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1.
Cancer Radiother ; 25(2): 161-168, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33454191

RESUMO

PURPOSE: The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. PATIENTS AND METHODS: This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. RESULTS: Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03mm, 5.42mm and 8.73mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5mm. The CTV to PTV margins ranged from 3.12mm to 3.25mm for external iliac vessels and from 3.12mm to 4.18mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. CONCLUSIONS: We recommend CTV to PTV margins of 8mm, 6mm and 9mm in AP, ML and SI directions for prostate. And, we suggest 4mm and 5mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3weeks and especially the first week to check rectum volume.


Assuntos
Adenocarcinoma/radioterapia , Linfonodos/diagnóstico por imagem , Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Reto/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Algoritmos , Análise de Variância , Antagonistas de Androgênios/uso terapêutico , Humanos , Artéria Ilíaca/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Linfonodos/anatomia & histologia , Irradiação Linfática/métodos , Masculino , Movimentos dos Órgãos , Órgãos em Risco/anatomia & histologia , Órgãos em Risco/diagnóstico por imagem , Ossos Pélvicos/anatomia & histologia , Ossos Pélvicos/diagnóstico por imagem , Pelve , Estudos Prospectivos , Próstata/anatomia & histologia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Planejamento da Radioterapia Assistida por Computador/métodos , Erros de Configuração em Radioterapia , Radioterapia Conformacional , Radioterapia Guiada por Imagem , Reto/anatomia & histologia , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X , Carga Tumoral , Bexiga Urinária/anatomia & histologia
2.
Zhonghua Nan Ke Xue ; 26(5): 409-413, 2020 May.
Artigo em Chinês | MEDLINE | ID: mdl-33354948

RESUMO

Objective: To investigate the factors influencing the positive rate of prostate biopsy and its relationship with the prostate volume and inflammatory cell infiltration (ICI). METHODS: We retrospectively analyzed the clinical data on 230 cases of double-plane transrectal ultrasound-guided prostate biopsy in our Department of Urology, including the patients' age, body mass index (BMI), serum total prostate-specific antigen (tPSA), PSA density (PSAD), prostate volume, and ICI in the prostate tissue. We also investigated the relationship of the above factors with the pathological results of prostate biopsy by binary logistic regression analysis. RESULTS: The positive rate of prostate biopsy was 38.7% (89/230) in the total number of cases, 28.57% (n = 56) in the 196 cases with tPSA < 100 µg/L, and 97.06% (n = 33) in the 34 cases with tPSA ≥ 100 µg/L. Binary logistic regression analysis showed that the positive rate of prostate biopsy in those with tPSA < 100 µg/L was correlated positively with age (P < 0.01, OR = 1.09), tPSA (P < 0.01, OR = 1.04) and PSAD (P < 0.01, OR = 10.04), negatively with the prostate volume (P < 0.01, OR = 0.98) and ICI (P < 0.01, OR = 0.22), but not with BMI (P > 0.05). As a predictor of positive prostate biopsy, tPSA > 10 µg/L exhibited a sensitivity of 82.14% and a specificity of 35.71%, while PSAD > 0.26 showed a sensitivity of 78.57% and a specificity of 71.43%. CONCLUSIONS: Non-specific elevation of the tPSA level induced by increased prostate volume and inflammatory cell infiltration may lead to unnecessary biopsies in some patients. As a predictor of positive prostate biopsy, PSAD > 0.26 has a higher clinical application value than tPSA > 10 µg/L.


Assuntos
Biópsia , Próstata/anatomia & histologia , Neoplasias da Próstata/diagnóstico , Humanos , Masculino , Próstata/patologia , Antígeno Prostático Específico/sangue , Estudos Retrospectivos , Sensibilidade e Especificidade
3.
Exp Mol Pathol ; 115: 104473, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32454105

RESUMO

The aim of this study was to evaluate the impact of prenatal testosterone exposure on prostate development in male and female neonatal gerbils. Pregnant females were exposed to subcutaneous injections of testosterone cypionate (500 µg/animal) at gestational days 20 and 22. Male and female pups were then euthanized at postnatal day 1. Morphological analysis showed that females were severely affected by androgen exposure. We also observed that male and female urogenital sinus (UGS) responded differentially to testosterone treatment, demonstrating heterogeneous immunostaining for the androgen receptor (AR), estrogen receptor alpha (ERα), and proliferating cell nuclear antigen (PCNA). Smooth muscle α-actin (α-SMA) analysis showed that testosterone delays the myodifferentiation, allowing buds to reach the ectopic mesenchymes of the female UGS. Our data showed that abnormal testosterone exposure disrupted prostate organogenesis, altered the expression patterns of important markers, and demonstrated that female UGS was particularly influenced by androgen exposure during a critical window in the developmental period.


