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Fetal age in Quarter Horses can be predicted within 2 weeks from 100- to 200- days of gestation using femur length, biparietal diameter (cranium diameter) and eye approximated volume. However, as pregnancy advances, the femur and cranium become too large to be imaged in their entirety using ultrasound and the corresponding biometric parameters can no longer be measured. In this longitudinal study, the proximal phalanx (P1) was evaluated as a novel biometric parameter for late gestation to predict fetal age and bone maturation. Transrectal ultrasound was performed in ten pregnant mares with known ovulation dates, every two weeks from 240- days of gestation until parturition. P1 was imaged in 69 % of the examinations. Inability to image P1 was due to obstructive positioning such as carpal or fetlock flexion, or posterior presentation of the fetus. Advancing fetal age did not affect visibility of P1. P1 length correlated significantly with days of gestation and a correlation equation was established: y = 0.3837x -69.55 where y is the predicted value of P1 length and x is the day of gestation (with day 0 being the day of ovulation). When P1 length was equal to or larger than the width of the ultrasound image (52.5 mm), 90 % of mares (9/10) were above 300- days of gestation. Ossification of the proximal and distal epiphysis of P1 typically appeared between 277- and 303 -days of gestation (mean: 288 days). The proximal epiphysis did not close before parturition whereas the distal one closed between 306- and 333-days of gestation (mean: 320 days). P1 epiphyseal appearance and closure occurred chronologically reflecting bone maturation. Radiographic findings at birth and prenatal ultrasound findings were in agreement, apart from timing of P1 distal epiphyseal closure. In conclusion, P1 length can be used as a new fetal biometric parameter to assess fetal age and growth after 240- days of gestation. The knowledge of P1 bone maturation process in utero as a marker for fetal bone development, may also be valuable in clinical decision-making when considering inducing parturition in the mare. [ABSTRACT FROM AUTHOR]

This study assessed the feasibility of using three-dimensional (3D) models of intrapelvic vascular patterns constructed using computed tomography (CT) and magnetic resonance imaging (MRI) fusion data for preoperative planning in patients with locally recurrent rectal cancer. Eleven patients scheduled for pelvic exenteration were included. The 3D fusion data of the intrapelvic vessels constructed using CT and MRI with true fast imaging with steady-state precession sequence (True FISP) were evaluated preoperatively. Contrast ratios (CR) between the piriformis muscle and the intrapelvic vessels were calculated to identify a valid modality for 3D modeling and creating CT/MRI fusion-reconstructed volume-rendered images. The CR values of the internal and external iliac arteries were significantly higher on CT images than MR images (CT vs. MRI; 0.63 vs. 0.45, p < 0.01). However, the CR value of the internal iliac vein was significantly higher on MR than CT images (CT vs. MRI; 0.23 vs. 0.55, p < 0.01). MRI with True FISP yielded high signal-to-noise ratios and aided in delineating the internal iliac vein around the piriformis muscle. More precise 3D models can be constructed using this technique in the future to aid in the resection of locally recurrent rectal cancer. [Display omitted] • MRI with True FISP is superior to what internal iliac vein delineation. • MRI with True FISP yielded high contrast ratios between internal iliac vein and piriformis muscle. • CT/MRI fusion is suitable for preoperative planning for locally recurrent rectal cancer. [ABSTRACT FROM AUTHOR]

Rectal toxicity is a significant concern in cervical cancer radiotherapy. Despite advancements in image-guided brachytherapy (IGBT), rectal morbidity remains a challenge. Injectable hydrogel showed promise in creating a space between the vagina and rectum, reducing rectal radiation dose; however, the traditional ultrasound-guided injection revealed some problems, such as the inadequate separation of the upper edge of the cervix, which can be mitigated through adopting CT-guided injection. This case report presents the successful use of computed tomography (CT)-guided hydrogel injection to limit rectal doses and improve treatment outcomes. A forty-year-old female with stage IIIC1r cervical cancer received external-beam radiotherapy and concurrent chemotherapy. Due to the proximity of the tumor to the rectum, a CT-guided hydrogel injection was performed to increase the distance between the cervix and rectum. Post-injection, magnetic resonance imaging (MRI) demonstrated increased distances between the cervix and rectum. Subsequent MRI-based IGBT achieved high clinical target volume doses while limiting rectal doses. During the six-month follow-up, the patient reported only mild adverse effects. CT-guided hydrogel injection offers advantages over ultrasound-guided injection in cervical cancer radiotherapy. The technique allows for better puncture position adjustment, reduced reliance on specialized ultrasound expertise, and shorter puncture distances. This case report highlights the potential of hydrogel injection as a viable method to reduce rectal morbidity and improve treatment outcomes in a broader range of cervical cancer patients. Further studies are warranted to validate these findings and explore its applicability in larger cohorts. [ABSTRACT FROM AUTHOR]

To create a reliable radiomic nomogram for the prediction of the International Society of Urological Pathology (ISUP) grading ≥ 3 prostate cancer (PCa) patients. patients with verified PCa were obtained from three different hospitals. The patients were divided into training, internal validation, and two external validation groups. A radiomic signature (rad-score) extracted from T2WI, diffusion-weighted imaging, and apparent diffusion coefficient (ADC) maps were constructed in the training cohort. Eight clinical features were performed to develop a clinical model using univariate and multivariate logistic regression. The combined model incorporated the radiomic signature and clinical model. The model's performance was assessed by the receiver operating characteristic (ROC) curve. Rad-score, magnetic resonance imaging T-stage, and ADC value were significant predictors of ISUP ≥ 3 PCa. A nomogram of these three factors was shown to have greater diagnostic accuracy than using only the radiomic signature or clinical model alone. The area under the ROC curve was 0.85, 0.88, 0.81, 0.81 for the training, internal, and two external validation cohorts, respectively. In the stratified analysis based on the MR scanner model, the area under the ROC curve of predicting ISUP ≥ 3 PCa for GE, Siemens, and combined groups were 0.84, 0.83, and 0.84, respectively, in the combined training group and an internal validation group. The proposed nomogram has the potential to predict the differentiation degree of ISUP PCa patients. • A radiomic nomogram has the potential to predict ISUP grading ≥3 prostate cancer. • The radiomic nomogram demonstrated robustness and generalization capability. • The prediction model included MRI T-stage, ADC value, and rad-score. [ABSTRACT FROM AUTHOR]

To investigate geometric and dosimetric inter-observer variability in needle reconstruction for temporary prostate brachytherapy. To assess the potential of registrations between transrectal ultrasound (TRUS) and cone-beam computed tomography (CBCT) to support implant reconstructions. The needles implanted in 28 patients were reconstructed on TRUS by three physicists. Corresponding geometric deviations and associated dosimetric variations to prostate and organs at risk (urethra, bladder, rectum) were analyzed. To account for the found inter-observer variability, various approaches (template-based, probe-based, marker-based) for registrations of CBCT to TRUS were investigated regarding the respective needle transfer accuracy in a phantom study. Three patient cases were examined to assess registration accuracy in-vivo. Geometric inter-observer deviations >1 mm and >3 mm were found for 34.9% and 3.5% of all needles, respectively. Prostate dose coverage (changes up to 7.2%) and urethra dose (partly exceeding given dose constraints) were most affected by associated dosimetric changes. Marker-based and probe-based registrations resulted in the phantom study in high mean needle transfer accuracies of 0.73 mm and 0.12 mm, respectively. In the patient cases, the marker-based approach was the superior technique for CBCT-TRUS fusions. Inter-observer variability in needle reconstruction can substantially affect dosimetry for individual patients. Especially marker-based CBCT-TRUS registrations can help to ensure accurate reconstructions for improved treatment planning. [ABSTRACT FROM AUTHOR]

There is no significant difference between transperineal and transrectal biopsy infection rates without and with targeted antibiotic prophylaxis, respectively. The cancer detection rates were similar. Transperineal biopsy was associated with slightly more pain, but it improves antibiotic stewardship. The transrectal biopsy approach is traditionally used to detect prostate cancer. An alternative transperineal approach is historically performed under general anesthesia, but recent advances enable transperineal biopsy to be performed under local anesthesia. We sought to compare infectious complications of transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis. We assigned biopsy-naïve participants to undergo transperineal biopsy without antibiotic prophylaxis versus transrectal biopsy with targeted prophylaxis (rectal culture screening for fluoroquinolone-resistant bacteria and antibiotic targeting to culture and sensitivity results) through a multicenter, randomized trial. The primary outcome was post-biopsy infection captured by a prospective medical review and patient report on a 7-d survey. The secondary outcomes included cancer detection, noninfectious complications, and a numerical rating scale (0–10) for biopsy-related pain and discomfort during and 7-d after biopsy. A total of 658 participants were randomized, with zero transperineal versus four (1.4%) transrectal biopsy infections (difference –1.4%; 95% confidence interval [CI] –3.2%, 0.3%; p = 0.059). The rates of other complications were very low and similar. Importantly, detection of clinically significant cancer was similar (53% transperineal vs 50% transrectal, adjusted difference 2.0%; 95% CI –6.0, 10). Participants in the transperineal arm experienced worse periprocedural pain (0.6 adjusted difference [0–10 scale], 95% CI 0.2, 0.9), but the effect was small and resolved by 7-d. Office-based transperineal biopsy is tolerable, does not compromise cancer detection, and did not result in infectious complications. Transrectal biopsy with targeted prophylaxis achieved similar infection rates, but requires rectal cultures and careful attention to antibiotic selection and administration. Consideration of these factors and antibiotic stewardship should guide clinical decision-making. In this multicenter randomized trial, we compare prostate biopsy infectious complications for the transperineal versus transrectal approach. The absence of infectious complications with transperineal biopsy without the use of preventative antibiotics is noteworthy, but not significantly different from transrectal biopsy with targeted antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Our main goal of this meta-analytical analysis was to evaluate the diagnostic effectiveness of prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) against multiparametric magnetic resonance imaging (mpMRI) in the context of identifying biochemical recurrence in patients with prostate cancer (PCa). A thorough search covering articles published until March 2023 was carried out across major databases such as PubMed, Embase, and Web of Science. Studies examining the direct comparison of PSMA PET/CT and mpMRI in patients with PCa suffering biochemical recurrence were included in the inclusion criteria. Using the renowned Quality Assessment of Diagnostic Performance Studies-2 technique, each study's methodological rigor was assessed. We analyzed data from six eligible studies involving 290 patients in total. The combined data showed that for PSMA PET/CT and mpMRI, respectively, the pooled overall detection rates for recurrent PCa after definitive treatment were 0.69 (95% confidence interval [CI]: 0.45–0.89) and 0.70 (95% CI: 0.44–0.91). The detection rates for local recurrence were specifically 0.52 (95% CI: 0.39–0.65) and 0.62 (95% CI: 0.31–0.89), while they were 0.50 (95% CI: 0.26–0.74) and 0.32 (95% CI: 0.18–0.48) for lymph node metastasis. Notably, there was no discernible difference between the two imaging modalities in terms of the overall detection rate (P = 0.95). The detection rates for local recurrence and lymph node metastasis did not differ statistically significantly (P = 0.55, 0.23). The performance of PSMA PET/CT and mpMRI in identifying biochemical recurrence in PCa appears to be comparable. However, the meta-analysis' findings came from research with modest sample sizes. In this context, more extensive research should be conducted in the future. • Pooled detection rates for recurrent prostate cancer (PCa): 0.69 with prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT), 0.70 with multiparametric magnetic resonance imaging (mpMRI). • PSMA PET/CT and mpMRI perform equally in detecting PCa recurrence. • This article is a head-to-head comparative meta-analysis. [ABSTRACT FROM AUTHOR]

