Evolution of Androgen Deprivation Therapy (ADT) and Its New Emerging Modalities in Prostate Cancer: An Update for Practicing Urologists, Clinicians and Medical Providers.

Androgen deprivation therapy (ADT) has been the main management strategy for prostate cancer for more than eight decades, nowadays achieved commonly by administration of luteinizing hormone-releasing hormone agonists. ADT markedly suppresses androgen hormones with the long-term risks of adverse events such as muscle weakness, impairment of glucose and lipid metabolism, impotence, osteoporosis, and secondary fractures. Extensive research has provided significantly better insight into the dynamics of ADT including identification of the benefits of sequential and combination therapies. This has led to the development of new pharmaceutical ADT modalities. This review provides a general overview of the evolution of ADT in the context of the new emerging pharmaceutical ADT modalities so that clinicians and medical providers have a better understanding of personalizing the available ADT options with their different risk-benefit profiles.

Histological changes of the peripheral zone in small and large prostates and possible clinical implications.

INTRODUCTION: It is well documented in literature that most prostate carcinomas (PCa) arise in the peripheral zone (PZ). Additionally, an inverse relationship between prostate size and the incidence of PCa has been demonstrated in recent studies. However, little is known about gland distribution in the peripheral zone of larger prostates compared to smaller prostates. In this study, we examined the histo-anatomical gland distribution within the peripheral zone in small and large prostates and discuss possible clinical implications. METHODS: A semi-quantitative analysis of gland density and capsule thickness was performed using light microscopy on 10 large (≥80 g) prostate specimens and 10 small (<30 g) prostate specimens from patients who underwent radical prostatectomy at Texas Tech University Health Sciences Center between the years 2010 and 2016. Samples from radical prostatectomies were used to ensure a whole, preserved prostate with an intact surgical capsule. Gland counts were performed on five random fields under 100 × magnification, while capsule thickness was measured on three random fields per case; thus, a total 50 fields and 30 fields were analyzed for each of the two groups for gland counts and capsule thickness measurements, respectively. Microscopy was standardized to the posterior aspect of the prostate, between 4 o'clock and 6 o'clock along the equatorial region between the apex and base. RESULTS: Large prostates possessed a significantly lower mean gland count per field compared to small prostates (10.34±4.15, n=50 vs 18.00±5.41, n=50; t=8.16, df=49, P<0.001). Additionally, large prostates showed a significantly higher average capsule thickness in millimeters compared to small prostates (1.80 mm, ±1.12 mm, n=30 vs 0.90 mm, ±0.56, n=30; t=8.16, df=49, P<0.001). CONCLUSION: The results demonstrate that prostate hypertrophy leads to both decreased gland density in the peripheral zone and increased capsule thickness, suggesting that growth-induced expansion of the prostate against its capsule leads to compression-induced atrophy and fibrosis of glandular tissue within the peripheral zone (PZ). A decrease in gland density within the PZ may have clinical implications shedding light, for instance, on the reduction in PCa incidence in patients with large prostates as compared to smaller prostates, a phenomenon well documented in the literature.

Accuracy of 3-dimensional-printed Endodontic Surgical Guide: A Human Cadaver Study.

INTRODUCTION: Cone-beam computed tomographic (CBCT)-based 3-dimensional-printed surgical guides, such as those used in implant placement and orofacial surgery, allow for accurate planning and performance of surgical procedures. The objective of this study was to evaluate the accuracy of CBCT-designed surgical guides for use during endodontic surgery. METHODS: A split-mouth design was conducted using 48 roots in a cadaver model. In the experimental group, using information from the preoperative CBCT scans and digital impressions, surgical guides were designed using Blue Sky Bio (Grayslake, IL) planning software and printed using a Form 2 3-dimensional printer (Formlabs, Somerville, MA). The guides were designed to allow for surgical access at 3 mm from the apex of each root with depth control to the lingual or palatal surface of the root. In the control group, surgical access was completed "freehand" by visually approximating measurements from the CBCT scan only. The planned and postoperative CBCT images were superimposed, and the deviation of the surgical access point from the planned target was measured using Invivo software (Anatomage, San Jose, CA). A 2-tailed t test and the Fisher exact test were conducted to compare the deviation in the experimental CBCT-guided group versus the control CBCT-approximated freehand group. RESULTS: The mean deviation for the guided group (1.743 mm) was significantly less than that of the approximated freehand group (2.638 mm, P < .001). Only in 11 of the 24 samples of the control group was surgical access considered clinically successful (within the apical area of the root), whereas all 24 of the experimental samples were considered clinically successful. CONCLUSIONS: Using a CBCT-designed printed surgical guide is a more accurate method for access to the apical portion of the root during surgical endodontics compared with a "freehand" CBCT-approximated method.