Assuntos
Organogênese/efeitos dos fármacos , Próstata/crescimento & desenvolvimento , Testosterona/farmacologia , Animais , Receptor alfa de Estrogênio/metabolismo , Feminino , Gerbillinae , Imageamento Tridimensional , Masculino , Antígeno Nuclear de Célula em Proliferação/metabolismo , Próstata/anatomia & histologia , Próstata/diagnóstico por imagem , Próstata/efeitos dos fármacos , Receptores Androgênicos/metabolismo , Testosterona/sangue
4.
Nat Rev Urol ; 17(3): 177-188, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32086498

RESUMO

The practice of radical prostatectomy for treating prostate cancer has evolved remarkably since its general introduction around 1900. Initially described using a perineal approach, the procedure was later popularized using a retropubic one, after it was first described as such in 1948. The open surgical method has now largely been abandoned in favour of the minimally invasive robot-assisted method, which was first described in 2000. Until 1980, the procedure was hazardous, often accompanied by massive blood loss and poor outcomes. For patients in whom surgery is indicated, prostatectomy is increasingly being used as the first step in a multitherapeutic approach in advanced local, and even early metastatic, disease. However, contemporary molecular insights have enabled many men to safely avoid surgical intervention when the disease is phenotypically indolent and use of active surveillance programmes continues to expand worldwide. In 2020, surgery is not recommended in those men with low-grade, low-volume Gleason 6 prostate cancer; previously these men - a large cohort of ~40% of men with newly diagnosed prostate cancer - were offered surgery in large numbers, with little clinical benefit and considerable adverse effects. Radical prostatectomy is appropriate for men with intermediate-risk and high-risk disease (Gleason score 7-9 or Grade Groups 2-5) in whom radical prostatectomy prevents further metastatic seeding of potentially lethal clones of prostate cancer cells. Small series have suggested that it might be appropriate to offer radical prostatectomy to men presenting with small metastatic burden (nodal and or bone) as part of a multimodal therapeutic approach. Furthermore, surgical treatment of prostate cancer has been reported in cohorts of octogenarian men in good health with minimal comorbidities, when 20 years ago such men were rarely treated surgically even when diagnosed with localized high-risk disease. As medical therapies for prostate cancer continue to increase, the use of surgery might seem to be less relevant; however, the changing demographics of prostate cancer means that radical prostatectomy remains an important and useful option in many men, with a changing indication.


Assuntos
Próstata/cirurgia , Prostatectomia/história , Neoplasias da Próstata/história , Procedimentos Cirúrgicos Robóticos/história , História do Século XX , História do Século XXI , Humanos , Excisão de Linfonodo/história , Excisão de Linfonodo/tendências , Masculino , Próstata/anatomia & histologia , Próstata/patologia , Prostatectomia/métodos , Prostatectomia/tendências , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos
5.
Prostate ; 80(6): 471-480, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32049374