The treatment of superficial rectal cancers (local excision, or proctectomy with total mesorectal excision (TME) remains controversial. Endoscopy and endorectal ultrasonography are essential for the precise initial definition of these small cancers. During endoscopy, the depth of the lesion can be estimated using virtual chromoendoscopy with magnification, thereby aiding the assessment of the possibilities of local excision. Current international recommendations indicate completion proctectomy after wide local excision for cases where the pathologic examination reveals poorly-differentiated lesions, lymphovascular invasion, grade 2 or 3 tumor budding, and incomplete resection. But debate persists regarding whether the depth of submucosal invasion can accurately predict the risk of lymph node spread. Recent data from the literature suggest that the depth of submucosal invasion should no longer, by itself, be an indication for additional oncological surgery. Adjuvant radio-chemotherapy could be an alternative to completion proctectomy in patients with pT1 rectal cancer and unfavorable histopathological criteria. A Dutch randomized controlled trial is underway to validate this strategy. [ABSTRACT FROM AUTHOR]

High-frequency, high-resolution transrectal micro-ultrasound (micro-US: ≥15 MHz) imaging of the prostate is emerging as a beneficial tool for scoring disease risk and accurately targeting biopsies. Adding photoacoustic (PA) imaging to visualize abnormal vascularization and accumulation of contrast agents in tumors has potential for guiding focal therapies. In this work, we describe a new imaging platform that combines a transrectal micro-US system with transurethral light delivery for PA imaging. A clinical transrectal micro-US system was adapted to acquire PA images synchronous to a tunable laser pulse. A transurethral side-firing optical fiber was developed for light delivery. A polyvinyl chloride (PVC)–plastisol phantom was developed and characterized to image PA contrast agents in wall-less channels. After resolution measurement in water, PA imaging was demonstrated in phantom channels with dyes and biodegradable nanoparticle contrast agents called porphysomes. In vivo imaging of a tumor model was performed, with porphysomes administered intravenously. Photoacoustic imaging data were acquired at 5 Hz, and image reconstruction was performed offline. PA image resolution at a 14-mm depth was 74 and 261 μm in the axial and lateral directions, respectively. The speed of sound in PVC–plastisol was 1383 m/s, and the attenuation was 4 dB/mm at 20 MHz. PA signal from porphysomes was spectrally unmixed from blood signals in the tumor, and a signal increase was observed 3 h after porphysome injection. A combined transrectal micro-US and PA imaging system was developed and characterized, and in vivo imaging demonstrated. High-resolution PA imaging may provide valuable additional information for diagnostic and therapeutic applications in the prostate. [ABSTRACT FROM AUTHOR]

To demonstrate the added benefit of multiparametric (mp)MRI risk stratification during active surveillance. This prospective, single-arm, nonrandomized study included 82 men with low-risk prostate cancer (PCa). We compared two biopsy strategies in parallel. The first biopsy strategy was an in-bore and transrectal ultrasound (TRUS) biopsy in men with suspicious mpMRI findings. The second was a TRUS biopsy in all 82 men, blinded to the results of the previously performed mpMRI. We identified 27/82 men with suspicious mpMRI. Of those 27 men, we detected 8/27 with csPCa on biopsy, and we identified two men with in-bore biopsy exclusively, three men with TRUS biopsy exclusively, and three men with both biopsy strategies. Of the 55/82 men with nonsuspicious mpMRI (who only received TRUS biopsies), two men had csPCa. TRUS biopsy of the entire cohort of 82 men would have led to the correct diagnosis of 80% men with csPCa, requiring all 82 men to receive biopsies (csPCa in 10% of the 82 biopsies). Conducting in-bore biopsies plus TRUS biopsies in men with suspicious mpMRI would have also led to the detection of 80% of men with csPCa, requiring only 27 men to receive biopsies (csPCa in 30% of the 27 biopsies). The combination of TRUS and in-bore biopsies, limited to men with suspicious mpMRI, resulted in a similar detection rate of csPCa compared to TRUS biopsies of all men but required only one-third of men to undergo biopsy. Our results indicate that in-bore and TRUS biopsies continue to complement each other. [ABSTRACT FROM AUTHOR]

To investigate the relevance of dynamic contrast enhanced imaging (DCE) within multiparametric magnetic resonance imaging (mpMRI) for the detection of clinically significant prostate cancer (csPC) depending on reader experience. Consecutive patients with 3 T mpMRI and subsequent combined MRI/ultrasound fusion-guided targeted and systematic biopsy from January to September 2019 were included. All mpMRI examinations were read separately by two less experienced (R1; <500 prostate MRI) and two expert radiologists (R2; >5,000 prostate MRI) in consensus and blinded re-read as biparametric MRI (bpMRI). The primary endpoint was the performance comparison of mpMRI versus bpMRI of R1 and R2. Fifty-three of 124 patients had csPC (43%). The PI-RADS agreement of bpMRI and mpMRI was fair for R1 (κ = 0.373) and moderate for R2 (κ = 0.508). R1 assessed 11 csPC with PI-RADS ≤3 (20.8%) on mpMRI and 12 (22.6%) on bpMRI (R2: 1 [1.9%] and 6 [11.3%], respectively). Sensitivity for csPC of mpMRI was 79.3% (NPV 79.3%) for R1 and 98.1% (NPV 97.5%) for R2 (bpMRI: 77.4% [NVP 75.5%] and 86.8% [NPV 84.4%], respectively). Specificity of mpMRI for csPC was 59.2% for R1 and 54.9% for R2 (bpMRI: 52.1% and 53.5%, respectively). Overall accuracy of mpMRI was 79.8% for R1 compared to bpMRI 66.9% (p= 0.017; R2: 87.1% and 81.5%; p= 0.230). Prostate MRI benefits from reader experience. Less experienced readers missed a relevant proportion of csPC with mpMRI and even more with bpMRI. The overall performance of expert readers was comparable for mpMRI and bpMRI but DCE enabled detection of some further ISUP 2 PC. • Greater experience improved sensitivity and negative predictive values for csPC detection in bpMRI and mpMRI. • Less experienced readers missed over 20% csPC with bpMRI or mpMRI and induced 25% more negative biopsies without DCE. • For experts, accuracy for csPC detection of bpMRI was comparable to mpMRI but 9% more csPC (ISUP 2) were detected with DCE. [ABSTRACT FROM AUTHOR]

Rhabdomyosarcoma (RMS) is among the most common pediatric solid malignancies. Fusion-negative, embryonal RMS is the predominant histology among prostate and bladder lesions. Management strategies depend on the clinical stage and risk group. Although the optimal strategy continues to evolve, the field has transitioned from radical upfront resection to organ preservation strategies with multi-modal therapy, including chemotherapy, radiation, and surgery. Survivors frequently develop late complications, including impaired fertility and sexual function, bladder dysfunction, and secondary malignancies. Our case describes an 11-year-old male who developed a radiation-induced prostatic sarcoma. We present a novel surgical technique and highlight the importance of multidisciplinary care. [ABSTRACT FROM AUTHOR]

To evaluate variation in magnetic resonance imaging (MRI) technique and reporting of rectal cancer staging examinations across the UK. A retrospective, multi-centre audit was undertaken of imaging protocols and information documented within consecutive MRI rectal cancer reports between March 2020 and August 2021, which were compared against American and European guidelines. Inclusion criteria included histologically proven rectal adenocarcinoma and baseline staging MRI rectum only. Fully anonymised data from 924 MRI reports by 78 radiologists at 24 centres were evaluated. Thirty-two per cent of radiologists used template reporting, but these reports offered superior documentation of 13 out of 18 key tumour features compared to free-text reports including T-stage, relation to peritoneal reflection and mesorectal fascia (MRF), nodal status, and presence of extramural venous invasion (EMVI; p< 0.027 in each). There was no significant differences in the remaining five features. Across all tumour locations, the tumour relationship to the MRF, the presence of EMVI, and the presence of tumour deposits were reported in 79.5%, 85.6%, and 44% of cases, respectively, and tumour, nodal, and distant metastatic stage documented in 94.4%, 97.7%, and 78.3%. In low rectal tumours, the relationship to the anal sphincter complex was reported in only 54.6%. Considerable variation exists in rectal cancer MRI acquisition and reporting in this sample of UK centres. Inclusion of key radiological features in reports must be improved for risk stratification and treatment decisions. Template reporting is superior to free-text reporting. Routine adoption of standardised radiology practices should now be considered to improve standards to facilitate personalised precision treatment for patients to improve outcomes. • MRI is now routinely used to stage rectal cancer. • International societies recommendations vary for technique and reporting standards. • To date, current UK practice had not been evaluated. • This national audit shows that considerable variation in rectal cancer MRI exists. • Template reports improved key imaging feature documentation used to decide management. [ABSTRACT FROM AUTHOR]

To determine the incidence of incidental prostate cancer detection (iPCa) after holmium laser enucleation of the prostate (HoLEP). The published rate of iPCa after HoLEP is widely variable from 7% to 23% and we aim to define preoperative risk factors for iPCa to inform risk-adjusted preoperative evaluation for PCa. Consecutive patients undergoing HoLEP from 2018 to 2022 were included and comprehensive clinical data abstracted from a prospectively maintained database. iPCa was defined as a diagnosis of PCa on pathologic examination of the HoLEP specimen. Patients with and without iPCa were compared with respect to preoperative clinical variables. Of 913 HoLEP patients, 183 (20%) were diagnosed with iPCa. Most patients (95%) had a preoperative prostate-specific antigen (PSA), 9% had negative MRI, and 30% had negative prostate biopsy. On multivariable analysis, PSA density (OR 1.06; 95% CI 1.03, 1.10; P <.001), preoperative biopsy status (OR 0.47, CI 0.30, 0.75; P =.002), and current 5-alpha reductase inhibitor use (OR 0.64, CI 0.43, 0.97; P =.034), were associated with iPCa diagnosis. In a significantly prescreened population, we identified a 20% rate of iPCa after HoLEP. Preoperative characteristics associated with iPCa diagnosis included increasing age, increasing PSA density, and current 5-alpha reductase inhibitor use. However, these factors alone may be of limited clinical utility to prospectively identify patients at high risk of iPCa diagnosis. We suggest and advocate for development of a standardized, risk-adapted evaluation focused on expanded use of imaging and selective biopsy to prioritize identification of clinically significant PCa prior to nononcologic surgery. [ABSTRACT FROM AUTHOR]

To compare equivalency of remote to in-person training during simulated transrectal ultrasound-guided prostate biopsy, we combined three technologies (mixed reality [MR] software, smart glasses, and hydrogel simulation model). Taken together, telemonitoring harnesses data streaming to provide real-time supervision and technical assistance for surgical procedures from an expert at a remote geographical location. Nineteen students were randomized into two groups (MR-first and in-person-first) and proctored to measure prostate volume and perform 14-biopsies over seven sessions: pretest, two MR/in-person-guided training sessions, mid-test, crossover into two in-person/MR-guided training sessions, and post-test. MR sessions utilized Vuzix smart glasses with MR software (HelpLightning) to share the student's first-person perspective and Zoom to project the ultrasound screen to a remote instructor. Training and test sessions utilized single-color and seven-color prostate models, respectively. Accuracy of biopsy cores from test sessions were compared. Perception of instruction following each training session using 5-point Likert scales across five domains was assessed. Preference of instruction modality was assessed qualitatively. Comparison of mid-test performance following two training sessions was similar across the two groups (MR-first 63.8% vs in-person-first 57.6%, P =.340). Following crossover, difference in post-test performance of the MR-first group and the in-person-first group approached significance (MR-first 80.2% vs in-person-first 70.8%, P =.050). Student evaluation of MR and in-person instruction following training sessions was similar across the five metrics. MR-based remote learning is equally effective when compared to traditional in-person instruction. [ABSTRACT FROM AUTHOR]

