Anterior Gland Research Articles

Quantifying Iodine-125 Placement Accuracy in Prostate Brachytherapy Using Post-Implant Transrectal Ultrasound Images

The quality of a prostate brachytherapy implant depends on the accurate placement of seeds in their intended locations. This study quantifies the displacement of iodine-125 seeds from the intended location using intraoperative ultrasound images. Intraoperatively, following the completion of each prostate brachytherapy implant, additional axial images at 5mm intervals were captured using transrectal ultrasound from the base of the prostate gland to the apex. The images were imported to VariSeed v8.0 and the prostate was contoured. Iodine-125 seeds were identified on the ultrasound images using seed ultrasound characteristics and the preoperative plan; due to the subjective nature of identifying seeds, only seeds identified with high confidence were included in the analysis. Displacements from the original intended coordinate were measured in the X, Y and Z axis. The measures of displacement were stratified between overall displacement, the regions of prostate gland divided into anterior vs posterior, medial vs lateral and base vs midgland vs apex. 1619 iodine-125 seeds using 357 strands were implanted in 15 patients’ prostate glands having a mean volume of 50.4cc (range 28.3-76.7cc). Of the 1619 seeds implanted, 1196 (73.87%) were confidently identified using the method described for the displacement analysis. The overall mean displacement in the X, Y and Z direction is 0.13, 0.15 and 0.37cm respectively. Greater seed displacement occurred in the anterior part of the prostate gland than the posterior part of the prostate gland by factor of 37.6% in the X direction (p-value 0.0001), 36.1% in the Y direction (p-value=0.0001) and 32.4% in the Z direction(p-value=0.0127) (See Table 1). Stratifying lateral vs medial regions of the prostate gland, no statistically significant differences in seed displacement were observed. Comparing displacement differences in the base vs midgland vs apex identified the greatest differences between the base and midgland in the Z-axis (47.2%, p value = 0.0001) and X-axis (22.3%, p value 0.0008). This study has identified significant displacement of iodine-125 seeds from their intended locations with the greatest error occurring in the Z-direction. Seed displacement tends to occur more commonly in the anterior gland (compared to the posterior gland) and in the base of the prostate (particularly in the X and Z direction) compared to the mid-gland or apex.Tabled 1Region of Prostate GlandSeed displacement (in cm)X-AxisY-AxisZ-AxisAnterior0.150.180.43Posterior0.110.130.33p-Value0.00010.00010.0127Lateral0.130.160.37Medial0.130.150.38p-Value0.66890.33430.6094Base0.140.150.46Mid Gland0.120.150.31Apex0.120.150.33p-Value (Comparing base vs midgland)0.00080.68650.0001 Open table in a new tab

Caspar Bauhin (1560-1624): Swiss anatomist and reformer of anatomical nomenclature

Caspar Bauhin (1560-1624) was a Swiss anatomist, physician and botanist. He commenced the study of medicine at a young age in Basel but had to move to Padua after an outbreak of plague in his native place. In Padua, he was privileged to study under Fabricius ab Aquapendente, an accomplished anatomist of his time, and other pioneers in the field of medicine, surgery and botany. He travelled extensively through Italy, France and Germany before finally returning to Basel, where he started to conduct public anatomy dissections and in due course was appointed to the Chair of Anatomy and Botany at the University of Basel. His treatise, Theatrum anatomicum (1605), was considered as the finest comprehensive text in anatomy during that period. Theatrum was highly appreciated as it followed a systemic approach with focus on anatomical anomalies and had a useful set of illustrations. His major contribution to Anatomy was the introduction of a descriptive terminology which replaced the prevalent trend of naming the structures with ordinal numbers and cleared the confusion among anatomists in relation to identification of structures. He was the first to describe the anterior lingual glands (Bauhin’s gland), which are seromucous glands located near the tip of tongue. He is presumed to be the first to report the ileocecal valve, which is also known as Bauhin’s valve. Bauhin’s contributions are a true testimony of his legacy in the domain of anatomical sciences.