RESUMO

BACKGROUND: The shape and function of the longitudinal muscular column (LMC) of the prostate have not been established in detail. The present study was undertaken to elucidate the roles of the LMC of the posterior wall of the prostatic urethra (PSU) in the emission phase of ejaculation by investigating the form and muscular arrangement of the LMC. METHODS: Prostates and urinary bladders were obtained from 14 Korean adult cadavers. Nine specimens were histologically analyzed using hematoxylin and eosin, Masson's trichrome, and Verhoeff-van Gieson staining. Two specimens were scanned using microcomputed tomography (micro-CT), and all scanned images were reconstructed into a three-dimensional model. RESULTS: At the proximal level of the prostate, the ejaculatory ducts (EDs) and prostatic utricle (PU) together were surrounded by circular smooth-muscle fibers. However, at the seminal colliculus (SC) where the EDs and PU opened, they were mainly surrounded by an abundance of longitudinal fibers. The longitudinal fibers posterior to the EDs and PU formed a distinctive LMC in the posterior urethral wall. In histologic sections and micro-CT images, the LMC extended distally from the level of the SC to the level of the membranous urethra (MBU). We simulated a potential mechanism of LMC using a mathematical model of its movements. CONCLUSIONS: Comprehensive analyses based on in-depth assessment of histologic characteristics and micro-CT images demonstrated extension of the LMC from the level of the SC to the level of the MBU, enabling a better understanding of ejaculation physiology involving the LMC. These results suggest that the LMC in the posterior wall of the PSU is a critical component of ejaculation by facilitating the ejection of seminal vesicle fluid into the PSU via well-coordinated contractions.


Assuntos
Ejaculação/fisiologia , Modelos Biológicos , Próstata/anatomia & histologia , Próstata/fisiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Elastina/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Músculo Liso/anatomia & histologia , Músculo Liso/citologia , Músculo Liso/fisiologia , Próstata/citologia , Próstata/diagnóstico por imagem , Uretra/anatomia & histologia , Uretra/citologia , Uretra/fisiologia , Microtomografia por Raio-X/métodos
6.
Einstein (Sao Paulo) ; 18: eAO4662, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32022105

RESUMO

OBJECTIVE: To assess accuracy of multiparametric magnetic resonance of the prostate to estimate gland volume, comparing the results with transrectal ultrasound and surgical specimen. METHODS: A retrospective study of 85 patients who underwent multiparametric magnetic resonance and transrectal ultrasound (for fusion image-guided biopsy) before radical prostatectomy. Prostate measurements were obtained from magnetic resonance axial and sagittal T2-weighted images and ultrasound; the prostate volume was determined using the ellipsoid formula. The results were compared with the surgical specimen weight. Maximum interval between multiparametric magnetic resonance imaging, transrectal ultrasound, and prostatectomy was 6 months. RESULTS: The prostate volume measured by multiparametric magnetic resonance imaging was 18-157cm3 (mean of 49.9cm3) and by transrectal ultrasound, 22-165cm3 (mean of 54.9cm3); the surgical specimen weight was 20-154g (mean of 48.6g), with no statistical differences. Based on the values obtained from imaging examinations, the prostate volume obtained was very close to the real prostatic weight, and the measures by multiparametric magnetic resonance were slightly more precise. CONCLUSION: Prostate volume measured by multiparametric magnetic resonance imaging and transrectal ultrasound showed similar values, and excellent agreement with real prostate weight of the surgical specimens. Prostate volume measured by magnetic resonance has been increasingly used in the clinical practice, and its value enables appropriate therapeutic planning and control of patients.


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica/métodos , Próstata/anatomia & histologia , Neoplasias da Próstata/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Precisão da Medição Dimensional , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Próstata/diagnóstico por imagem , Prostatectomia , Neoplasias da Próstata/patologia , Estudos Retrospectivos
7.
Urology ; 136: 190-195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31730940

RESUMO

OBJECTIVE: To provide the anatomy of the puboprostatic ligament and related structures to save urogenital competence after prostatectomy. MATERIALS AND METHODS: Pelvic areas of 31 adult cadavers were dissected to figure out the shape, number, and location of the puboprostatic ligaments. RESULTS: The puboprostatic ligament was the most important support structure between the pubic bone and prostate gland. Puboprostatic ligaments were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%). Ligaments were mostly I-shaped (53.8%). If ligaments had extra attachment to or from the arcuate line, the ligaments were λ-shaped (36.3%), or Y-shaped (8.8%). In one case, the ligament had a central fusion with an irregular shape. I-shaped puboprostatic ligaments were observed more frequently in specimens with double ligaments, while λ-shaped puboprostatic ligaments were observed more frequently in the cases with single ligaments. The average distance between both puboprostatic ligaments was 8.1 mm at the pubic site and 14.2 mm at the prostate site. The distance was narrower when the specimen had double puboprostatic ligaments on both sides. The neurovascular bundle ran beneath the puboprostatic ligament. If the ligament was the λ-shaped type, the neurovascular bundle frequently pierced the lateral band of the ligament. CONCLUSION: Puboprostatic ligaments hold and stabilize the prostate against the pubic bone. It is believed that a pelvis with bilateral, double puboprostatic ligaments would have advantages in urogenital competence. The morphologic data of the shape, multiplicity, and location of the PPLs would help to make a plan to approach the prostate.