The aims of this study were (1) to evaluate potential associations between genetic traits, postpartum phenotypes, cow factors, and postpartum vaginal discharge score (VDS); and (2) to investigate possible associations between postpartum VDS, plasma progesterone (P4) after first service, and reproductive performance. First- and second-parity (n = 2,842) spring-calving lactating dairy cows from 35 dairy herds were enrolled. Farm visits were performed every 2 wk during the postpartum period and weekly during the breeding period. Cows that were at wk 3 and wk 7 postpartum and between 7 and 13 d after first artificial insemination (AI) were examined. Body condition score (BCS) was measured on all farm visits using a 1-to-5 scale (low ≤2.5; target ≥2.75). Transrectal ultrasound examinations were conducted to determine the presence or absence of a corpus luteum (CL). Vaginal discharge score was determined at wk 3 and wk 7 using a Metricheck device (Simcro) and a 1-to-4 scale (1 = clear mucus; 4 = mucopurulent with >50% purulent material ± odor). At wk 3, cows having a VDS ≤2 were considered to have normal reproductive tract health status (RTHS). At wk 7, cows having VDS = 1 were considered to have normal RTHS. Blood samples were collected at each visit, and plasma concentrations of glucose, β-hydroxybutyrate, fatty acids, and progesterone (only during breeding visit) were analyzed. Animals with target BCS at wk 3 and wk 7 had greater odds of having normal RTHS at wk 3 and wk 7, respectively, than cows with low BCS. Cows with a CL at wk 3 and wk 7 had greater prevalence of normal RTHS at wk 3 and wk 7, respectively, compared with cows without a CL. Cows with normal RTHS had a lesser plasma concentration of β-hydroxybutyrate at wk 3 and wk 7 and greater plasma concentration of glucose at wk 3 compared with animals with abnormal RTHS. More cows in the greatest quartiles for the fertility subindex of the Economic Breeding Index and genetic merit for milk production traits (milk kg and milk protein [%]) had normal RTHS at wk 3 and wk 7 compared with the other quartiles. Cows with VDS = 4 at wk 7 postpartum had lesser plasma P4 concentration after first AI (−1.2, −1.1, and −1.0 ng/mL compared with cows with VDS = 1, 2, and 3, respectively). Similarly, cows with VDS = 4 at both wk 3 and wk 7 had lesser pregnancy at first service, lesser cumulative pregnancy rates at wk 3, 6, and 12 during the breeding period, and longer interval from mating start date to conception (+3 d if VDS = 4 at wk 3; +5 d if VDS = 4 at wk 7), compared with cows having other VDS. In conclusion, cows with superior genetic merit for fertility traits and milk production traits, and favorable fertility phenotypes at wk 3 and wk 7, were all associated with greater likelihood of having normal RTHS. In turn, abnormal postpartum RTHS and greater postpartum VDS (score = 4) were associated with lesser odds of successful pregnancy establishment. [ABSTRACT FROM AUTHOR]

To report an initial experience with a novel, "fully" transperineal (TP) prostate fusion biopsy using an unconstrained ultrasound transducer placed on the perineal skin to guide biopsy needles inserted via a TP approach. Conventional TP prostate biopsies for detection of prostate cancer have been performed with transrectal ultrasound, requiring specialized hardware, imposing limitations on needle trajectory, and contributing to patient discomfort. Seventy-six patients with known or suspected prostate cancer underwent 78 TP biopsy sessions in an academic center between June 2018 and April 2022 and were included in this study. These patients underwent TP prostate fusion biopsy using a grid or freehand device with transrectal ultrasound as well as TP prostate fusion biopsy using TP ultrasound in the same session. Per-session and per-lesion cancer detection rates were compared for conventional and fully TP biopsies using Fisher exact and McNemar's tests. After a refinement period in 30 patients, 92 MRI-visible prostate lesions were sampled in 46 subsequent patients, along with repeat biopsies in 2 of the 30 patients from the refinement period. Grade group ≥2 cancer was diagnosed in 24/92 lesions (26%) on conventional TP biopsy (17 lesions with grid, 7 with freehand device), and in 25/92 lesions (27%) on fully TP biopsy (P = 1.00), with a 73/92 (79%) rate of agreement for grade group ≥2 cancer between the two methods. Fully TP biopsy is feasible and may detect prostate cancer with detection rates comparable to conventional TP biopsy. [ABSTRACT FROM AUTHOR]

Rhabdomyosarcoma (RMS) treatment involves surgery, chemotherapy, and radiotherapy. A radioprotective space between the bladder/prostate and rectum reduces postradiation complications, as reported in adult patients. Describe pediatric preradiotherapy perirectal hyaluronic acid (HA) spacer injection for bladder/prostate RMS. We present a case of a 17-month-old male with bladder/prostate RMS. Before radiotherapy, an HA spacer was injected peri-rectally. Under general anesthesia, a transrectal ultrasound was positioned and 1 mL of HA spacer was injected into the perirectal space. No complications were reported at 6-month follow-up. This is the first report of pre-radiation therapy spacer injection for pediatric bladder/prostate RMS. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to evaluate the consistency of transrectal contrast-enhanced ultrasonography (TR-CEUS) with post-operative pathology and the value of contrast-enhanced ultrasonography (CEUS) in staging surgically treated cervical cancer when combined with conventional ultrasonography (US). From October 2020 to March 2023, hospitalized patients with stage IB and II cervical cancer confirmed by total hysterectomy were consecutively enrolled. The standard images of US and CEUS by transabdominal (TA-US/CEUS) and transrectal (TR-US/CEUS) approaches and magnetic resonance imaging (MRI) were acquired, on which the size and stage of the tumors were evaluated, and the consistency of results with the pathological specimen was analyzed. Thirty-nine patients with cervical cancer were finally enrolled in this study. The results showed that CEUS significantly improved the reliability of TA-US in evaluating tumor diameter; the intraclass correlation coefficient (ICC) was from 0.672 to 0.735. TR-US indicated good reliability with or without the addition of CEUS (ICC = 0.796 and 0.780). In terms of tumor staging, CEUS improved the consistency of transabdominal (weighted κ values from 0.689 to 0.731) and transrectal staging of tumors (κ from 0.758 to 0.785), and the staging of TR-US combined with TR-CEUS had the highest consistency with post-operative results, similar to MRI (κ , respectively 0.785 and 0.789). CEUS can reflect the heterogeneity of the tumor. Heterogeneous enhancement and perfusion defects were more common in >2 cm cervical cancer (50%, 20/40 and 52.5%, 21/40), respectively, and perfusion defects were more common in moderately to poorly differentiated tumors (66.67%, 20/30). For stage IB and IIA cervical cancer, CEUS can aid in assessing the International Federation for Gynecology and Obstetrics staging of tumors alongside TA-US and TR-US. The combination of TR-US and TR-CEUS has shown good consistency with pathology in the staging of cervical cancer, comparable to that of MRI. [ABSTRACT FROM AUTHOR]

MR Imaging is the gold standard for image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer (LACC), and CT is increasingly used when MRI is unavailable. The 2021 IBS-GEC ESTRO-ABS recommendations outline the methodology for CT-based contouring in IGABT for LACC. This approach involves defining the clinico-radiological environment and assessing residual parametrial disease extension by clinical examination with or without Transrectal Ultrasound (TRUS) at BT. To ensure the global dissemination and high quality of CT-based contouring, BrachyAcademy, in collaboration with the lead author of the Recommendations, has developed an online workshop program. Participants were radiation oncologists performing brachytherapy (BT) using 3D imaging and volume-based dose prescription for LACC. The online workshop, held between November 2023 to February 2024, consisted of 3 modules. Two weeks were allotted between modules to complete homework using Elekta's ProKnow software. The Homework 1 (H1) consisted of contouring for two clinical cases of LACC where combined intracavitary/interstitial BT was performed: Case 1 (FIGO stage IIIB with CT at diagnosis and CT+TRUS at BT); Case 2 (FIGO stage IIIC1 with MRI at diagnosis and CT+TRUS at BT). The participants delineated high-risk clinical target volume (CTV HR) and intermediate-risk clinical target volume (CTV IR). For Homework 2 (H2), participants were tasked with contouring the same cases again. To assess any potential improvements in participants' contouring proficiency, we compared various parameters for each contour with a master contour within both cases. The parameters included: missing volume (cc); extra volume (cc); dice similarity coefficient (DSC); and mean difference in X (left-right), Y (anterior-posterior), and Z (superior-inferior) directions (mm). Following the workshop completion, participants were requested to fill out an evaluation form. 35 participants represented Asia (17 people), Europe (10), Africa (5), Australia/Oceania (2), and South America (1). Seventy-seven percent of attendees fully completed H1 + H2 for both cases; 14% completed only H2 for both cases; 3% completed H1 + H2 for Case 2 only; and 6% partially completed the homework. The contouring analysis is shown in Fig. 1. In Case 1, CTV HR analysis revealed statistically significant improvements with H2 compared to H1. Specifically, there was a reduction in mean missing and mean extra volumes, alongside an increase in DSC, and a decrease in mean difference along the Y and Z directions. For CTV IR in Case 1, similar improvements were observed, although it was not statistically significant for the mean missing volume. In Case 2, CTV HR analysis demonstrated statistically significant improvements with H2 compared to H1, manifesting as reduced mean missing and mean extra volumes, as well as an increased DSC. However, the mean differences along the X, Y, and Z directions did not exhibit statistical significance. Regarding CTV IR , significant enhancements were noted in mean extra volume and DSC. The more modest improvement in Case 2 can be attributed to its discussion during Module 3, following the reception of H1 and H2. Based on participants' evaluation forms after the workshop, 92% and 96% met the objective to improve contouring of CTV HR and CTV IR , respectively. The workshop received a score of 9.4 out of 10. The online contouring workshop on CT-based IGABT showcased significant participant engagement, with additional individuals completing homework assignments following the case discussion. The quality of contouring for both CTV HR and CTV IR saw substantial improvement, consistent with the participants' feedback. Efforts are underway to expand accessibility of the online workshop to a wider audience of BT users. [ABSTRACT FROM AUTHOR]

