Prostate Perfusion Research Articles

Contrast-Enhanced Ultrasound (CEUS) Evaluation of Canine Prostatic Hyperplasia before and after Osaterone Acetate Therapy: Preliminary Results.

The prostate is the only sexual gland of the male dog, and dihydrotestosterone (DHT) regulates its growth. In intact dogs, constant DHT stimulation results in benign prostatic hyperplasia (BPH) that can be treated with osaterone acetate (OSA). This study describes the effects of OSA treatment, detected by contrast-enhanced ultrasonography (CEUS), highlighting prostatic vascularization with a contrast agent composed of gas microbubbles. Fifteen dogs (2-8 years) of different sizes and breeds (4-30 kg) diagnosed with BPH are involved in the study. Before treatment (D0), CPSE is measured (294.05 ± 115.97 ng/mL), and a B-mode ultrasound is performed (Vratio = 2.80 ± 1.85), confirming BPH. CEUS highlights the length of the wash-in (11.93 ± 2.08 s) and wash-out (42.20 ± 6.99 s) phases of the contrast agent in the prostate and the presence of cysts and parenchymal alteration. Dogs are treated with OSA (0.5 mg/kg for 7 days) and reassessed after 21 days (D1): CPSE and prostate volume are significantly (p < 0.001) reduced. The length of the wash-in (14.73 ± 2.54 s) and wash-out (51.13 ± 6.03 s) phases are significantly (p < 0.001) increased. The results confirm the effectiveness of the treatment, particularly the reduction in prostatic perfusion, confirmed by the increase in diffusion times of the contrast. Although preliminary, these findings are promising for the use of CEUS in monitoring dogs with BPH.

Digital postprocessing analysis of prostatic perfusion in neutered dogs.

B-mode ultrasound is routinely performed to evaluate the prostate gland in neutered dogs, although, the detection of malignancies may be challenging. Contrast-enhanced ultrasound (CEUS) has shown to be useful for the assessment of prostatic perfusion in normal and diseased dogs, although the interpretation of contrast ultrasonographic features may still be subjective. A quantitative tool for evaluating prostatic perfusion might improve the reliability of the results in terms of early detection of prostate neoplasia in neutered dogs. The present study aimed to evaluate the applicability of a postprocessing analysis tool to CEUS of the prostate in healthy neutered dogs, to provide quantitative measurements, and to study the influence of individual characteristics on prostatic regression. Twenty-three neutered dogs underwent a B-mode and CEUS examination of the prostate to acquire data about prostatic morphology and microcirculation. The prostate was imaged using a 5-7.5MHz linear transducer and contrast was administered intravenously. Videoclips were analyzed by using Qontrast software and a postprocessing digital analysis tool (ImageJ) to measure perfusion peak intensity, time to peak, and vascularization ratio at the moment of the peak, which were then related to body weight, age, and time elapsed since orchiectomy. Correlation tests revealed higher vascularization in younger compared with older dogs (P<.05) and in smaller compared with larger dogs (P<.05). Time elapsed since orchiectomy (P>.05) did not affect prostatic perfusion. Contrast-enhanced ultrasound and the postprocessing analysis tool ImageJ allowed analysis of vascular perfusion in all dogs and have the potential to improve the diagnostic possibilities for andrological examination.

Long-term ultrasonographic changes of the canine prostate gland after castration.

Ultrasound imaging (US) is the method of choice to assess the canine prostate gland. Whilst recent studies have documented the role of castration in the development of prostatic neoplasia, little is known about parenchymal and perfusion features of the normal and abnormal prostate in neutered dogs. No data are available concerning prostatic changes after the first 90 days following castration. The present study aimed to acquire data on the long-term ultrasonographic changes occurring to the canine prostate after castration. Ten adult neutered dogs underwent B-mode US and contrast-enhanced ultrasound (CEUS) of the prostate on two occasions: day of the first examination (T0) and six years later (T1). The prostate was evaluated via B-mode US and the volume was calculated using Atalan's formula. For CEUS examination, an intravenous contrast agent (SonoVue) was administered to assess prostatic perfusion. Videoclips were recorded, and time-intensity curves were obtained to determine contrast parameters: peak enhancement (PPI) and time to peak (TTP). Volumetric and perfusion results were then compared between timepoints. At both examinations, the prostate appeared similar on B-mode US in terms of morphology and echotexture, minimally decreasing in volume over time. Prostate perfusion was significantly reduced in all dogs between T0 and T1, with a PPI decrease from 54.9 to 29.6% and an increase in TTP from 26.3 to 47 s. These preliminary data provide baseline information on the B-mode appearance and CEUS measurements of the prostate gland of neutered dogs and suggest that prostatic involution after castration is not a short-term process but continues over several months.

