 (December 2006): 1343.e1-1343.e3.
PMID
17141824
Source
pubmed
Published In
Urology
Volume
68
Issue
6
Publish Date
2006
Start Page
1343.e1
End Page
1343.e3
DOI
10.1016/j.urology.2006.09.004

Effect of freeze time during renal cryoablation: a swine model.

BACKGROUND AND PURPOSE: Cryotherapy provides a minimally invasive treatment for small renal tumors via an open, percutaneous, or laparoscopic approach. We sought to determine the most appropriate duration of freezing and the number of probes necessary to produce cell death without concomitant morbidity. MATERIALS AND METHODS: Nine domestic female pigs were divided into three groups of three animals each. Each group underwent a single freeze cycle with a commercially available cryotherapy device with 3.4-mm probes: group 1 for 5 minutes, group 2 for 10 minutes, and group 3 for 15 minutes. The right kidney was treated with a single probe, the left with a double probe. Animals were permitted to survive for an average of 4.8 days (range 4-7 days), after which the kidneys were harvested. A single pathologist examined the kidneys for gross and histologic changes. Evidence of complications (fistula, bleeding, bowel injury) was documented at the time of necropsy. RESULTS: For group 1, the temperature obtained with a single probe 5, 10, 15, and 20 mm from the probe was -57 degrees C, 3 degrees C, 25 degrees C, and 33 degrees C, respectively; for group 2 -85 degrees C, -37 degrees C, -2 degrees C, and 25 degrees C; and for group 3 -10 degrees C, -45 degrees C, -20 degrees C, and 6 degrees C. For group 1, the temperature obtained with a double probe at 5, 10, 15, and 20 mm from each probe was -65 degrees C, 0 degrees C, 20 degrees C, and 30 degrees C, respectively; for group 2 -72 degrees C, -25 degrees C, 5 degrees C, 25 degrees C; and for Group 3 -82 degrees C, -30 degrees C, -12 degrees C, 13 degrees C. Complete necrosis was seen 5 mm from the cryoprobe within each group, but only in groups 2 and 3 did necrosis extend 10 mm or beyond the probes when utilizing either single or double probes. The maximum diameter of consistent necrosis was 35 to 40 mm in the animals in group 3 treated with a double probe. Bleeding and renal fracture were the two most common complications. CONCLUSIONS: A 5-minute freeze appears to be inadequate to cause tissue necrosis and is associated with excessive bleeding at the time of the procedure, whereas the 15-minute freeze produces consistent necrosis but is associated with renal fracture. In this animal model, the 10-minute freeze with the single or double probe configuration appears optimal to produce necrosis without complications.

Authors
Auge, BK; Santa-Cruz, RW; Polascik, TJ
MLA Citation
Auge, BK, Santa-Cruz, RW, and Polascik, TJ. "Effect of freeze time during renal cryoablation: a swine model." J Endourol 20.12 (December 2006): 1101-1105.
PMID
17206911
Source
pubmed
Published In
Journal of Endourology
Volume
20
Issue
12
Publish Date
2006
Start Page
1101
End Page
1105
DOI
10.1089/end.2006.20.1101

Laparoscopic renal cryoablation for tumors less than 3.5 cm

Authors
Polascik, TJ; Mouraviev, V; Nosnik, I
MLA Citation
Polascik, TJ, Mouraviev, V, and Nosnik, I. "Laparoscopic renal cryoablation for tumors less than 3.5 cm." August 2006.
Source
wos-lite
Published In
Journal of Endourology
Volume
20
Publish Date
2006
Start Page
A177
End Page
A177

Update on cryotherapy for prostate cancer in 2006.

PURPOSE OF REVIEW: With the recent introduction of novel, minimally invasive procedures for the treatment of prostate cancer, cryotherapy has become a feasible option as a viable alternative to traditional radical surgery and radiation therapy. In this review we update recent data concerning the basic science of cryobiology, technical trends, oncologic results and complications of this procedure. RECENT FINDINGS: As a result of better understanding of tumor cryodestruction at a molecular level, refinements in cryotechniques and improved patient selection, the results of cryotherapy are becoming more promising. Furthermore, the dramatic decrease in the number of complications after modern cryotherapy leads to a better quality of life, which may be a preferable option, especially for elderly patients with comorbidities. Current trends towards nerve-sparing and focal cryoablation are also discussed. Recent advances in cryobiology open up new opportunities to apply cryotherapy in combination with chemotherapy or radiotherapy for patients with intermediate or high-risk cancers. SUMMARY: Potential directions for future developments in cryosurgery include concepts to reduce side effects such as minimizing cryodamage of the neurovascular bundles (nerve-sparing procedure), and focal ablation of a specific tumor site in patients in whom saturation biopsy supports unifocal prostate cancer.

Authors
Mouraviev, V; Polascik, TJ
MLA Citation
Mouraviev, V, and Polascik, TJ. "Update on cryotherapy for prostate cancer in 2006." Curr Opin Urol 16.3 (May 2006): 152-156. (Review)
PMID
16679851
Source
pubmed
Published In
Current Opinion in Urology
Volume
16
Issue
3
Publish Date
2006
Start Page
152
End Page
156
DOI
10.1097/01.mou.0000193393.54598.9f

Ovarian hyperstimulation causing ureteral obstruction in a pregnant woman.

Obstruction of the urinary collecting system in pregnant women can present a unique challenge to the urologist. Although ureteral obstruction due to stone disease is well-documented and ureteral obstruction is a well-known and defined cause of acute renal failure, obstruction from extrinsic compression is a less-understood phenomenon. We report a case of ureteral obstruction from hyperplastic ovaries in a pregnant woman receiving hormonal therapy that was managed initially with ureteral stenting.

Authors
Wiygul, JB; Lallas, C; Silverstein, A; Polascik, TJ
MLA Citation
Wiygul, JB, Lallas, C, Silverstein, A, and Polascik, TJ. "Ovarian hyperstimulation causing ureteral obstruction in a pregnant woman." Urology 67.5 (May 2006): 1085.e5-1085.e6.
PMID
16698384
Source
pubmed
Published In
Urology
Volume
67
Issue
5
Publish Date
2006
Start Page
1085.e5
End Page
1085.e6
DOI
10.1016/j.urology.2005.11.033

Salvage prostate cryoablation after primary interstitial brachytherapy failure: a feasible approach.

Salvage treatment for recurrent prostate cancer remains a very difficult and challenging field in urologic oncology. The introduction of minimally invasive surgical procedures such a targeted cryoablation brings some hope with its feasibility and efficacy to become a potentially curable treatment. We present the case of a 75-year-old male with prostate cancer treated primarily by brachytherapy, who developed late locally recurrent disease that was successfully treated with targeted salvage cryoablation.

Authors
Mouraviev, V; Evans, B; Polascik, TJ
MLA Citation
Mouraviev, V, Evans, B, and Polascik, TJ. "Salvage prostate cryoablation after primary interstitial brachytherapy failure: a feasible approach." Prostate Cancer Prostatic Dis 9.1 (2006): 99-101.
PMID
16314889
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
9
Issue
1
Publish Date
2006
Start Page
99
End Page
101
DOI
10.1038/sj.pcan.4500853

Editorial comment

Authors
Mouraviev, V; Polascik, TJ
MLA Citation
Mouraviev, V, and Polascik, TJ. "Editorial comment." Journal of Urology 175.6 (2006): 2169--.
Source
scival
Published In
The Journal of Urology
Volume
175
Issue
6
Publish Date
2006
Start Page
2169-
DOI
10.1016/S0022-5347(06)00657-4

Laparoscopic ureteroureterostomy for retrocaval ureter

Objectives: To debate the different laparoscopic approaches for the surgical management of patients with circumcaval ureter. Methods: Updated literature review and discussion of personal experiences concerning the laparoscopic treatment of the circumcaval ureter. Results: Laparoscopic approaches promote less intraoperative bleeding, a shorter postoperative hospital stay, reduced postoperative pain, earlier return to daily activities and a significant superior aesthetics effect, while preserving therapeutic efficacy in performing reanastomosis of a circumcaval ureter. The main limiting factor for both a transabdominal and a retroperitoneal laparoscopic repair is the intracorporeal anastomosis of the ureter, which significantly increased the surgical time. Interestingly, a laparoscopic pyelopyelostomy for retrocaval ureter without resection of the retrocaval segment has been debated. Conclusions: Comparisons among historical reports regarding open surgery and laparoscopic transposition and reanastomosis of a circumcaval ureter have clearly shown the advantages of minimally invasive approaches.

Authors
Mouraviev, V; Polascik, TJ
MLA Citation
Mouraviev, V, and Polascik, TJ. "Laparoscopic ureteroureterostomy for retrocaval ureter." European Urology, Supplements 5.5 SPEC. ISS. (2006): 466-469.
Source
scival
Published In
European Urology Supplements
Volume
5
Issue
5 SPEC. ISS.
Publish Date
2006
Start Page
466
End Page
469
DOI
10.1016/j.eursup.2006.02.011

Preventing bone loss in patients with hormone-sensitive prostate cancer and bone metastases

Authors
Polascik, TJ
MLA Citation
Polascik, TJ. "Preventing bone loss in patients with hormone-sensitive prostate cancer and bone metastases." American Journal of Urology Review 4.3 (2006): 61-62+66.
Source
scival
Published In
American Journal of Urology Review
Volume
4
Issue
3
Publish Date
2006
Start Page
61
End Page
62+66

Editorial comment

Authors
Preminger, GM
MLA Citation
Preminger, GM. "Editorial comment." International Braz J Urol 32.4 (2006): 443--.
PMID
27260991
Source
scival
Published In
International braz j urol : official journal of the Brazilian Society of Urology
Volume
32
Issue
4
Publish Date
2006
Start Page
443-

Complications after percutaneous radiofrequency ablation of renal tumors.

OBJECTIVES: To evaluate our experience with percutaneous radiofrequency ablation (pRFA) to determine common characteristics of patients with complications, to elucidate possible relative contraindications to therapy. METHODS: Medical records of all patients undergoing pRFA were reviewed for demographic data, medical and surgical history, indication, tumor characteristics, and treatment information (complications and management). The group of patients with complications was analyzed for common characteristics. RESULTS: From January 2000 to September 2003, 24 patients (mean age 61 years, 5:1 male/female) with 32 renal tumors were treated with pRFA. Indications for pRFA included prior renal surgery and/or chronic renal insufficiency, significant medical disease, patient choice, von Hippel-Lindau disease, and treatment of a metastasis. Average pretreatment tumor size was 2.4 cm (range 0.5-8.6 cm). Of the 5 patients experiencing complications from pRFA treatment, 2 developed perinephric hematomas, 1 had a persistent urinoma and proximal ureteral stricture, and 2 had colonic injuries. Among patients with complications, 3 of 5 had undergone prior partial nephrectomy on the pRFA-treated kidney. Two of four patients treated for multiple tumors and 57% of patients (4 of 7) with anteriorly located tumors experienced complications. CONCLUSIONS: Early experience with pRFA for renal tumor seems promising, but patient selection criteria are evolving. On the basis of our limited experience, we recommend caution when using renal pRFA in patients with prior partial nephrectomy, multiple tumors treated in the same setting, and tumors located anteriorly or centrally. Further clinical experience will help establish guidelines for the use of this powerful technology in the management of renal tumors.

Authors
Weizer, AZ; Raj, GV; O'Connell, M; Robertson, CN; Nelson, RC; Polascik, TJ
MLA Citation
Weizer, AZ, Raj, GV, O'Connell, M, Robertson, CN, Nelson, RC, and Polascik, TJ. "Complications after percutaneous radiofrequency ablation of renal tumors." Urology 66.6 (December 2005): 1176-1180.
PMID
16360436
Source
pubmed
Published In
Urology
Volume
66
Issue
6
Publish Date
2005
Start Page
1176
End Page
1180
DOI
10.1016/j.urology.2005.06.125

Open-label trial evaluating the safety and efficacy of zoledronic acid in preventing bone loss in patients with hormone-sensitive prostate cancer and bone metastases.

OBJECTIVES: To evaluate the efficacy and safety of zoledronic acid in preventing bone loss in patients with hormone-sensitive prostate cancer and bone metastases who were receiving androgen deprivation therapy. METHODS: Patients received zoledronic acid 4 mg as a 15-minute infusion every 3 weeks for 1 year. Bone mineral density of the lumbar spine (L2 to L4) and total hip was measured by dual-energy x-ray absorptiometry at baseline and 12 months. Biochemical markers of bone turnover (N-telopeptide and bone alkaline phosphatase) and serum creatinine levels were evaluated at baseline and during the study. Skeletal-related events were assessed at each study visit. RESULTS: Of the 221 enrolled patients, 202 and 221 patients were included in the efficacy and safety analyses, respectively. The mean increase in bone mineral density of the lumbar spine and total hip was 7.7% (P <0.001) and 3.6% (P <0.001), respectively. Decreases in N-telopeptide and bone alkaline phosphatase levels were significant and sustained. The median time to the first skeletal-related event was not reached; 11.9% of patients had a skeletal-related event. Arthralgia (20.4%), nausea (14%), fatigue (14%), and back pain (12.2%) were the most common adverse events. Adverse events due to renal function deterioration were infrequent. The mean maximal change in serum creatinine level from baseline was 0.3 mg/dL. CONCLUSIONS: Zoledronic acid administration for 1 year to patients with hormone-sensitive prostate cancer and bone metastases who were receiving androgen deprivation therapy was safe and prevented bone loss, as demonstrated by significant increases in bone mineral density and sustained suppression of biochemical markers of bone turnover.