Radiotherapy is a well-established curative treatment for localized prostate cancer. Radiotherapy dose escalation is associated with lower rates of biochemical and local failure. Moreover, dose escalation with a high-dose-rate brachytherapy (HDR-BT) boost has been correlated with low toxicity rates. This study aimed to review toxicities, biochemical, and local control rates of patients treated with a single fraction 15 Gy HDR-BT boost followed by external beam radiation therapy (EBRT). Data was retrospectively collected from 179 consecutive prostate cancer patients who underwent treatment with HDR-BT boost and EBRT from February 2014 until February 2020 at a single tertiary cancer. All patients underwent HDR-BT at the study institution and 112 (62,5%) EBRT at the institution. All procedures were performed with the patient under general anesthesia, guided by transrectal ultrasound, using 10 to 18 needles. Axial images of the prostate were captured into the treatment planning system, and subsequent contours and intraoperative planning were performed. Standard dosimetry constraints of the institution were adhered to. External beam radiation therapy was administered in 15 to 25 fractions, with total doses ranging from 3750 to 4600 cGy. Pelvic nodal inclusion was at the discretion of the Radiation Oncologist. Data collection involved a review of electronic medical records for each patient, with staging based on NCCN Version 1.2024 Prostate Guidelines and clinical notes assessed for toxicity analyses graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Following treatment, patients were either discharged to a regional cancer center or regularly monitored for 4-5 years before discharge to a primary care practitioner. PSA levels were monitored every six months for the first two years, then annually until the completion of 5 years. Biochemical failure was defined as a nadir PSA level plus 2.0 ng/ml according to the Phoenix criterion, with local failures confirmed through prostate biopsy and disease progression in any event of local failure, nodal, or distant metastasis. 179 patients meeting the inclusion criteria were analyzed. The median follow-up time was 3 years. The distribution of risk groups was as follows: favorable intermediate risk (FIR) (13.2%), unfavorable intermediate risk (UIR) (57.1%), high risk (HR) (25.4%), and very high risk (VHR) (2.6%). 95 patients (52.2%) had cT1, 67 (36.8%) had cT2, 15 (8.2%) had cT3 disease. The median baseline PSA was 9 ng/mL (IQR: 6.19 - 15.45), with a median prostate volume of 37 cc (IQR: 29.75 - 46.25) and six cores (IQR: 4 - 9) involved with prostate cancer. Sixty-six percent of patients received hormonal therapy, with a median duration of 6 months. Urinary toxicity occurred in 23% of the patients, with 19.8% experiencing grade 1 or 2 toxicity and 3.2% experiencing grade 3. There were no urinary or gastrointestinal toxicities graded as 4 or 5. Only one patient developed urinary retention after the HDR-BT procedure, requiring the insertion of a urinary catheter. Out of 179 patients, 26 (14,5%) experienced biochemical recurrence. The crude rate of biochemical relapse per risk category was 12%, 14%, 28%, and 20% for FIR, UIR, HR, and VHR prostate cancer patients, respectively. Disease progression was observed in 18 of the 26 biochemical failures for an overall rate of 10% in the cohort (18/179), with the following locations of disease progression: 5.0% (9 patients) developed local failure, 3.3% (6 patients) had distant metastasis, and 1.6% (3 patients) had nodal metastasis. In this large single institutional study, 15 Gy HDR-BT boost plus EBRT resulted in favorable biochemical recurrence rates and local failure across various risk categories. The incidence of urinary retention post brachytherapy and urinary and gastrointestinal G3+ toxicity was very low. [ABSTRACT FROM AUTHOR]

Accurate fusion of magnetic resonance images (MR) with transrectal ultrasound (US) is important for lesion localization during catheter placement and contouring during treatment planning. Accurate MR-fusion is challenging today because of the need for a separate post-implant MR. The current methods to circumvent post-implant MR are cognitive fusion or by fusing the preoperative MR to post-implant planning image. However, preoperative MR-fusion suffers from challenges with swelling deformation from placing needles. Registration Chaining is a method that utilizes intermediate US information by using needles as landmarks to guide the registration to allow the preoperative MR to be used on post-implant planning volume more accurately. This work hypothesizes that the Registration Chaining process more accurately transfers the pre-MR lesion center of mass (centroid) to ground truth post-MR/CT fusions than without Registration Chaining. The Registration Chaining process begins with contouring the most recent preoperative MR. An initial registration is performed using Predictive Fusion (MIM Symphony), where the operator positions the US probe guided by the software to optimize the MR to US registration. An US volume reconstruction is acquired with only lesion-localized brachytherapy needles in place. A planning volume (CT or US) with the final needle configuration is also acquired immediately post-implant. A Registration Chaining workflow (MIM Symphony) is run to aid in the serial co-registration of the image volumes and to rigidly fuse the images allowing for translations and rotations. The workflow includes a mutual information algorithm that aligns needles on the intermediate US volume with the needles on the planning volume. Finally, the preoperative MR contours are transferred through the Registration Chain to the planning volume. For this study, Registration Chaining was compared to the conventional contour transfer method where pre-MR contours are rigidly fused directly to the final planning volume. To serve as the ground truth, a planning CT and MR were acquired together immediately post-implant and rigidly fused directly (GV). The transferred contours for both the conventional and Registration Chaining methods were evaluated to qualitatively confirm clinical acceptability by a board certified physician (PR) and a physicist (JS). The offset of the preoperative contours transferred to the post-implant CT between both methods was quantified as Euclidean distance between lesion centroids. The lesion centroid when transferred using the conventional method was displaced by 2.5 mm from the Registration Chaining method. The transferred contours from pre-MR to the post-implant MR using Registration Chaining were qualitatively superior to those from the conventional method and correctly included an additional needle which was not included within the conventionally transferred lesion contour (see Figure). Whether for lesion-boosting or easing the clinical workflow, the Registration Chaining method was shown to accurately transfer the lesion contour from the pre-MR to the post-implant planning volume. Registration Chaining is a feasible solution to assist in fusing various planning volumes. Additional quantitative study should be performed in further clinical data to confirm the general accuracy of the method against ground truth post-implant MR. [ABSTRACT FROM AUTHOR]

The ability to use MRI to accurately delineate target lesions during high-dose rate prostate brachytherapy with real-time ultrasound-guided planning has been limited by the uncertainty of available fusion methods. Recently, MRI-TRUS fusion-guided biopsy systems have been implemented and are expected to improve the detection rate of prostate cancer. At our institution, we have implemented this technology and adapted it to TRUS-guided HDR prostate brachytherapy treatment. A new ultrasound scanner with integrated contour-based image registration software (ARIETTA 65 IntuitiveFusion -BiopSee®) was installed in the brachytherapy operating room. A workstation with external contouring software was installed in the radiology department. The connection between the treatment planning system (Oncentra Prostate®) and the new ultrasound scanner has been completed using DICOM connectivity Services. To date, thirty-three patients treated with HDR prostate brachytherapy have been contoured using this technique. All underwent multiparametric MRI, in which the radiologist delineated the dominant prostate node. These images were transferred to the ultrasound scanner installed in the operating theatre. With the patient already anaesthetised and the ultrasound scanner in place, the first set of images was taken. Theses US images are sent from Oncentra Prostate® to Biopsee® where they are fused (elastic fusion) with the MRI images. Once the fusion has been checked, the images and the contours are sent back to the treatment planning system and the prostate brachytherapy procedure is carried out according to the centre's usual dynamic. The whole process of transferring the images and performing the fusion adds 10-15 minutes to the procedure. The integration of MRI/US fusion software into the HDR prostate brachytherapy procedure is possible and improves prostate dominant nodule identification and prostate contour delineation. Dosimetric data and impact on treatment outcome will be analysed with increased patient number and follow-up. [ABSTRACT FROM AUTHOR]

gMCO generated plans for HDR prostate brachytherapy have been shown to be superior to standard reference clinical plans in a blinded pairwise comparison[1]. The purpose of this work, a first-in-man trial, was to compare gMCO and reference plans in terms of planning time and plan quality for prostate HDR brachytherapy 15Gy boosts in a randomized clinical trial. The brachytherapy procedure was as follows: 1) Patient walk-in/installation/anaesthesia 2) Positioning/Catheter implantation under transrectal ultrasound (US) guidance 3) 3D US scan 4) Contouring/catheter reconstruction on Oncentra Prostate (Elekta, Veenendaal, Netherlands) 5) Planning 6) Treatment. Planning (step 5) was performed, after randomization, using either IPSA (Oncentra Prostate, Veenendaal, Netherlands) or gMCO (in-house platform). For gMCO planning, the contours and reconstructed catheters were exported to gMCO at step 4) and the resulting plan was imported on OCP at step 6). The planning times on IPSA or gMCO were recorded. Patients previously had a planning MR in order to identify the gross tumor volume (GTV, PIRADS 3 and above)and, if present, received a boost of 125% of the prescription dose. At the time of writing, 55 (of 60) patients have been accrued and treated on this trial. Of those, only 10 patients had no GTV. Dosimetric parameters (Prostate V100, V150, V200, GTV D90, Urethra D10, Rectum and Bladder V75 and D1cc) of gMCO and IPSA plans were compared (Student's T test) to determine if plan quality and planning times were statistically different. Figure 1 shows a) a boxplot of the the planning times (minutes), b) a boxplot of the GTV D90 coverage (Gy) and c) a histogram of the proportion of GTVs with more than 19, 19.5 and 20 Gy D90 coverage for gMCO and IPSA for the 55 accrued patients (29 gMCO and 26 IPSA). Figure 1 a) shows that the median planning time for clinical cases is roughly halved (p=0.0002) for gMCO (5.0 min) compared to IPSA (10.0 min) and b) shows a trend towards higher GTV D90s for gMCO planning compared to IPSA (p=0.26). The median GTV volume and standard deviation was 3.5 cc (4.2 cc std) for gMCO and 2.8 cc (2.3 cc std) for IPSA patients (p=0.21). Additionally, we found no learning curve effect in the planning using gMCO. No statistically significant differences were found between dosimetric parameters for the prostate V100, V150, D90, Bladder V75, Rectum V75 and Urethra D10. The prostate V200 was statistically higher for gMCO (p=0.048), possibly because of higher GTV D90 to the (19.8 Gy) compared to IPSA (19.3 Gy). Figure 1c) shows that a superior GTV D90 coverage can be obtained more consistently for gMCO as compared to IPSA at 19, 19.5 and 20 Gy. This work presents a first-in-man trial of GPU based multicriteria optimization in prostate HDR brachytherapy. The planning time was halved when using gMCO as compared to IPSA. Better GTV D90s were achieved without compromising the OARs. No learning curve effect was present in gMCO planning. [1] C. Bélanger et al., "Inter-observer evaluation of a GPU-based multicriteria optimization algorithm combined with plan navigation tools for HDR brachytherapy", Brachytherapy 21 (2022), 551-560. [ABSTRACT FROM AUTHOR]

The disease control and toxicity benefits of adding interstitial needles to cervix intracavitary implants are well established, as are the advantages of MRI for tumor visualization. Yet widespread adoption of these advanced techniques remains elusive, limited by access to frequent MR imaging and the technical challenges of precisely placing needles into the tumor. Ultrasound (US) remains the most accessible form of live imaging but the poorer image quality limits clear visualization of the tumor area and the inserted interstitial needles. We describe a novel system which combines a freehand, stepper-less transrectal ultrasound probe with an electro-magnetic (EM) tracker to continuously fuse a pre-acquired MR, offering a reconstructed MR image to the corresponding live ultrasound image. Inserted needles can be easily visualized using an EM tracked stylet/mandrin, placing a solid circle on the live ultrasound image where the needle is located. The clinical ultrasound system, the BK Spekto with a biplanar side-fire 9048 US probe, was instrumented with a Northern Digital Inc. EM tracker, part of the 3D Guidance Trakstar system. Software was developed using the 3D Slicer toolkit to enable live and continuous fusion of a pre-acquired MR. Contours generated on the MR can be imported and displayed on the live US image. An additional EM tracker can be placed inside a needle to visualize its location on the live US image and removed for treatment. The system was assessed on a Viomerse Gyn phantom before being deployed in clinical implants (Fig 1A). Initial registration between the live US image and the MR is accomplished by placing the freehand transrectal US probe within the patient to a known location, such as the top of the vaginal canal/cervix area. The corresponding MR/US fusion is then locked, any movement of the freehand probe will update both the US and MR images correspondingly. Fine tuning of the registration can be done in all six degrees of freedom as necessary to accommodate any shifts and/or deformations during the procedures. Needles can easily be identified on the live US when a stylet equipped with a miniature EM tracker is inserted: a yellow circle appears on the live US at the intersection on the imaging plane where the needle is expected (Fig 1B). In case of multiple needles, the trajectory of each needle can be digitally saved within the EM frame of reference, providing a colored mark where each needle was placed on the live US. HR-CTV contours can be overlaid on the live US to help highlight the area of interest (Fig 1C). A novel system has been developed and clinically tested to enhance the capabilities of US imaging for gyn brachytherapy procedures by incorporating clarifying MR information and easy needle recognition. These features can help guide the practitioner during the procedure to a geometrically more robust implant with actionable feedback. [ABSTRACT FROM AUTHOR]

