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Background: Granulomatous prostatitis is a medical condition that may mimic prostate cancer., Purpose: Granulomatous prostatitis resulting from BCG-exposure can confound the diagnosis of prostate cancer based on prostate imaging and data system (PI-RADS) classification observed on multiparametric prostate magnetic resonance imaging (mpMRI)., Study Type, Population, Assessment and Statistical Tests: A cohort study was conducted, enrolling consecutive males at risk for prostate cancer who underwent an mpMRI-targeted prostate biopsy between February 2016 and August 2023. The focus of the study was on prior BCG-exposure as adjuvant treatment for non-muscle-invasive urothelial carcinoma within the 3 years prior the magnetic resonance imaging (MRI). Exclusion criteria were a prior androgen deprivation therapy, prostate surgery or radiation, and BCG-exposure occurring more than 3 years and less than 3 months before the MRI. Chi-square, logistic-regression, statistical association, and homogeneity tests were used., Results: Total 712 patients, 899 biopsied lesions (218 PI-RADS 3, 521 PI-RADS 4 and 160 PI-RADS 5) and 20 patients with 30 lesions within the BCG-exposed cohort. Chi-square and logistic-regression tests showed an association between PI-RADS with malignancy and significant tumor (ST), considering PI-RADS3 as the reference (OR: 4.9 [95% CI, 3.4-7.1] for PI-RADS4 and OR: 21.7 [95% CI, 12.4-37.8] for PI-RADS5 for malignancy, and OR: 5.3 [95% CI, 3.2-8.7] for PI-RADS4 and OR: 16.5 [95% CI, 9.4-28.9] for PI-RADS5 regarding ST). A statistically significant negative association was demonstrated between malignancy and ST with respect to BCG-exposure (OR: 0.15 [95% CI, 0.06-0.39] and OR: 0.39 [95% CI, 0.15-1.0], respectively). Statistically significant risk-difference for malignancy in patients nonexposed to BCG regarding those exposed was 45% (61.6% vs. 16.7%) for PI-RADS4, and 68.5% (90.7% vs. 22.2%) and 42.7% (64.9% vs. 22.2%) concerning malignancy and ST for PI-RADS5, respectively., Data Conclusions: Granulomatous prostate reaction caused by BCG-exposure acts as confounding factor for prostate MRI interpretation. The risk of malignancy and significant tumor on targeted biopsy to PI-RADS 3, 4 and 5 is notably lower in exposed patients., Competing Interests: Disclosure The authors have stated that they have no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Objectives : Multiparametric magnetic resonance imaging (mpMRI) of the prostate and prostate-specific membrane antigen positron emission tomography (PSMA PET) are some examples of how the advancement of imaging techniques have revolutionized the diagnosis, staging, and consequently management of patients with prostate cancer (PCa). Although with less striking results, novel radiological modalities have also been proposed for bladder cancer (BCa) in recent years. Micro-ultrasound (MUS) is an imaging examination characterized by high real-time spatial resolution, recently introduced in the urological field. This article aimed to describe the current evidence regarding the application of MUS for the diagnosis and staging of PCa and BCa. Materials and Methods : We designed a narrative review. A comprehensive search in the MEDLINE, Scopus, and Cochrane Library databases was performed. Articles in English-language and published until July 2022 were deemed eligible. Retrospective and prospective primary clinical studies, as well as meta-analyses, were included. Results : MUS-guided prostate biopsy showed high sensitivity (0.91, 95% CI, 0.79-0.97) in the diagnosis of clinically significant PCa (csPCa). It was associated with a higher detection rate of csPCa than a systematic biopsy (1.18, 95% CI 0.83-1.68). No significant difference was found between MUS and mpMRI-guided biopsy in the total detection of PCa ( p = 0.89) and in the detection of Grade Groups ≥ 2 ( p = 0.92). The use of MUS to distinguish between non-muscle-invasive and muscle-invasive BCa was described, highlighting an up-staging with MUS only in a minority of cases (28.6%). Conclusions : Promising findings have emerged regarding the feasibility and accuracy of MUS in the diagnosis and staging of PCa and BCa. However, the available evidence is limited and should be considered preliminary.