Prostate perfusion mapping using Fourier-transform based velocity-selective arterial spin labeling: Choice of cutoff velocity and comparison with brain.

To develop velocity selective arterial spin labeling (VSASL) protocols for prostate blood flow (PBF) and prostate blood volume (PBV) mapping. Fourier-transform based velocity-selective inversion and saturation pulse trains were utilized in VSASL sequences to obtain blood flow and blood volume weighted perfusion signal, respectively. Here four cutoff velocities (Vcut = 0.25, 0.50, 1.00, and 1.50 cm/s) for PBF and PBV mapping sequences were evaluated with a parallel implementation in brain for measuring cerebral blood flow (CBF) and cerebral blood volume (CBV) with identical 3D readout. This study was performed at 3T on eight young and middle-aged healthy subjects comparing both perfusion weighted signal (PWS) and temporal SNR (tSNR). In contrast to CBF and CBV, the PWS of PBF and PBV were rather unobservable at Vcut of 1.00 or 1.50 cm/s and both PWS and tSNR of PBF and PBV considerably increased at the lower Vcut , indicating that blood moves much slower in prostate than in brain. Similar to the brain results, the tSNR of PBV-weighted signal was about two to four times over the corresponding values of PBF-weighted signal. The results also suggested a trend of reduced vascularity within prostate during aging. For prostate, a low Vcut of 0.25-0.50 cm/s seemed necessary for both PBF and PBV measurements to obtain adequate perfusion signal. As in brain, PBV mapping yielded a higher tSNR than PBF.

PD11-10 PROSTATE-SPECIFIC DELETION OF Cdh1 IN MICE MIMICS PROSTATIC PERFUSION OF BENIGN PROSTATIC HYPERPLASIA (BPH) PATIENTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research & Pathophysiology (PD11)1 Sep 2021PD11-10 PROSTATE-SPECIFIC DELETION OF Cdh1 IN MICE MIMICS PROSTATIC PERFUSION OF BENIGN PROSTATIC HYPERPLASIA (BPH) PATIENTS Pradeep Tyagi, Laura Pascal, Lesley Foley, Robin Frederick, T. Kevin Hitchens, Anthony Kanai, Naoki Yoshimura, and Zhou Wang Pradeep TyagiPradeep Tyagi More articles by this author , Laura PascalLaura Pascal More articles by this author , Lesley FoleyLesley Foley More articles by this author , Robin FrederickRobin Frederick More articles by this author , T. Kevin HitchensT. Kevin Hitchens More articles by this author , Anthony KanaiAnthony Kanai More articles by this author , Naoki YoshimuraNaoki Yoshimura More articles by this author , and Zhou WangZhou Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001986.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although BPH is an age-related comorbidity of cardiovascular disease and hypertension, the investigation into the direction of the relationship will require animal models. Recently, the downregulation of E-cadherin in hyperplastic nodules of BPH patients was mechanistically linked to the prostatic inflammation and vascular defects by the recapitulation of BPH phenotype following deletion of E-cadherin gene (Cdh1-/- ) in prostatic epithelium of adult mouse (Endocrinology 2021; 162(1) : bqaa212). Since the injected T1 shortening agent, Gadobutrol only resides in vascular and extracellular space, we enquired the effect of Cdh1-/-on dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). METHODS: Tamoxifen injection at 7 weeks of age generated PSA-CreERT2/Cdh1-/- mice and then anaesthetized 21-23 weeks old Cdh1-/- and wild type controls (n=3) were injected Gadobutrol 0.1mm/kg for T1 weighted DCE-MRI of prostate in 9 axial slices with number of excitations (NEX)=1 and temporal resolution of 12s in voxel size of 0.156x0.156x0.8mm3 at small animal 7T scanner followed by Masson’s trichome staining. RESULTS: Although ventral lobes of Cdh1-/- mice were similar in size to age matched controls, the kinetic modelling of DCE-MRI (repetition TR/echo time TE - 200/5.23ms) determined that clearance of Gadobutrol was four fold slower from ventral lobe of Cdh1-/- mice with efflux rate constant Kep of 0.17±1.48 min-1 vs 0.88±0.08 min-1 in controls. The prostate permeability metric, Kep of Cdh1-/- mice is determined by the widened and elongated venules (# telangiectasia) and the higher density of collagen (blue stain) in ventro/lateral lobes on Masson's trichrome staining, which retains the Gadobutrol even 30min after injection to increase T1 contrast more than adjacent dorsal lobes and ventral lobe of control mice in high resolution post-contrast images (TR/TE 2000/20ms; NEX=4). CONCLUSIONS: The link between the vascular defects and expanded extracellular space of prostate in Cdh1-/- mice with the slower clearance of Gadobutrol implicates a bidirectional relationship between prostatic inflammation and prostatic vasculature defects that are characteristic of BPH. Findings suggest that E-cadherin downregulation could be a driving force in human BPH development and progression. Source of Funding: UPMC Hillman Pilot Funding; DK112079; CA211242 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e201-e202 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pradeep Tyagi More articles by this author Laura Pascal More articles by this author Lesley Foley More articles by this author Robin Frederick More articles by this author T. Kevin Hitchens More articles by this author Anthony Kanai More articles by this author Naoki Yoshimura More articles by this author Zhou Wang More articles by this author Expand All Advertisement Loading ...

