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Background: Transperineal focal laser ablation (TPLA) treatment for prostate cancer (PCa) is an experimental focal ablative therapy modality with low morbidity. However, a dosimetry model for TPLA is lacking. Objective: To determine (1) the three-dimensional (3D) histologically defined ablation zone of single- and multifiber TPLA treatment for PCa correlated with magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) and (2) a reliable imaging modality of ablation zone volumetry. Design, setting, and participants: This was a prospective, multicenter, and interventional phase I/II pilot study with an ablate-and-resect design. TPLA was performed in 12 patients with localized prostate cancer divided over four treatment regimens to evaluate potential variation in outcomes. Intervention: TPLA was performed approximately 4 wk prior to robot-assisted radical prostatectomy (RARP) in a daycare setting using local anesthesia. Outcome measurements and statistical analysis: Four weeks after TPLA, ablation zone volumetry was determined on prostate MRI and CEUS by delineation and segmentation into 3D models and correlated with whole-mount RARP histology using the Pearson correlation index. Results and limitations: Twelve office-based TPLA procedures were performed successfully under continuous transrectal ultrasound guidance using local perineal anesthesia. No serious adverse events occurred. A qualitative analysis showed a clear demarcation of the ablation zone on T2-weighted MRI, dynamic contrast-enhanced MRI, and CEUS. On pathological evaluation, no remnant cancer was observed within the ablation zone. Ablation zone volumetry on CEUS and T2-weighted MRI compared with histology had a Pearson correlation index of r = 0.94 (95% confidence interval [CI] 0.74–0.99, p < 0.001) and r = 0.93 (95% CI 0.73–0.98, p < 0.001), respectively. Conclusions: CEUS and prostate MRI could reliably visualize TPLA ablative effects after minimally invasive PCa treatment with a high concordance with histopathological findings and showed no remnant cancer. Patient summary: The treatment effects of a novel minimally invasive ablation therapy device can reliably be visualized with radiological examinations. These results will improve planning and performance of future procedures.

The publisher regrets that, of the affiliations of the senior author Bas W.G. van Rhijn, only two of the four were shown in the published version of the article. The four correct affiliations, which were also already listed in the original submission to European Urology, now appear above in this erratum. The correct affiliations for author Bas W.G. van Rhijn is updated as above. The publisher would like to apologise for any inconvenience caused.

Additional file 1: Table S1. Thresholds of the Ct ratios for the marker panel GHSR/MAL in urine pellet, determined by Youden���s J index.

The aim of this study was to determine the role of PSMA-PET/CT imaging in patients who experience biochemical persistence (BCP) after robot-assisted laparoscopic radical prostatectomy (RARP). 150 patients with BCP after RARP who underwent radiolabeled PSMA-PET/CT imaging were evaluated. A multivariable logistic regression analysis was performed to identify predictors for the detection of metastases outside the prostatic fossa (≥ miN1) on PSMA-PET/CT. Results: In total, 89/150 patients (59%) had ≥ miN1 on PSMA-PET/CT at BCP. On multivariable analysis, higher PSA-values after RARP (p = 0.004) and positive pathological lymph node status (p = 0.006) were independent predictors for ≥ miN1. In presence of BCP, a high proportion of patients had ≥ miN1 disease, indicated by PSMA-PET/CT. Higher PSA-levels after RARP and positive pathological lymph node status were significantly associated with metastases outside the prostatic fossa. In conclusion, in patients with BCP, PSMA-PET/CT imaging is warranted to guide (salvage) treatment strategies.

177Lu-PSMA is a new, promising treatment option in patients with metastatic castration-resistent prostate carcinoma (mCRPC). The radioactive-labeled medication is given intravenously in 1–6 cycles, in which the β‑radiation causes damage to the cellular DNA and eventually cell death of prostate cancer cells that express PSMA. In mostly retrospective studies, a decrease is seen in the serum-PSA level of ≥ 50% in 40–60% of patients that have been previously extensively treated. A survival benefit is observed, but mostly within non-randomized studies. The toxicity of treatment is relatively mild with grade I–II CTCAE xerostomia in 30–50% of patients and a passing grade III–IV CTCAE hematologic toxicity (thrombocytopenia, leukopenia) in 0–15%. The medication is under study in multiple prospective studies in patients with mCRPC and in one randomized clinical trial. The use of 177Lu-PSMA in patients with earlier phases of disease is explored. Until proven of benefit in RCTs, 177Lu-PSMA therapy remains experimental.

