Rectal Preparation Research Articles

Implementation of Rectal Iodine Preparation in Transrectal US (TRUS) Prostate Biopsies: A Quality Improvement Project Based on EAU Guidelines

Implementation of Rectal Iodine Preparation in Transrectal US (TRUS) Prostate Biopsies: A Quality Improvement Project Based on EAU Guidelines

Thermo-activated in situ rectal gel preparation for Ibuprofen using eutectic mixture.

This study aimed to develop a thermosensitive in situ gel formulation for rectal delivery of Ibuprofen as an efficient alternative dosage form. Utilizing poloxamer 188, poloxamer 407, and HPMC via cold technique method, a thermosensitive in situ gel was successfully prepared. The concentration of Ibuprofen in the formulations was 1.2 % (w/w). The prepared gels underwent assessment for clarity, gelation temperature, gelation time, gel strength, spread ability, syringe-ability, pH, viscosity, FTIR, and drug content. The selected formulations exhibited a gelation temperature within the range of 30 °C to 36 °C, with consistent amount of drug soluble in the formulations (93 % - 110 %). Mucoadhesive studies, in vitro release tests, ex vivo modeling of drug release, kinetic studies modeling, and histopathology testing were also conducted. The formulation comprising 18 % poloxamer 407, 12 % poloxamer 188, and 1 % sodium chloride (FS15) demonstrated suitable gelation temperature and desirable drug release rate. In vitro drug release tests indicated completion within one hour for both FS10 (20 % P407 & 10 % P188) and FS15 (18 % P407 & 12 % P188), with consistent and predictable release patterns observed through kinetic modeling analysis. Microscopic histopathology examination confirmed the safety of the selected formula, exhibiting no irritation in the mucosal membrane of the sheep. In conclusion, Ibuprofen thermosensitive in situ gel presents a promising and convenient strategy as a rectal carrier and an alternative dosage form to solid suppositories.

Prostate cancer image guided radiotherapy: Why the commotion over rectal volume and motion?

IntroductionDistended rectums on pre-radiotherapy scans are historically associated with poorer outcomes in patients treated with two-dimensional IGRT. Subsequently, strict rectal tolerances and preparation regimes were implemented. Contemporary IGRT, daily online registration to the prostate, corrects interfraction motion but intrafraction motion remains. We re-examine the need for rectal management strategies when using contemporary IGRT by quantifying rectal volume and its effect on intrafraction motion. Materials and methodsPre and during radiotherapy rectal volumes and intrafraction motion were retrospectively calculated for 20 patients treated in 5-fractions and 20 treated in 20-fractions. Small (rectal volume at planning-CT ≤ median), and large (volume > median) subgroups were formed, and rectal volume between timepoints and subgroups compared. Rectal volume and intrafraction motion correlation was examined using Spearman’s rho. Intrafraction motion difference between small and large subgroups and between fractions with rectal volume < or ≥ 90 cm3 were assessed. ResultsMedian rectal volume was 74 cm3, 64 cm3 and 65 cm3 on diagnostic-MRI, planning-CT and treatment imaging respectively (ns). No significant correlation was found between patient’s rectal volume at planning-CT and median intrafraction motion, nor treatment rectal volume and intrafraction motion for individual fractions. No significant difference in intrafraction motion between small and large subgroups presented and for fractions where rectal volume breached 90 cm3, motion during that fraction was not significantly greater. ConclusionLarger rectal volumes before radiotherapy and during treatment did not cause greater intrafraction motion. Findings support the relaxation of strict rectal diameter tolerances and do not support the need for rectal preparation when delivering contemporary IGRT to the prostate.