Authors
Polascik, TJ; Given, RW; Metzger, C; Julian, SR; Vestal, JC; Karlin, GS; Barkley, CS; Bilhartz, DL; McWhorter, LT; Lacerna, LV
MLA Citation
Polascik, TJ, Given, RW, Metzger, C, Julian, SR, Vestal, JC, Karlin, GS, Barkley, CS, Bilhartz, DL, McWhorter, LT, and Lacerna, LV. "Open-label trial evaluating the safety and efficacy of zoledronic acid in preventing bone loss in patients with hormone-sensitive prostate cancer and bone metastases." Urology 66.5 (November 2005): 1054-1059.
PMID
16286123
Source
pubmed
Published In
Urology
Volume
66
Issue
5
Publish Date
2005
Start Page
1054
End Page
1059
DOI
10.1016/j.urology.2005.05.035

Supplement use among men with prostate cancer.

OBJECTIVES: To characterize supplement use within a sample population of men diagnosed with prostate cancer. METHODS: A census of men diagnosed with prostate cancer at Duke University Medical Center from 1997 to 2002 (n = 1402) was mailed a survey that ascertained data on health status, education, diet, exercise, smoking status, and information on supplement use. Differences between demographic and treatment subgroups were described and tested, as was change in supplement use after diagnosis. RESULTS: Data from 805 respondents indicated that a majority (73%) used supplements, and 68% claimed that this information was shared with their cancer care provider. The most commonly reported supplements were multivitamins (56%), vitamin E (43%), vitamin C (33%), and calcium (26%). On average, 2.7 +/- 2.8 supplements per day were taken, and use increased significantly after diagnosis for most supplements. Use was significantly higher among men who were white (P = 0.043), were more highly educated (P = 0.002), exercise regularly (P = 0.020), and who consume five or more daily servings of fruits and vegetables (P = 0.040). CONCLUSIONS: A high percentage of men with prostate cancer take supplements, especially those who are white, more educated, and who pursue healthful behaviors. Systematic means of capturing these data are necessary to begin to understand the potential impact of supplements on disease outcome, especially because no data exist to suggest that supplements are of any benefit after diagnosis.

Authors
Wiygul, JB; Evans, BR; Peterson, BL; Polascik, TJ; Walther, PJ; Robertson, CN; Albala, DM; Demark-Wahnefried, W
MLA Citation
Wiygul, JB, Evans, BR, Peterson, BL, Polascik, TJ, Walther, PJ, Robertson, CN, Albala, DM, and Demark-Wahnefried, W. "Supplement use among men with prostate cancer." Urology 66.1 (July 2005): 161-166.
PMID
15992901
Source
pubmed
Published In
Urology
Volume
66
Issue
1
Publish Date
2005
Start Page
161
End Page
166
DOI
10.1016/j.urology.2005.01.035

Renal cryoablation and radio frequency ablation: an evaluation of worst case scenarios in a porcine model.

PURPOSE: Although ablative technologies, including radio frequency (RF) ablation (RFA) and cryoablation (CA), are being used to treat renal masses, complications associated with injury to vital renal structures are not well understood. We investigated these worst case scenarios by deliberately targeting vital renal structures with CA or RFA in a porcine model. MATERIALS AND METHODS: Following surgical exposure of the right kidney in female pigs a cryoneedle or an RF probe was deliberately placed under visual and ultrasound guidance in the renal pelvis (CA in 5 pigs and RFA in 7), major calix (CA and RFA in 5 each) or subsegmental renal vessels (CA in 5 pigs and RFA in 7). Cryo-energy or RF energy was then applied to create a 3 cm lesion. After 10 days the kidneys underwent gross and histological examination for urine and blood extravasation, cell death and injury. Ex vivo retrograde pyelography was performed to evaluate for urinary fistulas. RESULTS: All pigs tolerated the treatment and no procedure related deaths occurred. No significant bleeding was noted. RFA and CA created reproducible lesions and areas of cell death and necrosis. Despite significant intentional injury to the collecting system no urinary fistulas were demonstrated in CA specimens (0 of 15). In contrast, damage to the renal pelvis (4 of 7) by dry (3 of 4) or wet (1 of 3) RFA was associated with a high likelihood of urinary extravasation. CONCLUSIONS: This short-term study demonstrates that CA is safe, effective and not associated with urinary extravasation. In contrast, RFA to the renal pelvis is associated with urinary extravasation. Further studies are needed to support these findings.

Authors
Brashears, JH; Raj, GV; Crisci, A; Young, MD; Dylewski, D; Nelson, R; Madden, JF; Polascik, TJ
MLA Citation
Brashears, JH, Raj, GV, Crisci, A, Young, MD, Dylewski, D, Nelson, R, Madden, JF, and Polascik, TJ. "Renal cryoablation and radio frequency ablation: an evaluation of worst case scenarios in a porcine model." J Urol 173.6 (June 2005): 2160-2165.
PMID
15879879
Source
pubmed
Published In
The Journal of Urology
Volume
173
Issue
6
Publish Date
2005
Start Page
2160
End Page
2165
DOI
10.1097/01.ju.0000158125.80981.f1

Does prior benign prostate biopsy predict outcome for patients treated with radical perineal prostatectomy?

OBJECTIVES: To determine the effect of prior benign prostate biopsies on the surgical and clinical outcomes of patients treated with radical perineal prostatectomy for prostate cancer. METHODS: A total of 1369 patients with clinically localized prostate cancer underwent radical prostatectomy by a single surgeon between 1991 and 2001. A subset of 203 patients (14.9%), who had undergone at least one prior benign prostate biopsy for a rising prostate-specific antigen and/or abnormal digital rectal examination, constituted our study population. A total of 1115 patients with no prior biopsy represented our control group. After prostatectomy, patients were evaluated at 6-month intervals for biochemical evidence of recurrence, defined as a prostate-specific antigen level of 0.5 ng/mL or greater. RESULTS: Patients with a prior benign biopsy had more favorable pathologic features with more organ-confined (74% versus 64%; P <0.001) and less margin-positive (9.8% versus 18%) disease. Only 24 patients (12%) in the study group (versus 20% in control group; P = 0.01) had eventual evidence of biochemical failure. Kaplan-Meier analyses suggested that patients with prior benign biopsies have improved biochemical disease-free survival, especially for those with more aggressive disease (Gleason sum 7 or greater; P <0.01). Overall, patients in the study group had lower probability (odds ratio 0.57, P <0.001) of biochemical failure compared with those in the control group. CONCLUSIONS: A prior benign prostate biopsy may be independently associated with more favorable surgical and biochemical outcomes after prostatectomy. Additional studies are needed to confirm these findings.

Authors
Raj, GV; Brashears, JH; Anand, A; Paulson, DF; Polascik, TJ
MLA Citation
Raj, GV, Brashears, JH, Anand, A, Paulson, DF, and Polascik, TJ. "Does prior benign prostate biopsy predict outcome for patients treated with radical perineal prostatectomy?." Urology 65.2 (February 2005): 332-336.
PMID
15708048
Source
pubmed
Published In
Urology
Volume
65
Issue
2
Publish Date
2005
Start Page
332
End Page
336
DOI
10.1016/j.urology.2004.09.027

ProstaScint (capromab pendetide) imaging using hybrid gamma camera-CT technology.

Authors
Wong, TZ; Turkington, TG; Polascik, TJ; Coleman, RE
MLA Citation
Wong, TZ, Turkington, TG, Polascik, TJ, and Coleman, RE. "ProstaScint (capromab pendetide) imaging using hybrid gamma camera-CT technology." AJR Am J Roentgenol 184.2 (February 2005): 676-680.
PMID
15671397
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
184
Issue
2
Publish Date
2005
Start Page
676
End Page
680
DOI
10.2214/ajr.184.2.01840676

Promoter hypermethylation profile of kidney cancer.

PURPOSE: Promoter hypermethylation is an important mechanism of inactivation of tumor suppressor genes in cancer cells. Kidney tumors are heterogeneous in their histology, genetics, and clinical behavior. To gain insight into the role of epigenetic silencing of tumor suppressor and cancer genes in kidney tumorigenesis, we determined a hypermethylation profile of kidney cancer. EXPERIMENTAL DESIGN: We examined the promoter methylation status of 10 biologically significant tumor suppressor and cancer genes in 100 kidney tumors (50 clear cell, 20 papillary, 6 chromophobe, 5 collecting duct, 5 renal cell unclassified, 7 oncocytoma, 6 transitional cell carcinomas of the renal pelvis, and 1 Wilms' tumor) by methylation-specific PCR. The hypermethylation profile was examined with regard to clinicopathological characteristics of the kidney cancer patients. RESULTS: Hypermethylation of one or more genes was found in 93 (93%) of 100 tumors. A total of 33% of kidney tumors had one gene, 35% two genes, 14% three genes, and 11% four or more genes hypermethylated. The frequency of hypermethylation of the 10 genes in the 100 tumor DNAs was VHL 8% (all clear cell), p16(INK4a) 10%, p14(ARF) 17%, APC 14%, MGMT 7%, GSTP1 12%, RARbeta2 12%, RASSF1A 45%, E-cadherin 11%, and Timp-3 58%. Hypermethylation was observed in all of the histological cell types and grades and stages examined. No hypermethylation was observed in specimens of normal kidney or ureteral tissue from 15 patients. Hypermethylation of VHL was specific to clear cell tumors. RASSF1A methylation was detected at a significantly higher frequency in papillary renal cell tumors and in high-grade tumors of all cell types. MGMT methylation was more frequent in nonsmokers. Simultaneous methylation of five or more genes was observed in 3 (3%) of 100 tumors and may indicate a methylator phenotype in kidney cancer. In addition, the CpG island in the promoter of the fumarate hydratase (FH) tumor suppressor gene was bisulfite sequenced and was found to be unmethylated in 15 papillary renal tumors. CONCLUSIONS: Promoter hypermethylation is common, can occur relatively early, may disrupt critical pathways, and, thus, likely plays an important role in kidney tumorigenesis. A hypermethylation profile may be useful in predicting a patient's clinical outcome and provide molecular markers for diagnostic and prognostic approaches to kidney cancer.

Authors
Dulaimi, E; Ibanez de Caceres, I; Uzzo, RG; Al-Saleem, T; Greenberg, RE; Polascik, TJ; Babb, JS; Grizzle, WE; Cairns, P
MLA Citation
Dulaimi, E, Ibanez de Caceres, I, Uzzo, RG, Al-Saleem, T, Greenberg, RE, Polascik, TJ, Babb, JS, Grizzle, WE, and Cairns, P. "Promoter hypermethylation profile of kidney cancer." Clin Cancer Res 10.12 Pt 1 (June 15, 2004): 3972-3979.
PMID
15217927
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
10
Issue
12 Pt 1
Publish Date
2004
Start Page
3972
End Page
3979
DOI
10.1158/1078-0432.CCR-04-0175

Pilot study to explore effects of low-fat, flaxseed-supplemented diet on proliferation of benign prostatic epithelium and prostate-specific antigen.

OBJECTIVES: Dietary factors may influence the prostate and have an impact on prostatic growth and disease. A small number of studies have suggested that flaxseed-supplemented, fat-restricted diets may thwart prostate cancer growth in both animals and humans. Unknown, however, is the potential effect of such a diet on benign prostatic epithelium. METHODS: We undertook a pilot study to explore whether a flaxseed-supplemented, fat-restricted diet affects the proliferation rates in benign epithelium. We also explored the effects on circulating levels of prostate-specific antigen (PSA), total testosterone, and cholesterol. Fifteen men who were scheduled to undergo repeat prostate biopsy were instructed to follow a low-fat (less than 20% kcal), flaxseed-supplemented (30 g/day) diet and were provided with a supply of flaxseed to last throughout the 6-month intervention period. The PSA, total testosterone, and cholesterol levels were determined at baseline and at 6 months of follow-up. Reports from the original and repeat biopsies were compared, and proliferation (MIB-1) rates were quantified in the benign prostatic epithelium. RESULTS: Statistically significant decreases in PSA (8.47 +/- 3.82 to 5.72 +/- 3.16 ng/mL; P = 0.0002) and cholesterol (241.1 +/- 30.8 to 213.3 +/- 51.2 mg/dL; P = 0.012) were observed. No statistically significant change was seen in total testosterone (434.5 +/- 143.6 to 428.3 +/- 92.5 ng/dL). Although 6-month repeat biopsies were not performed in 2 cases because of PSA normalization, of the 13 men who underwent repeat biopsy, the proliferation rates in the benign epithelium decreased significantly from 0.022 +/- 0.027 at baseline to 0.007 +/- 0.014 at 6 months of follow-up (P = 0.0168). CONCLUSIONS: These pilot data suggest that a flaxseed-supplemented, fat-restricted diet may affect the biology of the prostate and associated biomarkers. A randomized controlled trial is needed to determine whether flaxseed supplementation, a low-fat diet, or a combination of the two regimens may be of use in controlling overall prostatic growth.