Background: Focal therapy for prostate cancer has been proposed as an alternative treatment to whole-gland therapies in selected men to diminish side effects in localized prostate cancer. As nowadays imaging cannot offer complete prostate cancer disease characterization, multicore systematic biopsies are recommended (transrectal or transperineal). Optical imaging techniques such as confocal laser endomicroscopy and optical coherence tomography allow in vivo, high-resolution imaging. Moreover, they can provide real-time visualization and analysis of tissue and have the potential to offer additive diagnostic information. Objective: This study has 2 separate primary objectives. The first is to assess the technical feasibility and safety of in vivo focal imaging with confocal laser endomicroscopy and optical coherence tomography. The second is to identify and define characteristics of prostate cancer and normal prostate tissue in confocal laser endomicroscopy and optical coherence tomography imaging by comparing these images with the corresponding histopathology. Methods: In this prospective, in vivo feasibility study, needle-based confocal laser endomicroscopy and optical coherence tomography imaging will be performed before transperineal template mapping biopsy or radical prostatectomy. First, confocal laser endomicroscopy and optical coherence tomography will be performed in 4 patients (2 for each imaging modality) undergoing transperineal template mapping biopsy to assess the feasibility and safety of confocal laser endomicroscopy and optical coherence tomography. If proven to be safe and feasible, confocal laser endomicroscopy and optical coherence tomography will be performed in 10 patients (5 for each imaging modality) undergoing radical prostatectomy. Confocal laser endomicroscopy and optical coherence tomography images will be analyzed by independent, blinded observers. Confocal laser endomicroscopy- and optical coherence tomography-based qualitative and quantitative characteristics and histopathology will be compared. The study complies with the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) stage 2a recommendations. Results: At present, the study is enrolling patients and results and outcomes are expected in 2019. Conclusions: Confocal laser endomicroscopy and optical coherence tomography are promising optical imaging techniques that can visualize and analyze tissue structure, possible tumor grade, and architecture in real time. They can potentially provide real-time, high-resolution microscopic imaging and tissue characteristics of prostate cancer in conjunction with magnetic resonance imaging or transrectal ultrasound fusion-guided biopsy procedures. This study will provide insight into the feasibility and tissue-specific characteristics of confocal laser endomicroscopy and optical coherence tomography for real-time optical analysis of prostate cancer.

Contains fulltext : 294430.pdf (Publisher’s version ) (Open Access) BACKGROUND: Ta grade 3 (G3) non-muscle-invasive bladder cancer (NMIBC) is a relatively rare diagnosis with an ambiguous character owing to the presence of an aggressive G3 component together with the lower malignant potential of the Ta component. The European Association of Urology (EAU) NMIBC guidelines recently changed the risk stratification for Ta G3 from high risk to intermediate, high, or very high risk. However, prognostic studies on Ta G3 carcinomas are limited and inconclusive. OBJECTIVE: To evaluate the prognostic value of categorizing Ta G3 compared to Ta G2 and T1 G3 carcinomas. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for 5170 primary Ta-T1 bladder tumors from 17 hospitals were analyzed. Transurethral resection of the tumor was performed between 1990 and 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Time to recurrence and time to progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox-regression models with interaction terms stratified by institution. RESULTS AND LIMITATIONS: Ta G3 represented 7.5% (387/5170) of Ta-T1 carcinomas of which 42% were classified as intermediate risk. Time to recurrence did not differ between Ta G3 and Ta G2 (p = 0.9) or T1 G3 (p = 0.4). Progression at 5 yr occurred for 3.6% (95% confidence interval [CI] 2.7-4.8%) of Ta G2, 13% (95% CI 9.3-17%) of Ta G3, and 20% (95% CI 17-23%) of T1 G3 carcinomas. Time to progression for Ta G3 was shorter than for Ta G2 (p