Injectable spacers placed between the prostate and rectum before radiation therapy (RT) for prostate cancer can reduce the dose to the adjacent rectum. While this method has been studied extensively with external beam RT, there is limited data for its use in high-dose-rate brachytherapy (HDR-BT). Additionally, a new formulation using non-animal stabilized hyaluronic acid (NASHA) allows for improved anatomic visibility and thus may better facilitate accurate spacer placement, minimizing complications. This study aims to assess the feasibility and dosimetry of NASHA rectal spacer utilization during HDR-BT. This single-center study retrospectively reviewed consecutive patients with prostate cancer who received HDR-BT from 2021-2024. A subset received a NASHA rectal spacer via a transperineal approach under transrectal ultrasound guidance and returned 2-4 weeks after placement to undergo HDR-BT. Dosimetric variables were compared between patients with and without spacers using two sample t-tests. 76 patients received HDR-BT, 13 with a spacer and 63 without a spacer, including two patients for whom spacer implantation was intended but unachievable due to a small rectal-prostate interface. Median age was 67 years. Prostate cancer stage included low risk (n=1), favorable intermediate risk (n=23), unfavorable intermediate risk (n=22), high risk (n=21), very high risk (n=8), and node-positive (n=1). Median baseline PSA was 7.05 ng/mL (range 1.93 – 292). A total of 107 HDR-BT treatments were administered (21 spacer, 86 non-spacer). 23 patients (6 spacer, 17 non-spacer) were treated with prostate monotherapy (27 Gy in 2 fractions), 2 patients (1 spacer, 1 non-spacer), with salvage brachytherapy, and 51 patients (6 spacer, 45 non-spacer) with HDR brachytherapy boost and external beam RT. Mean prostate volume was 48.1cc. Use of a rectal spacer resulted in a reduction in mean rectal D0.1cc and V75% (80.0% vs 84.7%, p<0.0001; 0.69cc vs 0.93cc, p=0.0170, respectively). Patients treated with a rectal spacer had a higher mean prostate V125% (60.9% vs. 58.7%, p=0.0167). There were no differences in prostate V100% and V200%, urethra D0.1cc, and bladder D0.1cc between groups (p>0.05). Rectal spacer did not negatively impact the feasibility of HDR-BT catheter placement under ultrasound guidance, nor were there complications from placement. A NASHA rectal spacer can be placed prior to prostate HDR-BT to successfully increase the distance between the rectum and prostate without interfering with visibility and technical delivery of HDR-BT. Use of a rectal spacer effectively reduces dose to the rectum, while maintaining appropriate target coverage to the prostate. Future investigations will be performed to assess the impact of rectal spacer use on acute and late gastrointestinal toxicity. [ABSTRACT FROM AUTHOR]

The introduction of rectal spacers has improved patient care through minimizing rectal radiation exposure in prostate cancer treatment. Despite the clinical benefits of rectal spacers, an in-depth comparison of their direct and indirect costs—important for guiding cost-conscious clinical decision making—remains unexplored. This study provides results from a micro-costing analysis to compare the economic implications of using polyethylene glycol (PEG with iodine) hydrogel spacers versus non-animal stabilized hyaluronic acid (NASHA) spacers. By evaluating the comprehensive costs associated with each procedure and treatment planning, including materials, labor, and procedural time, this research seeks to provide valuable insights, provide detailed and accurate cost information. This analysis is pivotal for healthcare providers and policymakers in selecting the most economically viable rectal spacer, ultimately informing best practices in prostate cancer radiotherapy. A micro-costing study was conducted through assessing the workflow at a cancer treatment center for patients receiving a rectal spacer and prostate cancer radiotherapy. The study took place over a three-week period. The methods included observational time and motion studies and qualitative discussions with staff for data collection and workflow assessment. The workflow included staff activities related to patient consultation, scheduling, spacer implantation procedure, CT scan, MRI scan and treatment planning. All spacers included in the study were implanted transperineally, utilizing a transrectal ultrasound, with the patient under MAC sedation. The PEG with iodine spacer preparation and implantation direct handling combined labor was 13.6 minutes, compared to 24.5 minutes for NASHA spacer, for an estimated labor cost of $125.61 for PEG with iodine spacer and $149.79 for NASHA spacer. A second MRI for NASHA spacer patients may be ordered when not otherwise needed for PEG with iodine spacer. The total combined labor cost for a secondary MRI scan was $162.38. The total pre-radiotherapy cost, including consumables, labor, and anesthesia, for PEG with iodine spacer was $1,427.33, compared to $1,538.93 for NASHA spacer without secondary MRI and $1,701.31 with MRI. Contouring time performed by a highly experienced radiation physicist was 3.9 minutes for PEG with iodine spacer compared to 5.7 minutes NASHA spacer. PEG with iodine spacer reduces labor for implantation compared to NASHA spacer, offering potential labor savings and improved practice efficiency. These results highlight the importance of evaluating post-spacer MRI burden and advocates for a comprehensive approach to cost estimation, suggesting further research into indirect costs and broader economic impact. This research emphasizes the need for a holistic assessment of rectal spacer technologies in guiding cost-efficient prostate cancer treatment strategies. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the outcome and toxicity of brachytherapy in the treatment of primary vaginal cancer. In a retrospective analysis, 38 patients underwent treatment for vaginal carcinoma, and 4 were treated for carcinoma of Bartholin's gland using brachytherapy between 2010 and 2023. External beam radiation therapy (EBRT) was administered to 41 out of 42 patients, with a median dose of 45 Gy in 25 fractions. Concurrent chemotherapy was used in 29 patients. Endocavitary (3 single channel and 3 multichannel) brachytherapy alone was utilized in 6 of the 42 patients while 36 received interstitial brachytherapy. Most patients had a combination of vaginal cylinder and interstitial catheters, inserted under Transrectal Ultrasound (TRUS) and/or Transvaginal Ultrasound (TVUS) guidance. Brachytherapy planning was based on CT with MRI fusion. We used Inverse Planning Simulated Annealing (IPSA) to plan all cases and a class solution was developed to minimize high-dose points in the vaginal mucosa while maintaining the majority of the high dose inside the cylinder. Acute (<6 months) and late genitourinary (GU), gastrointestinal (GI), and vaginal toxicities were assessed using the Common Terminology Criteria for Adverse Events version 5 (CTCAE v5). Local control (LC), metastatic disease-free survival (mDFS), and overall survival (OS) were analyzed through Kaplan-Meier survival curves. The mean age was 68.9 years old, with a median follow-up of 50.5 months (3-168 months). 30 patients had squamous cell carcinoma (SCC), 6 adenocarcinoma, 3 clear cell carcinomas, 1 melanoma, and 2 gastric-type adenocarcinomas. FIGO stages was as follow: I (10%), II (71%), III (12%) and IV (7%). LC rates at 3 and 5 years were 86% and 82%, mDFS rates were 84% and 80%, and OS rates were 80.6% and 67.2%, respectively. When limited to SCC only, LC rates at 3 and 5 years were 92.2% and 92.2%, mDFS rates were 83.8% and 78.8%, and OS rates were 77% and 72%, respectively. Only 6 local relapses were recorded, with no late G3-4 GU/GI toxicity reported. Acute and late G3 vaginal toxicity (stenosis) occurred in 19% and 35% of patients, respectively. Three cases of vaginal necrosis and 2 suspicions of fistula were reported. 2 cases of vaginal necrosis were associated with local disease progression, except for one case where necrosis was limited and healed spontaneously. One patient required Hyperbaric Oxygen Therapy (HBOT). brachytherapy demonstrates excellent local control in primary vaginal cancer, particularly in SCC, with favorable toxicity profile. Only mild GU and GI toxicities were observed. We observed G3 vaginal stenosis in a third of our patients and necrosis in the absence of disease progression in only 1 patient. [ABSTRACT FROM AUTHOR]

Erectile dysfunction is a prevalent side effect following prostate radiotherapy, often linked to damage to the bilateral neurovascular bundles (NVBs). This study aims to investigate the blood flow of bilateral NVBs using pulsed wave Doppler ultrasound in prostate cancer patients undergoing prostate RT. Sixty-two patients (mean age: 66.1 ± 7.2 years; Gleason Score: 6: 4, 7: 41, 8: 8, 9: 9; Ethnicity: African American: 34, White: 28; and Treatment: EBRT+brachy: 33, brachy: 29) scheduled for prostate radiotherapy were enrolled. Transrectal ultrasound was performed on each patient in the lithotomy position using a 7.5 MHz bi-plane probe controlled by a mechanical stepper. NVB locations were identified via color flow Doppler imaging, and the blood flow rates of NVBs were measured bilaterally using pulsed wave Doppler. Doppler waveforms were analyzed using custom Python software, and five waveform features were computed: peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (Vm), resistive index (RI), and pulsatile index (PI). Furthermore, we compared Doppler blood flow measurements with patients' self-reported sexual function scores obtained from the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire, generating erectile scores ranging from 0 to 12. Doppler pulsed waveform parameters exhibited considerable variation among the 62 patients: PSV = 4.81 – 34.94 cm/s, EDV = 0 – 12.15 cm/s, Vm = 0.86 – 17.66 cm/s, RI = 0.27 – 1.0, and PI = 0.39 – 11.69. Blood flow discrepancy analysis of PSV revealed varying degrees of difference between left and right NVBs: among the 62 patients, 43 exhibited less than a 50% difference, 12 displayed a difference ranging between 50 to 100%, and 7 showed a difference exceeding 100%. Table 1 shows the bilateral discrepancy of five NVB pulsed wave Doppler parameters. The percentage discrepancy for EDV was calculated based on 17 patients, excluding those with an EDV value of 0. Among the 31 patients with available erectile scores, a subset analysis of those under 65 years old (n = 13) demonstrated a significant correlation between decreased blood flow (mean value of bilateral PSVs) and sexual dysfunction (Spearman correlation coefficient: -0.81, p < 0.01). Our Doppler study of the blood flow of NVBs in patients receiving prostate radiotherapy highlights substantial differences in Doppler ultrasound waveform features between bilateral NVBs. The proposed ultrasound method may prove valuable as clinicians strive to deliver NVB-sparing RT to preserve sexual function effectively and enhance patient overall well-being. [ABSTRACT FROM AUTHOR]