Abstract: Prostate-specific membrane antigen (PSMA) PET findings of urothelial carcinoma were rarely reported. We describe 18 F-FDG PET/CT and 68 Ga-PSMA-11 PET/MRI findings in a case of urothelial carcinoma of the bladder with bone metastases in the sternum, ribs, spine, pelvis, and femurs. The bone metastases showed isodensity to hyperdensity and mild to intense FDG uptake on FDG PET/CT and moderate to intense PSMA uptake on PSMA PET/MRI. PSMA PET/MRI more clearly delineated the bone metastases compared with FDG PET/CT., Competing Interests: Conflicts of interest and sources of funding: none declared. C.Z. was supported by Discipline Climbing 234 Plan for Disciplinary Platform Construction of Changhai Hospital of Navy Medical University (grants 2019YPT002 and 2020YPT002)., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

As surgical cases become more complex, intraoperative imaging is increasingly being used. This article discusses emerging imaging technologies used in prostate, kidney, and bladder cancer surgery, including ultrasound, fluorescence-based, and enhanced endoscopy techniques including their strengths and limitations., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: To assess the clinical applicability of local tumor staging in urinary bladder cancer (BC) with preoperative multiparametric MRI (mpMRI) using the five-point Vesical Imaging-Reporting and Data System (VI-RADS) scoring system and to compare it to dual-phase contrast-enhanced computed tomography (CECT)., Methods: 33 patients with primary untreated bladder cancer underwent CECT followed by preoperative multiparametric 3.0 T MRI between July 2019 and August 2020 and were enrolled in this retrospective study. Two radiologists initially performed staging on the CECT image data sets and - blinded to CT results - on subsequent mpMRI. BCs were staged according to the VI-RADS scoring system. Postoperative pathology was correlated to the VI-RADS score and the CECT results. The performance of VI-RADS in determining detrusor muscle invasion was analyzed using a receiver operating characteristic curve. Based on the histopathology, sensitivity, specificity and accuracy for muscle invasiveness between both image modalities were compared using the Chi square test., Results: A total of 33 patients (29 male, median age 70 years, IQR: 59-81 years) were included. 10 tumors were categorized as non-muscle invasive (30%) and 23 as muscle invasive BC (70%) in final histology. Tumor stages were correctly assigned as being either muscle invasive or non-muscle invasive on both CECT and mpMRI with regard to both early and late stages of BC (Ta-Tis and T3a-T4b). T-stages bordering the histopathologic limits of muscle invasiveness (T1-T2a-b) resulted in overestimation of muscle invasion in 43% of cases (VI-RADS 3-4) for the mpMRI image data sets and in an underestimation of muscle invasion in up to 55.5% of cases analysing the CECT data. Sensitivity and specificity for the determination of muscle invasion in CECT and mpMRI were 80%/80% and 74%/61% for Radiologist#1 and 70%/90% and 83%/70% for Radiologist#2, respectively., Conclusions: There are advantages and disadvantages of both CECT and mpMRI when used in the clinical assessment of BC muscular tumor invasion. In borderline cases, only the combination of cross-sectional imaging and histopathological staging may help in making the optimal treatment decisions., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Multiparametric Magnetic Resonance Imaging (mpMRI) has been proposed to add value in the diagnostic pathway of bladder cancer (BC). We wanted to evaluate the performance of mpMRI for muscle-invasion detection in BC patients using a subjective MRI visual T-category and the Vesical Imaging-Reporting and Data System (VI-RADS) score., Methods: This single centre clinical trial included 45 patients with suspected BC (ClinicalTrials.gov Identifier: NCT02662166). All patients had mpMRI prior to transurethral resection of bladder tumour (TUR-BT). The imaging was correlated to histopathological findings. Two individual radiologists evaluated all the mpMRI images. A binary cut-off point for the detection of muscle-invasion in the MRI visual T-category was defined between T1 and T2 and the VI-RADS cut-off score was 3. Cohen's Kappa values were used to evaluate the agreement between the two radiologists. Sensitivity, Specificity, Area Under Receiver Operator Characteristics Curve (AUC), Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated to evaluate the performance of both radiologists separately., Results: AUC values for reader A and B using the MRI visual T-category were 0.76 and 0.56, while the corresponding values for VI-RADS were 0.63 and 0.57, respectively. There was no statistically significant difference between the radiologists nor the reporting systems ( p  > .05) in the detection of muscle-invasion. The inter-reader agreement was substantial (0.61-0.80)., Conclusion: Both the subjective MRI visual T-category and VI-RADS score had only a low to moderate accuracy for the detection of muscle-invasion in BC with no statistically significant difference between the reporting systems.