The Schistosome Esophagus Is a ‘Hotspot’ for Microexon and Lysosomal Hydrolase Gene Expression: Implications for Blood Processing

BackgroundThe schistosome esophagus is divided into anterior and posterior compartments, each surrounded by a dense cluster of gland cell bodies, the source of distinct secretory vesicles discharged into the lumen to initiate the processing of ingested blood. Erythrocytes are lysed in the lumen, leucocytes are tethered and killed and platelets are eliminated. We know little about the proteins secreted from the two glands that mediate these biological processes.Methodology/Principal FindingsWe have used subtractive RNA-Seq to characterise the complement of genes that are differentially expressed in a head preparation, compared to matched tissues from worm tails. The expression site of representative highlighted genes was then validated using whole munt in situ hybridisation (WISH). Mapping of transcript reads to the S. mansoni genome assembly using Cufflinks identified ~90 genes that were differentially expressed >fourfold in the head preparation; ~50 novel transcripts were also identified by de novo assembly using Trinity. The largest subset (27) of secreted proteins was encoded by microexon genes (MEGs), the most intense focus identified to date. Expression of three (MEGs 12, 16, 17) was confirmed in the anterior gland and five (MEGs 8.1, 9, 11, 15 and 22) in the posterior gland. The other major subset comprised nine lysosomal hydrolases (aspartyl proteases, phospholipases and palmitoyl thioesterase), again localised to the glands.ConclusionsA proportion of the MEG-encoded secretory proteins can be classified by their primary structure. We have suggested testable hypotheses about how they might function, in conjunction with the lysosomal hydrolases, to mediate the biological processes that occur in the esophagus lumen. Antibodies bind to the esophageal secretions in both permissive and self-curing hosts, suggesting that the proteins represent a novel panel of untested vaccine candidates. A second major task is to identify which of them can serve as immune targets.

Will Magnetic Resonance Imaging-guided Biopsy Replace Systematic Biopsy?

The main disadvantages of the current diagnostic pathway in men with an elevated risk of prostate cancer (PCa) are that: (1) systematic transrectal ultrasound (TRUS) biopsy misses a substantial proportion (20%) of significant PCa because of inherent systematic sampling errors, especially in the anterior gland [1,2]; (2) misclassifies pathologic status including Gleason score (Gl) and tumour stage [3]; and (3) detects a high proportion of men with disease that is unlikely to be harmful (clinically insignificant), with subsequently overtreatments resulting in unintended harm [4]. The latter was the main reason for the U.S. Preventive Services Task Force recommendation against prostate-specific antigenbased screening for prostate cancer in 2012 [5].

Impact of selective pituitary gland incision or resection on hormonal function after adenoma or cyst resection.

With the resection of pituitary lesions, the anterior pituitary gland often obstructs transsphenoidal access to the lesion. In such cases, a gland incision and/or partial gland resection may be required to obtain adequate exposure. We investigate this technique and determine the associated risk of post-operative hypopituitarism. All patients who underwent surgical resection of a pituitary adenoma or Rathke cleft cyst (RCC) between July 2007 and January 2013 were analyzed for pre- and post-operative hormone function. The cohort of patients with gland incision/resection were compared to a case-matched control cohort of pituitary surgery patients. Total hypophysectomy patients were excluded from outcome analysis. Of 372 operations over this period, an anterior pituitary gland incision or partial gland resection was performed in 79 cases (21.2%). These include 53 gland incisions, 12 partial hemi-hypophysectomies and 14 resections of thinned/attenuated anterior gland. Diagnoses included 64 adenomas and 15 RCCs. New permanent hypopituitarism occurred in three patients (3.8%), including permanent DI (3) and growth hormone deficiency (1). There was no significant difference in the rate of worsening gland dysfunction nor gain of function. Compared to a control cohort, there was a significantly lower incidence of transient DI (1.25 vs. 11.1%, p=0.009) but no significant difference in permanent DI (3.8 vs. 4.0%) in the gland incision group. Selective gland incisions and gland resections were performed in over 20% of our cases. This technique appears to minimize traction on compressed normal pituitary gland during removal of large lesions and facilitates better visualization and removal of cysts, microadenomas and macroadenomas.