Hyaluronic Acid (HA) based rectal spacers are often placed prior to radiation therapy to provide a physical barrier between the rectum and prostate to reduce dose to the rectal wall. While these spacers are seen clearly on transrectal ultrasound which helps with placement, visualization on computed tomography (CT) remains less optimal. Magnetic resonance imaging (MRI) is often necessary for volume delineation. Spectral CT imaging can enhance the visualization of these spacers and possibly reduce the necessity of an MRI. A spectral CT acquires high and low energy data which can be recomposed into virtual monoenergetic (MonoE) CT at different kiloelectron volt (keV) levels. In this research we evaluated the potential of spectral CT imaging for enhancing the visibility of HA rectal spacers. MRI and Spectral CT were acquired and registered for volume delineation for six patients who underwent HA rectal spacer insertion prior to radiotherapy. The spacer for each patient was contoured by the physician on the MRI, the MonoE 40 keV and the conventional 120keV CT from the same spectral CT scan. The contour on the MRI was considered as the reference, and the overlaps between the contours of the MRI and MonoE CT (or the conventional CT) were assessed using the Dice Similarity Coefficient (DSC) and the Hausdorff Distance (HD). The contrast to noise ratio (CNR) was calculated to quantify the visualization on both MonoE and the conventional CT. All three metrics were evaluated using a paired t-test to check if the improvement of visualization is statistically significant (P <0.05) in MonoE 40 keV CT as compared to the conventional 120 kVp CT. The overlap of the contours between the MRI and the MonoE 40 keV CT was significantly better than the one between the MRI and the conventional CT based on the results of DSC and HD (P <0.05). The result of CNR showed that MonoE 40keV CT has better image contrast between the spacer and prostate than the conventional CT (P <0.05). We show that contours created from a recomposed monoenergetic 40 keV CT better resemble those created from MRI imaging. This shows that Spectral CT imaging can significantly improve visualization and delineation accuracy of rectal spacers. [ABSTRACT FROM AUTHOR]

To describe the laparoscopic management of an obstructed uterus didelphys before and after treatment for pelvic inflammatory disease. To compare the appearance of pelvic organs during active infection with their appearance after washout and appropriate antibiotic treatment, emphasizing the importance of knowing when to abort a procedure. Video demonstration of surgical and medical management considerations during a complex pelvic surgery. Visualization of tissue healing that occurs with appropriate antibiotic treatment. Academic Center. A patient who presents for definitive surgical management of a uterus didelphys with an obstruction at her right hemicervix. Her presentation is complicated by a tubo-ovarian abscess. A uterus didelphys is classically defined as two hemiuteri with duplicated cervices with or without a longitudinal vaginal septum. Uterus didelphys may have an obstruction and/or communication between the two uterine horns, in which case patients may present with complications such as cyclic pelvic pain from hematometra or genital tract infection. This is a case report of a 14-year-old G0 who presented to the emergency department with two weeks of vaginal bleeding, severe diffuse abdominal pain, and malodorous vaginal discharge. Transabdominal ultrasound and a magnetic resonance imaging of the pelvis established a new diagnosis of a uterus didelphys with an obstruction at her right hemicervix and a fistulous tract connecting her right and left hemiuteri at the level of the internal cervical os. She was also found to have a 3 cm left ovarian cyst and a new finding of congenital absence of her right kidney. Patient was administered ceftriaxone, doxycycline, and metronidazole antibiotics as treatment of presumed pelvic inflammatory disease but experienced minimal improvement after 24 hours. The decision was made to proceed with surgical intervention. A survey of the pelvis revealed significant inflammation, friable peritoneum, and endometriosis. The uterine horns in didelphic configurations were visualized. The fimbriae at the left fallopian tube were notably splayed out, swollen, and inflamed. There was a notable large mass in the location where the ovarian cyst had been previously described on imaging. A large amount of purulent material was expressed when compressed, consistent with a tubo-ovarian abscess. The infection likely originated from the menstrual blood collection at the right obstructed cervix that ascended through the communication between the right and left hemiuteri. The pelvis was irrigated thoroughly. At this point, the decision was made to stop the procedure, pursue antibiotic treatment, and resolve the active infection before correcting her complex müllerian anomaly. Patient continued on her antibiotic course, which included piperacillin-tazobactam, while hospitalized, followed by a five-day course of amoxicillin-clavulanate. She was also placed on medroxyprogesterone acetate for menstrual suppression. Advantage of allowing time for antibiotic treatment and tissue healing before repair of a complex müllerian anomaly. With antibiotic treatment, she recovered well postoperatively with resolution of her pain. Three months later, she returned to the operating room for definitive surgical management of her obstructed uterine didelphys. On laparoscopy, there was a significant improvement in tissue quality. Most notably, the fimbriae of the left fallopian tube were no longer inflamed. We proceeded with the planned correction of the complex müllerian anomaly. After resection of the right uterine horn, the fistula tract was identified and also resected. The defect in the right hemicervix was closed over, reinforcing the medial side of the left hemicervix. She had an uncomplicated postoperative recovery, and menses resumed without pain. The presented case provides unique insight into the tissue healing that occurs before and after antibiotic treatment. Knowing when to stop, especially in the setting of an active infection, is extremely important for performing a procedure safely, minimizing harm, and allowing for robust tissue repair. It is also important to optimize modifiable preoperative factors before correcting a complex müllerian anomaly. Assessing and reassessing the situation during a complex pelvic surgery is essential, especially in the setting of a complex müllerian anomaly where the preoperative examination and imaging may not be definitive. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) routinely employs magnetic resonance (MR) imaging, while metastatic PCa needs more complicated detection methods for precise localization. The inconvenience of using different methods to detect PCa and its metastases in patients and the limitations of single-mode imaging have brought great challenges to clinicians. Meanwhile, clinical treatments for metastatic PCa are still limited. Herein, we report a targeted theranostic platform of Au/Mn nanodots-luteinising hormone releasing hormone (AMNDs-LHRH) nano-system for multi-mode imaging guided photothermal therapy of PCa. The nano-system not only can simultaneously target Gonadotropin-Releasing Hormone Receptor (GnRH-R) positive PCa and its metastases for accurate preoperative CT/MR diagnosis, but also possesses fluorescence (FL) visualization navigated surgery, demonstrating its potential application in clinical cancer detection and surgery guidance. Meanwhile, the AMNDs-LHRH with promising targeting and photothermal conversion ability significantly improve the photothermal therapy effect of metastatic PCa. The AMNDs-LHRH nano-system guarantees the diagnostic accuracy and enhanced therapeutic effect, which provides a promising platform for clinical diagnosis and treatment of metastatic PCa. Accurate clinical diagnosis and treatment of prostate cancer and its metastases is challenging. A targeted theranostic platform of AMNDs-LHRH nano-system for multi-mode imaging (FL/CT/MR) guided photothermal therapy of metastatic prostate cancer has been reported. The nano-system not only can simultaneously target prostate cancer and its metastases for accurate preoperative CT/MR diagnosis, but also possesses fluorescence visualization navigated surgery, demonstrating its potential application in clinical cancer detection and surgery guidance. The nano-system with great targeting and photothermal conversion ability significantly improve the photothermal therapy effect of metastatic prostate cancer. Overall, the AMNDs-LHRH nano-system integrates tumor targeting, multi-mode imaging and enhanced therapeutic effect, which can provide an effective strategy for the clinical diagnosis and treatment of metastatic PCa. [Display omitted] [ABSTRACT FROM AUTHOR]

To assess the rates of detection of clinically significant prostate cancer (csPCa) and complications associated with transperineal (TP) and transrectal (TR) biopsy approaches to magnetic resonance imaging (MRI)-fusion targeted biopsy. We retrospectively identified men who underwent TP or TR MRI-targeted biopsy with concurrent systematic random biopsy from August 2020 to August 2021. Primary outcomes were detection rates of csPCa and 30-day complication rates between the 2 MRI-biopsy groups. Data were additionally stratified by prior biopsy status. A total of 361 patients were included in the analysis. No demographic differences were observed. No significant differences were observed between TP and TR approaches on any of the outcomes of interest. TR MRI-targeted biopsies identified csPCa in 47.2% of patients, and TP MRI-targeted biopsies identified csPCa in 48.6% of patients (P =.78). No significant differences were observed in csPCa detection between the 2 approaches for patients on active surveillance (P =.59), patients with prior negative biopsy (P =.34), and patients who were biopsy naïve (P =.19). Complication rates did not vary by approach (P =.45). Neither the identification of csPCa by MRI-targeted biopsy nor rates of complications differed significantly based on a TR or TP approach. No differences were seen between MRI-targeted approaches based on prior biopsy or active surveillance status. [ABSTRACT FROM AUTHOR]

To compare software-based three-dimensional-guided systematic prostate biopsy (3D-GSB) with conventional transrectal ultrasound-guided systematic biopsy (TGSB) regarding prostate cancer (PCa) detection rates (CDR). In total, 956 patients (200 TGSB patients and 756 3D-GSB patients) without prior positive biopsies and with a prostate-specific antigen value ≤20 ng/ml were eligible for analysis. TGSB and 3D-GSB cases were matched in a 1:1 ratio using propensity score matching with age, prostate-specific antigen, prostate volume, previous biopsy status, and suspicious palpatory finding as confounders. 3D-GSB was conducted with the semi-robotic prostate fusion-biopsy system Artemis. For each patient in both groups, SB was conducted in a similar pattern with 12 cores. All cores in 3D-GSB were automatically planned and mapped on a 3D-model as well as on the real-time transrectal ultrasound imaging. Primary end points were the clinically significant (cs) and overall CDR. Secondary end point was the cancer-positive core rate. After matching, the csCDR was not significantly different between the 3D-GSB and the TGSB groups (33.3% vs 28.8%, P =.385). Overall CDR was significantly higher for 3D-GSB compared to TGSB (55.6% vs 39.9%, P =.002). 3D-GSB detected significantly more non-significant PCa than TGSB (22.2% vs 11.1%, P =.004). In patients with PCa, the number of cancer-positive SB cores was significantly higher by TGSB (42% vs 25%, P <.001). 3D-GSB was associated with a higher CDR than TGSB. However, no significant difference was shown in detection of csPCa between both techniques. Therefore, currently, 3D-GSB does not appear to add value to conventional TGSB. [ABSTRACT FROM AUTHOR]

Prostate cancer is one of the most commonly diagnosed non-cutaneous malignant tumors and the sixth major cause of cancer-related death generally found in men globally. Automatic segmentation of prostate regions has a wide range of applications in prostate cancer diagnosis and treatment. It is challenging to extract powerful spatial features for precise prostate segmentation methods due to the wide variation in prostate size, shape, and histopathologic heterogeneity among patients. Most of the existing CNN-based architectures often produce unsatisfactory results and inaccurate boundaries in prostate segmentation, which are caused by inadequate discriminative feature maps and the limited amount of spatial information. To address these issues, we propose a novel deep learning technique called Multi-Stage FCN architecture for 2D prostate segmentation that captures more precise spatial information and accurate prostate boundaries. In addition, a new prostate ultrasound image dataset known as CCH-TRUSPS was collected from Chongqing University Cancer Hospital, including prostate ultrasound images of various prostate cancer architectures. We evaluate our method on the CCH-TRUSPS dataset and the publicly available Multi-site T2-weighted MRI dataset using five commonly used metrics for medical image analysis. When compared to other CNN-based methods on the CCH-TRUSPS test set, our Multi-Stage FCN achieves the highest and best binary accuracy of 99.15%, the DSC score of 94.90%, the IoU score of 89.80%, the precision of 94.67%, and the recall of 96.49%. The statistical and visual results demonstrate that our approach outperforms previous CNN-based techniques in all ramifications and can be used for the clinical diagnosis of prostate cancer. [ABSTRACT FROM AUTHOR]