Authors
Demark-Wahnefried, W; Robertson, CN; Walther, PJ; Polascik, TJ; Paulson, DF; Vollmer, RT
MLA Citation
Demark-Wahnefried, W, Robertson, CN, Walther, PJ, Polascik, TJ, Paulson, DF, and Vollmer, RT. "Pilot study to explore effects of low-fat, flaxseed-supplemented diet on proliferation of benign prostatic epithelium and prostate-specific antigen." Urology 63.5 (May 2004): 900-904.
PMID
15134976
Source
pubmed
Published In
Urology
Volume
63
Issue
5
Publish Date
2004
Start Page
900
End Page
904
DOI
10.1016/j.urology.2003.12.010

Erratum: Management of Small Renal Tumors with Radiofrequency Ablation (Urology (January 2003) 61 (23-29))

Authors
Raj, GV; Reddan, DJ; Hoey, MB; Polascik, TJ
MLA Citation
Raj, GV, Reddan, DJ, Hoey, MB, and Polascik, TJ. "Erratum: Management of Small Renal Tumors with Radiofrequency Ablation (Urology (January 2003) 61 (23-29))." Urology 64.1 (2004): 192--.
Source
scival
Published In
Urology
Volume
64
Issue
1
Publish Date
2004
Start Page
192-
DOI
10.1016/j.urology.2004.06.002

Renal radiofrequency ablation: Worst case scenarios in a porcine model

Authors
Brashears, JH; Crisci, A; Nelson, RC; Polascik, TJ
MLA Citation
Brashears, JH, Crisci, A, Nelson, RC, and Polascik, TJ. "Renal radiofrequency ablation: Worst case scenarios in a porcine model." 2004.
Source
wos-lite
Published In
AJR. American journal of roentgenology
Volume
182
Issue
4
Publish Date
2004
Start Page
14
End Page
15

Autoimmune testicular vasculitis.

A 38-year-old man presented for evaluation of new-onset left testicular pain with swelling. Testicular ultrasound revealed multiple intraparenchymal hypoechoic areas in the inferior portion of the left testicle. The patient was treated with a radical inguinal orchiectomy. Pathologic evaluation revealed intratesticular vasculitis, with involvement of medium-sized arteries. This appears to be a rare case of isolated testicular vasculitis, in the absence of any systemic symptoms.

Authors
Raj, GV; Ellington, KS; Polascik, TJ
MLA Citation
Raj, GV, Ellington, KS, and Polascik, TJ. "Autoimmune testicular vasculitis." Urology 61.5 (May 2003): 1035-.
PMID
12736037
Source
pubmed
Published In
Urology
Volume
61
Issue
5
Publish Date
2003
Start Page
1035

Use of bipolar laparoscopic forceps to occlude and transect the retroperitoneal vasculature: a porcine model.

BACKGROUND AND PURPOSE: Surgical clips are commonly employed during laparoscopic radical nephrectomy to ligate perihilar vessels reliably, yet these clips can interfere with the application of a vascular stapler to major vessels, potentially leading to catastrophic hemorrhage. We assessed the efficacy of the PlasmaKinetic trade mark (PK) bipolar cutting forceps (Gyrus Medical, Minneapolis, MN) as a single modality in coagulating and dividing the retroperitoneal vessels in a swine model. MATERIALS AND METHODS: Three 40- to 50-kg domestic swine (six renal units) underwent celiotomy and retroperitoneal exposure. The inferior vena cava (IVC) and the renal, gonadal, and iliac vessels were isolated, and, using 5- and 10-mm forceps, coagulated and divided. The mean diameter of the renal vein was 8.7 mm, the renal artery 6.5 mm, and the IVC 14 mm. RESULTS: Hemostasis was achieved consistently using the 5-mm and 10-mm PK Cutting Forceps on the renal artery, renal vein, and gonadal vein. The 10-mm forceps coagulated the iliac veins and IVC 83% of the time with only a single application. Larger vessels or vessels with higher inherent vascular pressure required additional applications of the device to achieve hemostasis. All animals were hemodynamically stable through division of the IVC, as measured by heart rate and pulse oximetry. No complications were noted with the device or using the cutting element. CONCLUSIONS: The PK bipolar cutting forceps appear to be effective in controlling and dividing the renal hilar vessels and larger low-pressure vessels of the porcine retroperitoneum, with no gross damage to adjacent structures. Although further studies are necessary before use during laparoscopic nephrectomy in humans, these results are promising. Bipolar cutting forceps may prove to be a safe, cost-effective, and time-saving device with numerous applications during urologic laparoscopy.

Authors
Santa-Cruz, RW; Auge, BK; Lallas, CD; Preminger, GM; Polascik, TJ
MLA Citation
Santa-Cruz, RW, Auge, BK, Lallas, CD, Preminger, GM, and Polascik, TJ. "Use of bipolar laparoscopic forceps to occlude and transect the retroperitoneal vasculature: a porcine model." J Endourol 17.3 (April 2003): 181-185.
PMID
12803992
Source
pubmed
Published In
Journal of Endourology
Volume
17
Issue
3
Publish Date
2003
Start Page
181
End Page
185
DOI
10.1089/089277903321618761

Management of small renal tumors with radiofrequency ablation.

Authors
Raj, GV; Reddan, DJ; Hoey, MF; Polascik, TJ
MLA Citation
Raj, GV, Reddan, DJ, Hoey, MF, and Polascik, TJ. "Management of small renal tumors with radiofrequency ablation." Urology 61.1 (January 2003): 23-29. (Review)
PMID
12559260
Source
pubmed
Published In
Urology
Volume
61
Issue
1
Publish Date
2003
Start Page
23
End Page
29

Molecular genetics and histopathologic features of adult distal nephron tumors.

Authors
Polascik, TJ; Bostwick, DG; Cairns, P
MLA Citation
Polascik, TJ, Bostwick, DG, and Cairns, P. "Molecular genetics and histopathologic features of adult distal nephron tumors." Urology 60.6 (December 2002): 941-946. (Review)
PMID
12475646
Source
pubmed
Published In
Urology
Volume
60
Issue
6
Publish Date
2002
Start Page
941
End Page
946

Effects of a low fat, flaxseed-supplemented diet on men with prostatic intraepithelial neoplasia (PIN) or atypia.

Authors
Demark-Wahnefried, W; Polascik, TJ; Robertson, CN; Walther, PJ; Paulson, DF
MLA Citation
Demark-Wahnefried, W, Polascik, TJ, Robertson, CN, Walther, PJ, and Paulson, DF. "Effects of a low fat, flaxseed-supplemented diet on men with prostatic intraepithelial neoplasia (PIN) or atypia." October 2002.
Source
wos-lite
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
11
Issue
10
Publish Date
2002
Start Page
1171S
End Page
1171S

Comparison of [18 F]fluorocholine and [18 F]fluorodeoxyglucose for positron emission tomography of androgen dependent and androgen independent prostate cancer.

PURPOSE: Positron emission tomography (PET) imaging is used for the metabolic evaluation of cancer. [18F]fluorodeoxyglucose (FDG) is commonly used as a radiotracer but its low cellular uptake rate in prostate cancer limits its usefulness. We evaluated the novel choline analog [18F]fluorocholine (FCH) for detecting androgen dependent and androgen independent prostate cancer, and its metastases. MATERIALS AND METHODS: The cellular uptake of FCH and FDG was compared in cultured prostate cancer cells (LNCaP and PC-3). FCH and FDG were injected into nude mice xenografts (CWR-22 and PC-3) and radiotracer uptake in various organs were evaluated. Patients with androgen dependent (9) and independent (9) prostate cancer were studied by FCH and FDG PET. RESULTS: FCH uptake was 849% and 60% greater than FDG uptake in androgen dependent (LNCaP) and independent (PC-3) cells, respectively. The addition of hemicholinium-3 (5 mM.) 30 minutes before radiotracer administration inhibited FCH uptake by 79% and 70% in LNCaP and PC-3 cells, respectively, whereas FDG uptake was not significantly affected. Although nude mice xenografts showed that FDG uptake was equal to or greater than FCH uptake, clinical imaging in patients demonstrated 2 to 4-fold higher uptake of FCH in those with androgen and androgen independent prostate carcinoma (p <0.001). More lesions were detected by FCH than by FDG in primary tumors, osseous metastases and soft tissue metastases. CONCLUSIONS: In vitro data demonstrated greater FCH than FDG uptake in androgen dependent (LNCaP) and androgen independent (PC-3) prostate cancer cells. Although the murine xenograft data showed greater accumulation of FDG than FCH in PC-3 tumors, PET in humans showed that FCH was better than FDG for detecting primary and metastatic prostate cancer. Overall the data from this study suggest that FCH is preferable to FDG for PET of prostate carcinoma and support the need for future validation studies in a larger number of subjects.

Authors
Price, DT; Coleman, RE; Liao, RP; Robertson, CN; Polascik, TJ; DeGrado, TR
MLA Citation
Price, DT, Coleman, RE, Liao, RP, Robertson, CN, Polascik, TJ, and DeGrado, TR. "Comparison of [18 F]fluorocholine and [18 F]fluorodeoxyglucose for positron emission tomography of androgen dependent and androgen independent prostate cancer." J Urol 168.1 (July 2002): 273-280.
PMID
12050555
Source
pubmed
Published In
The Journal of Urology
Volume
168
Issue
1
Publish Date
2002
Start Page
273
End Page
280

Hypertonic saline-augmented radiofrequency ablation of the VX-2 tumor implanted in the rabbit kidney: a short-term survival pilot study.

OBJECTIVES: The increased incidental detection of small (less than 4 cm) renal tumors has stimulated investigations of minimally invasive therapies. Radiofrequency energy is a relatively new and evolving technology that has been used for a variety of experimental and clinical applications. We evaluate the efficacy of hypertonic interstitial saline-augmented radiofrequency therapy to ablate a malignant VX-2 tumor implanted in a rabbit kidney, as measured by the completeness of tumor destruction and progression to metastasis. METHODS: The VX-2 tumor was surgically implanted into the left lower pole parenchyma of 18 New Zealand white rabbit kidneys. Ten days after implantation, hypertonic interstitial saline-augmented radiofrequency ablation was performed (n = 12) using a radiofrequency therapy system (RFT, United States Surgical Corp.). A sham operation was performed on a control group (n = 6). Animals were humanely killed at 5, 10, and 15-day intervals, and the clinical response and effect of radiofrequency energy on the malignant renal tissue was assessed. RESULTS: No postoperative complications were encountered. The mean size of the implanted VX-2 tumor was 1.87 cm2. Kidneys in the treated group exhibited marked destruction of tumor tissue. Histologic analysis revealed coagulative necrosis of both malignant and normal renal tissue in the treated group. Three rabbits (1 control, 2 treated) died of metastatic disease. CONCLUSIONS: Coagulative necrosis of renal parenchyma and tumor tissue was clearly demonstrated after radiofrequency ablation using the RFT system. The aggressive growth pattern of the VX-2 tumor often resulted in progression to metastatic disease while precluding complete tumor ablation. Hypertonic saline-augmented radiofrequency ablation is a promising new technology for the management of small, locally confined, renal tumors and has the potential for use with a minimally invasive approach.

Authors
Munver, R; Threatt, CB; Delvecchio, FC; Preminger, GM; Polascik, TJ
MLA Citation
Munver, R, Threatt, CB, Delvecchio, FC, Preminger, GM, and Polascik, TJ. "Hypertonic saline-augmented radiofrequency ablation of the VX-2 tumor implanted in the rabbit kidney: a short-term survival pilot study." Urology 60.1 (July 2002): 170-175.
PMID
12100957
Source
pubmed
Published In
Urology
Volume
60
Issue
1
Publish Date
2002
Start Page
170
End Page
175

Clinical utility of indium 111-capromab pendetide immunoscintigraphy in the detection of early, recurrent prostate carcinoma after radical prostatectomy.

