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- Diffusion-Weighted Imaging to Evaluate for Changes From Androgen Deprivation Therapy in Prostate Cancer. [JOURNAL ARTICLE]
- AJR Am J Roentgenol 2014 Dec; 203(6):W645-W650.
OBJECTIVE. The objective of our study was to investigate the usefulness of apparent diffusion coefficient (ADC) values in evaluating for therapeutic changes from androgen deprivation therapy (ADT) in prostate cancer patients. MATERIALS AND METHODS. Forty-eight patients with prostate cancer treated with ADT were enrolled in this retrospective study. Diffusion-weighted imaging (DWI) at 3 T was performed before and after ADT. Before and after treatment, ADC values were measured in the tumors and in the benign tissues of the prostate, and serum prostate-specific antigen (PSA) levels and prostate volumes were also assessed. Statistical analysis was performed using a paired Student t test, Wilcoxon signed rank test, and Spearman rank correlation. RESULTS. In 48 patients, 55 tumors were identified. After treatment, the mean ADC value of the tumors (1.06 × 10(-3) mm(2)/s) was significantly increased as compared with the pretreatment value (0.78 × 10(-3) mm(2)/s) (p < 0.001), whereas the ADC values of the benign tissues after treatment were significantly decreased compared with the pretreatment values (p < 0.001). The mean prostate volume and mean PSA level were significantly reduced from 42.8 cm(3) and 153.60 ng/mL before treatment to 21.4 cm(3) and 9.51 ng/mL, respectively, after treatment (p < 0.001). Changes in tumor ADC values showed a weak negative correlation with changes in PSA levels after treatment (correlation coefficient, ρ = -0.320; p = 0.028). CONCLUSION. DWI may have potential as a noninvasive tool for monitoring changes in response to ADT in prostate cancer patients.
- Examination of the Early Diagnostic Applicability of Active Dynamic Thermography for Burn Wound Depth Assessment and Concept Analysis. [JOURNAL ARTICLE]
- J Burn Care Res 2014 Nov 19.
Despite advances in perfusion imaging, burn wound imaging technology continues to lag behind that of other fields. Quantification of blood flow is able to predict time for healing, but clear assessment of burn depth is still questionable. Active dynamic thermography (ADT) is a noncontact imaging modality capable of distinguishing tissue of different thermal conductivities. Utilizing the abnormal heat transfer properties of the burn zones, we examined whether ADT was useful in the determination of burn depth in a model of early burn wound evaluation. Duroc pigs (castrated male; n = 3) were anesthetized, and two burns were created with an aluminum billet at 3 and 12 seconds. These contact times resulted in superficial partial and deep partial thickness burn wounds, respectively. ADT and laser Doppler imaging (LDI) imaging were performed every 30 minutes postburn for a total of five imaging sessions ending 150 minutes postburn. For ADT, imaging excitation was performed for 42-120 seconds with dual quartz-infrared lamps, and subsequent infrared image capture was performed for 300 seconds. MATLAB-assisted image analysis was performed to determine burn zone region of interest thermal relaxation and characteristic patterns. LDI was performed with a moorLDI system, and biopsies were captured for histology following the 150-minute imaging session. Both ADT and LDI imaging modalities are able to detect different physical properties at 30, 60, 90 120, and 150 minutes postburn with statistical significance (P < 0.05). Resultant ADT cooling curves characterize greater differences with greater stimulation and a potentially more identifiable differential cooling characteristic. Histological analysis confirmed burn depth. This preliminary work confirms that ADT can measure burn depth and is deserving of further research either as a stand-alone imaging technology or in combination with a device to assess perfusion.
- The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. [JOURNAL ARTICLE]
- Eur J Nucl Med Mol Imaging 2014 Nov 20.