Transabdominal ultrasound (TAUS) is usually the first approach for diagnosis of reproductive tract complaints in all adolescents. However, there are instances when transrectal ultrasound (TRUS) is more feasible. Although TRUS is considered more invasive and distressing, evidence-based data are lacking. The aim of this study was to evaluate the level of anxiety in adolescents subjected to TAUS and TRUS and in their caregivers. In this cross-sectional study, data were prospectively gathered using 2 instruments: the adult or child version of the State and Trait Anxiety Inventory (STAI or STAIC) and a self-developed survey. TAUS and TRUS are connected with high-level anxiety in patients and moderate anxiety in caregivers, as measured by the STAI/STAIC questionnaires. TRUS-related anxiety, fear, discomfort, and pain in adolescents are significantly higher compared with TAUS. The TRUS-related anxiety of caregivers, as well as the parent-estimated fear, discomfort, and pain of adolescents, is significantly higher compared with TAUS. Anticipated pain connected to TRUS is significantly higher than the post-exam, actually experienced pain. Pain and shame are the main reasons for adolescent anxiety connected with TRUS, whereas shame and unknown experience contribute to TAUS-related anxiety. Given the high level of anxiety associated with both exams, additional support should be provided to patients scheduled for any pelvic ultrasound exam. Given the even higher level of adolescent anxiety related to TRUS, specialists should be encouraged to train in TAUS and make efforts to begin with this approach. Because increased caregiver anxiety could adversely affect a child's reactions, anxiety-reducing interventions should be oriented toward the caregivers as well as the patients. [ABSTRACT FROM AUTHOR]

The objective of this observational study was to evaluate the association between increased physical activity at first artificial insemination (AI) and subsequent pregnancy per AI (P/AI) in lactating Holstein cows following spontaneous estrus or a timed AI (TAI) protocol. We also wanted to identify factors associated with the intensity of activity increase (PA) captured by automated activity monitors (AAM) and fertility. Two experiments were conducted, in which cows either were inseminated based on the alert of the AAM system (AAM cows) or received TAI following a 7-d Ovsynch protocol (TAI cows) if not inseminated within a farm-specific period after calving. Experiment 1 included 2,698 AI services from AAM cows and 1,042 AI services from TAI cows equipped with the Smarttag Neck (Nedap Livestock Management) from a dairy farm in Slovakia (farm 1). In the second experiment, 6,517 AI services from AAM cows and 1,226 AI services from TAI cows fitted with Heatime (Heatime Pro; SCR Engineers Ltd.) from 8 dairy farms in Germany (farms 2–9) were included. Pregnancy diagnosis was performed on a weekly basis by transrectal ultrasound (farms 1, 3, 7, 8) or by transrectal palpation (farms 2, 4–6, 9). Estrous intensity was represented by the peak value of the change in activity. In experiment 1, PA was categorized into low (x-factor 0–20) and high (x-factor 21–100) PA, and in experiment 2 into low (activity change = 35–89) and high (activity change = 90–100) PA. In TAI cows from both experiments, PA was additionally categorized into cows with no AAM alert. Data were analyzed separately for AAM and TAI cows using multinomial logistic regression models for PA in TAI cows and logistic regression models for PA in AAM cows and P/AI in both groups. In experiment 1, P/AI of AAM cows was greater for AI services performed with conventional frozen semen (57.6%) compared with sexed semen (47.2%), whereas type of semen only tended to be associated with P/AI in TAI cows (54.4% conventional frozen semen vs. 48.9% sexed semen). In experiment 2, P/AI was greater for fresh semen (AAM cows: 44.4% vs. TAI cows: 44.2%) compared with conventional frozen semen (AAM cows: 37.6% vs. TAI cows: 34.6%). In both experiments, pregnancy outcomes were associated with PA. In experiment 1, AAM cows with high PA (55.1%) had greater P/AI than cows with low PA (49.8%). Within TAI cows, cows with no alert (38.8%) had reduced P/AI compared with cows with low (54.2%) or high PA (61.8%). In experiment 2, AAM cows with high PA (45.8%) had greater P/AI compared with cows with low PA (36.4%). Timed AI cows with no alert (27.4%) had decreased P/AI compared with cows with low (41.1%) or high (50.8%) PA. The greatest risk factors for high PA were parity (experiment 1) and season of AI (except for TAI cows from experiment 1). We conclude that high PA at the time of AI is associated with greater odds of pregnancy for both AAM and TAI cows. In both experiments, about 2 thirds of AAM cows (experiment 1: 69.9% and experiment 2: 70.7%) reached high PA, whereas only approximately one-third or less of TAI cows (experiment 1: 37.3% and experiment 2: 23.6%) showed high PA. Although we observed similar results using 2 different AAM systems for the most part, risk factors for high PA might differ between farms and insemination type (i.e., AAM vs. TAI). [ABSTRACT FROM AUTHOR]

To develop and evaluate a risk-based antibiotic prophylaxis protocol for patients undergoing transrectal prostate biopsy. We created a risk-based protocol for antibiotic prophylaxis before transrectal prostate biopsy. Patients were screened for infection risk-factors with a self-administered questionnaire. The protocol was implemented from January 1, 2020 to March 31, 2020. We compared patient risk-factors, antibiotic regimens, and 30-day infection rates for patients undergoing transrectal prostate biopsies during the intervention and for a 3-month period before the intervention. There were 116 prostate biopsies in the preintervention group and 104 in the intervention group. Although there was no significant difference in the number of high-risk patients between the 2 groups (48% vs 55%; P =.33), the percentage of patients treated with augmented prophylaxis decreased from 74% to 45% (P = 0.03). The duration of antibiotic administration and the median number of doses prescribed also decreased significantly. Despite significant decreases in antibiotic use, there were no differences in infection rates (5% vs 5%; P =.90) or sepsis rates (1% vs 2%; P =.60). We developed a risk-based protocol for prophylactic antibiotics before prostate biopsy. The protocol was associated with less antibiotic use but did not lead to an increase in infectious complications. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study is to assess the risk of infection after transrectal ultrasound-guided fiducial marker insertion for image-guided radiotherapy of prostate cancer. Between January 2016 and December 2020, 829 patients scheduled for intensity-modulated radiotherapy for prostate cancer had an intraprostatic fiducial marker transrectal implantation under ultrasound guidance by radiation-oncologists specialized in brachytherapy. Patients received standard oral prophylactic antibiotic with quinolone. If Gram negative bacteria resistant to quinolone were detected at the time of the prostate cancer biopsies, the antibioprophylaxis regimen was modified accordingly. The resistance to quinolone screening test was not repeated before fiducial marker insertion. Infectious complications were assessed with questionnaires at the time of CT-planning and medical record reviewed. Toxicity was evaluated according to CTCAE v5.0. The median time between fiducial marker implantation and evaluation was 10 days (range: 0–165 days). Four patients (0.48%) developed urinary tract infection related to the procedure, mostly with Gram-negative bacteria resistant to quinolone (75%). Three had a grade 2 infection, and one patient experienced a grade 3 urosepsis. The quinolone-resistance status was known for two patients (one positive and one negative) and was unknown for the other two patients prior to fiducial marker implantation. Intraprostatic transrectal fiducial marker implantation for image-guided radiotherapy is well tolerated with a low rate of infection. With such a low rate of infection, there is no need to repeat the search of Gram-negative bacteria resistant to quinolone before fiducial marker implantation if it was done at the time of prostate biopsies. Optimal antibioprophylaxis should be adapted to the known status of Gram-negative bacteria resistant to quinolone. [ABSTRACT FROM AUTHOR]

Prostate magnetic resonance imaging and transrectal ultrasound guided prostate biopsy contribute a calculable environmental footprint. Wider use of evidence-based strategies for prostate cancer screening and biopsy selection that decrease low-value prostate biopsy would also reduce health care pollution. Reducing low-value clinical care is an important strategy to mitigate environmental pollution caused by health care. To estimate the environmental impacts associated with prostate magnetic resonance imaging (MRI) and prostate biopsy. We performed a cradle-to-grave life cycle assessment of prostate biopsy. Data included materials and energy inventory, patient and staff travel contributed by prostate MRI, transrectal ultrasound guided prostate biopsy, and pathology analysis. We compared environmental emissions across five clinical scenarios: multiparametric MRI (mpMRI) of the prostate with targeted and systematic biopsies (baseline), mpMRI with targeted biopsy cores only, systematic biopsy without MRI, mpMRI with systematic biopsy, and biparametric MRI (bpMRI) with targeted and systematic biopsies. We estimated the environmental impacts associated with reducing the overall number and varying the approach of a prostate biopsy by using MRI as a triage strategy or by omitting MRI. The study involved academic medical centers in the USA, outpatient urology clinics, health care facilities, medical staff, and patients. Greenhouse gas emissions (CO 2 equivalents, CO 2 e), and equivalents of coal and gasoline burned were measured. In the USA, a single transrectal prostate biopsy procedure including prostate MRI, and targeted and systematic biopsies emits an estimated 80.7 kg CO 2 e. An approach of MRI targeted cores alone without a systematic biopsy generated 76.2 kg CO 2 e, a systematic 12-core biopsy without mpMRI generated 36.2 kg CO 2 e, and bpMRI with targeted and systematic biopsies generated 70.5 kg CO 2 e; mpMRI alone contributed 42.7 kg CO 2 e (54.3% of baseline scenario). Energy was the largest contributor, with an estimated 38.1 kg CO 2 e, followed by staff travel (20.7 kg CO 2 e) and supply production (11.4 kg CO 2 e). Performing 100 000 fewer unnecessary biopsies would avoid 8.1 million kg CO 2 e, the equivalent of 4.1 million liters of gasoline consumed. Per 100 000 patients, the use of prostate MRI to triage prostate biopsy and guide targeted biopsy cores would save the equivalent of 1.4 million kg of CO 2 emissions, the equivalent of 700 000 l of gasoline consumed. This analysis was limited to prostate MRI and biopsy, and does not account for downstream clinical management. A prostate biopsy contributes a calculable environmental footprint. Modifying or reducing the number of biopsies performed through existing evidence-based approaches would decrease health care pollution from the procedure. We estimated that prostate magnetic resonance imaging (MRI) with a prostate biopsy procedure emits the equivalent of 80.7 kg of carbon dioxide. Performing fewer unnecessary prostate biopsies or using prostate MRI as a tool to decide which patients should have a prostate biopsy would reduce procedural greenhouse gas emissions and health care pollution. [ABSTRACT FROM AUTHOR]

The Vector technique uses electromagnetic needle tracking under local anaesthetic for transperineal magnetic resonance imaging/ultrasound fusion prostate biopsy with a stable probe. This allows accurate and precise targeting while maintaining patient comfort. Detection rates for cancer are high and complication rates are low. Prostate magnetic resonance imaging (MRI) is now standard for assessment of suspected prostate cancer (PCa). A variety of approaches to MRI-based targeting has revolutionised prostate biopsies. To describe the procedure and show the accuracy and tolerability of a novel Vector MRI/ultrasound fusion transperineal (TP) biopsy technique that uses electromagnetic (EM) needle tracking under local anaesthesia (LA). Vector prostate biopsy using BiopSee fusion software, EM tracking technology, and transrectal ultrasound was performed in 69 patients meeting the biopsy criteria in two UK centres between September 2020 and August 2022. Stepper-mounted rectal ultrasound images were fused with MRI scans. LA was applied into two defined perineal tracks and a needle sheath with an EM sensor was inserted. The biopsy needle was directed precisely through the sheath to MRI targets under EM tracking. Biopsies were taken without antibiotic prophylaxis. Cancer detection (any PCa; grade group ≥2), side effects, and patient experience measures were recorded. Cancer detection in patients with Likert 4–5 lesions was 98% for any PCa and 83% for grade group ≥2. According to the 50 questionnaires returned, 42 patients (84%) reported no or minimal pain, while 40 (80%) reported no or minimal discomfort. No episodes of postoperative urinary retention occurred, and only one patient required treatment for infection. Limitations include the low patient number and incomplete responses to questionnaires. This novel Vector technique provides a feasible and tolerable procedure for MRI/ultrasound fusion TP biopsy under LA, with high cancer detection rates. This is achieved while maintaining patient comfort and with minimal rates of complications. We report a novel technique that uses electromagnetic needle tracking to perform highly accurate and comfortable prostate biopsies through the perineum under local anaesthetic. [ABSTRACT FROM AUTHOR]

