scholarly journals Deflection Analysis of Different Needle Designs for Prostate Biopsy and Focal Therapy

2016 ◽  
Vol 16 (5) ◽  
pp. 654-661 ◽  
Author(s):  
Nelson N. Stone ◽  
Vladimir Mouraviev ◽  
David Schechter ◽  
Josh Goetz ◽  
M. Scott Lucia ◽  
...  
Keyword(s):  
Prostate Gland ◽  
Focal Therapy ◽  
Therapy Planning ◽  
Gelatin Matrix ◽  
Point Of Entry ◽  
Transrectal Biopsy ◽  
Significant Difference ◽  
Gland Tissue ◽  
Deflection Analysis ◽  
Needle Diameter

Objective: The biopsy needles currently used were designed for a transrectal biopsy and are known to experience significant deflection from the point of entry into the gland to the needle tip. Methods: Five designs were selected for testing: 18-gauge Bard, 15-gauge lancet tip needle with 12° vet-point cannula, and trocar tip needle with 12°, 15°, and 20° vet-point cannulas. The 15-gauge needle was designed to take a variable specimen sample between 20 and 60 mm, whereas the Bard needle specimen bed was fixed at 20 mm. The needles were bench tested on a spring-loaded platform and fired into gelatin matrix with modulus of elasticity similar to human prostate. Results: The Bard device with lancet tip needle deflected an average of 0.9 mm (range 0.3-1.3 mm) and 1.9° (range 0.6°-2.8°). Increasing needle diameter from 18-gauge Bard to 15-gauge variable with the same lancet tip needle design resulted in an average deflection across the 3 test lengths of 0.9 mm (range 0-2.0 mm) and 0.9° (range 0°-2.0°) with no significant difference. On the contrary, the use of the 3-point trocar tip needles with 12°, 15°, and 20° vet-point cannulas demonstrated significant reduction in the extent of deflection in both millimeters and degrees. There was no deflection at the 2- and 4-cm shots for both spring loads and preloads for the 3 vet tip angles tested. At 6 cm, the 20° vet tip performed the best. Conclusion: We proposed a mechanism that provides more accurate prostate sampling by combining a 3-point trocar tip on the needle with a 20° vet tip on the cutting cannula. Using the phantom, mimicking prostate gland tissue density, no deflection was revealed between 20- and 60-mm biopsy lengths, which should permit a straight sample in the majority of prostate glands and improve cancer localization for focal therapy planning.

Identification of occult prostate malignancy in a large patient cohort using a stereotactic transperineal prostate biopsy technique.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 9-9
Author(s):  
Brian Joseph Moran ◽  
Michelle H. Braccioforte
Keyword(s):  
Prostate Biopsy ◽  
Sequential Analysis ◽  
Prostate Gland ◽  
Specific Antigen ◽  
Significant Finding ◽  
Detection Rates ◽  
Transperineal Prostate Biopsy ◽  
Transrectal Biopsy ◽  
Large Patient ◽  
Significant Difference

9 Background: Continued rising PSA, despite prior transrectal prostate biopsy (TRPB), can cause significant anxiety for patients and physicians. This study investigates the detection rate of non-palpable, isoechoic occult malignancy using a stereotactic transperineal prostate biopsy (STPB) technique in patients with previous negative TRPB. Methods: 2,565 men with continued rising prostate specific antigen (PSA) with a minimum of 1 prior benign TRPB, underwent STPB at a single out-patient institution between 04/04 - 02/17 (See table). Specimens were obtained according to x, y, and z coordinates from 8 equal octants with pathology reported accordingly. A greater number of specimens were obtained from the apical half than the basilar half of the prostate; this was attributed to smaller glands in which the apical specimens sufficiently sampled the anterior curvature of the gland. Results: STPB yielded adenocarcinoma in 965/2,565 (37.6%) patients. The number of biopsy cores obtained per patient approximated the prostate gland volume in cm3. Statistical analysis demonstrated there was a significant difference in detection rates with the apex having a higher incidence of malignancy than the base of the prostate gland (p=.000). Furthermore, the anterior apex harbored significantly more adenocarcinoma when compared to the posterior apex (p=.026). Conclusions: STPB is efficacious for diagnosis of non-palpable, isoechoic occult prostate malignancy. Repeated sequential analysis of malignancy identification has consistently resulted in approximately 40% positive yield. Furthermore, a possible explanation for the significant finding in this study that occult malignancies occupy a higher percentage of apical biopsies using STPB may be related to difficulty and limitations of apical sampling using a standard transrectal biopsy approach. [Table: see text]

scholarly journals Molecular imaging of orthotopic prostate cancer with nanobubble ultrasound contrast agents targeted to PSMA