Contrast-Enhanced Ultrasound Imaging of Prostate Gland in Neutered Dogs.

Simple SummaryDiagnosis of prostatic neoplasia in dogs remains critical since none of the diagnostic methods routinely performed seem to have sufficient sensitivity or specificity. In recent years, contrast-enhanced ultrasound of the prostate gland has been successfully performed in intact dogs. However, data regarding the performance of the technique in castrated dogs have not been provided, despite the incidence of prostate neoplasia potentially being higher after castration. The purpose of the present study was to evaluate the application of contrast-enhanced ultrasound in castrated dogs and to describe the vascular pattern of the canine prostate. Prior to contrast-enhanced ultrasound evaluation, B-mode ultrasound was performed to assess prostate size and parenchymal features. In all cases, perfusion kinetics of the contrast agent within the prostate was analyzed, with the aim of detecting any areas with increased microvessel density. None of the dogs had any ultrasonographically detected pathology. Contrast ultrasound allowed an improved and enhanced ability to evaluate the prostate compared with B-mode ultrasound. This technique is not yet to become a first-choice diagnostic tool; however, since the results of this study are favorable, it seems likely that contrast ultrasound will have an important role in the future for the detection of prostate pathologies in neutered dogs.Prostatic neoplasia (PN) occurs in 5–7% of dogs with prostatic disease, with castrated dogs having the same or higher prevalence when compared to intact dogs. Considering the promising results achieved by performing contrast-enhanced ultrasound (CEUS) in intact dogs to detect PN, the present study aimed to acquire data on the prostatic perfusion pattern in neutered dogs. CEUS was performed in 64 neutered dogs, using a 5–7.5 MHz linear transducer with coded harmonic capability, dedicated analytical software, and a second-generation contrast agent, SonoVue. After B-mode evaluation was performed to assess mean prostate volume, the CEUS examination was undertaken. The flow of contrast agent was visible 10 s after injection. The subcapsular vessels were highlighted and produced rapid peripheral rim enhancement. Subsequently, the contrast agent reached the prostatic urethra via the parenchymal arterioles and gradually reached the entire prostate. Perfusion peak intensity (PPI) and time to peak (TTP) values were respectively 45.3% and 34.1 s. The measured parameters were compared with those obtained in previous studies on intact dogs with normal and with pathological patterns. In this study, CEUS showed features that may be promising for its use as a diagnostic tool for early detection of PN in neutered dogs.

Prostatic Artery Embolization through the Profunda Femoris Artery

AbstractAn 88-year-old catheter-dependent patient with peripheral vascular disease and benign prostatic hyperplasia was referred for prostatic artery embolization (PAE). Selective angiography of the left internal iliac artery (IIA) revealed a 2.5-cm aneurysm and a single artery comprising the anterior division of the IIA (inferior gluteal artery). No prostatic artery (PA) was identified on the left. Additional angiography of the left external iliac artery (EIA), right IIA, and right EIA did not demonstrate prostatic perfusion. The right profunda femoris artery was then selected given previously reported atherosclerotic collaterals, which revealed an ascending branch of the medial circumflex femoral artery coursing through the upper thigh into the pelvis and reconstituting the right anterior division of the IIA. A 2.4-French microcatheter (Terumo) and 0.018-inch wire (Transcend, Boston Scientific) were used to enter the pelvic vasculature, right PA was identified, and a 2-mm coil was used to perform embolization of a potential nontarget anterior division branch. Embolization of the right PA was then performed with 250-µm particulate and Gelfoam slurry. Two-week follow-up revealed spontaneous voiding and catheter independence.

