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Prostate-specific membrane antigen PET/CT for primary staging of prostate cancer is becoming increasingly popular due to simultaneous assessment of whole-body disease burden, with superior sensitivity and specificity for detecting metastases compared to conventional imaging. PSMA PET in combination with multiparametric MRI (mpMRI) improves the sensitivity of assessment of extra-prostatic extension and seminal vesicle invasion compared to mpMRI alone, and may serve as a second line modality for image-guided biopsy in selected patients with negative mpMRI and/or negative primary biopsies. The superior diagnostic accuracy of PSMA PET/CT affects clinical decision-making with a change of clinical management in one-fourth of patients compared to conventional imaging. However, at present, the effect of implementing PSMA PET/CT for primary staging on patient outcomes is not clear, and prospective studies are warranted. There are several PSMA tracers with similar performance and minor individual pharmacokinetic differences such as higher rate of unspecific bone uptake with 18F-PSMA-1007, but on the other hand, lower urinary excretion, which could give an advantage in the detection of local recurrence. Proper training of the reporting physicians and knowledge of the pitfalls of the specific PSMA tracer used is of utmost importance for high-quality reading. We aim to provide an overview of the current literature and an update on the status of PSMA PET/CT for primary staging of prostate cancer. [ABSTRACT FROM AUTHOR]

In the urinary tract, bladder cancer is the most common malignancy. It is a heterogenous cancer type with approximately 30% presenting as muscle invasive bladder cancer with a high risk of metastatic spread associated with risk of death from distant metastases. The other 70% of bladder cancer patients present with superficial tumors with tendency of recurrence but in general not life-threatening. Like in other malignancies, accurate and precise staging of bladder cancer is one of the mainstays at the time of diagnosis to select the optimal treatment for each patient. The detection of metastatic spread is of utmost importance for selection of treatment strategy. Hybrid imaging med with FDG PET/CT is widely used in the clinical management of a variety of malignancies. FDG PET/CT is increasingly used for primary staging of muscle invasive bladder cancer and for detection of recurrence after radical cystectomy. Few studies have used FDG PET/CT for response evaluation of neoadjuvant, induction chemotherapy or immunotherapy. Furthermore, small studies have tested non-FDG PET agents with little or no urinary excretions of the tracer. This review provides an update on PET/CT in bladder cancer. [ABSTRACT FROM AUTHOR]

Like all other medical specialties, radiotherapy has been deeply influenced by the COVID-19 pandemic. The pandemic has had severe influence on the entire patient trajectory in oncology, from diagnosis to treatment and follow-up. Many examples of how to deal with patient and staff safety, shortness of staff and other resources and the quest to continue high-quality, evidence-based treatment have been presented. The use of telemedicine and telehealth is frequently presented as a part of the solution to overcome these challenges. Some of the available presented solutions will only apply in an acute, local setting, whereas others might inspire the community to improve quality and cost-effectiveness of radiotherapy as well as knowledge sharing in the future. Some of the unresolved issues in many of the available technical solutions are related to data security and public regulation, for example, GDPR (General Data Protection Regulation) in the EU and HIPAA compliance (Health Insurance Portability and Accountability Act) in the USA. Using a solution that involves a supplier's server in a non-EU country is problematic within the EU. In this paper we shortly review the influence of COVID-19 on radiotherapy. We describe some of the possible solutions for telehealth in target delineation - a crucial part of high-quality radiotherapy, which often requires multidisciplinary effort, hands-on corporation, and high-quality multimodal imaging. Hereafter, our own technical solution will be presented as a case. [ABSTRACT FROM AUTHOR]

Preoperative assessment of peritoneal metastases is an important factor for treatment planning and selection of candidates for cytoreductive surgery (CRS) in primary advanced stage (FIGO stages III–IV) epithelial ovarian cancer (EOC). The primary aim was to evaluate the efficacy of DW-MRI, CT, and FDG PET/CT used for preoperative assessment of peritoneal cancer index (PCI). In this prospective observational cohort study, 50 advanced stage EOC patients were examined with DW-MRI and FDG PET/CT with contrast enhanced CT as part of the diagnostic program. All patients were deemed amenable for upfront CRS. Imaging PCI was determined for DW-MRI, CT, and FDG PET/CT by separate readers blinded to the surgical findings. The primary outcome was agreement between the imaging PCI and PCI determined at surgical exploration (the reference standard) evaluated with Bland-Altman statistics. The median surgical PCI was 18 (range: 3–32). For all three imaging modalities, the imaging PCI most often underestimated the surgical PCI. The mean differences between the surgical PCI and the imaging PCI were 4.2 (95% CI: 2.6–5.8) for CT, 4.4 (95% CI: 2.9–5.8) for DW-MRI, and 5.3 (95% CI: 3.6–7.0) for FDG PET/CT, and no overall statistically significant differences were found between the imaging modalities (DW-MRI – CT, p = 0.83; DW-MRI – FDG PET/CT, p = 0.24; CT – FDG PET/CT, p = 0.06). Neither DW-MRI nor CT nor FDG PET/CT was superior in preoperative assessment of the surgical PCI in patients scheduled for upfront CRS for advanced stage EOC. • Imaging evaluation of peritoneal metastasis in epithelial ovarian cancer is challenging. • The imaging peritoneal cancer index is underestimated compared to the surgical peritoneal cancer index. • Neither DW-MRI nor CT nor FDG PET/CT is superior in assessment of the surgical peritoneal cancer index. [ABSTRACT FROM AUTHOR]