BACKGROUND: Despite the ability of radical prostatectomy to eradicate prostate carcinoma, biochemical evidence of recurrent prostate carcinoma may be seen in approximately 40% of patients 15 years after they undergo surgery. Localization of recurrent disease after radical prostatectomy is difficult and may greatly influence subsequent clinical management. The authors examined the utility of indium 111 ((111)In)-capromab pendetide immunoscintigraphy to detect recurrent prostate carcinoma radiographically in men with early biochemical evidence of failure (serum prostate specific antigen [PSA] < or = 4.0 ng/mL) and assessed the minimum serum PSA level necessary for imaging recurrent disease. METHODS: Between May 1987 and August 1995, 255 hormone-naïve men with a mean (+/- standard deviation) age of 65 years +/- 7 years who underwent radical prostatectomy for clinically localized prostate carcinoma were followed without adjuvant therapy until early PSA recurrence in this multicenter study. Preoperatively, all patients had negative bone scans and pathologically negative lymph nodes, and they did not undergo hormonal ablation, chemotherapy, or radiation therapy preoperatively or postoperatively until the (111)In-capromab pendetide scan was performed. All men in this study had postoperative serum PSA levels < or = 4.0 ng/mL at the time of radionuclide imaging. All men underwent imaging with the capromab pendetide scan to localize recurrent disease, and charts were reviewed to document clinical evidence of recurrence. RESULTS: Pathologic findings included mean Gleason scores of 6.7 +/- 1.2; pathologic tumors classified as pT2a (18%), pT2b (26%), pT3a (38%), pT3b (16%), and pT4a (2%); a pathologic lymph node status of pN0 (100%); positive surgical margins (44%); and perineural invasion (42%). Capromab pendetide uptake was seen in 72% of 255 men throughout a range of patients' postoperative serum PSA levels (0.1-4.0 ng/mL), with 31% of men having local uptake (prostatic fossa) only. Of 151 men who underwent additional imaging studies, 16 of 139 men (12%) and 15 of 92 men (16%) showed evidence of recurrent disease by bone scintigraphy and computed tomography scans, respectively. Gleason score, pathologic stage, perineural invasion, and margin status were not correlated significantly with the (111)In-capromab pendetide scan. CONCLUSIONS: Capromab pendetide imaging can localize early PSA recurrence and may guide appropriate treatment after patients undergo radical prostatectomy. No minimum serum PSA value was needed to potentially detect radiographic disease after surgery. Further confirmatory studies and long-term follow-up of this cohort documenting response to salvage therapy are needed to validate these imaging findings.

Authors
Raj, GV; Partin, AW; Polascik, TJ
MLA Citation
Raj, GV, Partin, AW, and Polascik, TJ. "Clinical utility of indium 111-capromab pendetide immunoscintigraphy in the detection of early, recurrent prostate carcinoma after radical prostatectomy." Cancer 94.4 (February 15, 2002): 987-996.
PMID
11920467
Source
pubmed
Published In
Cancer
Volume
94
Issue
4
Publish Date
2002
Start Page
987
End Page
996

Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal levels, prostate-specific antigen, and histopathologic features.

OBJECTIVES: Dietary fat and fiber affect hormonal levels and may influence cancer progression. Flaxseed is a rich source of lignan and omega-3 fatty acids and may thwart prostate cancer. The potential effects of flaxseed may be enhanced with concomitant fat restriction. We undertook a pilot study to explore whether a flaxseed-supplemented, fat-restricted diet could affect the biomarkers of prostatic neoplasia. METHODS: Twenty-five patients with prostate cancer who were awaiting prostatectomy were instructed on a low-fat (20% of kilocalories or less), flaxseed-supplemented (30 g/day) diet. The baseline and follow-up levels of prostate-specific antigen, testosterone, free androgen index, and total serum cholesterol were determined. The tumors of diet-treated patients were compared with those of historic cases (matched by age, race, prostate-specific antigen level at diagnosis, and biopsy Gleason sum) with respect to apoptosis (terminal deoxynucleotidyl transferase [TdT]-mediated dUTP-biotin nick end-labeling [TUNEL]) and proliferation (MIB-1). RESULTS: The average duration on the diet was 34 days (range 21 to 77), during which time significant decreases were observed in total serum cholesterol (201 +/- 39 mg/dL to 174 +/- 42 mg/dL), total testosterone (422 +/- 122 ng/dL to 360 +/- 128 ng/dL), and free androgen index (36.3% +/- 18.9% to 29.3% +/- 16.8%) (all P <0.05). The baseline and follow-up levels of prostate-specific antigen were 8.1 +/- 5.2 ng/mL and 8.5 +/- 7.7 ng/mL, respectively, for the entire sample (P = 0.58); however, among men with Gleason sums of 6 or less (n = 19), the PSA values were 7.1 +/- 3.9 ng/mL and 6.4 +/- 4.1 ng/mL (P = 0.10). The mean proliferation index was 7.4 +/- 7.8 for the historic controls versus 5.0 +/- 4.9 for the diet-treated patients (P = 0.05). The distribution of the apoptotic indexes differed significantly (P = 0.01) between groups, with most historic controls exhibiting TUNEL categorical scores of 0; diet-treated patients largely exhibited scores of 1. Both the proliferation rate and apoptosis were significantly associated with the number of days on the diet (P = 0.049 and P = 0.017, respectively). CONCLUSIONS: These pilot data suggest that a flaxseed-supplemented, fat-restricted diet may affect prostate cancer biology and associated biomarkers. Further study is needed to determine the benefit of this dietary regimen as either a complementary or preventive therapy.

Authors
Demark-Wahnefried, W; Price, DT; Polascik, TJ; Robertson, CN; Anderson, EE; Paulson, DF; Walther, PJ; Gannon, M; Vollmer, RT
MLA Citation
Demark-Wahnefried, W, Price, DT, Polascik, TJ, Robertson, CN, Anderson, EE, Paulson, DF, Walther, PJ, Gannon, M, and Vollmer, RT. "Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal levels, prostate-specific antigen, and histopathologic features." Urology 58.1 (July 2001): 47-52.
PMID
11445478
Source
pubmed
Published In
Urology
Volume
58
Issue
1
Publish Date
2001
Start Page
47
End Page
52

Management of small renal tumors: an overview.

The incidental finding of a small renal mass poses a therapeutic dilemma. The traditional treatment of clinically important masses has been radical nephrectomy. Recently, nephron-sparing surgery has emerged as a viable alternative; and experimental minimally invasive percutaneous tissue ablation techniques, including cryotherapy and radiofrequency ablation, are being evaluated. In this review, we discuss the dilemma posed by frequent renal imaging and the increased proportion of incidental tumors being detected, the limitations of needle biopsies for histologic diagnosis, nephron-conserving and minimally invasive surgery, and the possible merits of radiofrequency ablation and cryotherapy. We envision a defined role for minimally invasive percutaneous or extracorporeal ablation of small renal tumors.

Authors
Reddan, DN; Raj, GV; Polascik, TJ
MLA Citation
Reddan, DN, Raj, GV, and Polascik, TJ. "Management of small renal tumors: an overview." Am J Med 110.7 (May 2001): 558-562. (Review)
PMID
11343669
Source
pubmed
Published In
The American Journal of Medicine
Volume
110
Issue
7
Publish Date
2001
Start Page
558
End Page
562

Utility of capromab pendetide (ProstaScint) imaging in the management of prostate cancer.

PURPOSE: Capromab pendetide (ProstaScint) is an indium In 111 ((111)In)-labeled monoclonal antibody to prostate-specific membrane antigen (PSMA) used to image prostate cancer. The appropriate techniques for obtaining images with this modality and the appropriate clinical indications for this study are in the process of being optimized. MATERIALS AND METHODS: From 1994 to 2000, 631 monoclonal antibody imaging studies with (111)In capromab pendetide were performed. The accuracy and utility of this modality in the primary staging of patients with disease at high risk of metastasis and patients with recurrent or residual disease after primary therapy were evaluated. RESULTS: In high-risk patients evaluated for risk of lymph node metastases prior to pelvic lymph node dissection, capromab pendetide imaging was found to have a positive predictive value (PPV) of 62%, negative predictive value (NPV) of 72%, sensitivity of 62%, and specificity of 72%. In patients evaluated with capromab pendetide imaging for prostatic fossa recurrence using prostatic fossa needle biopsy as the gold standard, capromab pendetide imaging was found to have a PPV of 50%, NPV of 70%, sensitivity of 49%, and specificity of 71%. CONCLUSIONS: The sensitivity and NPV of (111)In capromab pendetide imaging are better than those of computed tomography and magnetic resonance imaging for detection of soft-tissue and nodal metastases from prostate cancer. The utility of this modality has been demonstrated in the primary staging of patients with disease at high risk of metastasis. Patients with recurrent or residual disease after primary therapy also may benefit from capromab pendetide imaging prior to selection of salvage therapy. Innovative methods for the use of capromab pendetide imaging in radiation therapy treatment planning are under development.

Authors
Rosenthal, SA; Haseman, MK; Polascik, TJ
MLA Citation
Rosenthal, SA, Haseman, MK, and Polascik, TJ. "Utility of capromab pendetide (ProstaScint) imaging in the management of prostate cancer." Tech Urol 7.1 (March 2001): 27-37. (Review)
PMID
11272670
Source
pubmed
Published In
Techniques in urology
Volume
7
Issue
1
Publish Date
2001
Start Page
27
End Page
37

Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer.

The up-regulation of rates of choline uptake and phosphorylation in certain malignancies has motivated the development of positron-labeled choline analogues for noninvasive detection of cancer using positron emission tomography (PET). The choline analogue, no-carrier-added [18F]fluoromethyl-dimethyl-2-hydroxyethyl-ammonium (FCH), was synthesized through the intermediate [18F]fluorobromomethane. FCH was evaluated in relationship to 2-[18F]fluoro-2-deoxyglucose (FDG) as an oncological probe in cultured PC-3 human prostate cancer cells, a murine PC-3 human prostate cancer xenograft model, and in PET imaging studies of patients with prostate cancer. FCH was synthesized in 20-40% radiochemical yield and >98% radiochemical purity. Accumulation of FCH and FDG were comparable in cultured prostate cancer cells, whereas only FCH was inhibited (90%) by hemicholinium-3, a specific inhibitor of choline transport and phosphorylation. FCH showed similar biodistribution to [14C]choline in the tumor-bearing mouse, with prominent renal and hepatic uptake. Tumor uptake of FCH was similar to choline and FDG in the mouse model, although tumor:blood ratios were moderately higher for FCH. Initial PET imaging studies in prostate cancer patients showed high uptake of FCH in advanced prostate carcinoma and detection of osseous and soft tissue metastases. FCH uptake by tumors was markedly reduced in patients rescanned during androgen deprivation therapy. It is concluded that FCH closely mimics choline uptake by normal tissues and prostate cancer neoplasms. FCH is potentially useful as a PET tracer for detection and localization of prostate cancer and monitoring effects of therapy.

Authors
DeGrado, TR; Coleman, RE; Wang, S; Baldwin, SW; Orr, MD; Robertson, CN; Polascik, TJ; Price, DT
MLA Citation
DeGrado, TR, Coleman, RE, Wang, S, Baldwin, SW, Orr, MD, Robertson, CN, Polascik, TJ, and Price, DT. "Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer." Cancer Res 61.1 (January 1, 2001): 110-117.
PMID
11196147
Source
pubmed
Published In
Cancer Research
Volume
61
Issue
1
Publish Date
2001
Start Page
110
End Page
117

HIV infection presenting as an unusually large pure yolk sac tumor of the testis.

Authors
Munver, R; Donehower, RC; Kronz, JD; Polascik, TJ
MLA Citation
Munver, R, Donehower, RC, Kronz, JD, and Polascik, TJ. "HIV infection presenting as an unusually large pure yolk sac tumor of the testis." J Urol 164.5 (November 2000): 1653-1654.
PMID
11025732
Source
pubmed
Published In
The Journal of Urology
Volume
164
Issue
5
Publish Date
2000
Start Page
1653
End Page
1654

Survey of neuromuscular injuries to the patient and surgeon during urologic laparoscopic surgery.

OBJECTIVES: Laparoscopy may be complicated by neuromuscular injuries, both to the patient and to the surgeon. We used a survey to estimate the incidence of these injuries during urologic laparoscopic surgery, to assess risk factors for these injuries, and to determine preventive measures. METHODS: A survey of neuromuscular injuries associated with laparoscopy submitted to 18 institutions in the United States was completed by 18 attending urologists from 15 institutions. RESULTS: From among a total of 1651 procedures, there were 46 neuromuscular injuries in 45 patients (2.7%), including abdominal wall neuralgia (14), extremity sensory deficit (12), extremity motor deficit (8), clinical rhabdomyolysis (6), shoulder contusion (4), and back spasm (2). Neuromuscular injuries were twice as common with upper retroperitoneal as with pelvic laparoscopy (3. 1% versus 1.5%). Among patients with neuromuscular injuries, those with rhabdomyolysis were heavier (means 91 versus 80 kg) and underwent longer procedures (means 379 versus 300 minutes), and those with motor deficits were older (means 51 versus 42 years of age). Of the surgeons, 28% and 17% reported frequent neck and shoulder pain, respectively. CONCLUSIONS: Although not common, neuromuscular injuries during laparoscopy do contribute to morbidity. Abdominal wall neuralgias, injuries to peripheral nerves, and joint or back injuries likely occur no more frequently than during open surgery, but risk of rhabdomyolysis may be increased. Positioning in a partial rather than full flank position may reduce the incidence of some injuries. Measures to reduce neuromuscular strain on the surgeon during laparoscopy should be considered.