Chapter 1 is a general introduction. Chapter 2 describes currently known methylation markers in urine for diagnosis of bladder cancer and their diagnostic accuracy. In Chapter 3 several methylation markers in urine are evaluated to use for diagnosis of bladder cancer and an optimal two gene panel is proposed. In chapter 4 several additives are tested to preserve urinary DNA prior to the analysis of methylation markers in urine. A protocol for preservation is proposed. In chapter 5 the two systems used for grading bladder cancer are tested to determine their reproducibility, both are poorly reproducible. In chapter 6, several measurents are used to determine whether a more objective method to determine bladder cancer grade is possible. In chapter 7 the value of an immediate instillation of mitomycin C after transurethral resection of a bladder tumor is evaluated in a randomised controlled trial. The study shows that an immediate instillation reduces the risk of recurrent bladder cancer. In chapter 8, we evaluate whether the value of an immediate instillation is different in several subgroups of patients. We found that an immediate instillation is effective in all risk groups. In Chapter 9, the timing of an immediate instillation of mitomycin C is investigated. We found that, altough it is recommended to administer an immediate instillation as soon a possible after transurethral resection of a bladder tumour, patients may still benefit from an instillation 1 day after transurethral resection. In chapter 10, interleukin-2 instillations are tested in patients with bladder cancer with and without a marker lesion. The study was closed prematurely so no soli conclusions can be made. However no clear benefit of a marker lesion was detected. In part 3 bladder preservation using brachytherapiy in high risk non muscle invasive bladder cancer, and muscle invasive bladder cancer is evaluatied. We found that brachytherapy is a good alternative to cystectomy in selected patients, without compromising survival. Additionally, the implantaion of the brachytherapey cathethers can safely be conducted using a robot-assisted laparoscopic approach.

Summery The genital surgical phase of the gender affirming process in transgender men can alter the urological anatomy and urological function. This advocates urological involvement during this phase of the affirming process. This thesis is divided into three parts that describe respectively: measures taken to prevent postoperative urological complications after gGAS, experience and results after implantation of prostheses and results of psychological and sexual functioning and well-being after gGAS. Introduction The first part of the introduction provides an explanation of gender care. The rest describes the structure of the thesis. Part 1 Part one covers adjustments made to reduce risks after gGAS in transgender men. In chapter 2 functional and surgical outcomes and patient satisfaction are described after genital gender affirming surgery(gGAS) without urethral lengthening (UL). The outcomes of gGAS without UL, shows good surgical and urological results. After extensive counseling the majority of this selective group of patients show favorable patient reported outcomes. In chapter 3 a video article with the surgical technique of the scrotoplasty of gGAS without UL is presented together with surgical and the urological outcomes as described above. In chapter 4 the effectiveness of preoperative laser depilation of the neo-urethral donor site was assessed together with the correlation between urethral hair density and voiding. The outcomes show that laser depilation reduces hair and intraurethral hair does not cause voiding complaints. Part 2 In part two our experience and results of testicular and penile prostheses in the VUMC are presented. Chapter 5 describes the clinical outcomes and risk factors for postoperative complications of testicular prostheses implantation used for neo-scrotal augmentation in transgender men. This data shows that over the years, scrotoplasty techniques and testicular prostheses preferences have changed and explantation rates have dropped. In chapter 6 on overview is given of the preliminary experience with the ZSI 100 FtM malleable penile implant which was designed for phalloplastys. The outcomes of this study show that complication rate of the ZSI100FTM malleable penile implant is high at the start of the learning curve. Although designed specifically for the transgender community, not all transgender men will be eligible for this type of prosthesis. In chapter 7 a historical overview is given of surgical outcomes of penile prosthesis implantation in transgender men who underwent phalloplasty in the VUMC. Outcomes of this overview show that prosthesis explantation, replacement or revision surgery occurs frequently after penile prosthesis implantation. Part 3 In part three the process of the development of the decision aid for gGAS in transgender men is described. The next two chapters give the results of psychological and sexual functioning and well-being after gGAS in transgender men. Chapter 8 describes the process of the development of a decision aid (DA) for genital surgery in transgender men (DA-GST). At the end an online DA was developed to support transgender men with their decision-making process concerning all surgical options for removal of reproductive organs and genital GAS. In Chapter 9 a longitudinal study of 21 transgender men at least 1 year after GAS was conducted to evaluate motivations for and psychosexual outcomes after gGAS. These outcomes indicate that counseling and decision making for GAS in transmen should be a highly personalized and interdisciplinary practice. In Chapter 10 a clinical follow-up study was conducted in 38 transmen at least one year after gGAS in order to evaluate measures of experienced sexuality. The outcomes of the data show that genital GAS positively impacts transmen’s sexuality, although possible issues with genital sensation or penetration may exist and should be communicated preoperatively.