Purpose: To investigate the diagnostic performance of the overall Vesical Imaging Reporting and Data System (VI-RADS) score and its individual magnetic resonance imaging (MRI) parameters in assessing grade and muscle invasiveness of bladder cancer (BC)., Methods: This IRB-approved retrospective, single-center, cross-sectional study included patients with BC wo underwent 3 Tesla preoperative multiparametric (mp)-MRI including T2-weighted (T2w), diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE) sequences. An independent evaluation according to VI-RADS was performed by two radiologists in separate sessions, blinded to histological findings., Results: The mean age of 59 included patients was 68.2 (±13.6 standard deviation) years. Among bladder cancer patients, 26 (51%) were identified as high grade and 14 (27.5%) as muscle invasive urothelial carcinomas in histological sections. The area under the curve (AUC) for the overall VI-RADS score to predict muscle invasion was 0.986 (R1) and 0.992 (R2). The AUC to diagnose high grade bladder cancer was 0.908 (R1) and 0.905 (R2). There was no significance difference between the AUC of single parameters (T2w, DWI and DCE) compared to the total VI-RADS score (P > 0.05, respectively). Upon multivariate logistic regression, only the T2w VI-RADS score contributed independently to the diagnosis of high grade and muscle invasive bladder cancer (P = 0.001 (R1) and P = 0.0022 (R2) for high grade cancer; P = 0.0007 (R1) and P = 0.0019 (R2) for muscle invasiveness)., Conclusion: VI-RADS provides high diagnostic accuracy to diagnose high grade and muscle invasive BC. Our results suggest, that mp-MRI parameters provide overlapping information and for sake of clinical simplicity, a biparametric, contrast free image acquisition may be approached without sacrificing diagnostic accuracy., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Vesical Imaging Reporting and Data System (VI-RADS) is a useful tool for evaluating muscle layer invasion of bladder cancer (BCa) on magnetic resonance imaging (MRI)., Purpose: To evaluate the diagnostic performance of bladder MRI to detect the muscle layer invasion of BCa using VI-RADS score and quantitative MRI parameters., Methods: Preoperative bladder MRI was performed in 73 BCa patients. Two observers independently evaluated the MR blinded to histopathological data and classified the tumors according to VI-RADS criteria. Moreover, the quantitative parameters (maximum tumor diameter; Dmax, tumor contact length; TCL, and tumor apparent diffusion coefficient; ADC values) were independently measured by observers. The diagnostic performance of the VI-RADS score and quantitative values were evaluated by using receiver operating characteristic (ROC) analysis. Interobserver agreement was evaluated using the weighted-kappa coefficient (κ)., Results: For the VI-RADS score, the AUC (area under the curve) was 0.968 and accuracy was 90.4% for Observer 1, and AUC was 0.953, accuracy was 89% for Observer 2. The AUC of TCL, TCL/DMax, and ADC values was 0.918, 0.675, and 0.832. In patients with a VI-RADS score ≥ 3, when a threshold value of TCL > 19.5 mm is used as complementary to the VI-RADS score, the accuracy of MRI for Observer-1 increases 100% and 97.26% for Observer-2. There was a good-excellent agreement between the observers in assessing the VI-RADS scores and quantitative parameters., Conclusion: Evaluation of bladder MRI using both VI-RADS criteria and TCL is successful and highly reproducible for detecting muscle layer invasion in patients with BCa., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The optimal management of clinical T4 (cT4) prostate cancer (PC) is still uncertain. At our institution, carbon ion radiotherapy (CIRT) for nonmetastatic PC, including tumors invading the bladder, has been performed since 2010. Since carbon ion beams provide a sharp dose distribution with minimal penumbra and have biological advantages over photon radiotherapy, CIRT may provide a therapeutic benefit for PC with bladder invasion. Hence, we evaluated CIRT for PC with bladder invasion in terms of the safety and efficacy., Methods: Between March 2010 and