Formulation and Evaluation of Diazepam as a Rectal Preparation

Diazepam has become a commonly used drug for treatment of acute repetitive epileptic seizures and febrile convulsions in children. Considering the advantages of rectal administration of diazepam, the objective of this study was to formulate and evaluate rectal hydrogels containing diazepam as a drug substance in combination with suitable co - solvents and preservatives.Prepared HPMC (hydroxypropyl methylcellulose) hydrogels containing different concentrations of diazepam (2, 4 and 6 mg I ml) manifested good quality in respect to physicochemical parameters (pH value, drug content, ingredients content and viscosity), antimicrobial efficiency and microbiological quality. Under the proposed HPLC conditions, satisfactory separation of diazepam and the preservatives used was achieved. In vitro release studies have shown that the total amount ofdiazepam was released in a period of 3 hours. Prepared formulations were stable for four months at 26 C (ambient temperature characteristic of the second climate zone

An Analysis of PTV Margins for Postoperative Pelvic Nodal Radiotherapy (PNRT) Using a Dose Accumulation Workflow

<h3>Purpose/Objective(s)</h3> PTV margins are created to ensure coverage of the target volume. There is no uniform consensus on the PTV margins for prostate bed radiotherapy. Our institution's PTV margins for prostate bed are 8mm everywhere but posterior - a size that leads to PTVs on the order of 2.5 times the prostate bed. We hypothesized that the current PTV margins for prostate bed is larger than necessary in the context of daily cone-beam CT (CBCT)-guided intensity-modulated arc therapy. <h3>Materials/Methods</h3> Nineteen PCa patients treated with daily CBCT-guided intensity-modulated arc therapy were studied. Patients received 68 Gy to the prostate bed (PTV68) and 52.7 Gy to the elective pelvic nodes (CTV52.7, no PTV margins), all in 34 fractions. Patients followed strict bladder and rectal preparation protocols and had daily pretreatment CBCT images. Patient data, consisting of planning CTs and 7 representative CBCTs (1/week), were anonymized. Using a dose accumulation workflow, synthetic CTs (sCT) were created from the planning CTs and the representative CBCTs. Volumes were deformed to the sCT and checked for consistency. The sCTs were sent to the planning system, and a single fraction of the treatment plan was recalculated on the sCT. These daily dose distributions were used to assess target coverages and OAR doses on a daily/weekly basis. <h3>Results</h3> One hundred and thirty-three CBCTs were assessed. In 100% of the fractions, at least 97% of the prostate bed was covered by the prescription dose. Only 2 patients had a max, mean, and median dose to the prostate bed less than planned (though the mean, max and median doses were all greater than 2Gy/fx) at approximately 1 cGy below a value planned per fraction; the remaining 17 patients were at or above the aforementioned planned doses. Though the CTV52.7 coverage dropped slightly compared to the original plan, in 100% of the fractions the CTV52.7 received a median dose equal to or higher than planned. In 74% of the fractions, at least 95% of CTV52.7 was covered by 95% of the prescription dose. In 100% of the fractions at least 90% of the CTV52.7 received 90% of the planned prescription dose. On average there was a 2% difference in the volumes of OARs at the V40, V65 and maximum dose points. <h3>Conclusion</h3> Our results suggest that, in the context of daily CBCT-guided postoperative RT with strict bladder and rectal preparation protocols, a PTV margin of 8 mm everywhere and 6 mm posteriorly is sufficient if not slightly larger than needed. Further studies on margin reduction and its clinical implications are warranted.

32: Setup and Treatment Efficiency of Two Prostate SBRT Rectal Preparation Techniques: Experience from Program Development at a Community Centre

32: Setup and Treatment Efficiency of Two Prostate SBRT Rectal Preparation Techniques: Experience from Program Development at a Community Centre

Head-to-Head Comparison between High-Resolution Microultrasound Imaging and Multiparametric MRI in Detecting and Local Staging of Bladder Cancer: The BUS-MISS Protocol.