Assuntos
Ligamentos/anatomia & histologia , Próstata/anatomia & histologia , Prostatectomia/métodos , Osso Púbico/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Humanos , Masculino , Pessoa de Meia-Idade
8.
Prostate ; 80(2): 153-161, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31746484

RESUMO

BACKGROUND: The evidence of pelvic lymph node metastases after radical prostatectomy (RP) with pelvic lymph node dissection (PLND) is one of the strongest prognostic factors for poor oncologic outcome. The extent of PLND, although representing a crucial step in RP, is still controversial. Currently, there is a critical drawback in clinical practice due to the lack of congruence between the known lymphatic drainage and cancer dissemination despite defined management by a surgical approach. We hypothesized the existence of alternative pathways for the lymphatic drainage of the prostate currently not considered in clinical daily practice. METHODS: We carried out a literature review of the anatomic description of nodal drainage of prostate reported by online databases (MEDLINE/PubMed, EBSCO, Web of Science, Ovid, and Scopus) and the original texts since the 18th century, with an additional anatomical dissection on a human cadaver to confirm theoretical data. RESULTS: The anatomical dissection study converged with the historical anatomical treatises in describing three groups of lymphatics devoted to carrying out prostatic nodal drainage. Apart from the ascending ducts from the cranial gland leading to the external iliac nodes; the lateral ducts leading to the hypogastric nodes; small lymphatic vessels from the posterior surface of the prostate, directed to the pararectal lymphatic plexus, in the direction of the lateral sacral lymph nodes and those at the sacral promontory (ie, pararectal and presacral lymph nodes) were observed. CONCLUSIONS: Our preliminary findings demonstrate that lymphatic drainage of the prostate extends beyond standard nodal templates actually considered in surgical daily practice, despite the knowledge reported by historical anatomical treatises. Further anatomical and experimental evidence are needed to investigate anatomical variability in humans, as well as to add more topographical details.


Assuntos
Sistema Linfático/anatomia & histologia , Próstata/anatomia & histologia , Idoso , Cadáver , Dissecação , Humanos , Masculino
9.
Prostate ; 80(3): 241-246, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31825529

RESUMO

BACKGROUND: There are limited studies describing the detailed nonhistologic anatomy of the prostatic urethra. We studied radical prostatectomy specimens to describe the ex vivo anatomical details of its shape and size. METHODS: We conducted an observational study examining the prostatic urethra anatomy. Prostatic urethra casts (molds) were made using vinyl polysiloxane immediately after fresh specimens had been retrieved following prostatectomy for organ-confined prostate cancer. The following measurements were taken from the casts: anterior length, posterior length, maximal diameter, bladder neck to verumontanum, verumontanum to apex length, and prostate urethral angle (PUA). Prostate volume was calculated using the ellipsoid formula: ((p/6) × transverse × length × height). RESULTS: Thirty-three prostatic urethral casts were obtained. The mean prostate volume was 38.59 cc. The mean PUA was 127.6°. The mean transverse, apex, and length of the prostate were 4.65, 4.06, and 3.63 cm, respectively. The mean distance from the verumontanum to sphincter was 1.2 cm. The ratio between the anterior and posterior length of the prostatic urethra was 0.82 cm and did not correlate with prostatic size (Figure 8). CONCLUSION: The distance from the verumontanum to the apex does not change with prostate size; it is uniform with a mean length of 1.2 cm. The anterior length, posterior length, and maximum diameter of the prostatic urethra increase with prostate size. The mean difference between the anterior and posterior length is 0.8 cm and did not correlate with prostate size. Urethral angulation decreased with prostate size but was not significant. Information obtained from this study is of value designing prostatic stents and devices for benign prostatic hyperplasia.


