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Purpose: To quantitatively assess 12-month prostate volume (PV) reduction based on T2-weighted MRI and immediate post-treatment contrast-enhanced MRI non-perfused volume (NPV), and to compare measurements with predictions of acute and delayed ablation volumes based on MR-thermometry (MR-t), in a central radiology review of the Phase I clinical trial of MRI-guided transurethral ultrasound ablation (TULSA) in patients with localized prostate cancer.Materials and Methods: Treatment day MRI and 12-month follow-up MRI and biopsy were available for central radiology review in 29 of 30 patients from the published institutional review board-approved, prospective, multi-centre, single-arm Phase I clinical trial of TULSA. Viable PV at 12 months was measured as the remaining PV on T2-weighted MRI, less 12-month NPV, scaled by the fraction of fibrosis in 12-month biopsy cores. Reduction of viable PV was compared to predictions based on the fraction of the prostate covered by the MR-t derived acute thermal ablation volume (ATAV, 55°C isotherm), delayed thermal ablation volume (DTAV, 240 cumulative equivalent minutes at 43°C thermal dose isocontour) and treatment-day NPV. We also report linear and volumetric comparisons between metrics.Results: After TULSA, the median 12-month reduction in viable PV was 88%. DTAV predicted a reduction of 90%. Treatment day NPV predicted only 53% volume reduction, and underestimated ATAV and DTAV by 36% and 51%.Conclusion: Quantitative volumetry of the TULSA phase I MR and biopsy data identifies DTAV (240 CEM43 thermal dose boundary) as a useful predictor of viable prostate tissue reduction at 12 months. Immediate post-treatment NPV underestimates tissue ablation.Key Points: • MRI-guided transurethral ultrasound ablation (TULSA) achieved an 88% reduction of viable prostate tissue volume at 12 months, in excellent agreement with expectation from thermal dose calculations. • Non-perfused volume on immediate post-treatment contrast-enhanced MRI represents only 64% of the acute thermal ablation volume (ATAV), and reports only 60% (53% instead of 88% achieved) of the reduction in viable prostate tissue volume at 12 months. • MR-thermometry-based predictions of 12-month prostate volume reduction based on 240 cumulative equivalent minute thermal dose volume are in excellent agreement with reduction in viable prostate tissue volume measured on pre- and 12-month post-treatment T2w-MRI. [ABSTRACT FROM AUTHOR]

Bladder cancer is the most frequently occurring tumor of the urinary system, with over 10,000 new diagnoses each year in the UK. Approximately 70% of these are non-muscle-invasive and limited to the mucosa (Ta) or submucosa (T1). These tumors are generally managed with transurethral resection followed by adjuvant intravesical chemo- or immuno-therapy and regular cystoscopic surveillance. The principal end points in the management of these tumors are prevention of recurrence and progression. Muscle-invasive bladder cancer is a life-threatening disease with overall 5-year mortality of 50%. Neoadjuvant chemotherapy, where possible followed by radical surgery, is currently considered the best standard of care. Open radical cystectomy is the gold-standard treatment for muscle-invasive or high-risk non-muscle-invasive (multifocal or recurrence after intravesical therapy) bladder cancer. Historically, this procedure has carried significant morbidity, although mortality of open radical cystectomy has reduced to 1-2% owing to improvements in anesthesia and intensive care facilities. Over the last 15 years, minimally invasive techniques in radical cystectomy have evolved, with the aim of reducing morbidity. In this article, we review the development of laparoscopic radical cystectomy and robot-assisted radical cystectomy, along with current evidence on perioperative morbidity and medium-term oncological outcomes. [ABSTRACT FROM AUTHOR]

Prostate core saturation biopsy (SB) is today considered in patients where clinical or biochemical hypothesis of prostate cancer (PCa) is still present after previous normal core biopsies. The technique rationale is to increase the detection rate (DT) both by increasing the number of cores for the pathologist, in order to obtain more tissue to be analyzed, and both by mapping regions that are not usually investigated with a standard or extended prostate biopsy. Moreover, the technique is not free from complications and today, one of the main controversies about SB is how many cores have to be taken in order to maintain high detection rate with low complication rate. Aim of the present retrospective study is to compare safety and DT of 3 different schemes of SB, performed with different number of cores. MATERIALS AND METHODS. We retrospectively reviewed the data of 106 patients who underwent SB from January 2003 to December 2008 at 2 urological divisions. SB was performed in all cases as a further biopsy because of biochemical and/or clinical hypothesis of PCa, in patients previously undergoing one or more baseline core biopsies. SB was performed under general anesthesia by 3 urologists in each division. Core biopsies were obtained using a Boston Scientific TruPath 18G 15cm needle, in transrectal ultrasound-guided approach. All patients were submitted to a 32-core SB scheme. We compared the 32-core scheme with a 28 and a 24-core scheme, each one including peripheral, transitional and anterior prosta tic portion biopsies. End-points of the study were: DT and safety. Statistical analysis was carried out using chi- square test (p<0.05). RESULTS. Mean age was 65.4 (50-79) years, mean PSA at biopsy was 11.2 ng/ml (3.23-30) and mean number of previous biopsies was 1.5 (1-5). Median value of cores positive for PCa in the 32, 28 and 24-core scheme was 2 (1-10), 2 (2-12) and 1.5 (0-11), respectively. Homogeneous distribution of positive cores was registered in all records, but in 3 areas (right base external, left base external, left transitional basal) the detection rate was very low (0-0. 1%). PCa was found more frequently in base in median portion of left and right prosta tic lobes. In the 32-core SB scheme, DT was 30. 1%, whereas in the 28 and 24-core SB scheme DT proved to be 28. 7% and 29. 1 %, respectively. No statistical difference was found among the schemes in terms of detection rate (p>0. 05). A Gleason score >7 was registered in 62.5% of cases. [ABSTRACT FROM AUTHOR]

Abstract Bladder cancer is the commonest malignancy of the urinary tract. In this review, we look at the latest developments in the diagnosis and management of this condition. Cystoscopy and urine cytology are the most important tools in the diagnosis and follow-up of bladder cancer. Various alternatives have been investigated, either to reduce the frequency of cystoscopy, or improve its sensitivity for detection of tumors. These include urine-based markers and point-of-care tests. Narrow-band imaging and photodynamic diagnosis/blue-light cystoscopy have shown promise in improving detection and reducing recurrence of bladder tumors, by improving the completion of bladder resection when compared with standard resection in white light. The majority of patients with a new diagnosis of bladder cancer have non-muscle-invasive bladder cancer, which requires adjuvant intravesical chemotherapy and/or immunotherapy. Recent developments in post-resection intravesical regimens are discussed. For patients with muscle-invasive bladder cancer, both laparoscopic radical cystectomy and robot-assisted radical cystectomy have been shown to reduce peri-operative morbidity, while being oncologically equivalent to open radical cystectomy in the medium term. Bladder-preserving strategies entail resection and chemoradiation, and in selected patients give equivalent results to surgery. The development, advantages, and disadvantages of these newer approaches are also discussed.