EP-1236: Multiparametric MRI appearance of prostate after androgen deprivation therapy ñ preliminary results

Purpose/Objective: Globally, prostate cancer is responsible for around 250000 deaths annually. Radiotherapy is an effective definitive treatment and, for more aggressive disease, is commonly preceded by neo-adjuvant androgen deprivation therapy (ADT). It has been demonstrated that dose escalated radiotherapy improves biochemical free survival but not overall survival. Further dose escalation is limited by OAR tolerances. Giving a further focal boost to the dominant intra-prostatic lesion (DIPL) appears to be feasible. The DIPL is effectively identified using multi-parametric (MP) MR imaging, however, ADT results in a reduction in prostate and tumour volume and also a loss of contrast on T2w MR images, making lesions less conspicuous. The DIPL is therefore conventionally identified on pre-hormone imaging but it is known that response to therapy is variable and directing a DIPL boost to disease that is resistant to ADT may be most likely to improve clinical outcome. The aim of this work was to compare pre and post treatment imaging to evaluate the feasibility of using post treatment MP-MRI to locate the DIPL. Materials and Methods: Six patients with prostate cancer stage T2b or greater were recruited. All underwent local pre ADT DWI. Patients were imaged post ADT at 1.5 T (Achieva, Philips Medical Systems, Best, The Netherlands) using the cardiac coil. The MR examination included high resolution T2w images, DCE-MRI and diffusion-weighted imaging (DWI). ADC and DCE-MRI parameter maps were calculated on a voxel-by-voxel basis for the whole prostate. Results: Four patients had a clear DIPL pre ADT. This remained largely unchanged in appearance in three cases post ADT, as shown in the example case in the top row of figure 1, where arrows indicate the high flow (left, Fp in ml/ml tissue/min overlayed on T2w imaging), low ADC (right, overlayed on T2w imaging) regions matching those reported as tumour on pre-treatment imaging. In one case the pre ADT DIPL in the right peripheral zone was hard to identify post ADT on T2w imaging (black arrow bottom row, figure 1). However a further lesion in the left anterior gland (white arrow), which was equivocal in appearance pre-treatment, was now conspicuous in both Fp (left) and ADC maps (right).

Biopsy follow-up in patients with isolated atypical small acinar proliferation (ASAP) in prostate biopsy

The incidence of prostate cancer (PCA) was evaluated in 155 patients with isolated Atypical Small Acinar Proliferation (ASAP) found on initial prostate biopsy, after a medium-term follow-up (40 months) with at least one re-biopsy. Clinical and histological data were analysed. Cancer was detected in 81 of 155 (52.3%). The cancer detection rate was 71.6%, 91.3%, 97.5%, 100% at the 1st re-biopsy, 2nd, 3rd, and 4th rebiopsy respectively. At the uni- and multivariate analyses, prostate volume (≤ 30 cc), transition zone volume (≤ 10 cc), small core length at the initial biopsy (≤ 10 mm) and few number of cores at initial biopsy (≤ 8) are predictive of cancer. Furthermore, tumour characteristics on the whole surgical specimens was assessed in 30 men: 13 of 30 (43 %) had clinically relevant cancer (volume > 0.5 ml or/and Gleason score ≥ 7, or pT3). Most of relevant cancers were detected in the distal apex, anterior gland and midline. These anatomical sites could be under-sampled at the initial biopsy using the transrectal approach. Our data suggest that follow-up biopsy is recommended in all cases of isolated ASAP detected after biopsy using endfire transrectal probe. The re-biopsy strategy should increase the number of cores (or a saturation biopsy), focusing on area of ASAP in the initial biopsy, but also including the under-sampled areas (anterior gland, distal apex and midline) to detect clinically relevant cancers.

Light and Scanning Electron Microscopy Studies of Quail Tongues

The present study was conducted on the tongues of six Punjab white quails. The tissues from the apex, body and root of the tongue were processed for paraffin sectioning and scanning electron microscopy studies. The tongue was triangular in shape having an apex, body and root. The dorsal surface of the apex and body was smooth whereas large lingual conical papillae were located symmetrically and converging in median line between the body and the root. There was an additional layer of conical papillae composed of two large papillae behind the main row of papillae. The tongue was lined by stratified squamous epithelium which was keratinised at the apex. The anterior lingual salivary glands were mainly serous type whereas the posterior salivary glands were mucous type. There were topographical differences in the size, shape and appearance of the exfoliated superficial cells of the dorsal surface epithelium in the apex and body of the tongue.