Ischemic heart disease ranges in severity from slightly reduced myocardial perfusion with preserved contractile function to chronic occlusion of coronary arteries with myocardial cells replaced by acontractile scar tissue-ischemic heart failure (iHF). Progression towards scar tissue is thought to involve a period in which the myocardial cells are acontractile but still viable despite severely reduced perfusion. This state of reduced myocardial function that can be reversed by revascularization is termed "hibernation." The concept of hibernating myocardium in iHF has prompted an increasing amount of requests for preoperative patient workup, but while the concept of viability is widely agreed upon, no consensus on clinical testing of hibernation has been established. Therefore, a variety of imaging methods have been used to assess hibernation including morphology based (MRI and ultrasound), perfusion based (MRI, SPECT, or PET) and/or methods to assess myocardial metabolism (PET). Regrettably, the heterogeneous body of literature on the subject has resulted in few robust prospective clinical trials designed to assess the impact of preoperative viability testing prior to revascularization. However, the PARR-2 trial and sub-studies has indicated that >5% hibernating myocardium favors revascularization over optimized medical therapy. In this paper, we review the basic concepts and current evidence for using PET to assess myocardial hibernation and discuss the various methodologies used to process the perfusion/metabolism PET images. Finally, we present our experience in conducting PET viability testing in a tertiary referral center. [ABSTRACT FROM AUTHOR]

Objectives This study sought to perform a prospective head-to-head comparison of the predictive value of clinical risk factors and a variety of cardiac imaging modalities including coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography (ICA) on major adverse cardiac events (MACE) and all-cause mortality in kidney transplantation candidates. Background Current guidelines recommend screening for coronary artery disease in kidney transplantation candidates. Furthermore, noninvasive stress imaging is recommended in current guidelines, despite its low diagnostic accuracy and uncertain prognostic value. Methods The study prospectively evaluated 154 patients referred for kidney transplantation. All patients underwent CACS, coronary CTA, SPECT, and ICA testing. The clinical endpoints were extracted from patients’ interviews, patients’ records, and registries. Results The mean follow-up time was 3.7 years. In total, 27 (17.5%) patients experienced MACE, and 31 (20.1%) patients died during follow-up. In a time-to-event analysis, both risk factors and CACS significantly predicted death, but only CACS predicted MACE. Combining risk factors with CACS identified a very-low-risk cohort with a MACE event rate of 2.1%, and a 1.0% mortality rate per year. Of the diagnostic modalities, coronary CTA and ICA significantly predicted MACE, but only coronary CTA predicted death. In contrast, SPECT predicted neither MACE nor death. Conclusions Compared with traditional risk factors and other cardiac imaging modalities, CACS and coronary CTA seem superior for risk stratification in kidney transplant candidates. Applying a combination of risk factors and CACS and subsequently coronary CTA seems to be the most appropriate strategy. (Angiographic CT of Renal Transplantation Candidate Study [ACToR]; NCT01344434 ) [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) is the most common malignancy in men and a major cause of cancer death. Accurate imaging plays an important role in diagnosis, staging, restaging, detection of biochemical recurrence, and for therapy of patients with PCa. Because no effective treatment is available for advanced PCa, there is an urgent need to develop new and more effective therapeutic strategies. To optimize treatment outcome, especially in high-risk patients with PCa, therapy for PCa is moving rapidly toward personalization. Medical imaging, including positron emission tomography (PET)/computed tomography (CT), plays an important role in personalized medicine in oncology. In the recent years, much focus has been on prostate-specific membrane antigen (PSMA) as a promising target for imaging and therapy with radionuclides, as it is upregulated in most PCa. In the prostate, one potential role for PSMA PET imaging is to help guide focal therapy. Several studies have shown great potential of PSMA PET/CT for initial staging, lymph node staging, and detection of recurrence of PCa, even at very low prostate-specific antigen values after primary therapy. Furthermore, studies have shown that PSMA PET/CT has a higher detection rate than choline PET/CT. Radiolabeled PSMA ligands for therapy show promise in several studies with metastatic PCa and is an area of active investigation. The "image and treat" strategy, with radiolabeled PSMA ligands, has the potential to improve the treatment outcome of patients with PCa and is paving the way for precision medicine in PCa. The aim of this review is to give an overview of recent advancement in PSMA PET and radionuclide therapy for PCa. [ABSTRACT FROM AUTHOR]