Since the introduction of positron emission tomography (PET) imaging with (68)Ga-PSMA-HBED-CC (=(68)Ga-DKFZ-PSMA-11), this method has been regarded as a significant step forward in the diagnosis of recurrent prostate cancer (PCa). However, published data exist for small patient cohorts only. The aim of this evaluation was to analyse the diagnostic value of (68)Ga-PSMA-ligand PET/CT in a large cohort and the influence of several possibly interacting variables.We performed a retrospective analysis in 319 patients who underwent (68)Ga-PSMA-ligand PET/CT from 2011 to 2014. Potential influences of several factors such as prostate-specific antigen (PSA) level and doubling time (DT), Gleason score (GSC), androgen deprivation therapy (ADT), age and amount of injected tracer were evaluated. Histological verification was performed in 42 patients after the (68)Ga-PSMA-ligand PET/CT. Tracer uptake was measured in 901 representative tumour lesions.In 82.8 % of the patients at least one lesion indicative of PCa was detected. Tumor-detection was positively associated with PSA level and ADT. GSC and PSA-DT were not associated with tumor-detection. The average maximum standardized uptake value (SUVmax) of tumour lesions was 13.3 ± 14.6 (0.7-122.5). Amongst lesions investigated by histology, 30 were false-negative in 4 different patients, and all other lesions (n = 416) were true-positive or true-negative. A lesion-based analysis of sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) revealed values of 76.6 %, 100 %, 91.4 % and 100 %. A patient-based analysis revealed a sensitivity of 88.1 %. Of 116 patients available for follow-up, 50 received local therapy after (68)Ga-PSMA-ligand PET/CT.(68)Ga-PSMA-ligand PET/CT can detect recurrent PCa in a high number of patients. In addition, the radiotracer is highly specific for PCa. Tumour detection is positively associated with PSA and ADT. (68)Ga-PSMA-ligand PET/CT can help delay systemic therapy of PCa.
- Kinetically-controlled growth of cubic and octahedral Rh-Pd alloy oxygen reduction electrocatalysts with high activity and durability. [JOURNAL ARTICLE]
- Nanoscale 2014 Nov 19.
Rh is a promising candidate as an indispensible component in bimetallic catalysts due to its unique capability to resist against the aggressive corrosion from the reaction medium. However, Rh has a very strong oxygen binding ability and is generally not suitable for the oxygen reduction reaction (ORR). Here, we have demonstrated shape-controlled synthesis of Rh-Pd alloy nanocrystals with high activity and durability for ORR by retarding the reaction kinetics at an ultra-slow injection rate of metal salts using a syringe pump. Under precise control of sluggish reaction kinetics, Pd followed a preferential overgrowth along the <100> direction, whereas the growth behavior of Rh was dominant along the <111> direction. These different kinetically-controlled growth behaviors associated with Rh and Pd were essential for achieving the shape transition between the cube and the octahedron of their alloys. The Rh8Pd92 alloy octahedra exhibited the highest mass activity with a value of 0.18 mA μg(-1) in terms of the equivalent Pt cost, and were two-fold higher than that of commercial Pt/C. Significantly, all Rh-Pd alloy nanocrystals were highly stable with only less than 25% loss in mass activity after 30 000 CV cycles in O2 saturated acid solution compared to ∼56% loss of the commercial Pt/C (E-TEK). Indeed, the mass activity of Rh8Pd92 was 3.3 times higher than that of commercial Pt/C after the accelerated stability test (ADT). This improvement in activity and durability may arise possibly from synergistic effects between the facet and the surface composition.
- Management and Characteristics of Patients with Metastatic Prostate Cancer in a Cohort of New Zealand Men. [JOURNAL ARTICLE]
- Oncology 2014 Nov 15; 88(3):157-163.