Assuntos
Modelos Anatômicos , Polivinil , Próstata/anatomia & histologia , Siloxanas , Uretra/anatomia & histologia , Fatores Etários , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/cirurgia , Prostatectomia
10.
BJU Int ; 125(2): 322-332, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31677325

RESUMO

OBJECTIVES: To incorporate and validate clinically relevant performance metrics of simulation (CRPMS) into a hydrogel model for nerve-sparing robot-assisted radical prostatectomy (NS-RARP). MATERIALS AND METHODS: Anatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created from patient MRI by injecting polyvinyl alcohol (PVA) hydrogels into three-dimensionally printed injection molds. The following steps of NS-RARP were simulated: bladder neck dissection; seminal vesicle mobilization; NVB dissection; and urethrovesical anastomosis (UVA). Five experts (caseload >500) and nine novices (caseload <50) completed the simulation. Force applied to the NVB during the dissection was quantified by a novel tension wire sensor system fabricated into the NVB. Post-simulation margin status (assessed by induction of chemiluminescent reaction with fluorescent dye mixed into the prostate PVA) and UVA weathertightness (via a standard 180-mL leak test) were also assessed. Objective scoring, using Global Evaluative Assessment of Robotic Skills (GEARS) and Robotic Anastomosis Competency Evaluation (RACE), was performed by two blinded surgeons. GEARS scores were correlated with forces applied to the NVB, and RACE scores were correlated with UVA leak rates. RESULTS: The expert group achieved faster task-specific times for nerve-sparing (P = 0.007) and superior surgical margin results (P = 0.011). Nerve forces applied were significantly lower for the expert group with regard to maximum force (P = 0.011), average force (P = 0.011), peak frequency (P = 0.027) and total energy (P = 0.003). Higher force sensitivity (subcategory of GEARS score) and total GEARS score correlated with lower nerve forces (total energy in Joules) applied to NVB during the simulation with a correlation coefficient (r value) of -0.66 (P = 0.019) and -0.87 (P = 0.000), respectively. Both total and force sensitivity GEARS scores were significantly higher in the expert group compared to the novice group (P = 0.003). UVA leak rate highly correlated with total RACE score r value = -0.86 (P = 0.000). Mean RACE scores were also significantly different between novices and experts (P = 0.003). CONCLUSION: We present a realistic, feedback-driven, full-immersion simulation platform for the development and evaluation of surgical skills pertinent to NS-RARP. The correlation of validated objective metrics (GEARS and RACE) with our CRPMS suggests their application as a novel method for real-time assessment and feedback during robotic surgery training. Further work is required to assess the ability to predict live surgical outcomes.


Assuntos
Impressão Tridimensional , Próstata/anatomia & histologia , Prostatectomia/educação , Procedimentos Cirúrgicos Robóticos/educação , Treinamento por Simulação , Cirurgia Assistida por Computador/educação , Anastomose Cirúrgica/normas , Benchmarking , Competência Clínica , Simulação por Computador , Estudos de Viabilidade , Humanos , Hidrogéis , Internato e Residência , Masculino , Modelos Anatômicos , Prostatectomia/normas , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Robóticos/normas , Análise e Desempenho de Tarefas
11.
Magn Reson Imaging ; 66: 22-29, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31715250

RESUMO

We propose a novel processing method for reducing shading artifacts in quantitative susceptibility mapping (QSM) for prostate imaging. In the conventional method, calculation errors in the boundary regions between water and fat cause shading artifacts that degrade the image quality for QSM. In the proposed method, water and fat regions are separated, and susceptibilities in these two regions are calculated separately and then combined. Susceptibility in the water regions is calculated by using the fat regions as a background susceptibility source to remove shading artifacts. Susceptibility in the fat regions is calculated by using the constraint that shading artifacts in the water regions are suppressed to improve accuracy. In quantitative evaluation of the method with a numerical simulation, calculation errors for the water and fat regions were reduced by 62% and 85%, respectively, compared with the conventional method. In visual evaluation using human prostate imaging, the proposed method also reduced the shading artifacts unlike the conventional method. The proposed method is expected to improve the performance of QSM in diagnosing such diseases as prostate cancer.