MRI has been proposed as a new staging tool for bladder cancer (BC), but use is limited by its high costs and low availability. 29-MHz high-resolution micro-ultrasound (mUS) technology has been suggested as an alternative to detect BC and distinguish between muscle-invasive and non-muscle invasive BC. The aim was to compare the diagnostic accuracy of mUS vs. magnetic resonance imaging (MRI) in differentiating NMIBC and MIBC at definitive pathological examination. This is a prospective study of patients with a primary diagnosis of BC with either positive urine cytology (UC) or negative UC and a tumor size > 25 mm from a tertiary care high volume center. mUS, with the ExactVu system with an EV29L 29 MHz side-fire transducer, and a 3-Tesla MRI were performed before transurethral resection of bladder tumor (TURBT) in every patient before undergoing TURBT. We compared the imaging results with pathological reports. The analyzed population consisted of 58 individuals. The reported mUS and MRI sensitivity, specificity, positive, and negative predictive values were 85.0%, 76.3%, 65.4%, and 90.6%, versus 85.0%, 50.0%, 47.2%, and 86.4%, respectively. In accuracy analysis, the AUC for mUS and MRI were respectively 0.807 and 0.675. In our population mUS seems to have a better performance in distinguishing NMIBC from MIBC. The main limitation of mUS is the probe shape that makes its use problematic in cases with a large prostate and inadequate rectal preparation. Further studies with a larger population are ongoing to compare and validate these techniques in this setting.

Literature Review: The Effects of Dietary and Pharmaceutical Interventions on Bowel Preparation for Prostate Cancer Irradiation

Purpose: Rectal preparation for the purposes of radiation treatment to the prostate is routine for patients, yet there is no standardized protocol delineating a most effective strategy. This research is especially crucial for patients who are unable to have daily bowel movements. The methodologies practiced at each institution vary, but they all aim to increase the accuracy of treatment delivery and decrease side effects by limiting the area of the rectum receiving radiation. The aim of this literature review is to examine the effectiveness of diet and other forms of interventions to address the issue of extraneous rectal dose during radiation treatment to the prostate.

Rectal preparation significantly improves prostate imaging quality: Assessment of the PI-QUAL score with visual grading characteristics

PurposeTo investigate the effects of a rectal preparation regimen, that consisted of a rectal cleansing enema and an endorectal gel filling protocol, on prostate imaging quality (PI-QUAL). MethodsMultiparametric MRI (mpMRI) was performed in 150 consecutive patients divided into two groups of 75 patients. One group received a rectal preparation with a cleansing enema and endorectal gel filling (median age 65.3 years, median PSA level 6 ng/ml). The other patient group did not receive such a preparation (median age 64 years, median PSA level 6 ng/ml). Two uroradiologists independently rated general image quality and lesion visibility on diffusion-weighted imaging (DWI), T2-weighted (T2w), and dynamic contrast-enhanced (DCE) images using a five-point ordinal scale. In addition, two uroradiologists assigned PI-QUAL scores, using the dedicated scoring sheet. Data sets were compared using visual grading characteristics (VGC) and receiver operating characteristics (ROC)/ area under the curve (AUC) analysis. ResultsVGC revealed significantly better general image quality for DWI (AUC R1 0.708 (0.628–0.779 CI, p < 0.001; AUC R2 0.687 (0.606–0.760 CI, p < 0.001) and lesion visibility for both readers (AUC R1 0.729 (0.607–0.831 CI, p < 0.001); AUC R2 0.714 (0.590–0.818CI, p < 0.001) in the preparation group. For T2w imaging, rectal preparation resulted in significantly better lesion visibility for both readers (R1 0.663 (0.537–0.774 CI, p = 0.014; R2 0.663 (0.537–0.774 CI, p = 0.014)). Averaged PI-QUAL scores were significantly improved with rectal preparation (AUC R3/R4 0.667, CI 0.581–0.754, p < 0.001). ConclusionRectal preparation significantly improved prostate imaging quality (PI-QUAL) and lesion visibility. Hence, a rectal preparation regimen consisting of a rectal cleansing enema and an endorectal gel filling could be considered.