December 2016, a total of 1337 patients with nonmetastatic PC received CIRT at a total dose of 57.6 Gy (RBE) in 16 fractions over 4 weeks. Among them, seven patients who had locally advanced PC with bladder invasion were identified. Long-term androgen-deprivation therapy (ADT) was also administered to these patients. Adverse events were graded according to the Common Terminology Criteria for Adverse Event version 5.0., Results: At the completion of our study, all the patients with cT4 PC were alive with a median follow-up period of 78 months. Grade 2 acute urinary disorders were observed in only one patient. Regarding late toxicities, only one patient developed grade 2 hematuria and urinary urgency. There was no grade 3 or worse toxicity, and gastrointestinal toxicity was not observed. Six (85.7%) patients had no recurrence or metastasis. One patient had biochemical and local failures 42 and 45 months after CIRT, respectively. However, the recurrent disease has been well controlled by salvage ADT., Conclusions: Seven patients with locally advanced PC invading the bladder treated with CIRT were evaluated. Our findings seem to suggest positive safety and efficacy profiles for CIRT., (© 2021. The Author(s).)

Abstract: A 77-year-old man with prostate cancer had prostatectomy and hormonal therapy and underwent pelvic MRI and 68Ga-PSMA-11 PET/CT during clinical follow-up. A pelvic MRI scan showed suspected metastasis along the posterior wall of urinary bladder. The 68Ga-PSMA-11 PET/CT was acquired in a dual-time point fashion, at 60 minutes and 110 minutes postinjection. At 60 minutes postinjection, the known bladder wall lesion showed lower than urine background uptake. On 110 minutes delayed images, the bladder wall lesion showed avid PSMA uptake, much higher than the urine background, increased PSMA uptake by the tumor over time, and improved contrast in the lesion., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: (1) To investigate whether a contrast-free biparametric MRI (bp-MRI) including T2-weighted images (T2W) and diffusion-weighted images (DWI) can be considered an accurate alternative to the standard multiparametric MRI (mp-MRI), consisting of T2, DWI, and dynamic contrast-enhanced (DCE) imaging for the muscle-invasiveness assessment of bladder cancer (BC), and (2) to evaluate how the diagnostic performance of differently experienced readers is affected according to the type of MRI protocol., Methods: Thirty-eight patients who underwent a clinically indicated bladder mp-MRI on a 3-T scanner were prospectively enrolled. Trans-urethral resection of bladder was the gold standard. Two sets of images, set 1 (bp-MRI) and set 2 (mp-MRI), were independently reviewed by four readers. Descriptive statistics, including sensitivity and specificity, were calculated for each reader. Receiver operating characteristic (ROC) analysis was performed, and the areas under the curve (AUCs) were calculated for the bp-MRI and the standard mp-MRI. Pairwise comparison of the ROC curves was performed., Results: The AUCs for bp- and mp-MRI were respectively 0.91-0.92 (reader 1), 0.90 (reader 2), 0.95-0.90 (reader 3), and 0.90-0.87 (reader 4). Sensitivity was 100% for both protocols and specificity ranged between 79.31 and 89.66% and between 79.31 and 83.33% for bp-MRI and mp-MRI, respectively. No significant differences were shown between the two MRI protocols (p > 0.05). No significant differences were shown accordingly to the reader's experience (p > 0.05)., Conclusions: A bp-MRI protocol consisting of T2W and DWI has comparable diagnostic accuracy to the standard mp-MRI protocol for the detection of muscle-invasive bladder cancer. The experience of the reader does not significantly affect the diagnostic performance using VI-RADS., Key Points: • The contrast-free MRI protocol shows a comparable accuracy to the standard multiparametric MRI protocol in the bladder cancer muscle-invasiveness assessment. • VI-RADS classification helps non-expert radiologists to assess the muscle-invasiveness of bladder cancer. • DCE should be carefully interpreted by less experienced readers due to inflammatory changes representing a potential pitfall.