Authors
Wolf, JS; Marcovich, R; Gill, IS; Sung, GT; Kavoussi, LR; Clayman, RV; McDougall, EM; Shalhav, A; Dunn, MD; Afane, JS; Moore, RG; Parra, RO; Winfield, HN; Sosa, RE; Chen, RN; Moran, ME; Nakada, SY; Hamilton, BD; Albala, DM; Koleski, F; Das, S; Adams, JB; Polascik, TJ
MLA Citation
Wolf, JS, Marcovich, R, Gill, IS, Sung, GT, Kavoussi, LR, Clayman, RV, McDougall, EM, Shalhav, A, Dunn, MD, Afane, JS, Moore, RG, Parra, RO, Winfield, HN, Sosa, RE, Chen, RN, Moran, ME, Nakada, SY, Hamilton, BD, Albala, DM, Koleski, F, Das, S, Adams, JB, and Polascik, TJ. "Survey of neuromuscular injuries to the patient and surgeon during urologic laparoscopic surgery." Urology 55.6 (June 2000): 831-836.
PMID
10840086
Source
pubmed
Published In
Urology
Volume
55
Issue
6
Publish Date
2000
Start Page
831
End Page
836

Capromab Pendetide imaging of prostate cancer.

Capromab Pendetide imaging illustrates the successful translation of monoclonal antibody technology from the laboratory to the clinic. It provides a means of identifying otherwise occult soft tissue metastases in patients with adenocarcinoma of the prostate. When utilized with other clinical, pathological and laboratory findings, Capromab Pendetide imaging enables more accurate disease staging and monitoring than is afforded by other imaging modalities such as CT and MRI. In the primary disease setting Capromab Pendetide imaging should be reserved for use in patients with negative bone scans who are at high risk for metastatic disease based on such factors as advanced clinical stage, high Gleason score and significantly elevated serum PSA or alkaline phosphatase. Due to low sensitivity for small-volume disease, a negative Mab scan may not eliminate the need for a staging lymph node dissection but should encourage further consideration of local treatment options. Capromab Pendetide should be used with caution in patients at low risk for metastatic disease. Positive scan findings in low risk patients should be confirmed before altering the treatment plan since some false positive scans should be anticipated in a population with low disease prevalence. Capromab Pendetide imaging has not been shown to be reliable in determining the local extent of the primary tumor but new techniques involving co-registration of SPECT and CT images show promise in this regard. In the patient with recurrent disease following primary therapy, the predictive value of Capromab Pendetide imaging of the prostate or prostate fossa is limited, particularly following RT. Its more important role in this setting is to identify lymph node metastases in the high risk patient with a negative bone scan who might otherwise be a candidate for local salvage therapy. A large prospective study is needed for confirmation, but preliminary data suggest that Capromab Pendetide imaging is helpful in identifying those patients with PSA elevation after radical prostatectomy who are most likely to benefit from salvage RT. As with any imaging technique, Capromab Pendetide has strengths and weaknesses that must be understood to maximize patient benefit by utilizing the scan in clinical settings where it is most likely to be useful and least likely to be misleading. Capromab Pendetide is a technically demanding procedure best performed and interpreted at sites with experience and expertise.

Authors
Haseman, MK; Rosenthal, SA; Polascik, TJ
MLA Citation
Haseman, MK, Rosenthal, SA, and Polascik, TJ. "Capromab Pendetide imaging of prostate cancer." Cancer Biother Radiopharm 15.2 (April 2000): 131-140. (Review)
PMID
10803318
Source
pubmed
Published In
Cancer Biotherapy & Radiopharmaceuticals
Volume
15
Issue
2
Publish Date
2000
Start Page
131
End Page
140
DOI
10.1089/cbr.2000.15.131

Influence of sextant prostate needle biopsy or surgery on the detection and harvest of intact circulating prostate cancer cells.

PURPOSE: The feasibility of harvesting intact, circulating prostate cancer cells from the blood of men with advanced prostate cancer has previously been demonstrated. We studied the influence of sextant prostate needle biopsy and radical prostatectomy on harvesting intact circulating prostate cancer cells. MATERIALS AND METHODS: Via standard venipuncture 20 c.c. blood were obtained preoperatively, and 30 minutes and 3 days postoperatively from 23 men with clinically localized prostate cancer undergoing surgery. Similarly, blood was obtained before and after routine prostate biopsy from 13 men for an elevated prostate specific antigen level and/or abnormal digital rectal examination. The blood cells were removed via density centrifugation and magnetic cell sorting. The remaining prostate epithelial cells were characterized by indirect fluorescent immunocytochemical staining and fluorescent in situ hybridization using deoxyribonucleic acid probes. RESULTS: Sextant biopsy of the prostate induced circulating cells in 3 of 13 men (23%), only 1 of whom demonstrated cells with aneuploidy (Gleason score 3+4 = 7). Circulating cells were detected preoperatively, 30 minutes or 3 days postoperatively in 35% of radical prostatectomy cases. Of the patients 13% had detectable circulating cells 30 minutes postoperatively only and 9% had cells harvested on postoperative day 3. Persistence of circulating prostate cancer cells was noted in 13% of men on postoperative day 3. Serum prostate specific antigen level and pathological stage did not appear to be related to harvested cell number. CONCLUSIONS: Prostate cancer cells can be harvested from men with clinically localized disease undergoing sextant needle biopsy or radical prostatectomy. Routine prostate biopsy and surgery may influence the number of measurable circulating cells in the short term but the clinical significance and long-term prevalence of detectable circulating cells are unknown. Further studies are needed to evaluate the clinical usefulness of this assay for detecting, staging and monitoring prostate cancer.

Authors
Polascik, TJ; Wang, ZP; Shue, M; Di, S; Gurganus, RT; Hortopan, SC; Ts'o, PO; Partin, AW
MLA Citation
Polascik, TJ, Wang, ZP, Shue, M, Di, S, Gurganus, RT, Hortopan, SC, Ts'o, PO, and Partin, AW. "Influence of sextant prostate needle biopsy or surgery on the detection and harvest of intact circulating prostate cancer cells." J Urol 162.3 Pt 1 (September 1999): 749-752.
PMID
10458358
Source
pubmed
Published In
The Journal of Urology
Volume
162
Issue
3 Pt 1
Publish Date
1999
Start Page
749
End Page
752

Prostate specific antigen: a decade of discovery--what we have learned and where we are going.

PURPOSE: Many advances have occurred during the last decade in the clinical use of prostate specific antigen (PSA) for detecting, staging and monitoring prostate cancer. We review the clinical usefulness and limitations of serum PSA as a tumor marker of prostate cancer. MATERIALS AND METHODS: The English language literature was reviewed with respect to the major contributions and limitations of PSA in present clinical practice. RESULTS: Although controversial, age specific PSA reference ranges can improve the sensitivity for prostate cancer detection in young men and the specificity in older men. Percent free PSA improves the specificity for prostate cancer detection in men with PSA values between 4 and 10 ng./ml., and a PSA density of greater than 0.15 may better distinguish benign prostatic hyperplasia from prostate cancer. PSA velocity can improve the ability to detect prostate cancer when 3 serial PSA values are measured during a 2-year period. For prostate cancer staging PSA is most useful combined with clinical stage and Gleason score in multivariate analysis. Percent free PSA may prove useful for staging prostate cancer but further clinical trials are needed to determine its clinical usefulness. PSA is the most clinically useful means to monitor disease recurrence after treatment of prostate cancer. With ultrasensitive PSA assays it is now possible to increase the lead time for detection of disease recurrence by several months. CONCLUSIONS: During the last decade much of the focus has been on improving the ability of this tumor marker to detect prostate cancer. PSA remains the best and most widely used tumor marker in urology today.

Authors
Polascik, TJ; Oesterling, JE; Partin, AW
MLA Citation
Polascik, TJ, Oesterling, JE, and Partin, AW. "Prostate specific antigen: a decade of discovery--what we have learned and where we are going." J Urol 162.2 (August 1999): 293-306. (Review)
PMID
10411025
Source
pubmed
Published In
The Journal of Urology
Volume
162
Issue
2
Publish Date
1999
Start Page
293
End Page
306

Comparison of clinical staging algorithms and 111indium-capromab pendetide immunoscintigraphy in the prediction of lymph node involvement in high risk prostate carcinoma patients.

BACKGROUND: The pretherapy prediction of occult lymph node involvement and the avoidance of otherwise futile and potentially morbid definitive local therapy is paramount in men with newly diagnosed prostate carcinoma. To identify patients with prostate carcinoma who likely have lymph node involvement and would benefit from staging lymphadenectomy prior to definitive local therapy, the authors compared the ability of several predictive staging algorithms and a radiolabeled monoclonal antibody scan to predict lymphatic metastases prior to treatment. METHODS: Between August 1991 and June 1994, 198 men with clinical T2 or T3 classified (TNM) prostate carcinoma (bone scan negative) who were at high risk of lymph node involvement underwent a 111In-capromab pendetide scan prior to staging lymphadenectomy. Several predictive models based on preoperative prostate specific antigen level, biopsy Gleason score, and clinical stage were selected to predict those men having a > or =20% probability of lymph node involvement. The ability to predict pathologic stage using several clinical algorithms and the monoclonal antibody scan was compared with pathologic examination of the lymph nodes. RESULTS: Overall, 39% of the pelvic lymph node specimens were positive for metastatic disease by pathologic analysis. Published algorithms predicting lymph node metastases had a positive predictive value (PPV) ranging from 40.5% to 46.6% and an area under the receiver operating characteristic curve (AUC) ranging from 0.52 to 0.61. The monoclonal antibody scan had a PPV of 66.7% and an AUC of 0.71. The differences between the PPV and the AUC for the individual clinical algorithms when compared with immunoscintigraphy were statistically significant. Combining the radiolabeled monoclonal antibody scan with clinical predictive models, a PPV of up to 72.1% could be obtained. CONCLUSIONS: These data suggest that the PPVs for the clinical predictive algorithms are similar and that the PPV of the radiolabeled monoclonal antibody scan alone or in combination with the algorithms has additional value in predicting lymph node involvement in prostate carcinoma patients at high risk of regional disease spread. These algorithms and the 111In-capromab pendetide scan may be used for the appropriate selection of candidates for definitive local therapy in men with clinically localized prostate carcinoma and significant risk of lymph node involvement.

Authors
Polascik, TJ; Manyak, MJ; Haseman, MK; Gurganus, RT; Rogers, B; Maguire, RT; Partin, AW
MLA Citation
Polascik, TJ, Manyak, MJ, Haseman, MK, Gurganus, RT, Rogers, B, Maguire, RT, and Partin, AW. "Comparison of clinical staging algorithms and 111indium-capromab pendetide immunoscintigraphy in the prediction of lymph node involvement in high risk prostate carcinoma patients." Cancer 85.7 (April 1, 1999): 1586-1592.
PMID
10193950
Source
pubmed
Published In
Cancer
Volume
85
Issue
7
Publish Date
1999
Start Page
1586
End Page
1592

Ablation of renal tumors in a rabbit model with interstitial saline-augmented radiofrequency energy: preliminary report of a new technology.

OBJECTIVES: To evaluate the efficacy of interstitial saline radiofrequency energy for reproducibly ablating nonmalignant (control) and malignant (the VX-2 tumor) renal tissue in a rabbit model, and to determine the ability of conventional gray-scale and power sonography to image the tumor and ablative process in real time before, during, and after treatment. METHODS: The VX-2 tumor was implanted beneath the renal capsule in 18 rabbit kidneys. Twelve days after implantation, 50 W of 500-kHz radiofrequency energy was delivered into the surgically externalized renal tumor and contralateral control kidney for 30 or 45-second treatment intervals using an interstitial saline-augmented radiofrequency probe (the virtual electrode). Localization of the tumor and response to treatment were imaged with gray-scale and power Doppler ultrasonography. The effect of radiofrequency and extent of the destructive process on benign and malignant renal tissue were evaluated histologically. RESULTS: Mean tumor size was 1.3 x 0.7 cm. Both 30 and 45-second treatment intervals provided marked tissue/tumor ablation. Gross anatomic and histologic analysis showed time-dependent ablated lesions averaging 1.4+/-0.3 x 1.0+/-0.3 cm (30-second treatment) and 1.8+/-0.4 x 1.5+/-0.3 cm (45-second treatment), with clear demarcation of the surrounding parenchyma. Conventional gray-scale sonography allowed visualization of the ablative process, and power Doppler ultrasound demonstrated changes in the vascular pattern of the tumor both before and after ablation. No immediate treatment-related complications were observed. CONCLUSIONS: These preliminary studies in a rabbit model demonstrate the feasibility of using the interstitial saline-augmented electrode to ablate small renal tumors and the ability to simultaneously visualize the ablative process using real-time ultrasonography. This technology may have the potential to treat small renal tumors in a minimally invasive manner in the clinical setting.