ROLE OF POVIDONE-IODINE-SOAKED GAUZE IN PREVENTING INFECTIOUS COMPLICATIONS FOLLOWING TRANS RECTAL DIGITAL GUIDED PROSTATE BIOPSY

Objective: To identify the role of povidone iodine-soaked gauze following transrectal digital guided prostate biopsy in the prevention of infectious complications. Methodology: This prospective comparative study was conducted in the urology department of Lady Reading Hospital including 201 patients. Patients who had indications for prostate biopsy, including an elevated pros­tate-specific antigen (PSA) or abnormal prostatic nodule on digital rectal findings were included. Patients were distributed into two groups by the closed envelop method. Group, I (n=101) received a povidone-iodine-soaked gauze intrarectally along with xylocaine lubricant for 5 minutes just before biopsy, while group 2 (n=100) did not receive povidone-soaked gauze. The transrectal digital guided prostate biopsy guided method was used in this study. The rectal swab was taken before using povidone-soaked gauze and after doing biopsy in both groups The bacterial colonies were counted in swabs before using povidone-soaked gauze and after biopsy using biopsy Mueller-Hinton agar medium. Results: The mean age of group 1 was 64 years (range, 39–80) and group 2 was 61.7 years (range, 35–82). The average PSA values were 7.3 ng/ml and 8.34 ng/ml in groups 1 and 2, respectively. The rate of infectious complications in group1 was 0.9% (n=1) whereas in group 2 was 10% (n=10). A single-use of povidone-soaked rectal gauze significantly lowered the risk of infectious complications P&lt;0.05. There was a 99.9% decrease in the mean number of colony-forming units after rectal preparation. Conclusion: Findings concluded that using povidone iodine-soaked gauze before doing digital guided prostate biopsy is a significant method to minimize complications.

Analysis of the Effectiveness of Different Types of Shock Wave Therapy for the Treatment of Patients with Chronic Prostatitis

The article provides a comparative assessment of various methods of shock wave therapy used to treat patients with chronic calculous prostatitis and the presence of chronic pelvic pain syndrome. The mechanism of action of the radial pressure wave and focused shock wave therapy is analyzed in detail.&#x0D; The treatment was carried out in 648 patients divided into 4 groups. In groups 1, 3 and 4, focused shock wave therapy was used using Piezo Wave devices from Richard Wolf of various generations with a piezoelectric generator G-4 (the source of shock waves is a piezoelectric self focusing hemisphere with an energy flux density in the focus area of up to 0,4 mJ/mm2 and pressure up to 82,2 mPa, shock wave pulsation frequency of 8 Hz) and G-10 (the source of shock waves is a piezoelectric self-focusing hemisphere with an energy flux density in the focus area of up to 0,6–2 mJ/mm2 and a pressure of up to 100,0 mPa, shock wave pulsation frequency 8 Hz).&#x0D; The second group used a BTL-6000 SWT Topline radial pressure wave apparatus with a pressure of up to 5 bar and a frequency of up to 20 Hz. The treatment was carried out according to the method developed on the basis of the Research Institute of Urology of the National Academy of Medical Sciences of Ukraine. The technique includes: the use of shock wave therapy, transrectal photo-electrostimulation and electrophoresis of the rectal preparation fermencol. The technique has long established itself as an effective way to combat chronic pelvic pain syndrome.&#x0D; The study was conducted in order to establish the most effective method of shock wave therapy and the optimal number and power of impulses per session, as well as the required number of sessions to achieve the maximum effect in relation to pain and in relation to a decrease in the area of prostate gland lesions by secondary changes: fibrosis and calculi, in order to further improve the technique, in connection with the emergence of new models of shock wave therapy devices with improved characteristics on the medical equipment market, article provides a comparative assessment of various methods of shock wave therapy used to treat patients with chronic calculous prostatitis and the presence of chronic pelvic pain syndrome. The mechanism of action of the radial pressure wave and focused shock wave therapy is analyzed in detail.

Infektionskomplikationen bei Prostatabiopsie 2020 – Was hat sich geändert?

Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been suspended in Germany by the national authorities. This review is intended to highlight current strategies for reducing infectious complications following prostate biopsy. The European Association of Urology (EAU) guideline group on urological infections recently published ameta-analysis in two parts based on randomized controlled trials (RCTs). The most important contents shall be presented here. Transperineal prostate biopsy is associated with significantly reduced infectious complications than transrectal biopsy. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric monoprophylaxis with nonfluoroquinolones. Here data from RCTs are available for aminoglycosides, third generation cephalosporines, and fosfomycin trometamol. The transperineal approach is preferred to reduce prostate biopsy-related infections. Fluoroquinolones are no longer approved for prophylaxis. Thus, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal prostate biopsy.

Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis.

We identify which nonantibiotic strategies could reduce the risk of infectious complications following prostate biopsy. We performed a literature search on MEDLINE®, Embase® and the Cochrane Database for randomized controlled trials (inception to May 2020) assessing nonantibiotic interventions in prostate biopsy. Primary outcome was pooled infectious complications (fever, sepsis and symptomatic urinary tract infection) and secondary outcome was hospitalization. Cochrane risk of bias tool and GRADE approach were used to assess the bias and the certainty of evidence. The study protocol was registered with PROSPERO (CRD42015026354). A total of 90 randomized controlled trials (16,941 participants) were included in the analysis, with 83 trials being categorized into one of 10 different interventions. Transperineal biopsy was associated with significantly reduced infectious complications as compared to transrectal biopsy (RR 0.55, 95% CI 0.33-0.92, p=0.02, I2=0%, 1,330 participants, 7 studies). Rectal preparation with povidone-iodine was also shown to reduce infectious complications (RR 0.50, 95% CI 0.38-0.65, p <0.000001, I2=27%, 1,686 participants, 8 studies) as well as hospitalization (RR 0.38, 95% CI 0.21-0.69, p=0.002, I2=0%, 620 participants, 4 studies). We found no difference in infectious complications/hospitalization for 6 other interventions, ie number of biopsy cores, periprostatic nerve block, number of injections for periprostatic nerve block, needle guide type, needle type and rectal preparation with enema. In 2 interventions (needle diameter, rectal preparation with chlorhexidine) meta-analysis was not possible. Finally, 7 studies had unique interventions. The certainty of evidence was rated as low/very low for all interventions. Transperineal biopsy significantly reduces infectious complications compared to transrectal biopsy and should therefore be preferred. If transrectal biopsy is performed, rectal preparation with povidone-iodine is highly recommended. The other investigated nonantibiotic strategies did not significantly influence infection and hospitalization after prostate biopsy.

Randomized clinical trial on the use of a colon-occlusion device to assist rectal washout

BackgroundTransrectal Natural Orifice Transluminal Endoscopic Surgery is currently limited by the inherent risk of surgical site infection due to peritoneal contamination after rectotomy. Coloshield has been developed as a temporary colon occlusion device to facilitate rectal washout. However, effectiveness and safety has not been evaluated in humans.MethodsTwenty-two patients have been randomly assigned to undergo proctological intervention with a rectal washout with and without the use of Coloshield. Patients and assessors were blinded. Boston Bowel Preparation Scale (BBPS) has been determined 30 min as well as immediately after rectal washout. Feasibility, pain, intra- and postoperative morbidity as well as bowel function and continence 6 weeks after surgery were assessed.ResultsBBPS 30 min after rectal washout with and without Coloshield was in mean 2.42 ± 1.02 and 2.12 ± 0.89 (p = 0.042). Mean BBPS immediately after rectal washout was 2.39 ± 1.02 and 2.24 ± 0.66 (p = 0.269). Mean BBPS immediately after rectal washout and 30 min thereafter did not differ (p = 0.711). Coloshield application was feasible without any complications. The median (interquartile range) numeric rating scale for pain 4 h after surgery was 1 (0–1) and 3 (0–4) (p = 0.212). Six weeks after surgery 0/11 and 1/11 patients suffered from evacuation difficulties (p = 1.0) and the median Vaizey–Wexner score was 1 (0–3) and 1 (0–2) (p = 0.360).ConclusionsColoshield application in humans is feasible and safe. Slight benefits in rectal preparation by washout are found when Coloshield is used. Colon occlusion by Coloshield for transrectal NOTES should be evaluated within clinical studies.Trial registrationClinicaltrials.gov NCT02579330

Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis.

Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been banned by the European Commission. In this systematic review we summarize the evidence for different antibiotic prophylaxis regimens. We searched MEDLINE®, Embase® and Cochrane Database for randomized controlled trials (inception to October 2019) assessing antimicrobial interventions in prostate biopsy. Primary outcome was infectious complications. Exclusion criteria were simultaneous interfering interventions. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used to assess the certainty of evidence. Protocol was registered with PROSPERO (CRD42015026354). Overall 59 randomized controlled trials (14,153 participants) and 7 different antimicrobial interventions were included. Antibiotic prophylaxis reduced infectious complications compared to no prophylaxis (RR 0.56, 95% CI 0.40-0.77, p=0.0005, I2=15%, participants 1,753, studies 11). A short-term prophylaxis (single shot to 3 days) was inferior to a long-term prophylaxis (1 to 7 days) with fluoroquinolone (RR 1.89, 95% CI 1.37-2.61, p=0.0001, I2=0%, participants 3,999, studies 17). Fosfomycin trometamol was an alternative to fluoroquinolone with reduced rates of infectious complications (RR 0.49, 95 CI 0.27-0.87, p=0.02, I2=54%, participants 1,239, studies 3). Empiric prophylaxis was inferior to targeted prophylaxis (RR 1.81, 95% CI 1.28-2.55, p=0.0008, I2=48%, participants 1,511, studies 6). Standard prophylaxis was inferior to augmented prophylaxis (using multiple rather than single agent) using a fixed model (RR 2.10, 95% CI 1.53-2.88, p <0.0001, I2=71%, participants 2,597, studies 9), but not using a random model (p=0.07). No difference was observed in infectious complications based on route or timing of antimicrobial prophylaxis. The certainty of evidence was rated as low/very low. In countries where fluoroquinolones are allowed as antibiotic prophylaxis, a minimum of a full 1-day administration as well as targeted therapy in case of fluoroquinolone resistance is recommended. In countries with a ban on fluoroquinolones, fosfomycin is a good alternative, as is augmented prophylaxis, although no established standard combination exists to date.

Prostate bed and organ-at-risk deformation: Prospective volumetric and dosimetric data from a phase II trial of stereotactic body radiotherapy after radical prostatectomy

PurposeStereotactic body radiotherapy (SBRT) in the post-prostatectomy setting is investigational. A major concern is the deformable prostate bed clinical target volume (CTV) and the closely juxtaposed organs-at-risk (OARs). We report a volumetric and dosimetric analysis of kilovoltage cone-beam CT (CBCT) data from the first 18 patients enrolled on a phase II trial of post-prostatectomy SBRT. With instructions on bladder filling and rectal preparation, we hypothesized acceptable CTV coverage while minimal overdosing to OARs could be achieved. MethodsAll patients received 5 fractions of 6–6.8 Gy to the prostate bed. CBCT were taken prior to and halfway through each fraction. CTV and OARs were contoured for each CBCT. Changes in inter- and intra-fraction volume and dose were calculated. Relative changes in CTV V95%, bladder V32.5 Gy, and rectal V32.5 Gy and V27.5 Gy were evaluated. ResultsInterfraction CTV volume remained stable, with median change +5.69% (IQR −1.73% to +9.84%). CTV V95% exhibited median change −0.74% (IQR −9.15% to −0.07%). Volumetric and dosimetric changes were minor from interfraction rotation and intrafraction motion. CTV V95% was ≥93% in 13 of 18 (72%) patients; in the remaining five, median change was −14.09% (IQR −16.64% to −13.56%). Interfraction CTV volume change was significantly larger among patients with CTV V95% <93% (+25.04% vs. +2.85%, p = 0.002). ConclusionsWith specific bladder and rectum filling protocols, CTV underdosing and overdosing to bladder and rectum are avoided in majority of patients. Changes in CTV shape may account for the underdosing that may be observed.

Can the rectal size of prostate patients at MRI be used as a predictor of rectal size at CT for patients referred for radiotherapy planning?