The effect of pharmacotherapy on prostate volume, prostate perfusion and prostate-specific antigen (prostate morphometric parameters) in patients with lower urinary tract symptoms and benign prostatic obstruction. A systematic review and meta-analysis.

IntroductionThe clinical effect of pharmacotherapy on prostate morphometric parameters is largely unknown. The sole exception is 5α-reductase inhibitors (5-ARI) that reduce prostate volume and prostate-specific antigen (PSA). This review assesses the effect of pharmacotherapy on prostate parameters effect on prostate parameters, namely total prostate volume (TPV), transitional zone volume (TZV), PSA and prostate perfusion.Material and methodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) reporting on morphometric parameters’ changes after pharmacotherapy, as primary or secondary outcomes. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RCTs’ quality was assessed by the Cochrane tool and the criteria of the Agency for Healthcare Research and Quality. The effect magnitude was expressed as standard mean difference (SMD). The study protocol was published on PROSPERO (CRD42020170172).ResultsSixty-seven RCTs were included in the review and 18 in the meta-analysis. The changes after alpha-blockers are comparable to placebo. Long-term studies reporting significant changes from baseline, result from physiologic growth. Finasteride and dutasteride demonstrated large effect sizes in TPV reduction ([SMD]: -1.15 (95% CI: -1.26 to -1.04, p <0.001, and [SMD]:-0.66 (95% CI: -0.83 to -0.49, p <0.001, respectively), and similar PSA reductions. Dutasteride’s effect appears earlier (1st vs 3rd month), the changes reach a maximum at month 12 and are sustained thereafter. Phosphodiesterase-5 (PDE-5) inhibitors have no effect on morphometric parameters. Phytotherapy’s effect on TPV is non-significant [SMD]: 0.12 (95% CI: -0.03 to 0.27, p = 0.13). Atorvastatin reduces TPV as compared to placebo (-11.7% vs +2.5%, p <0.01). Co-administration of testosterone with dutasteride spares the prostate from the androgenic stimulation as both TPV and PSA are reduced significantly.ConclusionsThe 5-ARIs show large effect size in reducing TPV and PSA. Tamsulosin improves perfusion but no other effect is evident. PDE-5 inhibitors and phytotherapy do not affect morphometric parameters. Atorvastatin reduces TPV and PSA as opposed to testosterone supplementation.

Perfusion change in benign prostatic hyperplasia before and after castration in a canine model: Contrast enhanced ultrasonography and CT perfusion study

Hormonal and vascular changes affecting the canine prostate after castration were investigated to identify the effects of hormones and perfusion on the development of benign prostatic hyperplasia (BPH). Concentrations of serum testosterone and estrogen and intraprostatic dihydrotestosterone (DHT) were compared between 5 normal dogs, 6 dogs with mild BPH, and 6 dogs with marked BPH. In addition, prostatic perfusion using contrast-enhanced ultrasonography (CEUS) and CT perfusion (CTP), as well as CT volumes of the prostates were compared. The changes in these values following castration were assessed in 6 dogs with marked BPH. CEUS revealed significantly slower prostatic arterial inflow and relatively faster venous outflow in BPH versus normal prostate. Permeability and blood volume were not significantly different between the groups via CTP. Intraprostatic DHT level was higher in BPH than in normal prostate and decreased significantly following castration, which was accompanied by a rapid decrease in prostatic volume. On CEUS, arterial inflow to the prostate significantly decreased following castration. Blood volume within the prostate decreased significantly by day 60 following castration. Permeability increased significantly during the early phase after castration; however, by day 60 post-castration, all perfusion parameters decreased significantly. Perfusion changes including venous parameters measured by CEUS and blood volume changes measured by CTP, however, did not support the backflow theory postulating that BPH is induced by vascular changes from congested testes. The major etiology for the development of BPH is attributed to be increased levels of DHT rather than vascular changes.