Authors
Polascik, TJ; Hamper, U; Lee, BR; Dai, Y; Hilton, J; Magee, CA; Crone, JK; Shue, MJ; Ferrell, M; Trapanotto, V; Adiletta, M; Partin, AW
MLA Citation
Polascik, TJ, Hamper, U, Lee, BR, Dai, Y, Hilton, J, Magee, CA, Crone, JK, Shue, MJ, Ferrell, M, Trapanotto, V, Adiletta, M, and Partin, AW. "Ablation of renal tumors in a rabbit model with interstitial saline-augmented radiofrequency energy: preliminary report of a new technology." Urology 53.3 (March 1999): 465-472.
PMID
10096368
Source
pubmed
Published In
Urology
Volume
53
Issue
3
Publish Date
1999
Start Page
465
End Page
472

Ablation of renal tumors in a rabbit model with interstitial saline- augmented radiofrequency energy [1] (multiple letters)

Authors
Zlotta, AR; Schulman, CC; Polascik, TJ
MLA Citation
Zlotta, AR, Schulman, CC, and Polascik, TJ. "Ablation of renal tumors in a rabbit model with interstitial saline- augmented radiofrequency energy [1] (multiple letters)." Urology 54.2 (1999): 382-383.
PMID
10443745
Source
scival
Published In
Urology
Volume
54
Issue
2
Publish Date
1999
Start Page
382
End Page
383

Use of multivariate models to improve prediction of pathologic stage for men with clinically localized prostate cancer.

To benefit from definitive local therapy, men with clinically localized prostate cancer should have organ-confined disease. We discuss the use of multivariate analysis using serum PSA, biopsy Gleason score and clinical stage to improve the prediction of pathologic stage. Serum PSA, biopsy Gleason scores and clinical stage correlate with pathologic stage by univariate analysis are used in this study. However, each of these variables cannot accurately predict stage for the individual patient. Several investigators have proposed clinical algorithms based on multivariate analysis to enhance pretreatment staging. For men with clinically localized prostate cancer, multivariate algorithms are useful to determine the probability of a man having organ-confined disease, seminal vesicle invasion and lymph node involvement. This information will better enable clinicians and patients to make informed decisions about appropriate treatment options.

Authors
Polascik, TJ; Pearson, JD; Partin, AW; Polascik, DTJ
MLA Citation
Polascik, TJ, Pearson, JD, Partin, AW, and Polascik, DTJ. "Use of multivariate models to improve prediction of pathologic stage for men with clinically localized prostate cancer." Prostate Cancer Prostatic Dis 1.6 (December 1998): 301-306.
PMID
12496871
Source
pubmed
Published In
Prostate Cancer and Prostatic Diseases
Volume
1
Issue
6
Publish Date
1998
Start Page
301
End Page
306
DOI
10.1038/sj.pcan.4500258

Frequent occurrence of metastatic disease in patients with renal cell carcinoma and intrahepatic or supradiaphragmatic intracaval extension treated with surgery: an outcome analysis.

OBJECTIVES: Previous reports indicate that up to 10% of patients with localized renal cell carcinoma have direct intracaval neoplastic extension. Many patients with locally confined tumors and small intracaval tumor extensions can be surgically cured. Few studies have documented long-term survival after radical surgery for renal cell carcinoma involving higher vena caval tumor extension. We report the follow-up of 34 consecutive patients undergoing radical nephrectomy and intrahepatic or supradiaphragmatic intracaval thrombectomy for renal cell carcinoma. METHODS: From October 1982 through January 1993, 34 consecutive patients with a mean age of 60 years were identified as having clinical Stage T3 renal cell carcinoma (mean diameter 9.5+/-4.0 cm) with intrahepatic (41%) or supradiaphragmatic (59%) intracaval neoplastic extension. Patients underwent radical nephrectomy with intrahepatic caval thrombectomy (38%) or supradiaphragmatic caval thrombectomy using cardiac bypass with hypothermia and circulatory arrest (62%). Clinical outcome was assessed during a mean follow-up of 30 months (range 1 to 182). RESULTS: A total of 24 (71%) of 34 tumors demonstrated capsular penetration, and 22 (65%) of 34 had significant perinephric extension into Gerota's fascia by pathologic analysis. Metastatic disease was identified in 35% of patients either at the time of surgery or by pathologic analysis. Using Kaplan-Meier actuarial analysis, the likelihood of survival for all 34 consecutive patients after surgery was 68% (95% confidence interval [CI] 49% to 81%) at 1 year, 32% (95% CI 18% to 48%) at 2 years, 14% (95% CI 5% to 28%) at 5 years, and 9% (95% CI 2% to 24%) at 10 years. Neither capsular penetration, perinephric extension, the level of intracaval extension of tumor, nor the use of cardiopulmonary bypass significantly affected survival. CONCLUSIONS: In patients with renal cell carcinoma and intrahepatic or supradiaphragmatic intracaval extension of tumor, the presence of metastases is a frequent occurrence and, if present, greatly diminishes survival. Improvements in the preoperative detection of occult metastases are needed if surgery alone is to improve survival.

Authors
Polascik, TJ; Partin, AW; Pound, CR; Marshall, FF
MLA Citation
Polascik, TJ, Partin, AW, Pound, CR, and Marshall, FF. "Frequent occurrence of metastatic disease in patients with renal cell carcinoma and intrahepatic or supradiaphragmatic intracaval extension treated with surgery: an outcome analysis." Urology 52.6 (December 1998): 995-999.
PMID
9836543
Source
pubmed
Published In
Urology
Volume
52
Issue
6
Publish Date
1998
Start Page
995
End Page
999

Multivariate models as predictors of pathological stage using Gleason score, clinical stage, and serum prostate-specific antigen.

The patient presented is a 58-year-old man with newly diagnosed prostate cancer who likely has at least a 10- to 15-year life expectancy. In staging this man's extent of disease, several preoperative clinical variables are provided to assess whether the patient has local disease before offering definitive surgical therapy. It has been demonstrated that the combination of several of these variables in a multivariate analysis has greater predictive power than any of these variables do alone. Multivariate analysis using clinical stage, prostate-specific antigen (PSA), and Gleason score will provide both the physician and patient with 95% confidence intervals for determining the probability of having organ-confined disease, extracapsular penetration, seminal vesicle involvement, and lymphatic metastases. Several of the clinical variables given indicate that this patient has advanced disease, such as a PSA of 12 ng/mL, a stage T2b lesion, Gleason sum 7 disease in 2 of 3 cores from the right side associated with perineural invasion, and an additional Gleason sum 7 biopsy from the contralateral apex. For a man with these preoperative variables, there is a 13% chance of organ-confined disease, an 18% probability of seminal vesicle invasion, and a 17% chance of positive pelvic lymph nodes based on a nomogram constructed from multivariate analysis. Using this information, this man should be counseled that he has a high probability (87%) of extracapsular disease and a significant risk (15% to 20%) of having either seminal vesicle or lymph node involvement. Recognizing the risks and benefits of various forms of definitive therapy for prostate cancer, the patient has additional information to make an informed decision.

Authors
Polascik, TJ; Pearson, JD; Partin, AW
MLA Citation
Polascik, TJ, Pearson, JD, and Partin, AW. "Multivariate models as predictors of pathological stage using Gleason score, clinical stage, and serum prostate-specific antigen." Semin Urol Oncol 16.3 (August 1998): 160-171.
PMID
9741421
Source
pubmed
Published In
Seminars in urologic oncology
Volume
16
Issue
3
Publish Date
1998
Start Page
160
End Page
171

Laparoscopic ureteroureterostomy for retrocaval ureter.

Authors
Polascik, TJ; Chen, RN
MLA Citation
Polascik, TJ, and Chen, RN. "Laparoscopic ureteroureterostomy for retrocaval ureter." J Urol 160.1 (July 1998): 121-122.
PMID
9628620
Source
pubmed
Published In
The Journal of Urology
Volume
160
Issue
1
Publish Date
1998
Start Page
121
End Page
122

Comparison of radical prostatectomy and iodine 125 interstitial radiotherapy for the treatment of clinically localized prostate cancer: a 7-year biochemical (PSA) progression analysis.

OBJECTIVES: To evaluate the relative efficacy of brachytherapy to radical prostatectomy, we compared biochemical progression rates from a published series of men who underwent iodine 125 (125I) interstitial radiotherapy for localized prostate cancer to a similar group of men who underwent anatomic radical prostatectomy using appropriate end points. METHODS: Seventy-six men who underwent anatomic radical prostatectomy between 1988 and 1990 were carefully matched for Gleason score and clinical stage to a recently reported contemporary series of patients treated at another institution with 125I brachytherapy without adjuvant treatment. The definition of biochemical progression was a serum PSA level greater than 0.2 ng/mL after anatomic radical prostatectomy and greater than 0.5 ng/mL for brachytherapy-treated patients. RESULTS: The 7-year actuarial PSA progression-free survival following anatomic radical prostatectomy was 97.8% (95% confidence interval [CI], 85.6% to 99.7%) for this group of men selected to match the brachytherapy group, compared to 79% (95% CI not published) for men treated with 125I interstitial radiotherapy. CONCLUSIONS: Using comparative end points for biochemical-free progression, failure rates may be higher following 125I interstitial radiotherapy compared to anatomic radical prostatectomy. These data provide a better comparison of biochemical progression than previously published studies and emphasize the need for caution in interpreting the relative efficacy of brachytherapy in controlling localized prostate cancer.

Authors
Polascik, TJ; Pound, CR; DeWeese, TL; Walsh, PC
MLA Citation
Polascik, TJ, Pound, CR, DeWeese, TL, and Walsh, PC. "Comparison of radical prostatectomy and iodine 125 interstitial radiotherapy for the treatment of clinically localized prostate cancer: a 7-year biochemical (PSA) progression analysis." Urology 51.6 (June 1998): 884-889. (Review)
PMID
9609622
Source
pubmed
Published In
Urology
Volume
51
Issue
6
Publish Date
1998
Start Page
884
End Page
889

Long-term survival after radical nephrectomy with intrahepatic or supradiaphragmatic intracaval thrombectomy for renal cell carcinoma

Purpose: Four to ten percent of patients with renal cell carcinoma have direct extension of tumor into the inferior vena cava. Although many patients, particularly those with locally confined lesions and small intracaval tumor extensions, may be surgical cured, long-term survival data following radical surgery for RCC involving significant vena caval tumor extension is lacking. We report the long-term follow-up of 34 patients undergoing radical nephrectomy with intrahepatic or supradiaphragmatic intracaval thrombectomy for RCC. Materials and Methods: From October 1982 through January 1993, 34 patients (24 men and 10 women) with a mean ago of 60 years (range, 33-79 years) underwent surgical treatment of clinical stage T3 RCC with intrahepatic (41%) or supradiaphragmatic (59%) intracaval neoplastic extension. Patients underwent nephrectomy with intrahepatic caval thrombectomy (13 patients or 38%) or supradiaphragmatic caval thrombectomy using cardiac bypass with hypothermia (21 patients or 62%). There were 24 right-sided tumors and 10 lefl-sided tumors with an overall mean diameter of 9.5 +/- 4.0 cm (range, 4-18 cm). In all, 24 of 33 (73%) patients had capsular penetration and 22 of 3 3 (67%) had perinephric extension. Metastatic disease was identified in 7 patients (21%). Mean follow-up was 30 months (range, 1-182 months). Results: Using Kaplan-Meier actuarial analysis, the likelihood of survival was 68 +/- 8% at 1 year, 32 +/- 8% at 2 years, 14 +- 6% at 5 years and 9 +/- 6% at 10 years. Although capsular penetration did not significantly affect survival, patients with perinephric extension had significantly worse survival (p=0.025). There was no statistically significant difference in survival between patients with intrahepatic extension compared to those with tumor extension to the heart (p=0.4). Survival was not significantly different between patients undergoing cardiac bypass compared to intrahepatic caval thrombectomy (p=10). Two patients are alive without disease at 76 and 172 months and a third patient is alive with metastases 70 months postoperatively. Conclusions: Given the extensive disease burden, survival following radical surgery for significant intracaval neoplastic extension of RCC appears limited. However, select patients will endure long-term survival following radical nephrectomy with intrahepatic or supradiaphragmatic intracaval thrombectomy.