• Detection of index lesion (IL) by MRI is crucial to perform targeted biopsy, to monitor the progression of the PCa and to guide the focal therapy. • In prostate with multifocal lesions, the IL can be the smallest markedly hypointense lesion vs the largest with moderate hypointensity on ADC maps. • Sensitivity in the detection of IL was 79.6–83% and 93.2–94.9% with the PI-RADS v2.1 and S-PI-RADS criteria, respectively [ABSTRACT FROM AUTHOR]

Prostate magnetic resonance imaging (MRI) is increasingly used prior to biopsy in response to the overdiagnosis and overtreatment of prostate cancer (CaP) associated with prostate-specific antigen (PSA) based screening. However, technical limitations in the conventional diffusion-weighted imaging (DWI) sequences as well as the high degree of radiologist-to-radiologist variability in interpreting prostate MRI result in inadequate accuracy. Specifically, the insufficient negative predictive value (NPV) of prostate MRI (76%–87%) does not allow biopsy to be omitted in the negative MRI setting. Additionally, the variable, and relatively low positive predictive value (PPV) of MRI (27%–44%) provides only an incremental improvement in risk prediction compared to readily available clinical tools such as the Prostate Cancer Prevention Trial risk calculator. This small benefit is likely confined to the minority of patients with positive MRI findings in a typically under-sampled region of the prostate (e.g., anterior lesions), which may be obviated by newer biopsy approaches and tools such as transperineal prostate biopsy and micro-ultrasound technology. With these considerations in mind, pre-biopsy prostate MRI in its current form is unlikely to provide a clinically significant benefit, and should not be considered as routine practice until its accuracy is sufficiently improved. [ABSTRACT FROM AUTHOR]

Although positron emission tomography (PET) imaging products targeting prostate-specific membrane antigen (PSMA) have been approved for marketing, clinical challenges remain in the study of its use as a therapeutic target, such as the complex synthesis process and side effects after treatment. Here, we developed a strategy for targeted photothermal therapy (PTT) using PSMA as the target. The results of molecular docking demonstrated that the synthesized PEG modified urea-based PSMA inhibitor (small molecular PSMA inhibitor, PI) PI-PEG has a high affinity energy (binding energy = − 8.3 kcal mol−1) for the PSMA target. Therefore, modification of PI-PEG onto the surface of gold@polydopamine (Au@PDA) with NIR-II absorption could enable targeted PTT against PSMA. This work revealed that the prepared Au@PDA/PEG-PI were not only highly selective for PSMA, but also could efficiently ablate PSMA expression by targeted PTT at the maximum permissible exposure (MPE) of the NIR-II laser. Moreover, Au@PDA/PEG-PI also have potential for photoacoustic (PA) imaging and computed tomography (CT) imaging. As the first strategy to downregulate the expression of PSMA and successfully inhibit prostate cancer by targeted PTT, this study case provides a new idea for the clinical translation of PSMA as an integrated target for tumor diagnosis and anti-tumor treatment. (1) Au@PDA/PEG-PI NPs were the novel PTT agent to target PSMA and successfully down-regulate PSMA expression. (2) Molecular docking results demonstrated that PI-PEG inhibitors have a high affinity energy for PSMA (binding energy = − 8.3 kcal mol−1). (3) Au@PDA/PEG-PI NPs can be targeted for efficient PTT at the MPE of the NIR-II laser. (4) Au@PDA/PEG-PI NPs also have the potential for PA and CT imaging. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of catheterization before transperineal ultrasound-guided prostate biopsy in reducing risk of urethrorrhagia. Currently, transperineal ultrasound-guided prostate biopsy (TPPB) is one of the most commonly used measures to help diagnose prostate cancer. However, whether the retention of catheterization before transperineal ultrasound-guided prostate biopsy is associated with the reduced risk of urethrorrhagia remains uncertain.Methods: A cohort study was conducted in our hospital from January 2021 to September 2021. This study included 93 patients who participated in transperineal ultrasound-guided prostate biopsy. We compared the risk of urethrorrhagia in patients who underwent indwelling catheterization before biopsy and those who did that after biopsy, and performed an unadjusted analysis. We also analyzed the use of related confounding factors to limit the cohort of men, and applied propensity-score adjustment to control potential confounders. Analyses that restricted the cohort men with the related confounding factors and that used propensity-score adjustment to control for potential confounders.Results: A total of 93 men were recruited in the cohort study, and the numbers of patients in group 1 and group 2 were 64 and 29, respectively. There were 34 patients (53.1%) of urethrorrhagia in group 1, and 22 patients (75.8%) of urethrorrhagia in group 2. This was a significant difference between the 2 groups (P = .008). After adjusting for correlative factors, the preoperative catheterization is still a protective factor for postoperative urethrorrhagia through multivariate multiple piecewise linear regression analysis.Conclusion: The result of this cohort study suggested that preoperative catheterization can significantly reduce the risk of urethrorrhagia. [ABSTRACT FROM AUTHOR]

To compare multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) to estimate prostate volume and prostate specific antigen density (PSAD) as well as subsequent impact on prostate cancer (PCa) detection. Patients referred for mpMRI prior to mpMRI-TRUS fusion-guided prostate biopsy between 2015 and 2020 were identified. Volume and calculated PSAD by mpMRI and TRUS were compared. Associations with presence of any PCa and clinically significant PCa (csPCa; Gleason ≥3 + 4) were evaluated using linear regression (interaction by volume quartile), logistic regression, and receiver operating characteristics. Among 640 men, TRUS underestimated prostate volume relative to mpMRI (median 49.2cc vs. 54.1cc) with 8% lower volume per cc up to 77.5cc (First-third quartile) and 39% lower volume per additional cc above 77.5cc (fourth quartile). For men undergoing radical prostatectomy, mpMRI had a higher correlation coefficient relative to TRUS (0.913 vs 0.878) when compared to surgical pathology. mpMRI PSAD had slightly higher odds vs TRUS PSAD for detecting any PCa (OR 2.94 and OR 2.78, both P <.001) or csPCa (OR 4.20 and OR 4.02, both P <.001). AUC improvements were of borderline significance for mpMRI vs. TRUS PSAD for any PCa (0.689 vs 0.675, P =.05) and not significant for csPCa (0.732 vs 0.722, P =.20). PSAD was not associated with PCa detection for prostates ≥77.5cc. TRUS underestimates prostate volume relative to mpMRI. PSAD based on mpMRI may be better associated with detection of PCa compared to TRUS, but utility of PSAD may be limited for larger prostates. [ABSTRACT FROM AUTHOR]

To explore the factors that influence sample adequacy and safety of ultrasound (US)-guided biopsy for peripheral pulmonary lesions (PPLs) with 16-G needles. A total of 263 patients (150 men, 113 women; mean age, 60.7 ± 13 years) who received US-guided biopsy for PPLs with 16-G needles from July 2017 to March 2021 were included. Variables including patient demographics, lesion location, lesion size, proportion of lesion necrosis, presence of emphysema, presence of bullae around lesion, patient position, and number of needle passes were recorded. Univariate analysis and multivariable logistic regression analysis were performed to explore the factors that influence sample adequacy and safety. Biopsy specimens were adequate for diagnosis in 242/263 (92%) cases. Multivariable logistic regression analysis revealed lesion size was significantly associated with sample adequacy (p= 0.005, odds ratio [OR] = 1.039). The incidence of overall complication rate was 10.6% (28/263), including pneumothorax and haemorrhage, which occurred in 2.7% (7/263) and 9.9% (26/263) of patients, respectively. Patient position (lateral versus supine) was associated with overall complication rates (p= 0.029, OR=3.407) and haemorrhage (p= 0.013, OR=4.870). The presence of bullae around the lesion (p= 0.026, OR=73.128) was an independent factor associated with pneumothorax. US-guided percutaneous biopsy for PPLs with 16-G needles is effective and safe. Sample adequacy is significantly affected by lesion size. Patient lateral position is a risk factor for overall complication and haemorrhage. The presence of bullae around the lesion is a predictor of pneumothorax. • US-guided biopsy for PPLs with 16-G needles is effective and safe. • Lesion size affected sample adequacy. • Lateral position and presence of bullae raised complications. [ABSTRACT FROM AUTHOR]

The standard treatment of T2-T3ab,N0,M0 rectal cancers is total mesorectal excision (TME) due to the high recurrence rates recorded with local excision. Initial reports of the combination of pre-operative chemoradiotherapy (CRT) and transanal endoscopic microsurgery (TEM) have shown reductions in local recurrence. The TAU-TEM study aims to demonstrate the non-inferiority of local recurrence and the improvement in morbidity achieved with CRT-TEM compared with TME. Here we describe morbidity rates and pathological outcomes. This was a prospective, multicentre, randomised controlled non-inferiority trial including patients with rectal adenocarcinoma staged as T2-T3ab,N0,M0. Patients were randomised to the CRT-TEM or the TME group. Patients included, tolerance of CRT and its adverse effects, surgical complications (Clavien–Dindo and Comprehensive Complication Index classifications) and pathological results (complete response in the CRT-TEM group) were recorded in both groups. Patients attended follow-up controls for local and systemic relapse. Trial registration: NCT01308190. From July 2010 to October 2021, 173 patients from 17 Spanish hospitals were included (CRT-TEM: 86, TME: 87). Eleven were excluded after randomisation (CRT-TEM: 5, TME: 6). Modified intention-to-treat analysis thus included 81 patients in each group. There was no mortality after CRT. In the CRT-TEM group, one patient abandoned CRT, 1/81 (1.2%). The CRT-related morbidity rate was 29.6% (24/81). Post-operative morbidity was 17/82 (20.7%) in the CRT-TEM group and 41/81 (50.6%) in the TME group (P < 0.001, 95% confidence interval 42.9% to 16.7%). One patient died in each group (1.2%). Of the 81 patients in the CRT-TEM group who received the allocated treatment, 67 (82.7%) underwent organ preservation. Pathological complete response in the CRT-TEM group was 44.3% (35/79). In the TME group, pN1 were found in 17/81 (21%). CRT-TEM treatment obtains high pathological complete response rates (44.3%) and a high CRT compliance rate (98.8%). Post-operative complications and hospitalisation rates were significantly lower than those in the TME group. We await the results of the follow-up regarding cancer outcomes and quality of life. • CRT-TEM treatment achieves high rates of pathological complete response (44.3%). • CRT-TEM treatment achieves a high CRT compliance rate (98.8%). • Post-operative complications and hospitalisation rates were significantly lower than those in the TME group. • The accuracy of the endorectal ultrasound, rectal magnetic resonance imaging in the CRT-TEM group was not as high as expected. [ABSTRACT FROM AUTHOR]