Background: The Vesical Imaging Reporting and Data System (VI-RADS) was recently introduced as a standardized approach to reporting multiparametric magnetic resonance imaging (mpMRI) for bladder cancer. We aimed to prospectively analyze its routine use and its diagnostic performance in discriminating non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC)., Patients and Methods: A total of 38 patients with diagnosis of suspect bladder cancer at cystoscopy underwent bladder mpMRI before transurethral resection of the bladder (TURB). Bladder tumors were categorized according to the VI-RADS. After TURB, the VI-RADS score was compared with histological report for each lesion separately. Receiving operating characteristic and decision curve analyses were used to assess its accuracy and clinical utility., Results: A total of 68 lesions were included, of which 7 (10.3%) were MIBC. The pooled accuracy was 90.0% (95% confidence interval [CI], 75.4%-98.7%). The best threshold was estimated as VI-RADS 4, showing a sensitivity of 85.7% (95% CI, 57.1%-100%) and a specificity of 86.9% (95% CI, 78.7%-95.1%). Decision curve analyses showed that using VI-RADS ≥4 improved the net benefit compared with any default strategy for threshold probabilities of MIBC up to ∼40%, which is a reasonable clinical threshold for planning further treatments., Conclusions: Our prospective study shows that the use of VI-RADS as a standardized reporting method is appealing and could be considered in clinical practice owing to its high accuracy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The Vesical Imaging-Reporting and Data System (VI-RADS) is a newly developed system of bladder cancer staging with multiparametric MRI (mpMRI), which can be used to predict the presence of muscle invasion for bladder cancer., Purpose: To evaluate the accuracy of three mpMRI series (T 2 WI, diffusion-weighted imaging [DWI], and dynamic contrast-enhanced image [DCEI]) and VI-RADS for diagnosing the muscle invasive bladder cancer (MIBC)., Study Type: Retrospective., Population: In all, 66 pathologically proven bladder cancers in 32 patients., Field Strength/sequence: Before the diagnostic MRI with an intramuscular antispasmodic agent, optimal bladder distension was confirmed. 3.0T MRI with T 2 WI, DWI, and DCEI., Assessment: Three reviewers independently assessed and scored the bladder cancers in T 2 WI, DWI, and DCEI using a five-point score system. Based on the scores in the three sequences, reviewers scored each bladder cancer with reference to VI-RADS categories. We evaluated the diagnostic performance of each of three mpMRI sequences and the final VI-RADS categorization for diagnosing MIBC., Statistical Tests: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the curve (AUC) of each of three sequences separately and VI-RADS categorization for diagnosing the MIBC., Results: The diagnostic performances of each of the three mpMRI series and VI-RADS for diagnosing MIBC were excellent. Especially using the optimal cutoff score >3 for predicting MIBC on DWI, DCEI, and VI-RADS, the sensitivity, specificity, PPV, NPV, and AUC values were 90% (95% confidence interval [CI]: 0.56, 1.00), 100% (95% CI: 0.94, 1.00), 100% (95% CI: 0.66. 1.00), 98.3% (95% CI: 0.91, 1.00), and 0.95, respectively. DATA CONCLUSION: mpMRI based on VI-RADS can stratify patients with bladder cancer according to the presence of muscle invasion., Level of Evidence: 3., Technical Efficacy Stage: 2. J. Magn. Reson. Imaging 2020;52:1249-1256., (© 2020 International Society for Magnetic Resonance in Medicine.)