Authors
Polascik, TJ; Partin, AW; Pound, CR; Marshall, FF
MLA Citation
Polascik, TJ, Partin, AW, Pound, CR, and Marshall, FF. "Long-term survival after radical nephrectomy with intrahepatic or supradiaphragmatic intracaval thrombectomy for renal cell carcinoma." British Journal of Urology 80.SUPPL. 2 (1997): 120--.
Source
scival
Published In
British journal of urology
Volume
80
Issue
SUPPL. 2
Publish Date
1997
Start Page
120-

Partial nephrectomy: technique, complications and pathologic findings

Small renal tumors are being discovered more commonly because of frequent radiologie examinations for a variety of symptoms. Partial nephrectomy rather than radical nephrectomy has been considered in many of these patients in order to conserve renal tissue. The technique of the surgery, the complications and pathological findings are evaluated. One hundred and two patients underwent partial nephrectomy between 1977 and 1996. The incidence of partial nephrectomy has increased dramatically; thirty-five patients underwent partial nephrectomy in 1995 and 1996. The majority of patients underwent partial nephrectomy for renal cell carcinoma; however, oncocytoma, angiomyolipoma, transitional cell carcinoma and several benign lesions were also responsible for the operation. Improvements in surgical technique have reduced the complications of urinary fistula, renal failure, hemorrhage and local recurrence. Our current operative approach includes use of the OmniTract retractor, intraoperative sonography, renal vascular occlusion with regional hypothermia, meticulous dissection, multiple frozen section biopsies to ensure tumor-free margins and injection of the collecting system with methylene blue dye. Since initiating injection of the collecting system in 1988 with methylene blue dye, no urinary fistulas have occurred. Prior to 1988, 6 of 28 patients or 21% developed urinary fistulas. Although approximately one third of the patients had preoperative renal impairment (mean serum creatinine ≥ 2.0 mg/dl) there were minimal post-operative changes in renal function and only one patient required acute dialysis following partial nephrectomy. Any later renal insufficiency appeared to occur as a result of the underlying renal disease rather than as a direct consequence of the procedure. Local recurrence was usually separate from the operative site. These patients typically had negative surgical margins. These findings suggest multifocal disease as the likely etiology of the local recurrence. Pathological findings also indicated at least 5 patients with capsular penetration with a tumor less than 3.5 cm in size. This finding underscores the need to surgically excise perinephric tissue with the partial nephrectomy specimen since capsular invasion and aggressive behavior can occur in small tumors. In conclusion, with careful attention to surgical technique, partial nephrectomy is a safe and effective procedure in properly selected patients, even in the presence of a normal contralateral kidney.

Authors
Polascik, TJ; Pound, CR; Meng, MZ; Partin, AW; Marshall, FF
MLA Citation
Polascik, TJ, Pound, CR, Meng, MZ, Partin, AW, and Marshall, FF. "Partial nephrectomy: technique, complications and pathologic findings." British Journal of Urology 80.SUPPL. 2 (1997): 118--.
Source
scival
Published In
British journal of urology
Volume
80
Issue
SUPPL. 2
Publish Date
1997
Start Page
118-

High-density mapping of chromosomal arm 1q in renal collecting duct carcinoma: region of minimal deletion at 1q32.1-32.2.

Collecting duct carcinoma (CDC) of the kidney is a rare malignant neoplasm of distal nephron origin. Previous studies of CDC have shown loss of heterozygosity on chromosomal arm 1q in 57% of the cases studied. To better characterize 1q loss in CDC, we performed high-density mapping of the entire long arm of chromosome 1 in 13 CDC tumor samples. We observed complete deletion of chromosomal arm 1q in 5 samples and partial deletion in 4 additional tumors. Our study further showed that the region of minimal deletion is located at 1q32.1-32.2. Sixty-nine percent (9 of 13) of the tumors showed loss of heterozygosity in this area. These data suggest that a gene or group of genes that contribute to the development of distal nephron tumors may be located within the 1q32.1-32.2 region.

Authors
Steiner, G; Cairns, P; Polascik, TJ; Marshall, FF; Epstein, JI; Sidransky, D; Schoenberg, M
MLA Citation
Steiner, G, Cairns, P, Polascik, TJ, Marshall, FF, Epstein, JI, Sidransky, D, and Schoenberg, M. "High-density mapping of chromosomal arm 1q in renal collecting duct carcinoma: region of minimal deletion at 1q32.1-32.2." Cancer Res 56.21 (November 1, 1996): 5044-5046.
PMID
8895762
Source
pubmed
Published In
Cancer Research
Volume
56
Issue
21
Publish Date
1996
Start Page
5044
End Page
5046

Reappraisal of the role of human chorionic gonadotropin in the diagnosis and treatment of the nonpalpable testis: a 10-year experience.

PURPOSE: We retrospectively evaluated the ability of human chorionic gonadotropin (HCG) to make the nonpalpable cryptorchid testis become palpable and promote testicular descent. MATERIALS AND METHODS: Through surgical bookings we identified 94 patients younger than 11 years who received HCG between 1984 and 1994 for the diagnosis or treatment of a nonpalpable undescended testis. The dose of HCG was 1,500 IU/m.2 intramuscularly 2 times weekly for 4 weeks. Testis location was determined by physical examination before and after hormone administration, and confirmed at surgical exploration. RESULTS: Of the 99 nonpalpable testes identified in 94 patients 39 (39%) became palpable following HCG administration and only 2 (2%) completely descended. A total of 60 testes remained nonpalpable with the most common reason being an absent or severely atrophic testis (40, 67%). Of the testes remaining nonpalpable after hormonal stimulation 73% were surgically located at or distal to the internal ring. CONCLUSIONS: HCG is preoperatively efficacious in causing the nonpalpable undescended testis to become palpable. For patients failing to respond to hormonal stimulation we recommend preliminary inguinal exploration, since most testes or testicular remnants are located within the inguinal canal or immediately below the internal ring.

Authors
Polascik, TJ; Chan-Tack, KM; Jeffs, RD; Gearhart, JP
MLA Citation
Polascik, TJ, Chan-Tack, KM, Jeffs, RD, and Gearhart, JP. "Reappraisal of the role of human chorionic gonadotropin in the diagnosis and treatment of the nonpalpable testis: a 10-year experience." J Urol 156.2 Pt 2 (August 1996): 804-806.
PMID
8683788
Source
pubmed
Published In
The Journal of Urology
Volume
156
Issue
2 Pt 2
Publish Date
1996
Start Page
804
End Page
806

Distal nephron renal tumors: microsatellite allelotype.

Tumors of varying malignant potential arise from the complex epithelial lining of the nephron. Although the molecular characteristics of renal clear cell carcinomas, which arise from the proximal tubule, have been studied, little is known about tumors that develop from other parts of the renal tubular system. To elucidate common molecular lesions that may contribute to the development or progression of nonproximal tubule renal tumors, we performed a detailed microsatellite allelotype of lesions thought to arise from the renal collecting duct. Eighteen collecting duct carcinomas (CDCs) and 13 renal oncocytomas were studied using highly informative microsatellite markers on all autosomal arms. Loss of heterozygosity (LOH) was identified on multiple chromosomal arms in CDCs and renal oncocytomas. Microsatellite analysis revealed LOH of 1q in 57% of informative CDCs. LOH was also observed on arms 6p (45%), 8p (40%), and 21q (40%). In renal oncocytomas, LOH of 1q occurred in approximately 30% of tumors, but 1p LOH was observed in 57% of informative cases analyzed. High levels of LOH were also observed on arms 8p, 14q, 19q, and 21q in the oncocytomas studied. Loss of chromosomal arm 3p was infrequent in both tumor types. Our results suggest that the molecular events that contribute to the development of distal nephron tumors are distinct from those associated with the etiology of proximal tubule renal cancers.

Authors
Polascik, TJ; Cairns, P; Epstein, JI; Fuzesi, L; Ro, JY; Marshall, FF; Sidransky, D; Schoenberg, M
MLA Citation
Polascik, TJ, Cairns, P, Epstein, JI, Fuzesi, L, Ro, JY, Marshall, FF, Sidransky, D, and Schoenberg, M. "Distal nephron renal tumors: microsatellite allelotype." Cancer Res 56.8 (April 15, 1996): 1892-1895.
PMID
8620510
Source
pubmed
Published In
Cancer Research
Volume
56
Issue
8
Publish Date
1996
Start Page
1892
End Page
1895

Distinct regions of allelic loss on chromosome 4 in human primary bladder carcinoma.

Accumulating evidence implicates the presence of putative tumor suppressor genes on human chromosome 4 that are potentially inactivated in the genesis of several different neoplasms. To accurately determine the frequency of allelic loss on both arms of human chromosome 4, we screened 282 fresh-frozen human bladder carcinomas for allelic loss. Loss of heterozygosity of at least one marker for chromosome 4 was identified in 129 tumors (45.7%). Fine mapping was accomplished using up to 15 polymorphic markers on the p arm and 19 markers on the q arm. We identified a 3-cM minimal area of loss on the p arm between microsatellite markers D4S1608 and D4S404 deleted in 82 tumors (29%). A total of 68 tumors (24%) targeted a 14-cM critical region identified on the distal q arm between markers D4S426 and D4S408. Loss of these two regions correlated with advanced stage and grade of the lesions. These data identify distinct regions of loss on chromosome 4 potentially involved in the late progression of bladder carcinoma.

Authors
Polascik, TJ; Cairns, P; Chang, WY; Schoenberg, MP; Sidransky, D
MLA Citation
Polascik, TJ, Cairns, P, Chang, WY, Schoenberg, MP, and Sidransky, D. "Distinct regions of allelic loss on chromosome 4 in human primary bladder carcinoma." Cancer Res 55.22 (November 15, 1995): 5396-5399.
PMID
7585608
Source
pubmed
Published In
Cancer Research
Volume
55
Issue
22
Publish Date
1995
Start Page
5396
End Page
5399

Intraoperative sonography for the evaluation and management of renal tumors: experience with 100 patients.

PURPOSE: Intraoperative sonography was used to evaluate prospectively the renal parenchyma of patients undergoing surgery for presumed renal neoplasia. MATERIALS AND METHODS: One surgeon (F.F.M.) evaluated 100 kidneys using a triple-head sector ultrasonic transducer (5 MHz., 7.5 MHz. and 10 MHz. with duplex Doppler imaging). The size, number, echo texture, location, and relationship of suspected lesions to the collecting system, vasculature and renal capsule were recorded. Real-time Doppler imaging was used to distinguish among renal arteries, renal veins and the collecting system. Sonography was used to delineate the extent of the tumor and presence or absence of satellite lesions. All patients were evaluated preoperatively with abdominal computerized tomography. RESULTS: Under ultrasonic guidance partial nephrectomy was done in 40 cases, radical nephrectomy in 56, unroofing of renal cysts in 3 and renal biopsy in 1. Of the patients 8 were considered candidates for partial nephrectomy but underwent radical nephrectomy after intraoperative sonography revealed more extensive tumor, especially at the renal hilum. Similarly, 3 patients with a suspected malignancy were spared nephrectomy after intraoperative sonography and frozen section analysis revealed benign multilocular cysts. All surgical margins after sonographic evaluation were negative in patients undergoing partial nephrectomy. CONCLUSIONS: Intraoperative ultrasound is a useful adjunct for the dynamic evaluation of renal tumors in the surrounding environment of renal cysts, the collecting system and the renal vasculature. It is particularly beneficial in defining preoperative indeterminate renal lesions and in evaluating extrarenal structures for tumor involvement, such as the renal vein, inferior vena cava, adrenal gland and liver. Intraoperative sonography is most useful during partial nephrectomy and may improve tumor-free surgical margins. Sonography is routinely used during partial nephrectomy.

Authors
Polascik, TJ; Meng, MV; Epstein, JI; Marshall, FF
MLA Citation
Polascik, TJ, Meng, MV, Epstein, JI, and Marshall, FF. "Intraoperative sonography for the evaluation and management of renal tumors: experience with 100 patients." J Urol 154.5 (November 1995): 1676-1680.
PMID
7563320
Source
pubmed
Published In
The Journal of Urology
Volume
154
Issue
5
Publish Date
1995
Start Page
1676
End Page
1680

Partial nephrectomy: technique, complications and pathological findings.

PURPOSE: We evaluate whether partial nephrectomy can be performed safely and efficaciously for renal tumors. MATERIALS AND METHODS: The results of 67 partial nephrectomies performed between 1977 and 1994 for renal cell carcinoma (51), oncocytoma (9), angiomyolipoma (3), transitional cell carcinoma (3) and other nonneoplastic lesions (2) were analyzed retrospectively in detail. RESULTS: Diminished complication rates were noted after 1988, and were attributed to improvements in surgical technique and an increased incidence of smaller, serendipitously discovered tumors. Although 35.5% of the patients had preoperative renal impairment (mean serum creatinine 2.1 mg./dl.), there were minimal changes in renal function and no patient required acute hemodialysis following partial nephrectomy. Among 42 patients with clinical stage T1 to T2 renal cell carcinoma undergoing partial nephrectomy local recurrence was identified in 8.3% of those with primary neoplasms. All 6 patients with local recurrence had negative surgical margins, recurrence often, distant from the operative site and multifocal disease, implicating multicentricity as the etiology of local recurrence. Five patients (83.3%) with local recurrence were alive and asymptomatic at a mean of 138 months after partial nephrectomy. Since capsular penetration was identified in 5 of 27 renal cell carcinomas (18.5%) with a diameter of 3.5 cm. or less, aggressive surgical resection with adequate tumor-free parenchymal and perinephric margins is necessary even for small lesions. CONCLUSIONS: With improved surgical techniques, including regional hypothermia, intraoperative sonography, meticulous dissection and injection of the collecting system with methylene blue, partial nephrectomy is safe and effective in properly selected patients.