Assuntos
Artefatos , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Próstata/anatomia & histologia , Tecido Adiposo/diagnóstico por imagem , Adulto , Algoritmos , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Imagens de Fantasmas , Água
12.
BMC Urol ; 19(1): 95, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638952

RESUMO

BACKGROUND: Electrical conductivity-based magnetic resonance (MR) imaging may provide unique information on tissue condition because its contrast originates from the concentration and mobility of ions in the cellular space. We imaged the conductivity of normal canine prostate in vivo and evaluated tissue contrast in terms of both the conductivity distribution and anatomical significance. METHODS: Five healthy laboratory beagles were used. After clipping the pelvis hair, we attached electrodes and placed each dog inside the bore of an MRI scanner. During MR scanning, we injected imaging currents into two mutually orthogonal directions between two pairs of electrodes. A multi spin echo pulse sequence was used to obtain the MR magnitude and magnetic flux density images. The projected current density algorithm was used to reconstruct the conductivity image. RESULTS: Conductivity images showed unique contrast depending on the prostatic tissues. From the conductivity distribution, conductivity was highest in the center area and lower in the order of the middle and outer areas of prostatic tissues. The middle and outer areas were, respectively, 11.2 and 25.5% lower than the center area. Considering anatomical significance, conductivity was highest in the central zone and lower in the order of the transitional and peripheral zones in all prostates. The transitional and peripheral zones were, respectively, 7.5 and 17.8% lower than the central zone. CONCLUSIONS: Current conductivity-based MR imaging can differentiate prostatic tissues without using any contrast media or additional MR scans. The electrical conductivity images with unique contrast to tissue condition can provide a prior information on tissues in situ to be used for human imaging.


Assuntos
Imagem por Ressonância Magnética/métodos , Próstata/anatomia & histologia , Próstata/diagnóstico por imagem , Animais , Cães , Condutividade Elétrica , Estudos de Viabilidade , Masculino
13.
Med Sci Sports Exerc ; 51(11): 2210-2216, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31626054

RESUMO

INTRODUCTION: Aerobic training and green tea extract can be used to reduce the risk of prostate cancer. The goal of this study was to evaluate the effects of 8-wk aerobic exercise training and administration of green tea extract on the level of nuclear factor kappa B (NF-kB), cyclooxygenase-2 (COX-2) and p53 tumor suppressor protein (p53) in prostate of rats which were stimulated by N-methyl-N-nitrosourea to induce the prostate cancer. METHODS: Sixty adult male Wistar rats were assigned into six groups including healthy control, cancer control (CCt), cancer training (CTr: 45 min·d at low to moderate intensity, five times per week, 8 wk), cancer extract (CEx: 1.34 mL of green tea extract, three times per week, 8 wk), cancer training+ cancer extract (CTr + CEx) and sham groups. Rats were sacrificed 48 h after the last intervention session, and the prostate tissue was isolated to measure the levels of NF-kB, COX-2, and p53. RESULTS: The NF-kB level in CCt group was increased significantly compared to the healthy control (P = 0.02). In the CTr group, NF-kB level was decreased significantly compared to the CCt and CEx groups (P = 0.001 and 0.05, respectively). In addition, the levels of P53 protein were reduced in CTr, CEx, and CTr + CEx groups compared to CCt group (P = 0.001, 0.02 and 0.004, respectively). No significant changes were found in the level of COX-2 between groups. CONCLUSIONS: These results suggest that a long-term exercise training combined with the intake of green tea extract may reduce levels of NF-kB and p53 in rats with prostate cancer. Given the importance of recognizing complementary therapies in this regard, future studies are warranted.


Assuntos
Anticarcinógenos/administração & dosagem , Condicionamento Físico Animal , Extratos Vegetais/administração & dosagem , Neoplasias da Próstata/prevenção & controle , Chá , Animais , Peso Corporal , Ciclo-Oxigenase 2/metabolismo , Masculino , Metilnitrosoureia , NF-kappa B/metabolismo , Tamanho do Órgão , Próstata/anatomia & histologia , Próstata/metabolismo , Neoplasias da Próstata/induzido quimicamente , Ratos Wistar , Proteína Supressora de Tumor p53/metabolismo
14.
Toxicol Pathol ; 47(8): 1038-1042, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31662055