WOS: 000433883200033 PubMed ID: 29784633 Background: Focal therapy for prostate cancer has been proposed as an alternative treatment to whole-gland therapies in selected men to diminish side effects in localized prostate cancer. As nowadays imaging cannot offer complete prostate cancer disease characterization, multicore systematic biopsies are recommended (transrectal or transperineal). Optical imaging techniques such as confocal laser endomicroscopy and optical coherence tomography allow in vivo, high-resolution imaging. Moreover, they can provide real-time visualization and analysis of tissue and have the potential to offer additive diagnostic information. Objective: This study has 2 separate primary objectives. The first is to assess the technical feasibility and safety of in vivo focal imaging with confocal laser endomicroscopy and optical coherence tomography. The second is to identify and define characteristics of prostate cancer and normal prostate tissue in confocal laser endomicroscopy and optical coherence tomography imaging by comparing these images with the corresponding histopathology. Methods: In this prospective, in vivo feasibility study, needle-based confocal laser endomicroscopy and optical coherence tomography imaging will be performed before transperineal template mapping biopsy or radical prostatectomy. First, confocal laser endomicroscopy and optical coherence tomography will be performed in 4 patients (2 for each imaging modality) undergoing transperineal template mapping biopsy to assess the feasibility and safety of confocal laser endomicroscopy and optical coherence tomography. If proven to be safe and feasible, confocal laser endomicroscopy and optical coherence tomography will be performed in 10 patients (5 for each imaging modality) undergoing radical prostatectomy. Confocal laser endomicroscopy and optical coherence tomography images will be analyzed by independent, blinded observers. Confocal laser endomicroscopy-and optical coherence tomography-based qualitative and quantitative characteristics and histopathology will be compared. The study complies with the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) stage 2a recommendations. Results: At present, the study is enrolling patients and results and outcomes are expected in 2019. Conclusions: Confocal laser endomicroscopy and optical coherence tomography are promising optical imaging techniques that can visualize and analyze tissue structure, possible tumor grade, and architecture in real time. They can potentially provide real-time, high-resolution microscopic imaging and tissue characteristics of prostate cancer in conjunction with magnetic resonance imaging or transrectal ultrasound fusion-guided biopsy procedures. This study will provide insight into the feasibility and tissue-specific characteristics of confocal laser endomicroscopy and optical coherence tomography for real-time optical analysis of prostate cancer. STW Funding for this trial was obtained within STW. The funding source had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, or decision to submit results.

WOS: 000444019900009 PubMed ID: 30094972 Diagnostic accuracy of needle-based optical coherence tomography (OCT) for prostate cancer detection by visual and quantitative analysis is defined. 106 three-dimensional (3-D)-OCT data sets were acquired in 20 prostates after radical prostatectomy and precisely matched with pathology. OCT images were grouped per histological category. Two reviewers performed blind assessments of the OCT images. Sensitivity and specificity for malignancy detection were calculated. Quantitative analyses by automated optical attenuation coefficient calculation were performed. OCT can reliably differentiate between fat, cystic, and regular atrophy and benign glands. The overall sensitivity and specificity for malignancy detection was 79% and 88% for reviewer 1 and 88% and 81% for reviewer 2. Quantitative analysis for differentiation between stroma and malignancy showed a significant difference (4.6 mm(-1) versus 5.0 mm(-1) Mann-Whitney U-test p < 0.0001). A Kruskal-Wallis test showed a significant difference in median attenuation coefficient between stroma, inflammation, Gleason 3, and Gleason 4 (4.6, 4.1, 5.9, and 5.0 mm(-1), respectively). However, attenuation coefficient varied per patient and a related-samples Wilcoxon signed-rank test showed no significant difference per patient (p = 0.17). This study confirmed the one to one correlation of histopathology and OCT. Precise matching showed that most histological tissues categories in the prostate could be distinguished by their unique pattern in OCT images. In addition, the optical attenuation coefficient can play a role in the differentiation between stroma and malignancy; however, a per patient analysis of the optical attenuation coefficient did not show a significant difference. (C) The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Cure for Cancer Foundation This study was funded by an unrestricted research grant from the Cure for Cancer Foundation.