Objective: To explore the training mode of individual urine volume control, to take indi-vidual expected urine volume as the goal of bladder control in patients with urinary system tumors, and to improve the accuracy of bladder control during radiotherapy by active training of bladder receptivity., Methods: Twenty-five patients of urinary system tumors were enrolled from May 2019 to September 2019, of whom, 21 patients had prostate cancer, and 4 had bladder cancer. Training of bladder filling started before CT simulation. The patients were required to take the individual bladder filling as the training goal, and the optimal bladder volume range was suggested to be 200－400 mL. After 2－4 weeks of training, the prescribed volume of the bladder was determined according to the patient's bladder receptivity. The volume of the bladder was measured by images of plain CT and images 8-minutes after intravenous contrast injection. The patient's bladder volume was measured using BladderScan before treatment. CBCT (Cone-beam CT) was performed, and bladder volume was measured before treatment. The bladder volume was measured again using BladderScan after treatment., Results: The mean bladder volume of simulation (V CT01 ) was (262±130) mL, ranging from 78 mL to 505 mL. The mean self-evaluation bladder volume before radiotherapy (V EVA01 ) was (238±107) mL, ranging from 100 mL to 400 mL. The mean BladderScan measured volume before radiotherapy (V BVI01 ) was (253±123) mL, ranging from 60 mL to 476 mL. The mean cone-beam CT measured volume before radiotherapy (V CBCT ) was (270±120) mL, ranging from 104 mL to 513 mL. There was a correlation between V EVA01 and V BVI01 , V CT01 and V BVI01 , V CT01, and V BVI01 , and there was no significant difference in paired t -test. There was a correlation between differences of self-evaluation bladder volume before radiotherapy(V EVA01 ) and simulation CT (V CT01 ) and differences of self-evaluation bladder volume before radiotherapy (V EVA01 ) and cone-beam CT (V CBCT ), and there was no significant difference in paired samples by t -test., Conclusion: During radiotherapy for urinary system tumors, such as prostate cancer and bladder cancer, with the assistance of BladderScan, the patients could try to hold their urine moderately according to their conditions, and individualized bladder prescription may be beneficial to achieve stable bladder volume during radiotherapy.

The present communication details the imaging characteristics, peculiarities, and response to 177 Lu-labeled prostate-specific membrane antigen (PSMA)-617-targeted radioligand therapy (PRLT) in accordance with Gleason score and use of dual-tracer PET ( 68 Ga-PSMA-11 and 18 F-FDG) in patients with urinary bladder invasion or metastasis by prostate cancer, including the prognostic value of 18 F-FDG PET in predicting response to treatment. The CT attenuation units (Hounsfield units) correlated with the prostate primary in the case of direct tumor extension from the prostate, whereas in hematogenous metastatic seeding the Hounsfield units were lower than in the primary prostatic tumor. A favorable outcome to 177 Lu-PSMA-617 PRLT was observed in patients with low or no baseline 18 F-FDG uptake despite a high Gleason score and a high-risk National Comprehensive Cancer Network prognostic category and did not correlate with the latter alone, whereas a high SUV max on 18 F-FDG PET/CT was associated with an adverse outcome. These findings suggest a promising role for 18 F-FDG PET/CT in predicting therapeutic outcomes more confidently, and hence the concept of dual-tracer PET appears to hold good in prostate adenocarcinoma theranostics., (© 2020 by the Society of Nuclear Medicine and Molecular Imaging.)

Objective: ICG navigation in cancer surgery may help during pelvic lymphadenectomy., Methods: We performed a systematic review combining the terms: bladder cancer or radical cystectomy and ICG, and prostate cancer or radical prostatectomy and ICG. We used the PRISMA guidelines recommendations. We describe the populations studied in each work, the pathological results, as well as the parameters specificity, sensitivity and predictive values., Results: In muscle-invasive bladder cancer, 4 case series analyzed the performance of lymphography with ICG. The most accepted injection method is under endoscopic vision. Several punctures are done in the submucosa and the detrusor surrounding the scar. Sentinel nodes were found in up to 92% of patients with a technique sensitivity to find metastases of 88% in the series with largest casuistry. In prostate cancer, we collected data from 11 case series. Nine of them apply transrectal or transperineal dilution immediately before surgery. Sensitivity in the detection of all adenopathies ranged between 44% and 100%. The sensitivity of the technique to know the lymph node stage ranges between 67% and 100%., Conclusions: There is little experience of ICG-guided lymph node dissedction in bladder tumors. Endoscopic fluorophore injection allows us to find the nodes that drain the infiltrated area. However, the use of this technique is not widespread. In prostate cancer, it is a reproducible and efficient technique for staging patients with prostate cancer.