389 - The effect of pharmacotherapy on prostate volume, prostate perfusion and PSA (Prostate Morphometric Parameters) in patients with Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Obstruction (BPO)? A systematic review and meta-analysis

389 - The effect of pharmacotherapy on prostate volume, prostate perfusion and PSA (Prostate Morphometric Parameters) in patients with Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Obstruction (BPO)? A systematic review and meta-analysis

Predicting clinically significant prostate cancer from quantitative image features including compressed sensing radial MRI of prostate perfusion using machine learning: comparison with PI-RADS v2 assessment scores.

To investigate if supervised machine learning (ML) classifiers would be able to predict clinically significant cancer (sPC) from a set of quantitative image-features and to compare these results with established PI-RADS v2 assessment scores. We retrospectively included 201, histopathologically-proven, peripheral zone (PZ) prostate cancer lesions. Gleason scores ≤3+3 were considered as clinically insignificant (inPC) and Gleason scores ≥3+4 as sPC and were encoded in a binary fashion, serving as ground-truth. MRI was performed at 3T with high spatiotemporal resolution DCE using Golden-angle RAdial SParse (GRASP) MRI. Perfusion maps (Ktrans, Kep, Ve), apparent diffusion coefficient (ADC), and absolute T2-signal intensities (SI) were determined in all lesions and served as input parameters for four supervised ML models: Gradient Boosting Machines (GBM), Neural Networks (NNet), Random Forest (RF) and Support Vector Machines (SVM). ML results and PI-RADS scores were compared with the ground-truth. Next ROC-curves and AUC values were calculated. All ML models outperformed PI-RADS v2 assessment scores in the prediction of sPC (RF, GBM, NNet and SVM vs. PI-RADS: AUC 0.899, 0.864, 0.884 and 0.874 vs. 0.595, all P<0.001). Using quantitative imaging parameters as input, supervised ML models outperformed PI-RADS v2 assessment scores in the prediction of sPC. These results indicate that quantitative imagining parameters contain relevant information for the prediction of sPC from image features.

Compressed Sensing Radial Sampling MRI of Prostate Perfusion: Utility for Detection of Prostate Cancer.

Purpose To investigate the diagnostic performance of a dual-parameter approach by combining either volumetric interpolated breath-hold examination (VIBE)- or golden-angle radial sparse parallel (GRASP)-derived dynamic contrast agent-enhanced (DCE) MRI with established diffusion-weighted imaging (DWI) compared with traditional single-parameter evaluations on the basis of DWI alone. Materials and Methods Ninety-four male participants (66 years ± 7 [standard deviation]) were prospectively evaluated at 3.0-T MRI for clinical suspicion of prostate cancer. Included were 101 peripheral zone prostate cancer lesions. Histopathologic confirmation at MRI transrectal US fusion biopsy was matched with normal contralateral prostate parenchyma. MRI was performed with diffusion weighting and DCE by using GRASP (temporal resolution, 2.5 seconds) or VIBE (temporal resolution, 10 seconds). Perfusion (influx forward volume transfer constant [Ktrans] and rate constant [Kep]) and apparent diffusion coefficient (ADC) parameters were determined by tumor volume analysis. Areas under the receiver operating characteristic curve were compared for both sequences. Results Evaluated were 101 prostate cancer lesions (GRASP, 61 lesions; VIBE, 40 lesions). In a combined analysis, diffusion and perfusion parameters ADC with Ktrans or Kep acquired with GRASP had higher diagnostic performance compared with diffusion characteristics alone (area under the curve, 0.97 ± 0.02 [standard error] vs 0.93 ± 0.03; P < .006 and .021, respectively), whereas ADC with perfusion parameters acquired with VIBE had no additional benefit (area under the curve, 0.94 ± 0.03 vs 0.93 ± 0.04; P = .18and .50, respectively, for combination of ADC with Ktrans and Kep). Conclusion If used in a dual-parameter model, incorporating diffusion and perfusion characteristics, the golden-angle radial sparse parallel acquisition technique improves the diagnostic performance of multiparametric MRI examinations of the prostate. This effect could not be observed combining diffusing with perfusion parameters acquired with volumetric interpolated breath-hold examination. © RSNA, 2018.