MP53-06 MAGNETIC RESONANCE IMAGING DETECTED PROSTATE EVASIVE ANTERIOR TUMORS: FURTHER INSIGHTS

Introduction: Clinical confusion continues to exist regarding the underestimation of cancers among patients on active surveillance and among men with repeated negative prostate biopsies despite worrisome prostate-specific antigen (PSA) levels. We have previ ously described our initial experience with magnetic resonance imaging (MRI)-based detection of tumours in the anterior prostate gland. In this report, we update and expand our experience with these tumours in terms of multiparametric-MRI findings, staging, and grading. Furthermore, we report early treatment outcomes with these unique cancers. Methods: We reviewed our prostate MRI dataset of 1117 cases from January 2006 until December 2012 and identified 189 patients who fulfilled criteria for prostate evasive anterior tumors (PEATS). Descriptive analyses were performed on multiple covariates. Kaplan-Meier actuarial technique was used to plot the treatmentrelated outcomes from PEATS tumours. Results: Among the 189 patients who had MRI-detectable anterior tumours, 148 had biopsy proven disease in the anterior zone. Among these tumours, the average PSA was 18.3 ng/mL and most cancers were Gleason 7. In total, 68 patients chose surgical therapy. Among these men, most of their cancers had extra prostatic extension and 46% had positive surgical margins. Interestingly, upgrading of tumours that were biopsy Gleason 6 in the anterior zone was common, with 59% exhibiting upgrading to Gleason 7 or higher. Biochemical-free survival among men who elected surgery was not ideal, with 20% failing by 20 months. Conclusion: PEATS tumours are found late and are disproportionally high grade tumours. Careful consideration to MRI testing should be given to men at risk for PEATS.

Does prostate HistoScanning™ play a role in detecting prostate cancer in routine clinical practice? Results from three independent studies

To evaluate the ability of prostate HistoScanning™ (PHS; Advanced Medical Diagnostics, Waterloo, Belgium) to detect, characterize and locally stage prostate cancer, by comparing it with transrectal ultrasonography (TRUS)-guided prostate biopsies, transperineal template prostate biopsies (TTBs) and whole-mount radical prostatectomy specimens. Study 1. We recruited 24 patients awaiting standard 12-core TRUS-guided biopsies of the prostate to undergo PHS immediately beforehand. We compared PHS with the TRUS-guided biopsy results in terms of their ability to detect cancer within the whole prostate and to localize it to the correct side and to the correct region of the prostate. Lesions that were suspicious on PHS were biopsied separately. Study 2. We recruited 57 patients awaiting TTB to have PHS beforehand. We compared PHS with the TTB pathology results in terms of their ability to detect prostate cancer within the whole gland and to localize it to the correct side and to the correct sextant of the prostate. Study 3. We recruited 24 patients awaiting radical prostatectomy for localized prostate cancer to undergo preoperative PHS. We compared PHS with standardized pathological analysis of the whole-mount prostatectomy specimens in terms of their measurement of total tumour volume within the prostate, tumour volume within prostate sextants and volume of index lesions identified by PHS. The PHS-targeted biopsies had an overall cancer detection rate of 38.1%, compared with 62.5% with standard TRUS-guided biopsies. The sensitivity and specificity of PHS for localizing tumour to the correct prostate sextant, compared with standard TRUS-guided biopsies, were 100 and 5.9%, respectively. The PHS-targeted biopsies had an overall cancer detection rate of 13.4% compared with 54.4% for standard TTB. PHS had a sensitivity and specificity for cancer detection in the posterior gland of 100 and 13%, respectively, and for the anterior gland, 6 and 82%, respectively. We found no correlation between total tumour volume estimates from PHS and radical prostatectomy pathology (Pearson correlation coefficient -0.096). Sensitivity and specificity of PHS for detecting tumour foci ≥0.2 mL in volume were 63 and 53%. These three independent studies in 105 patients suggest that PHS does not reliably identify and characterize prostate cancer in the routine clinical setting.

Chapter 9 - Central regulation of the hypothalamo–pituitary–thyroid (HPT) axis: focus on clinical aspects