Objective: This study aims to (1) characterise men diagnosed with metastatic prostate cancer, (2) describe their management and (3) look at their survival. Methods: We identified patients registered with prostate cancer in the New Zealand Cancer Registry in the Midland Cancer Network region in 2009-2012 and examined these patients' clinical records to identify the metastatic cases. We investigated the patients' characteristics and the treatment pattern. All-cause survival was estimated by the Cox proportional hazards model. Results: Of the 2,127 men diagnosed with prostate cancer, 234 (26 Maori/Pacific and 208 non-Maori/non-Pacific) were diagnosed with metastatic prostate cancer. After the diagnosis, 194 (82.9%) patients received androgen deprivation therapy (ADT), 5 had chemotherapy and 104 (44.4%) had radiotherapy. Of the patients treated with ADT, 46 (23.7%) had no monitoring prostate-specific antigen tests. Fifty-nine percent of the patients were alive after 12 months and 35% after 24 months. The hazard ratio for the Maori/Pacific men was 1.49. Conclusion: Overall, the survival of patients with metastatic prostate cancer was poor. There seems to be a strong case for the development of New Zealand guidelines on the management of metastatic disease including the use of first-line treatments, the ongoing monitoring for the development of castration-resistant prostate cancer (CRPC) and the treatment of CRPC. © 2014 S. Karger AG, Basel.
- Stereotactic body radiation therapy (SBRT) for prostate cancer in men with large prostates (¿50 cm 3 ). [JOURNAL ARTICLE]
- Radiat Oncol 2014 Nov 15; 9(1):241.
BackgroundPatients with large prostate volumes have been shown to have higher rates of genitourinary and gastrointestinal toxicities after conventional radiation therapy for prostate cancer. The efficacy and toxicity of stereotactic body radiation therapy (SBRT), which delivers fewer high-dose fractions of radiation treatment, is unknown for large prostate volume prostate cancer patients. We report our early experience using SBRT for localized prostate cancer in patients with large prostate volumes.Methods57 patients with prostate volumes ¿50 cm3 prior to treatment with SBRT for localized prostate carcinoma and with a minimum follow up of two years were included in this retrospective review of prospectively collected data. Treatment was delivered using Cyberknife (Accuray) with doses of 35¿36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were scored using the CTCAE v.4. Quality of life was assessed using the American Urological Association (AUA) Symptom Score and the Expanded Prostate Cancer Index Composite (EPIC)-26.Results57 patients (23 low-, 25 intermediate- and 9 high-risk according to the D¿Amico classification) at a median age of 69 years (range, 54¿83 years) received SBRT with a median follow-up of 2.9 years. The median prostate size was 62.9 cm3 (range 50¿138.7 cm3). 33.3% of patients received ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.5 ng/ml and decreased to a median PSA of 0.4 ng/ml by 2 years (p <0.0001). A mean baseline AUA symptom score of 7.5 significantly increased to 13 at 1 month (p =0.001) and returned to baseline by 3 months (p =0.21). 23% of patients experienced a late transient urinary symptom flare in the first two years following treatment. Mean baseline EPIC bowel scores of 95.8 decreased to 78.1 at 1 month (p <0.0001), but subsequently improved to 93.5 three months (p =0.08). The 2-year actuarial incidence rates of GU and GI toxicity¿¿¿grade 2 were 49.1% and 1.8%, respectively. Two patients (3.5%) experienced grade 3 urinary toxicity, and no patient experienced grade 3 gastrointestinal toxicity.ConclusionsSBRT for clinically localized prostate cancer was well tolerated in men with large prostate volumes.
- Prostate cancer therapy may raise risk of death in men with heart problems. [Journal Article]
- Nurs Stand 2014 Nov 12; 29(11):17.
Men who are prescribed androgen deprivation therapy (ADT) for prostate cancer may have an increased risk of dying if they have congestive heart failure or a prior myocardial infarction, suggests a study in the United States.
- Cardiovascular events associated with androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis. [JOURNAL ARTICLE]
- World J Urol 2014 Nov 12.