Prostate cancer is a common cancer in men and continues to be a major health problem. Imaging plays an important role in the clinical management of patients with prostate cancer. An important goal for prostate cancer imaging is more accurate disease characterization through the synthesis of anatomic, functional, and molecular imaging information. Positron emission tomography (PET)/computed tomography (CT) in oncology is emerging as an important imaging tool. The most common radiotracer for PET/CT in oncology, 18F-fluorodeoxyglucose (FDG), is not very useful in the imaging of prostate cancer. However, in recent years other PET tracers have improved the accuracy of PET/CT imaging of prostate cancer. Among these, choline labeled with 18F or 11C, 11C-acetate, and 18F-fluoride has demonstrated promising results, and other new radiopharmaceuticals are under development and evaluation in preclinical and clinical studies. Large prospective clinical PET/CT trials are needed to establish the role of PET/CT in prostate cancer patients. Because there are only limited available therapeutic options for patients with advanced metastatic prostate cancer, there is an urgent need for the development of more effective treatment modalities that could improve outcome. Prostate cancer represents an attractive target for radioimmunotherapy (RIT) for several reasons, including pattern of metastatic spread (lymph nodes and bone marrow, sites with good access to circulating antibodies) and small volume disease (ideal for antigen access and antibody delivery). Furthermore, prostate cancer is also radiation sensitive. Prostate-specific membrane antigen is expressed by virtually all prostate cancers, and represents an attractive target for RIT. Antiprostate-specific membrane antigen RIT demonstrates antitumor activity and is well tolerated. Clinical trials are underway to further improve upon treatment efficacy and patient selection. This review focuses on the recent advances of clinical PET/CT imaging and RIT of prostate cancer. [Copyright &y& Elsevier]

Abstract: Objectives: Recently, we have demonstrated that human detrusor smooth muscle cells in culture secrete the chemokine monocyte chemoattractant protein 1. In the present study, we extended these studies to include the effect of the proinflammatory cytokines tumor necrosis factor (TNF)-α and interleukin (IL)-1β on IL-8, IL-6, and RANTES (regulated on activation, normal T cell expressed and secreted) release by human detrusor smooth muscle cells (HDSMCs) and examined their regulation. Methods: With ethical approval, detrusor muscle biopsies were obtained from patients with benign noninvasive bladder diseases undergoing control cystoscopy. HDSMCs were cultured using an explant technique and used at maximum third passage. HDSMCs were cultured in the presence or absence of TNF-α and IL-1β. Supernatants were collected after 6, 12, and 24 hours. IL-8, IL-6, and RANTES were measured using enzyme-linked immunosorbent assays. Results: TNF-α and IL-1β (0.01 to 100 ng/mL) induced secretion of IL-8, IL-6, and RANTES in a dose and time-dependent manner. The production of chemokines reached a maximum after 24 hours of incubation. In nonstimulated HDSMCs, the basal secretion of IL-8, IL-6, and RANTES was detectable. Induction of cytokine release by IL-1β was synergistic with TNF-α. Conclusions: These findings for the first time demonstrate that HDSMCs release IL-8, IL-6, and RANTES in response to IL-1β and TNF-α. The constitutive and cytokine-stimulated production of chemokines and cytokines suggest that the human detrusor may contribute to mast cell infiltration into the bladder interstitium. The new evidence that HDSMCs secrete immunomodulatory proteins makes the detrusor muscle cell a target for anti-inflammatory therapy. [Copyright &y& Elsevier]

Abstract: β3-Adrenoceptors are major players in detrusor relaxation and have been suggested as a new putative target for the treatment of overactive bladder syndrome. We determined the effects of mirabegron (YM178), a novel β3-adrenoceptor agonist, on carbachol-induced tone in isolated human detrusor preparations from patients with bladder outflow obstruction (BOO) with and without detrusor overactivity (DO), and from patients with normal bladder function. We compared the effects to those of isoprenaline, a non-selective β-adrenoceptor agonist. Detrusor specimens were obtained from patients with benign prostatic hyperplasia undergoing cystoscopy and from patients undergoing radical prostatectomy/cystectomy (in total 33 donors). Detrusor contractility was evaluated by organ bath studies and strips were incubated with carbachol (1μM) to induce and enhance tension. Both mirabegron and isoprenaline reduced carbachol-induced tone in tissues from all groups. Isoprenaline decreased tension with higher potency than mirabegron in normal, BOO and BOO+DO detrusor strips with pIC50 values of 7.49±0.16 vs. 6.23±0.26 (P=0.0002), 6.89±0.34 vs. 6.04±0.31 (P=0.01), and 6.57±0.20 vs. 5.41±0.08 (P<0.0001, n=4), respectively. The maximal relaxant effect of isoprenaline and mirabegron in the normal, BOO and BOO+DO detrusor was 37.7±14.4% and 36.1±23.3%, 14.4±12.2% vs. 33.4±21.0% and 18.3±10.0% vs. 28.3±12.2% (n=4, P>0.05), respectively. Mirabegron and isoprenaline reduced carbachol-induced tone in both normal bladders and obstructed bladder with and without DO. Isoprenaline had higher potency than mirabegron, but the efficacy of mirabegron effect was the same as that of isoprenaline. [Copyright &y& Elsevier]