Keywords: Prostate cancer, computed tomography, magnetic resonance Introduction: To audit the dynamic interrelationship between rectal distension at diagnosis magnetic resonance (MRI) scan with the computed tomography (CT) radiotherapy planning scan; to determine the effect of rectal movement on the position of the prostatic gland. This review will examine the efficacy of rectal preparation. At present rectal distension at RT CT planning scan is assessed on control slices using GSTT protocol prior to having a full CT scan. If this is outside tolerance a repeat CT scan appointment whereby the patient is given an enema. If rectal size can be predicted prior to the CT planning scan, bowl preparation can be pre-empted to ensure efficiencies in the patient pathway. Method: A retrospective audit looking at the MRI diagnostic scans and radiotherapy CT planning scans of 141 patients with adenocarcinoma of the prostate between May to August 2019. To find out if rectal size at MRI serves as an indicator of rectal size at planning RT CT. Dependent on the outcome of the retrospective study, a prospective study will then be undertaken to assess if an intervention prior to RT CT scan such as a prescription of Docusate Sodium enema help resolve the issue of rectal size at planning. Results: Results pending. Conclusions & Discussion: The outcome should inform clinical practice, benefit patients and clinicians and provision of service. The audit may result in reduction of rebooking patients for repeat CT scan and cease the delay of treatment processes. Numerical

Developing patient specific rectal preparation for patients receiving prostate radiotherapy

Developing patient specific rectal preparation for patients receiving prostate radiotherapy

Prostate Bed and Organ-at-Risk Deformation: Prospective Volumetric and Dosimetric Data from a Phase II Trial of Stereotactic Body Radiotherapy after Radical Prostatectomy

Stereotactic body radiotherapy (SBRT) for localized prostate cancer has emerged as an attractive treatment currently being studied in phase III trials. SBRT in post-prostatectomy setting, however, has been minimally investigated. A major concern for this setting is the highly deformable nature of adjacent organs-at-risk (OARs) and prostate bed clinical target volume (CTV). We report a volumetric and dosimetric analysis of kilovoltage cone-beam CT (CBCT) data from 18 patients enrolled on a phase II clinical trial of post-prostatectomy SBRT. We hypothesized that with instructions on bladder filling and rectal preparation, we could achieve acceptable CTV coverage and avoid overdosing OARs. Eighteen patients receiving 5 fractions of 6-6.8 Gy to prostate bed were included. Patients received instructions on bladder filling and rectal preparation, specifically to urinate 60 minutes and drink 16-24 oz of water prior to treatment, as well as take enemas the night and morning before treatment. CBCT prior to each fraction was taken for anatomic verification and image guidance, and a second CBCT halfway through treatment for intrafractional motion analysis. CBCTs were imported into a deformable registration algorithm. Prostate bed CTV and OARs were contoured for each image. Percent changes in inter and intrafractional volume and mean dose change were calculated for all structures; V95 was also calculated for each CTV. Interfractional volumetric and dosimetric changes are summarized in Table 1. CTV volume was relatively constant (median change +5.7% [IQR -1.7% to + 9.8%]) as was CTV V95 (median change -0.74% [IQR -9.2% to -0.1%]). Rectal volume showed greatest change between treatment sessions and treatment plan, with median change of +21.0% [IQR +5.1% to 34.6%]. Intrafractional volumetric and dosimetric changes were overall nonsignificant. Among 11 patients with at least 3 months follow-up, there was one instance of acute grade 2 gastrointestinal toxicity by CTCAE 4.03, and no instances of grade 2 genitourinary toxicity. So far, one patient had biochemical failure which may be due to an out of field relapse. All others have had PSA response. Dosimetric and volumetric data from this prospective trial indicate CTV coverage is well maintained without overdosing OARs despite the highly deformable anatomy involved with post-prostatectomy SBRT. Acute toxicity is favorable, though longer follow-up and more patients are needed to evaluate late toxicity and efficacy.Abstract 1253; Table 1Interfractional percent change in volume and dose of critical treatment structuresMeanMedianQ1Q3CTV volume2.95%5.69%-1.73%9.84%CTV mean dose-1.63%-0.40%-2.43%-0.17%Bladder volume0.85%2.17%-28.19%10.55%Bladder mean dose0.30%-1.33%-11.77%6.55%Rectum volume25.38%20.97%5.10%34.64%Rectum mean dose-6.98%-8.53%-15.34%-2.86%Rectal wall volume23.76%23.14%3.46%40.13%Rectal wall mean dose-11.72%-12.79%-19.58%-6.76%CTV V95-5.05%-0.74%-9.15%-0.07% Open table in a new tab