The hypothalamus is the most prominent brain region involved in setpoint regulation of the thyroid axis. It generates the diurnal thyroid-stimulating hormone (TSH) rhythm, and it plays a central role in the adaptation of the thyroid axis to environmental factors such as caloric deprivation or infection. Many studies, including studies in human post-mortem tissue samples, have confirmed a key role for the thyrotropin-releasing hormone (TRH) neuron in the hypothalamic paraventricular nucleus (PVN) in thyroid axis regulation. In addition to their negative feedback action on TRH neurons in the hypothalamus, intrahypothalamic thyroid hormones can also modulate metabolism in adipose tissue and the liver via the autonomic nervous system. Congenital or acquired dysfunction of the hypothalamus or pituitary gland may result in central hypothyroidism (CeH). In the Netherlands, the prevalence of permanent congenital CeH as detected by neonatal screening is approximately 1 in 18000. In most neonates congenital CeH is accompanied by additional anterior pituitary hormone deficiencies, and many show clear morphological abnormalities such as a small anterior gland, a thin or absent pituitary stalk, or an ectopic posterior pituitary gland. Recently, a mutation in the immunoglobulin superfamily member 1 (IGSF1) gene was reported as a novel cause of X-linked, apparently isolated CeH occurring in neonates, children and adults. In adults, the most frequent cause of acquired CeH is a pituitary macroadenoma, usually accompanied by other pituitary hormone deficiencies. Central hyperthyroidism is a rare disorder, especially in children. In adults, it is mostly caused by a TSH-secreting pituitary adenoma.

Prostate Imaging: Evaluation of a Reusable Two-Channel Endorectal Receiver Coil for MR Imaging at 1.5 T

To prospectively compare image quality with use of a two-channel solid reusable phased-array endorectal receiver coil (SPAC) with that of the single-channel inflatable endorectal balloon coil currently in widespread use for 1.5-T magnetic resonance (MR) imaging of the prostate. Institutional review board approval and informed consent were obtained. Multiparametric prostate MR imaging at 1.5 T was performed in patients who were suspected of having cancer. Thirty consecutive patients were included (mean age, 66.1 years; range, 49-76 years). The first 15 patients were imaged by using a balloon coil and an eight-channel external array, and the remaining 15 were imaged with a SPAC alone. One patient was imaged with both techniques. Axial T2-weighted images acquired at both standard and high spatial resolution were used to compare image quality between coils. Qualitative assessments of image quality were made separately by three radiologists. Signal-to-noise ratio (SNR) profiles were determined on a pixel-by-pixel basis in a 1-cm central band in the prostate by using T1-weighted axial images at the apex, midgland, and base. Interrater reliability was determined by using a two-way intraclass correlation coefficient, qualitative scores were compared by using the Student t test for independent samples, and SNR profiles were plotted by using a Biot-Savart curve approximation. SNR of the SPAC was significantly better compared with that of the balloon coil at distances up to 3.0 cm at the apex and 3.5 cm at the base and midgland (P < .001). There was a 7% improvement in SNR at the mean maximal anteroposterior prostate dimension in this cohort and a 96% improvement at half this distance. At both standard and high spatial resolution, significant improvements in overall image quality (P = .015 and P < .001, respectively), visibility of the anterior gland (P = .009 and P < .001, respectively), and noise (P < .001 and P < .001, respectively) were seen when the SPAC was used. Interrater reliability was 0.536 (95% confidence interval: 0.461, 0.603). Both SNR and image quality were significantly improved with use of the SPAC at 1.5 T compared with use of the single-channel inflatable endorectal balloon coil.

Cushing’s disease due to mixed pituitary adenoma-gangliocytoma of the posterior pituitary gland presenting with Aspergillus sp. sinus infection

Gangliocytic lesions of the pituitary gland producing Cushing's disease are extremely rare entities that may exist with or without a pituitary adenoma. The latter have been designated mixed pituitary adenoma-gangliocytomas, the majority of which produce growth hormone, not adrenocorticotropin (ACTH), and are localized to the anterior gland. We now report an immunocompetent woman with hypercortisolism who presented with an intranasal aspergilloma eroding the bony sellar floor. The fungal ball was contiguous with, and extended into, a large neurohypophyseal-centered mass. Transsphenoidal resection revealed a gangliocytic lesion of the posterior gland with small clusters of intimately admixed ACTH-immunoreactive adenoma cells as the cause of her Cushing's disease. Rare transitional sizes and shapes of cells coupled with immunohistochemical findings supported interpretation as advanced neuronal metaplasia within an ACTH adenoma. This mixed ACTH adenoma-gangliocytoma is the first example to present clinically with an opportunistic infection.