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu Wang ◽  
Al Christopher De Leon ◽  
Reshani Perera ◽  
Eric Abenojar ◽  
Ramamurthy Gopalakrishnan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Ultrasound Imaging ◽  
Prostate Gland ◽  
Ultrasound Contrast Agent ◽  
Tumor Model ◽  
Focal Therapy ◽  
Ultrasound Contrast Agents ◽  
Time Intensity Curve ◽  
Ultrasound Contrast

AbstractUltrasound imaging is routinely used to guide prostate biopsies, yet delineation of tumors within the prostate gland is extremely challenging, even with microbubble (MB) contrast. A more effective ultrasound protocol is needed that can effectively localize malignancies for targeted biopsy or aid in patient selection and treatment planning for organ-sparing focal therapy. This study focused on evaluating the application of a novel nanobubble ultrasound contrast agent targeted to the prostate specific membrane antigen (PSMA-targeted NBs) in ultrasound imaging of prostate cancer (PCa) in vivo using a clinically relevant orthotopic tumor model in nude mice. Our results demonstrated that PSMA-targeted NBs had increased extravasation and retention in PSMA-expressing orthotopic mouse tumors. These processes are reflected in significantly different time intensity curve (TIC) and several kinetic parameters for targeted versus non-targeted NBs or LUMASON MBs. These, may in turn, lead to improved image-based detection and diagnosis of PCa in the future.

scholarly journals MRI-directed biopsy for primary detection of prostate cancer in a population of 223 men: MRI In-Bore vs MRI-transrectal ultrasound fusion-targeted techniques

2021 ◽  
Author(s):  
Maurizio Del Monte ◽  
Stefano Cipollari ◽  
Francesco Del Giudice ◽  
Martina Pecoraro ◽  
Marco Bicchetti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Detection Rate ◽  
Transrectal Ultrasound ◽  
Focal Therapy ◽  
Malignant Cells ◽  
Median Percentage ◽  
Detection Rates ◽  
Biopsy Core ◽  
Significant Difference ◽  
Chi Squared

Objectives: To compare the detection rates of overall prostate cancer (PCa) and clinically significant PCa (csPCa) and the median percentage of cancer per biopsy core between MRI-guided In-bore and MRI-TRUS fusion-targeted biopsy (TBx). Methods: In this retrospective study, 223 patients who underwent prostate multiparametric MRI (mpMRI) and subsequent MR-directed biopsy were included. For PCa and csPCa detection rate (DR), contingency tables were tested via the Pearson’s chi-squared to explore the variance of the outcome distribution. The percentage of cancer per biopsy core was tested with a two-tailed Mann-Withney test. Results: One hundred and seventeen and 106 patients underwent MRI-TRUS fusion or MRI In-bore TBx, respectively. 402 MRI biopsy targets were identified, of which 206 (51.2%) were biopsied with the MRI-TRUS TBx and 196 (48.8%) with the MRI In-bore TBx technique. Per-patient PCa and csPCa detection rates were 140/223 (62.8%) and 97/223 (43.5%), respectively. PCa-DR was 73/117 (62.4%) and 67/106 (63.2%) for MRI-TRUS and MRI In-Bore TBx (p = 0.9), while csPCa detection rate reached 50/117 (42.7%) and 47/106 (44.3%), respectively (p = 0.81). The median per-patient percentage of malignant tissue within biopsy cores was 50% (IQR: 27–65%) for PCa and 60% (IQR: 35–68%) for csPCa, with a statistically significant difference between the techniques. Conclusion No statistically significant difference in the detection rate of MRI In-bore and MRI-TRUS fusion TBx was found. MRI In-bore TBx showed higher per-core percentage of malignant cells. Advances in knowledge MRI In-bore biopsy might impact risk stratification and patient management considering the higher per-core percentage of malignant cells, especially for patients eligible for active surveillance or focal therapy.