A recently published meta-analysis of randomized clinical trials (RCT) showed that androgen deprivation therapy (ADT) did not significantly increase cardiovascular mortality in prostate cancer patients. However, cardiovascular morbidity, which can impact quality of life, was not evaluated.To evaluate the risk of cardiovascular morbidity associated with ADT in patients with prostate cancer.We conducted a literature search from January 1960 to June 2012. RCT and large cohort studies that evaluated first-line endocrine therapy and ADT longer than 6 months were screened for inclusion.In total, 126,898 patients were included in four cohort studies, and 10,760 patients were included in nine RCTs. Analysis of the RCTs showed no differences in the development of acute myocardial infarction (AMI) (OR 1.23; 95 % CI 0.92-1.64; I (2): 0 %) among the patients receiving ADT or not. The analysis of randomized studies that reported other nonfatal cardiovascular events demonstrated a significant increase in such events in the group receiving ADT (OR 1.55; 95 % CI 1.09-2.20; I (2): 0 %). When the large cohort studies were included in the analysis, an increased risk of AMI among men with ADT was found (OR 2.01, 95 % CI 1.90-2.13; I (2): 91,3 %).The use of ADT in prostate cancer patients corresponded with a significant increase in cardiovascular morbidity associated with AMI and with nonfatal events. Therefore, ADT is linked to a significant negative impact on quality of life. Periodic cardiovascular evaluation is required for these patients.
- Development of a nomogram model predicting current bone scan positivity in patients treated with androgen-deprivation therapy for prostate cancer. [Journal Article]
- Front Oncol 2014.:296.
To develop a nomogram predictive of current bone scan positivity in patients receiving androgen-deprivation therapy (ADT) for advanced prostate cancer; to augment clinical judgment and highlight patients in need of additional imaging investigations.A retrospective chart review of bone scan records (conventional (99m)Tc-scintigraphy) of 1,293 patients who received ADT at the Memorial Sloan-Kettering Cancer Center from 2000 to 2011. Multivariable logistic regression analysis was used to identify variables suitable for inclusion in the nomogram. The probability of current bone scan positivity was determined using these variables and the predictive accuracy of the nomogram was quantified by concordance index.In total, 2,681 bone scan records were analyzed and 636 patients had a positive result. Overall, the median pre-scan prostate-specific antigen (PSA) level was 2.4 ng/ml; median PSA doubling time (PSADT) was 5.8 months. At the time of a positive scan, median PSA level was 8.2 ng/ml; 53% of patients had PSA <10 ng/ml; median PSADT was 4.0 months. Five variables were included in the nomogram: number of previous negative bone scans after initiating ADT, PSA level, Gleason grade sum, and history of radical prostatectomy and radiotherapy. A concordance index value of 0.721 was calculated for the nomogram. This was a retrospective study based on limited data in patients treated in a large cancer center who underwent conventional (99m)Tc bone scans, which themselves have inherent limitations.This is the first nomogram to predict current bone scan positivity in ADT-treated prostate cancer patients, providing high predictive accuracy.
- Bone Scan Index as a prognostic imaging biomarker during androgen deprivation therapy. [Journal Article]
- EJNMMI Res 2014.:58.
Bone Scan Index (BSI) is a quantitative measurement of tumour burden in the skeleton calculated from bone scan images. When analysed at the time of diagnosis, it has been shown to provide prognostic information on survival in men with metastatic prostate cancer (PCa). In this study, we evaluated the prognostic value of BSI during androgen deprivation therapy (ADT).Prostate cancer patients who were at high risk of a poor outcome and who had undergone bone scan at the time of diagnosis and during ADT were recruited from two university hospitals for a retrospective study. BSI at baseline and follow-up were calculated using an automated software package (EXINIbone(bsi)). Associations between BSI, other prognostic biomarkers and overall survival (OS) were evaluated using a Cox proportional hazards regression model.One hundred forty-six PCa patients were included in the study. A total of 102 patient deaths were registered, with a median survival time after the follow-up bone scan of 2.4 years (interquartile range (IQR) =0.8 to 4.4). Both at baseline and during ADT, BSI was significantly associated with OS in univariate and multivariate analyses. When BSI was added to a prognostic base model including age, prostate-specific antigen, clinical tumour stage and Gleason score, the concordance index increased from 0.73 to 0.77 (p =0.0005) at baseline and from 0.77 to 0.82 (p <0.0001) during ADT.Automated BSI during ADT is an independent prognostic indicator of OS in PCa patients with bone metastasis. It represents an emerging imaging biomarker that can be used in a prognostic model for risk stratification of PCa patients at the time of diagnosis and at later stages of the disease. BSI could then help physicians identify patients who could benefit from more aggressive therapies.