Cloacal Anatomy of the Male Carpathian Newt,Lissotriton montandoni(Amphibia, Salamandridae), in the Breeding Season

This study presents the first light microscopy-based description of the cloacal anatomy of male Carpathian newts (Lissotriton montandoni). This European newt species hybridizes with its sister species, the smooth newt (L. vulgaris), despite a high level of prezygotic isolation. The goal of the study was to ascertain possible anatomical differences in cloacal anatomy, especially pheromone and spermatophore producing glands, which might potentially affect reproductive isolation between L. montandoni and L. vulgaris. The cloaca of L. montandoni males consists of the cloacal tube, cloacal chamber, pseudopenis, and aggregations of cloacal glands. Four main types of cloacal glands were recognized. Pheromone-producing dorsal glands are of two types due to differences in their secretory epithelium: cuboidal and high prismatic. The remaining glands: ventral, pelvic, and Kingsbury's glands, are most likely involved in the synthesis of spermatophore components. Two distinct groups of ventral glands were identified: posterior and anterior ventral glands. In comparison with L. vulgaris, no evident differences were found that could potentially affect courtship pheromone synthesis by dorsal glands or the base and the cap of the spermatophore produced by the remaining cloacal glands.

Diagnosis of relevant prostate cancer using supplementary cores from magnetic resonance imaging-prompted areas following multiple failed biopsies

ObjectivesTo establish the value of MRI in targeting re-biopsy for undiagnosed prostate cancer despite multiple negative biopsies and determine clinical relevance of detected tumors. Materials and MethodsThirty-eight patients who underwent MRI after 2 or more negative biopsies due to continued clinical suspicion and later underwent TRUS-guided biopsy supplemented by biopsy of suspicious areas depicted by MRI were identified. Diagnostic performance of endorectal 3T MRI in diagnosing missed cancer foci was assessed using biopsy results as the standard of reference. Ratio of positive biopsies using systematic versus MRI-prompted approaches was compared. Gleason scores of detected cancers were used as surrogate for clinical relevance. ResultsThirty-four percent of patients who underwent MRI before re-biopsy had prostate cancer on subsequent biopsy. The positive biopsy yield with systematic sampling was 23% versus 92% with MRI-prompted biopsies(p<0.0001). Seventy-seven percent of tumors were detected exclusively in the MRI-prompted zones. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRI to provide a positive biopsy were 92%, 60%, 55%, 94% and 71%, respectively. The anterior gland and apical regions contained most tumors; 75% of cancers detected by MRI-prompted biopsy had Gleason score≥7. ConclusionsClinically relevant tumors missed by multiple TRUS-guided biopsies can be detected by a MRI-prompted approach.

2204 IS MRI WITH DIFFUSION WEIGHTED IMAGING EFFECTIVE IN DETECTING PROSTATE CANCER IN MEN WITH PREVIOUS NEGATIVE BIOPSIES?