RESUMO

The purpose of this symposium report is to summarize information from a session 3 oral presentation at the Society of Toxicologic Pathology Annual Symposium in Raleigh, North Carolina. Mice are genetically tractable and are likely to play an important role in elucidating environmental, genetic, and aging-related mechanisms of urinary dysfunction in men. We and others have made significant strides in developing quantitative methods for assessing mouse urinary function and our collaborators recently showed that aging male mice, like men, develop urinary dysfunction. Yet, it remains unclear how mouse prostate anatomy and histology relate to urinary function. The purpose of this report is to share foundational resources for evaluating mouse prostate histology and urinary physiology from our recent publication "Impact of Sex, Androgens, and Prostate Size on C57BL/6J Mouse Urinary Physiology: Functional Assessment." We will begin with a review of prostatic embryology in men and mice, then move to comparative histology resources, and conclude with quantitative measures of rodent urinary physiology.


Assuntos
Androgênios/metabolismo , Organogênese/fisiologia , Próstata/embriologia , Bexiga Urinária/fisiologia , Fenômenos Fisiológicos do Sistema Urinário , Envelhecimento/fisiologia , Animais , Congressos como Assunto , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Tamanho do Órgão/fisiologia , Próstata/anatomia & histologia , Próstata/metabolismo , Especificidade da Espécie , Bexiga Urinária/anatomia & histologia , Bexiga Urinária/metabolismo
15.
Am J Physiol Renal Physiol ; 317(4): F996-F1009, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31390231

RESUMO

Laboratory mice are used to identify causes of urinary dysfunction including prostate-related mechanisms of lower urinary tract symptoms. Effective use of mice for this purpose requires a clear understanding of molecular, cellular, anatomic, and endocrine contributions to voiding function. Whether the prostate influences baseline voiding function has not been specifically evaluated, in part because most methods that alter prostate mass also change circulating testosterone concentrations. We performed void spot assay and cystometry to establish a multiparameter "baseline" of voiding function in intact male and female 9-wk-old (adult) C57BL/6J mice. We then compared voiding function in intact male mice to that of castrated male mice, male (and female) mice treated with the steroid 5α-reductase inhibitor finasteride, or male mice harboring alleles (Pbsn4cre/+; R26RDta/+) that significantly reduce prostate lobe mass by depleting prostatic luminal epithelial cells. We evaluated aging-related changes in male urinary voiding. We also treated intact male, castrate male, and female mice with exogenous testosterone to determine the influence of androgen on voiding function. The three methods used to reduce prostate mass (castration, finasteride, and Pbsn4cre/+; R26RDta/+) changed voiding function from baseline but in a nonuniform manner. Castration feminized some aspects of male urinary physiology (making them more like intact female mice) while exogenous testosterone masculinized some aspects of female urinary physiology (making them more like intact male mice). Our results provide evidence that circulating testosterone is responsible in part for baseline sex differences in C57BL/6J mouse voiding function while prostate lobe mass in young, healthy adult mice has a lesser influence.


Assuntos
Androgênios/fisiologia , Próstata/anatomia & histologia , Próstata/fisiologia , Fenômenos Fisiológicos do Sistema Urinário , Inibidores de 5-alfa Redutase/farmacologia , Envelhecimento , Animais , Células Epiteliais/fisiologia , Feminino , Finasterida/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Orquiectomia , Próstata/citologia , Caracteres Sexuais , Testosterona/farmacologia , Fenômenos Fisiológicos do Sistema Urinário/efeitos dos fármacos , Fenômenos Fisiológicos do Sistema Urinário/genética , Urodinâmica
16.
Khirurgiia (Mosk) ; (3): 111-120, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30938366

RESUMO

Robot-assisted operations as widely used in urology, gynecology, general and cardiovascular surgery are considered by many experts as a new 'gold standard' of surgical treatment of various diseases in developed countries. Robot-assisted radical prostatectomy for prostate cancer is the most common robotic procedure. Better functional outcomes of robot-assisted radical prostatectomy are due to another (new) understanding of pelvic surgical anatomy, new approach implying dissection and preservation of external urethral sphincter and neurovascular structures. Prostate neuroanatomy, various approaches to preserve neurovascular structures and own experience of nerve-sparing robot-assisted radical prostatectomy with functional results are reviewed in the article.