Biópsia Prostática Transretal Após Preparação Profilática do Recto com Iodo-Povidona: Estudo Prospectivo Randomizado

Introduction: Transrectal ultrasound guided prostate biopsy (TRUS-Bx), according to the literature, can lead to urinary tract infections in up to 11% and sepsis in up to 2% of patients. We evaluate whether an original way to apply povidone-iodine rectal preparation just prior to TRUS-Bx can reduce infectious complications.&#x0D; Material and Methods: Between January 2014 and September 2016, 94 men in private office were prospectively randomized to two groups, before TRUS-Bx: • Rectal cleansing (an original transrectal “prostate massage” for about half a minute with 2.5 mL of betadine dermic solution 100 mg/mL) (n=47) or • No cleansing (n=47). All of the patients received prophylactic antibiotics: levofloxacin 500 mg PO for 7 days, beginning the day before procedure. Patients completed a telephone interview 4 days after undergoing the biopsy and went to the office 2 weeks after biopsy. The primary end point was the rate of infectious complications. An infectious complication when one or more of the following events occurred: 1) fever greater than 38.0Cº, 2) urinary tract infection or 3) sepsis (standardized definition). Student t test and multivariate regression analysis were used for data analysis.&#x0D; Results: Infectious complications developed in 6 cases (12.7%) in the non-rectal preparation group: five patients had fever without sepsis (11%) and one had sepsis (2%). In the povidone-iodine rectal preparation group there were no infectious complications (0.0%). Multivariate analysis did not identify any patient subgroups at significantly higher risk of infection after prostate biopsy. Of the 94 men who underwent TRUS-Bx 45 (47.9%) were diagnosed with prostate cancer and 3 (3.2%) had ASAP in the result. The hospital admission rate for urological complications within 30 days of the procedure was 1%, and only for infection related reasons (sepsis).&#x0D; Conclusion: The administration of quinolone-based prophylactic antibiotics and the simple use of 2.5 mL of povidone-iodine dermic solution in a transrectal prostate massage for Introduction: Transrectal ultrasound guided prostate biopsy (TRUS-Bx), according to the literature, can lead to urinary tract infections in up to 11% and sepsis in up to 2% of patients. We evaluate whether an original way to apply povidone-iodine rectal preparation just prior to TRUS-Bx can reduce infectious complications. Material and Methods: Between January 2014 and September 2016, 94 men in private office were prospectively randomized to two groups, before TRUS-Bx: • Rectal cleansing (an original transrectal “prostate massage” for about half a minute with 2.5 mL of betadine dermic solution 100 mg/mL) (n=47) or • No cleansing (n=47). All of the patients received prophylactic antibiotics: levofloxacin 500 mg PO for 7 days, beginning the day before procedure. Patients completed a telephone interview 4 days after undergoing the biopsy and went to the office 2 weeks after biopsy. The primary end point was the rate of infectious complications. An infectious complication when one or more of the following events occurred: 1) fever greater than 38.0Cº, 2) urinary tract infection or 3) sepsis (standardized definition). Student t test and multivariate regression analysis were used for data analysis. Results: Infectious complications developed in 6 cases (12.7%) in the non-rectal preparation group: five patients had fever without sepsis (11%) and one had sepsis (2%). In the povidone-iodine rectal preparation group there were no infectious complications (0.0%). Multivariate analysis did not identify any patient subgroups at significantly higher risk of infection after prostate biopsy. Of the 94 men who underwent TRUS-Bx 45 (47.9%) were diagnosed with prostate cancer and 3 (3.2%) had ASAP in the result. The hospital admission rate for urological complications within 30 days of the procedure was 1%, and only for infection related reasons (sepsis). Conclusion: The administration of quinolone-based prophylactic antibiotics and the simple use of 2.5 mL of povidone-iodine dermic solution in a transrectal prostate massage for