Intra-Arterial and Intravenous Contrast-Enhanced Ultrasonography in Prostate Artery Embolization: A Case Series

This retrospective case series details early experience with intra-arterial (IA) and intravenous (IV) contrast-enhanced ultrasound (CEUS) in 8 patients (mean age, 70.4 years) who underwent prostatic arterial embolizations from July 2014 to March 2017. Technical success was achieved in 7 of the 8 patients. IA CEUS demonstrated ipsilateral prostatic perfusion in 15 out of 20 interrogated prostatic arteries (PAs), confirming proper catheter placement. Four of the 20 interrogated PAs demonstrated extraprostatic perfusion. One PA was not successfully interrogated owing to a localized wire perforation. IV CEUS, performed on 4 of the 8 patients, demonstrated decreased enhancement after embolization in all 4 patients, confirming the procedural end point.

Prostate Perfusion Mapped by Technetium-99m Macroaggregated Albumin after Selective Arterial Injection

PurposeTo determine if perfusion of the prostate can be mapped using technetium-99m (99mTc) macroaggregated albumin (MAA) after selective prostate artery catheterization. Materials and MethodsSelective prostate artery injections of MAA were performed and analyzed in 14 patients; 9 patients received unilateral injection, and 5 patients received bilateral injections (37 MBq/1 mCi per injection). Fused single-photon emission computed tomography/computed tomography (SPECT/CT) images were subsequently acquired using a fiducial marker technique. Perfusion distribution was assessed, and relative intraprostatic versus extraprostatic activity was quantified and compared between groups. ResultsThe percentage of the prostate gland containing activity was significantly greater for the bilateral injection group compared with the unilateral injection group (76.6% vs 44.3%, P < .05). The percentage of relative intraprostatic versus extraprostatic activity was significantly lower for the bilateral injection group compared with the unilateral injection group (40.3% vs 75.9%, P < .05). Sites of visualized extraprostatic activity included the seminal vesicles (8 of 14 patients), internal iliac vessels (7 of 14 patients), bladder wall (5 of 14 patients), space of Retzius (3 of 14 patients), rectal wall (3 of 14 patients), and penis (1 of 14 patients). ConclusionsPerfusion mapping with 99mTc-MAA can be effectively performed with SPECT/CT after selective prostate artery catheterization. The relative percentage of intraprostatic versus extraprostatic activity can be quantified, and the distribution of activity within and outside the prostate gland can be determined.

Response of blood flow to hyperthermia in human prostate tumors: Opportunities for enhanced radiation effect and drug delivery.

189 Background: Tissue perfusion may be a significant factor affecting outcome of prostate cancer treatment. Hyperthermia has been shown to have beneficial anti-cancer effects when combined with other anti-neoplastic modalities including radiation, chemotherapy, and immunotherapy. For instance, hyperthermia may increase prostate perfusion resulting in radiosensitization through increased oxygenation and chemotherapy through enhanced drug delivery. We previously reported significant benefit to the addition of hyperthermia to radiation on a phase II trial for men with locally advanced prostate cancer. To better understand tissue perfusion in patients with prostate cancer and response to hyperthermia, we measured perfusion levels in patients on this trial before and after hyperthermia. Methods: Prostate perfusion was measured before and immediately after heating in a total of 21 hyperthermia treatments in 14 patients with prostate cancer. A trans-rectal ultrasound device with a water cooled jacket was used to heat the prostate. Prostate tissue temperatures were measured using three multisensory thermocouple probes. Perfusion was measured with the TDP-200 Thermal Diffusion Probe, a thermistor-based device which quantifies perfusion with a modified wash-out technique. Results: In 19 treatments in which perfusion was measured before heating, average and standard deviation was 18.3 ± 10.6 ml/100g-min and in 17 treatments in which perfusion was measured after heating, it was 30.7 ± 20.8 ml/100g-min. This represents a statistically significant increase of 68% (p = 0.018). Perfusion increased 12 of 15 treatments in which measurements were obtained before and after hyperthermia. Notably, prostate tissue that was most ischemic prior to heating experienced the largest heat-induced perfusion increase. Conclusions: Prostate perfusion increased significantly with a majority of hyperthermia treatments. Enhanced prostate oxygenation may have been a contributing factor to the benefit noted with hyperthermia in this phase II trial. The use of hyperthermia to augment prostate perfusion to enhance radiation, chemotherapy, and immunotherapy warrants further investigation.

Prostate functional magnetic resonance image analysis using multivariate curve resolution methods

This paper discusses the potential of multivariate curve resolution models to extract physiological dynamics behaviors from dynamic contrast‐enhanced magnetic resonance imaging prostate perfusion studies for cancer diagnosis. A relationship with biomarkers (“hidden” parameters for assessing the possible existence of a tumor) from pharmacokinetic models is also studied. Copyright © 2013 John Wiley &amp; Sons, Ltd.