Tubeless Percutaneous Nephrolithotomy with Hemostatic Plug Using Surgiflo® versus Standard Percutaneous Nephrolithotomy using a Nephrostomy Tube: A Prospective Randomized Controlled Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hisham Mohamed Fathey Elshawaf ◽  
Mohamed Ismail Shabayek ◽  
Mohamed Ahmed Saleh Ahmed
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Intraoperative Complications ◽  
Demographic Data ◽  
Renal Stones ◽  
Controlled Study ◽  
P Value ◽  
Nephrostomy Tube ◽  
Gelatin Matrix ◽  
Significant Difference ◽  
Tubeless Pcnl

Abstract Background Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large renal stones (over 2cm in diameter). It involves keyhole surgery performed through a small skin incision overlying the kidney. Objectives Our study aimed at evaluating the safety and efficacy of local hemostatic sealant (surgiflo®) use in tubeless PCNL to enhance postoperative outcomes of PCNL. Patients and Methods We randomized our patients into two groups, Group A nephrostomy tube was used as standard PCNL, and at group B tubeless PCNL was done followed by injection of the local hemostatic flowable gelatin matrix (surgiflo®) under fluoroscopic guidance in the prone position Results There was no statistically significant difference between two groups regarding demographic data age, sex and BMI (P- value 0.280, 0.736 and 0.440 respectively), stone site and size (P- value 0.525 and 0.533 respectively), operative time (P- value 0.855), intraoperative complications as blood loss and pelvicalyceal perforation, (P- value 0.92 and P- value 0.83 respectively), postoperative complication as fever, haematuria and UTI (P- value 1.000, 0,113 and 1.000 respectivly), and Hb drop (P- value 0.735). Conclusion Tubeless PCNL with hemostatic sealant use is associated with less pain, no leakage from nephrostomy tract, less narcotic agent use, and a shorter hospital stay.

MRI-guided fusion biopsy of the prostate resection bed among post-radical prostatectomy patients with rising PSA.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 208-208
Author(s):  
Cheyenne Williams ◽  
Nabila Khondakar ◽  
Michael Daneshvar ◽  
Luke P. O'Connor ◽  
Jillian Egan ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Gland ◽  
Lesion Size ◽  
Prostate Tissue ◽  
Gleason Grade ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Prostate Bed ◽  
Gland Tissue ◽  
Benign Prostate

208 Background: Following treatment of prostate cancer with radical prostatectomy (RP), biochemical recurrence (BCR) can be detected with elevated PSA. This may be attributed to either cancer recurrence or retained benign prostatic gland tissue. Options for detecting malignancy after RP currently entail diagnostic imaging and biopsy with transrectal ultrasound (TRUS). TRUS alone has limited accuracy in detecting recurrence in the prostate bed. MRI fusion-guided biopsy (Fbx) may be a more accurate method of detecting post-RP local recurrence. We hypothesize that Fbx for diagnosing benign versus malignant recurrence in the prostate bed is feasible and produces clinically meaningful results. Methods: Our institutional database was queried for patients who received RP and demonstrated BCR between February 2015 and July 2020. All patients with evidence of prostate bed recurrence on mpMRI were included in this analysis. Cancer detection via mpMRI-guided fusion biopsy using the UroNav platform was evaluated and patient variables including final Gleason Grade group (GG), margin involvement, PSA at BCR, and prostate bed lesion size were analyzed with univariate logistic regression. Results: 40 patients (median age = 68) with BCR underwent post-RP mpMRI. 25/40 (62.5%) patients had MRI-visible lesions, and among those, 17/25 (68%) patients underwent Fbx of the prostate bed. 15/17 (88.2%) Fbxs detected prostate tissue (either benign or cancer), 11/17 (64.7%) contained cancer, and 4/17 (23.5%) contained benign prostate glands. Median cores per biopsy was 4 (IQR 4-6). Among the 83 cores obtained, 57 (68.6%) cores contained prostate gland tissue and 26 (31.3%) contained fibromuscular tissue. Of those 57 with gland tissue, 33 (57.9%) cores contained cancer, and 24 (42.1%) contained benign prostate tissue. Among patients with benign biopsies, none had further evidence of metastasis at median follow-up of 13.5 months after Fbx and 182 months after RP. On final RP pathology, 4 patients had GG1 disease, 4 had GG2, 4 had GG3, 2 had GG4, and 3 had GG5. 6/17 (35%) patients had positive RP margins. Median prostate bed lesion size was 1.3 cm (IQR 0.9-1.5). Prostate bed lesion size (cm) was the only variable significantly associated with cancer on Fbx (OR = 2.20, 95% CI:1.29-3.76, p = 0.011). Conclusions: mpMRI-Fbx is a feasible method for reliably targeting prostate bed lesions. With this technique, we found improved accuracy for biopsy-proven recurrence in the prostate bed. This technique will help direct treatment planning of salvage therapies among patients with detectable PSA post-RP. [Table: see text]