Assuntos
Próstata/inervação , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Dissecação/métodos , Humanos , Masculino , Pelve/anatomia & histologia , Pelve/inervação , Pelve/cirurgia , Próstata/anatomia & histologia , Resultado do Tratamento , Uretra/anatomia & histologia , Uretra/cirurgia
18.
Prog Urol ; 29(5): 263-269, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30948187

RESUMO

INTRODUCTION: Prostatic arterial embolization (PAE) is an experimental therapy for benign prostatic hyperplasia. Its feasibility is based on the knowledge of the pelvic arterial anatomy, and more specifically the prostate. The aim of this study was to describe the prostatic arterial supply: origins, distribution and variability. MATERIAL AND METHODS: We reviewed retrospectively, with two radiologists, 40 arteriographies of patients who underwent PAE in our center. With these observations of 80 hemipelvics, we described the number of prostatic arteries, their origins, their distributions and eventually their anastomoses with other pelvic arteries. RESULTS: There was one prostatic artery in 70% of the cases. It came from a common trunk for the prostate and the bladder in 55% of the cases, from the obturator artery in 17.5% of the cases, from the pudendal artery in 25% of the cases, from the intern iliac artery in 1% of the cases, and from the superior gluteal artery in 1% of the cases. The prostatic artery splitted in two branches (medial and lateral), with no anastomoses in 37% of the cases. Anastomoses with penile and rectal arteries were observed in 29% of the cases. CONCLUSIONS: For our 40 patients, we observed many variations of arterial prostatic anatomy. We proposed a classification in order to increase security and efficacy of PAE, and it should be validated with more patients. LEVEL OF EVIDENCE: 2.


Assuntos
Artérias/anatomia & histologia , Artérias/patologia , Embolização Terapêutica/métodos , Próstata/anatomia & histologia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Artérias/diagnóstico por imagem , Artérias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/patologia , Estudos Retrospectivos
20.
Med Phys ; 46(7): 3078-3090, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31002381

RESUMO

PURPOSE: Accurate regional segmentation of the prostate boundaries on magnetic resonance (MR) images is a fundamental requirement before automated prostate cancer diagnosis can be achieved. In this paper, we describe a novel methodology to segment prostate whole gland (WG), central gland (CG), and peripheral zone (PZ), where PZ + CG = WG, from T2W and apparent diffusion coefficient (ADC) map prostate MR images. METHODS: We designed two similar models each made up of two U-Nets to delineate the WG, CG, and PZ from T2W and ADC map MR images, separately. The U-Net, which is a modified version of a fully convolutional neural network, includes contracting and expanding paths with convolutional, pooling, and upsampling layers. Pooling and upsampling layers help to capture and localize image features with a high spatial consistency. We used a dataset consisting of 225 patients (combining 153 and 72 patients with and without clinically significant prostate cancer) imaged with multiparametric MRI at 3 Tesla. RESULTS AND CONCLUSION: Our proposed model for prostate zonal segmentation from T2W was trained and tested using 1154 and 1587 slices of 100 and 125 patients, respectively. Median of Dice similarity coefficient (DSC) on test dataset for prostate WG, CG, and PZ were 95.33 ± 7.77%, 93.75 ± 8.91%, and 86.78 ± 3.72%, respectively. Designed model for regional prostate delineation from ADC map images was trained and validated using 812 and 917 slices from 100 and 125 patients. This model yielded a median DSC of 92.09 ± 8.89%, 89.89 ± 10.69%, and 86.1 ± 9.56% for prostate WG, CG, and PZ on test samples, respectively. Further investigation indicated that the proposed algorithm reported high DSC for prostate WG segmentation from both T2W and ADC map MR images irrespective of WG size. In addition, segmentation accuracy in terms of DSC does not significantly vary among patients with or without significant tumors. SIGNIFICANCE: We describe a method for automated prostate zonal segmentation using T2W and ADC map MR images independent of prostate size and the presence or absence of tumor. Our results are important in terms of clinical perspective as fully automated methods for ADC map images, which are considered as one of the most important sequences for prostate cancer detection in the PZ and CG, have not been reported previously.


Assuntos
Imagem de Difusão por Ressonância Magnética , Processamento de Imagem Assistida por Computador/métodos , Próstata/anatomia & histologia , Próstata/diagnóstico por imagem , Automação , Humanos , Masculino
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