Utility of Cone-Beam CT Imaging in Prostatic Artery Embolization

PurposeTo evaluate the utility of cone-beam computed tomography (CT) in patients undergoing prostatic artery (PA) embolization (PAE) for benign prostatic hyperplasia. Materials and MethodsFrom January 2012 to January 2013, 15 patients (age range, 59–81 y; mean, 68 y) with moderate- or severe-grade lower urinary tract symptoms, in whom medical management had failed were enrolled in a prospective United States trial to evaluate PAE. During pelvic angiography, 15 cone-beam CT acquisitions were performed in 11 patients, and digital subtraction angiography was performed in all patients. Cone-beam CT images were reviewed to assess for sites of potential nontarget embolization that impacted therapy, a pattern of enhancement on cone-beam CT suggesting additional PAs, confirmation of prostatic parenchymal perfusion before embolization, and contralateral prostatic parenchymal enhancement. ResultsCone-beam CT was successful in 14 of 15 acquisitions, and PAE was successful in 14 of 15 patients (92%). Cone-beam CT provided information that impacted treatment in five of 11 patients (46%) by allowing for identification of sites of potential nontarget embolization. Duplicated prostatic arterial supply and contralateral perfusion were each identified in 21% of patients (three of 11). Prostatic perfusion was confirmed before embolization in 50% of acquisitions (seven of 14). ConclusionsCone-beam CT is a useful technique that can potentially mitigate the risk of nontarget embolization. During treatment, it can allow for the interventionalist to identify duplicated prostatic arterial supply or contralateral perfusion, which may be useful when evaluating a treatment failure.

Feasibility of measuring prostate perfusion with arterial spin labeling

Feasibility of measuring prostate perfusion with arterial spin labeling

Feasibility of measuring prostate perfusion with arterial spin labeling

Prostate perfusion has the potential to become an important pathophysiological marker for the monitoring of disease progression or the assessment of the therapeutic response of prostate cancer. The feasibility of arterial spin labeling, an MRI approach for the measurement of perfusion without an exogenous contrast agent, is demonstrated in the prostate for the first time. Although various arterial spin labeling methods have been demonstrated previously in highly perfused organs, such as the brain and kidneys, the prospect of obtaining such measurements in the prostate is challenging because of the relatively low blood flow, long transit times, susceptibility-induced image distortion and local motion. However, despite these challenges, this study demonstrates that, with a whole-body transmit coil and external receiver array, global prostate perfusion can be measured with arterial spin labeling at 3 T. In five healthy subjects with a mean age of 44 years, the mean total prostate blood flow was measured to be 25.8 ± 7.1 mL/100 cm(3) /min, with an estimated bolus duration and arterial transit time of 884 ± 209 ms and 721 ± 131 ms, respectively.

Metabolic syndrome decreases tissue perfusion and induces glandular hyperplasia in the fructose‐fed rat prostate

The effects of metabolic syndrome on the prostate blood perfusion and histological structure were studied using fructose-fed rats (FR). Age-matched male Wistar rats were divided into two groups: group I, normal control rats and group II, 9-week FR. Animal body weight, blood pressure, and serum metabolic parameters were monitored. With the rats under anesthesia, prostatic blood flow volume and flow velocity were measured by laser Doppler flowmetry. The prostate was then removed for histological examination and morphometric study. The 9-week FR showed significant increases in body weight, blood pressure, plasma glucose, insulin, and triglyceride levels. The blood flow volume (345.8 ± 20.57 ml/min/100 g vs. 440.4 ± 35.57 ml/min/100 g of tissue, P < 0.05 for n = 8) and flow rate (29.4 ± 1.25 units vs. 40.9 ± 2.65 units, P < 0.05 for n = 8) in the FR ventral prostate were significantly decreased when compared to controls. Structurally, the FR prostate weight was significantly higher than that of the controls (612.4 ± 16.9 mg vs. 427.3 ± 6.5 mg, P < 0.05 for n = 8). Prostate histology showed glandular hyperplasia while morphometry showed increased stromal component in the FR. Metabolic syndrome in the FR decreases prostatic perfusion and induces prostatic glandular hyperplasia. The findings suggest that chronic ischemia may be a link between metabolic syndrome and prostatic enlargement.