You have accessJournal of UrologyProstate Cancer: Detection & Screening (V)1 Apr 20132204 IS MRI WITH DIFFUSION WEIGHTED IMAGING EFFECTIVE IN DETECTING PROSTATE CANCER IN MEN WITH PREVIOUS NEGATIVE BIOPSIES? Matthew Young, Ryan Levey, James Rosoff, Josh Smith, George Ghareeb, Brian Lane, Andrew Hardie, Thomas Keane, and Stephen Savage Matthew YoungMatthew Young Charleston, SC More articles by this author , Ryan LeveyRyan Levey Charleston, SC More articles by this author , James RosoffJames Rosoff Charleston, SC More articles by this author , Josh SmithJosh Smith Grand Rapids, MI More articles by this author , George GhareebGeorge Ghareeb Grand Rapids, MI More articles by this author , Brian LaneBrian Lane Grand Rapids, Macedonia More articles by this author , Andrew HardieAndrew Hardie Charlestons, SC More articles by this author , Thomas KeaneThomas Keane Charleston, SC More articles by this author , and Stephen SavageStephen Savage Charleston, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2113AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate biopsy is typically triggered by elevated serum prostate specific antigen (PSA) or abnormal digital rectal examination (DRE). However, the false negative rate of initial biopsy can be as high as 35%. A diagnostic dilemma exists in those individuals with continued clinical suspicion of cancer and negative initial biopsy. These individuals have often been subjected to repeat biopsy which may have significant morbidity, including peri and post-procedural discomfort, infection, and psychological stress. We examined whether pelvic MRI with gadolinium and diffusion-weighted imaging is an effective adjunct in identifying prostate cancer in patients who have had previous negative prostate biopsy. METHODS After obtaining IRB approval, a retrospective review from two institutions was performed to identify patients who have had an MRI of the prostate after a previous negative prostate needle biopsy. A total of 76 patients were identified. Multi-parametric, phased array coil MRI was performed of the prostate. Image sequences obtained included high resolution T1 and T2-weighted, diffusion-weighted and dynamic pre and post contrast sequences. Patient charts were reviewed for biopsy results and techniques, PSA dynamics, age, and physical exam. RESULTS 76 patients with a median of 2 previous negative biopsies (range 1-5) were evaluated, with 36 having suspicious findings on MRI, of whom 32 underwent biopsy. 8 patients had pathologically-proven prostate cancer, 5 from the anterior gland, 1 from the apex, and 2 from the transition zone. For patients with suspicious findings on MRI, those with subsequent negative biopsies had a significantly lower PSA density than those with positive biopsies (0.15ng/ml/cc vs 0.31 ng/ml/cc; p =0.004), with a median prostate volume of 56.5 cc. No significant difference in PSA velocity (0.058 vs 0.051 ng/ml/year) or doubling time (7.4 VS 7.8 years) was found. CONCLUSIONS The exact role of MRI in patients with previous negative biopsies remains controversial. Detection rates using MRI following at least one negative biopsy vary from 38-52% in multiple studies. Our results suggest PSA density, in addition to MRI findings, may improve the sensitivity of MRI and help guide physicians in management for patients with persistently elevated PSA and initial negative prostate biopsies. In addition, MRI findings may help direct biopsies to regions not typically biopsied during a standard 12 core office biopsy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e903-e904 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Young Charleston, SC More articles by this author Ryan Levey Charleston, SC More articles by this author James Rosoff Charleston, SC More articles by this author Josh Smith Grand Rapids, MI More articles by this author George Ghareeb Grand Rapids, MI More articles by this author Brian Lane Grand Rapids, Macedonia More articles by this author Andrew Hardie Charlestons, SC More articles by this author Thomas Keane Charleston, SC More articles by this author Stephen Savage Charleston, SC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Relationship between growth of nursing pigs and composition of sow colostrum and milk from anterior and posterior mammary glands

Piglets that nurse anterior mammary glands grow faster than those suckling posterior mammary glands. The underlying mechanisms are not known. The purpose of this study was to investigate if there is a difference in composition in colostrum and milk secreted by anterior and posterior mammary glands. Seven healthy sows were used. The first three pairs of mammary glands were defined as anterior mammary glands (AMG) and the rest as posterior mammary glands (PMG). Additionally, the total of 87 born piglets from 7 litters derived from the sows involved in the experiment was analyzed. Piglets from each litter that nursed AMG were defined as AMG group while the rest of piglets from the litter were defined as PMG group. Colostrum and milk were collected at days 1, 2, 3 and 7 after parturition. Samples taken from anterior and posterior mammary glands were pooled, respectively. Results showed that total protein, IGF-I and insulin concentrations were significantly higher in the colostrum of anterior than posterior glands and IGF-I concentration remained significantly higher in milk of anterior compared to posterior glands. There were no significant differences in fat, dry matter and lactose among anterior and posterior glands during all examined periods. Additionally, blood samples from nursing sows were obtained at days 1 and 7 after parturition. Results showed that concentrations of Ca, glucose, total protein, albumin, globulin, total bilirubin and insulin significantly increased from day 1 to day 7 of parturition while concentrations of P, BUN, CK and IGF-I did not significantly change during this period. Initial body weight of pigs nursing the anterior gland was higher but not significantly that those suckling posterior glands. Pigs that nursed anterior glands gained weight faster then those which suckled posterior glands resulting with significantly higher body weigh of piglets nursing anterior compared to posterior glands at day 8 of neonatal life (p < 0.05). Therefore, it may be concluded that the priority of anterior glands milk secretion in total protein and grow stimulating factors may have an impact on increased body weight gain of nursing pigs.