Authors
Polascik, TJ; Pound, CR; Meng, MV; Partin, AW; Marshall, FF
MLA Citation
Polascik, TJ, Pound, CR, Meng, MV, Partin, AW, and Marshall, FF. "Partial nephrectomy: technique, complications and pathological findings." J Urol 154.4 (October 1995): 1312-1318. (Review)
PMID
7658526
Source
pubmed
Published In
The Journal of Urology
Volume
154
Issue
4
Publish Date
1995
Start Page
1312
End Page
1318

Frequency of homozygous deletion at p16/CDKN2 in primary human tumours.

Many tumour types have been reported to have deletion of 9p21 (refs 1-6). A candidate target suppressor gene, p16 (p16INK4a/MTS-1/CDKN2), was recently identified within the commonly deleted region in tumour cell lines. An increasing and sometimes conflicting body of data has accumulated regarding the frequency of homozygous deletion and the importance of p16 in primary tumours. We tested 545 primary tumours by microsatellite analysis with existing and newly cloned markers around the p16 locus. We have now found that small homozygous deletions represent the predominant mechanism of inactivation at 9p21 in bladder tumours and are present in other tumour types, including breast and prostate cancer. Moreover, fine mapping of these deletions implicates a 170 kb minimal region that includes p16 and excludes p15.

Authors
Cairns, P; Polascik, TJ; Eby, Y; Tokino, K; Califano, J; Merlo, A; Mao, L; Herath, J; Jenkins, R; Westra, W; Rutter, JL; Buckler, A; Gabrielson, E; Tockman, M; Cho, KR; Hedrick, L; Bova, GS; Isaacs, W; Koch, W; Schwab, D; Sidransky, D
MLA Citation
Cairns, P, Polascik, TJ, Eby, Y, Tokino, K, Califano, J, Merlo, A, Mao, L, Herath, J, Jenkins, R, Westra, W, Rutter, JL, Buckler, A, Gabrielson, E, Tockman, M, Cho, KR, Hedrick, L, Bova, GS, Isaacs, W, Koch, W, Schwab, D, and Sidransky, D. "Frequency of homozygous deletion at p16/CDKN2 in primary human tumours." Nat Genet 11.2 (October 1995): 210-212.
PMID
7550353
Source
pubmed
Published In
Nature Genetics
Volume
11
Issue
2
Publish Date
1995
Start Page
210
End Page
212
DOI
10.1038/ng1095-210

Novel suppressor loci on chromosome 14q in primary bladder cancer.

Two hundred eighty-five primary human carcinomas of the urinary bladder were examined for allelic loss on chromosome 14q. Seventeen highly polymorphic dinucleotide markers spanning the long arm of this acrocentric chromosome were selected for fine PCR-based mapping. Loss of heterozygosity for at least one marker was observed in 72 (25.3%) tumors. Thirty-four of these 72 tumors (47.2%) lost the entire long arm (monosomy), as suggested by loss of heterozygosity at all informative sites. Allelic loss on 14q occurred in all grades and stages of bladder cancer but was more commonly associated with muscle-invasive tumors (Ta, 9.4%; T1, 24.1%; and > or = T2, 41%). A deletion map of 16 primary tumors with partial losses delineated two minimal regions of loss. One region (approximately 2 cM) was bounded by markers D14S75 and D14S288 and the other (approximately 3 cM) by D14S51 and D14S267. Our results demonstrate that 14q loss is common in invasive bladder cancer and suggest that two potential suppressor loci at 14q12 and 14q32.1-32.2 may contribute to the genetic progression of this common cancer.

Authors
Chang, WY; Cairns, P; Schoenberg, MP; Polascik, TJ; Sidransky, D
MLA Citation
Chang, WY, Cairns, P, Schoenberg, MP, Polascik, TJ, and Sidransky, D. "Novel suppressor loci on chromosome 14q in primary bladder cancer." Cancer Res 55.15 (August 1, 1995): 3246-3249.
PMID
7614456
Source
pubmed
Published In
Cancer Research
Volume
55
Issue
15
Publish Date
1995
Start Page
3246
End Page
3249

Radical retropubic prostatectomy: the influence of accessory pudendal arteries on the recovery of sexual function.

Arterial insufficiency is a major factor responsible for impotence in men following nerve sparing radical prostatectomy. Previously, accessory internal pudendal arteries have been identified traveling over the anterolateral surface of the prostate. Based on this observation, during the last 7 years we have consistently looked for the presence of these arteries and have developed a surgical technique for their preservation. Between 1987 and 1994, 835 potent men underwent radical prostatectomy and accessory pudendal arteries were identified in 33 (4%). Following the development of the surgical technique, it was possible to preserve arteries in 19 of 24 patients (79%). Followup evaluation of 1 year or longer was available for 22 men who did not undergo wide excision of a neurovascular bundle. Recovery of erection sufficient for unassisted intromission and orgasm occurred in 8 of 12 patients (67%) in whom the arteries were preserved and in 5 of 10 (50%) in whom the arteries were sacrificed. We conclude that 1) the presence of accessory internal pudendal arteries is rare (4%); 2) although these arteries were preserved in 79% of the patients, dissection of these arteries from the dorsal vein complex may be associated with excessive bleeding, and 3) because potency rates are similar in men with or without preservation of accessory arteries, routine preservation may not be productive.

Authors
Polascik, TJ; Walsh, PC
MLA Citation
Polascik, TJ, and Walsh, PC. "Radical retropubic prostatectomy: the influence of accessory pudendal arteries on the recovery of sexual function." J Urol 154.1 (July 1995): 150-152.
PMID
7776410
Source
pubmed
Published In
The Journal of Urology
Volume
154
Issue
1
Publish Date
1995
Start Page
150
End Page
152

Comparison of laparoscopic and open retropubic urethropexy for treatment of stress urinary incontinence.

OBJECTIVES: Laparoscopic retropubic urethropexy has recently been described as an alternative method to the surgical correction of pure stress urinary incontinence. This study compares the operative technique and results of laparoscopic colposuspension with traditional open Burch urethropexy to treat women with stress urinary incontinence. METHODS: We assessed the short-term results of 12 women who underwent a modified laparoscopic Burch urethropexy for the correction of stress urinary incontinence and compared these with a similar contemporary group of 10 women who underwent a traditional open Burch colposuspension procedure. RESULTS: Ten women (83%) who underwent the laparoscopic procedure are continent with a mean follow-up of 20.8 months, and 7 women (70%) who had an open Burch colposuspension are continent at a mean follow-up of 35.6 months. The laparoscopic procedure took an average of 1.5 hours longer than the open repair (P < 0.01). Patients who underwent the laparoscopic urethropexy required less postoperative analgesia (mean, 14.2 mg morphine equivalents versus 131.4 mg; P < 0.01), shorter length of hospitalization (mean, 1.9 days versus 4.9 days; P < 0.01), and a more expedient return to normal activity when compared with those who underwent open Burch colposuspension. CONCLUSIONS: Laparoscopic bladder neck suspension offers a less invasive approach to the surgical correction of stress urinary incontinence and can provide successful outcomes in properly selected patients.

Authors
Polascik, TJ; Moore, RG; Rosenberg, MT; Kavoussi, LR
MLA Citation
Polascik, TJ, Moore, RG, Rosenberg, MT, and Kavoussi, LR. "Comparison of laparoscopic and open retropubic urethropexy for treatment of stress urinary incontinence." Urology 45.4 (April 1995): 647-652.
PMID
7716846
Source
pubmed
Published In
Urology
Volume
45
Issue
4
Publish Date
1995
Start Page
647
End Page
652
DOI
10.1016/S0090-4295(99)80057-0

Radical prostatectomy in men less than 50 years old.

We studied the effect of age on tumor progression (defined as postoperative prostate specific antigen elevation) in 543 men who underwent radical prostatectomy for clinically localized prostate cancer. Patients were divided into two age groups: patients under 50 years (N = 85) and patients older than 50 years (N = 458). The mean follow-up for both groups was S.3 years. Clinical stage was similar in both groups, with only 3% in each group detected by screening techniques. By Kaplan-Meier analysis, men under 50 years showed slightly less progression than men older than 50 years (p = 0.04), especially during the first 5 years following surgery. The key differentiating feature was a lower incidence of positive margins in the younger age group (18.8%) than the older age group (42.6%; p < 0.0001). There was a higher incidence of lymph node metastasis in the younger age group (14.1%) than the older age group (6.1%; p = 0.01); this adverse feature was present in only a small fraction of the patients and did not play a major role in the difference in progression between age groups. There was no statistically significant difference between the two age groups in tumor grade, capsular penetration, or seminal vesicle invasion. Gland volume was significantly higher in the older age group. Within the younger age group, progression was not affected by a family history of prostate cancer. We found that, despite the tendency in younger men to preserve the neurovascular bundles and cut closer to the prostate, this age group still has a lower incidence of positive surgical margins possibly due to greater ease of surgical removal of small glands. Young men who are candidates for radical prostatectomy do not have a worse prognosis following surgery than older men, and even fare better during the first five postoperative years.

Authors
Riopel, MA; Polascik, TJ; Partin, AW; Sauvageot, J; Walsh, PC; Epstein, JI
MLA Citation
Riopel, MA, Polascik, TJ, Partin, AW, Sauvageot, J, Walsh, PC, and Epstein, JI. "Radical prostatectomy in men less than 50 years old." Urol Oncol 1.2 (March 1995): 80-83.
PMID
21224096
Source
pubmed
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
1
Issue
2
Publish Date
1995
Start Page
80
End Page
83

Equivalent antihypertensive effects of combination therapy using diuretic + calcium antagonist compared with diuretic + ACE-inhibitor

To test the hypothesis that the combination of a calcium antagonist and diuretic is less effective in lowering BP than the combination of ACE inhibitor plus diuretic, we compared two groups of patients. The first was a group of 157 consecutive patients (32% male, 90% black, aged 57 +/- 1 years) in whom the only change in therapy was the addition or deletion of either a calcium antagonist or diuretic. Each patient served as his/her own control, with a follow-up time of 41 +/- 4 days. The BP responses of this group were compared with those of another group of 170 consecutive patients (33% male, 85% black, aged 55 +/- 1 years), who had had the addition or deletion of an ACE inhibitor or diuretic some 32 +/- 2 days previously. As there were no statistically significant differences either between drugs within the classes or between the addition or deletion of a drug, the BP results were pooled. Combination therapy with calcium antagonist + diuretic was associated with a 13.4 +/- 1.7/5.4 +/- 0.9 mmHg drop in supine BP; the ACE inhibitor + diuretic combination lowered supine BP by 12.3 +/- 1.6/8.0 +/- 0.9 mmHg compared with monotherapy (all P less than 0.001 by paired t-test). The effects on standing BP were similar: calcium antagonist + diuretic, 13.2 +/- 1.9/5.6 +/- 0.9 mmHg; and ACE inhibitor + diuretic, 12.3 +/- 1.5/7.0 +/- 0.9 mmHg (all P less than 0.001). There were no significant differences in BP responses between the calcium antagonist + diuretic and ACE inhibitor + diuretic combinations. These data indicate that, regardless of the order of addition or subtraction, the combination of calcium antagonist + diuretic was more effective in lowering BP than either agent used alone, and that the combination of calcium antagonist + diuretic was as effective as the ACE inhibitor + diuretic combination.

Authors
Elliott, WJ; Polascik, TJ; Murphy, MB
MLA Citation
Elliott, WJ, Polascik, TJ, and Murphy, MB. "Equivalent antihypertensive effects of combination therapy using diuretic + calcium antagonist compared with diuretic + ACE-inhibitor." Journal of Human Hypertension 4.6 (December 1990): 717-723.
Source
manual
Published In
Journal of Human Hypertension
Volume
4
Issue
6
Publish Date
1990
Start Page
717
End Page
723

Neomycin cannot be used as a selective inhibitor of inositol phospholipid hydrolysis in intact or semi-permeabilized human platelets. Aminoglycosides activate semi-permeabilized platelets

Authors
Polascik, T; Godfrey, PP; Watson, SP
MLA Citation
Polascik, T, Godfrey, PP, and Watson, SP. "Neomycin cannot be used as a selective inhibitor of inositol phospholipid hydrolysis in intact or semi-permeabilized human platelets. Aminoglycosides activate semi-permeabilized platelets." Biochemical Journal 243.3 (May 1, 1987): 815-819.
Source
crossref
Published In
The Biochemical journal
Volume
243
Issue
3
Publish Date
1987
Start Page
815
End Page
819
DOI
10.1042/bj2430815
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