Incidental uptake of 18F-fluorodeoxyglucose in the prostate gland

2014 ◽  
Vol 53 (06) ◽  
pp. 249-258 ◽  
Author(s):  
R. Sadeghi ◽  
L. Giovanella ◽  
G. Treglia ◽  
F. Bertagna
Keyword(s):  
Fdg Pet ◽  
Prostate Gland ◽  
Significant Risk ◽  
Published Data ◽  
Pooled Prevalence ◽  
Pet Ct ◽  
Significant Difference ◽  
Risk Of Malignancy ◽  
18F Fdg ◽  
Fdg Pet Ct

SummaryAim: To perform a systematic review and meta-analysis of published data on the prevalence and risk of malignancy of pros- tatic incidental uptake (PIU) detected by flu- orine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) or PET/computed tomography (PET/CT). Patients, material, methods: A comprehensive literature search of studies published up to February 2014 was performed. Pooled prevalence and malignancy risk of PIU were calculated on a per patient-based analysis including 95% confidence interval (95%CI). Furthermore, we assessed some parameters as potential predictors of malignant PIU. Results: Six studies including 47925 patients who underwent 18F-FDG PET/CT were selected. Pooled prevalence of PIU was 1.8% (95%CI: 1.3–2.3%). Overall, 444 patients with PIU were further evaluated and 121 underwent biopsy. The pooled risk of malignancy in patients with PIU further evaluated or verified by biopsy were 17% (95%CI: 12–23%) and 62% (95%CI: 54–71%), respectively. A higher mean age was observed in the group of malignant PIUs compared to benign PIUs. There was a trend towards a higher mean SUVmax in the group of malignant PIUs but without a statistically significant difference compared to benign PIUs. Peripheric site of PIU but not presence or absence of calcification was a predictor of malignancy. Conclusions: PIU is observed in about 1.8% of 18F-FDG PET/CT scans performed in male patients carrying a significant risk of malignancy. Therefore, whenever a PIU is detected further investigation is warranted to exclude malignancy, in particular when PIU is located in the peripheric site of prostate gland.

scholarly journals Age-dependent expression of 5alpha-reductase and androgen receptors mRNA by the canine prostate

2009 ◽  
pp. 155-158
Author(s):  
F Shidaifat
Keyword(s):  
Mrna Expression ◽  
Androgen Receptors ◽  
Prostate Gland ◽  
Normal Growth ◽  
Prostate Hyperplasia ◽  
Reductase Gene ◽  
Significant Difference ◽  
Growth Requirement ◽  
Benign Prostate ◽  
Androgen Effect

The growth of the prostate gland is androgen-dependent. Testosterone is converted to the most potent dihydrotestosterone (DHT) by 5α-reductase within the prostate. Androgen interacts with androgen receptors (AR) to regulate normal growth of the prostate and has also been implicated in both the progression of benign prostate hyperplasia and prostate cancer. This study was conducted to compare the mRNA expression of AR and 5αreductase by the prostate gland from three age categories: immature, young-mature and old dogs. Quantitative gene expression was assessed by the real-time PCR and the results were expressed as a relative mRNA expression of the target gene. This study revealed that there was no significant difference in the mRNA expression of the AR gene by the prostate gland of immature, young and old dogs. In contrast, there is a highly significant (P<0.001) down-regulation in 5α-reductase gene by the prostate of young and old dogs as compared with immature dogs. However, there is no significant difference in mRNA expression of the 5α-reductase gene by the prostate gland from young and old dogs. This differential expression of AR and 5αreductase genes, which are involved in the regulation of androgen effect on prostate gland, might reflect an agedependent growth requirement of the gland for androgens.

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