Prognostic Implications of Partial Sampling of Radical Prostatectomy Specimens: Comparison of 3 Methods

We analyzed the prognostic implications of positive margins and extraprostatic extension missed by different methods of partially sampling prostatectomy specimens. The study group consisted of 1,499 patients treated with radical prostatectomy. All specimens were processed uniformly and submitted entirely. For each patient with a positive margin or extraprostatic extension we determined whether these pathological characteristics would have been diagnosed had the specimen been examined by 3 partial sampling techniques. The Harrell concordance index was used to quantify the predictive performance of the Cox models based on the potential findings of the different sampling methods. Partial sampling methods 1 and 2, which included the examination of alternate slides, missed 13% to 21% of positive margins and 27% to 46% of extraprostatic extensions. The effect on biochemical recurrence-free survival of these undetected pathological features was similar to that of positive margins and extraprostatic extension that would have been diagnosed by corresponding techniques. Method 3, which sampled the entire posterior region, the mid anterior prostate and the rest of the ipsilateral anterior gland (if sizeable tumor was seen), detected 95% of positive margins and 94% of extraprostatic extensions. The extraprostatic extension missed by this method was not associated with a significant increase in the risk of biochemical recurrence. The Harrell concordance index of the multivariate models was 0.806, 0.797, 0.795 and 0.804 based on the results of complete sampling, and methods 1, 2 and 3, respectively. Examining alternate sections of prostatectomy specimen results in missing clinically important positive margins and extraprostatic extension. It decreases our ability to predict biochemical recurrence-free survival.

Re: Phantom Study of a Novel Stereotactic Prostate Biopsy System Integrating Preinterventional Magnetic Resonance Imaging and Live Ultrasonography Fusion(From: Kuru TH, Roethke M, Popeneclu V, et al. J Endourol 2012;26:807–813.)

Dear Editor: Prostate biopsies may soon be “unblinded” as new techniques are translated to clinic that add MRI to transrectal ultrasonographic guidance. The team from Heidelberg is to be commended for performing an elegant phantom study defining the accuracy of their novel MRI-ultrasound fusion-guided biopsy system using stereotaxy. The targeting error of under a millimeter is certainly impressive and should translate into clinical benefit. The National Institutes of Health urology and radiology teams have developed and implemented a similar approach over the past decade using electromagnetic tracking to register the preprocedural MRI to the real-time ultrasonography in an outpatient office-based setting to track the location of more than 11,000 biopsies in more than 600 patients, with an initial significant improvement in cancer detection rates in specific populations.1–3 There are several different methods for MRI + ultrasound fusion-guided prostate biopsies, including electromagnetic tracking, optical tracking, stereotactic mechanical arms, and retrospective image based registration. The emergence of multiple fusion technologies that can be deployed in an office setting could augment the “blind” or “random” transrectal ultrasonography guided prostate biopsy for patients with anterior lesions, central zone lesions (Fig. 1), previously negative biopsy in the face of a rising prostate-specific antigen level, or patients undergoing active surveillance for low Gleason score prostate cancers.1 FIG. 1. Transrectal ultrasound and corresponding preprocedural magnetic resonance imaging with anterior gland prostate cancer target (red-blue dot) in area not normally sampled by standard blind (random or sextant) biopsy. The team from Heidelberg has shown tremendous accuracy with their system, which should translate into fertile ground for clinical impact as the MRI “ManoGram” matures and evolves for use in specific settings.

Anatomical and histological structure of the tongue and histochemical characteristics of the lingual salivary glands in the Chukar partridge (Alectoris chukar, Gray 1830)

1. The aim of the study was to examine the morphology of the tongue and the histochemical features of the lingual salivary glands in this species. 2. The tongue was elongated, terminating in a rather sharp, dagger-like apex. On the surface of the tongue and situated between the body and root of the tongue, two rows of conical papillae, the sharp apices of which pointed towards the posterior part of the tongue, were observed. The keratinised epithelium lining the dorsal surface lacked typical gustatory papillae. However, it was observed that taste buds were present in the epithelium of the lingual body and root. The tongue was supported by a structure composed of hyaline cartilage, the paraglossum, which extended from the lingual root to the apex. Simple branched tubular glands, which were encapsulated by connective tissue, were embedded within the submucosa in the body (anterior salivary glands) and root (posterior salivary glands) of the tongue. It was observed that the secretion of the lingual glands contained neutral mucins, proteoglycans containing carboxylic acid, weak and strong sulphated groups, N-acetylated sialomucins, but lacked glycogen. 3. It was demonstrated that, the general morphological features, papillary distribution of the tongue and the histological structure of the mucosa epithelium and the supportive elements displayed similarity to those of other domestic avian species. It was also determined that, in view of the particular feeding types, in the partridge, the presence of the papillary crest was not correlated with diet.