Positron-emission tomography/computed tomography combining both functional and morphological information has emerged as a powerful tool in oncological imaging within the past decades. The most commonly used radiotracer in oncology visualizing metabolic information is 2-[18F]fluoro-2-deoxy-d-glucose. However, the use of 2-[18F]fluoro-2-deoxy-d-glucose in urological oncology is challenging, as it is limited by physiological excretion through the urinary system. Therefore, it is only useful when applied to specific indications in selected patients with urological malignancy; for example, for detection of residual disease in the post-chemotherapy management of patients with seminoma. Despite initial promising results in bladder cancer, no relevant additional diagnostic value with positron-emission tomography using 2-[18F]fluoro-2-deoxy-d-glucose or choline-based tracers could be obtained, and should therefore be used with caution or only within clinical trials. In prostate cancer, however, a paradigm shift in imaging can be observed after development of new tracers that target the prostate-specific membrane antigen. Biochemical recurrent prostate cancer has become a clinically widely accepted indication for prostate-specific membrane antigen ligand positron-emission tomography/computed tomography, with several studies showing superior detection efficacy compared with conventional imaging. For primary high-risk prostate cancer, growing evidence suggests well-improved staging. The present review aimed to provide an overview of the current status of positron-emission tomography imaging in cancer of the urogenital system including the latest advances in 68 Ga-labeled and 18 F-labeled positron-emission tomography agents targeting the prostate-specific membrane antigen for positron-emission tomography imaging of prostate cancer., (© 2018 The Japanese Urological Association.)

Ga-PSMA-HBED-CC PET/CT has proven to be a useful modality in patients with prostate carcinoma, especially in those with suspected recurrence and in detection of locoregional and distant metastases. However, with expanding use of this tracer, several recent reports of in vivo expression of PSMA in nonprostatic benign and malignant entities have been published. We report a patient with PSMA-avid synchronous urinary bladder paraganglioma and metastatic prostate carcinoma.

Purpose: In the era of multiparametric magnetic resonance imaging (mpMRI) of the prostate gland, incidental findings are occasionally discovered on imaging. We aimed to report our experience of detecting incidental bladder cancers on mpMRI of the prostate in asymptomatic patients without irritative voiding symptoms or microscopic or gross hematuria., Methods: A retrospective review was performed on a prospectively maintained database of all men who underwent prostate mpMRI at our institution from 2012 to 2018. Patients who were found to have incidental bladder lesions were identified and baseline demographics, imaging and histopathologic data were recorded. All patients with incidental bladder lesion detection on mpMRI, not attributable to extension of prostate cancer, underwent cystoscopy in addition to a biopsy and/or transurethral resection of bladder tumor (TURBT) if warranted on cystoscopy., Results: There were 3147 prostate mpMRIs performed during this period and 25 cases (0.8%) of incidental bladder lesions were detected. These patients did not have any presenting symptoms such as gross or microscopic hematuria to prompt bladder lesion workup. The largest diameter of incidentally discovered bladder lesions ranged from 0.4 cm to 1.7 cm. Of the 25 cases of incidental bladder lesions, five were suspected to be due to prostate cancer invasion into the bladder. Only two of these five patients underwent biopsy, which confirmed prostate adenocarcinoma in both cases. Of the 20 patients without suspected prostate cancer invasion of the bladder, four had no suspicious lesions on cystoscopy to warrant a biopsy. The remaining 16 patients had bladder lesions seen on cystoscopy and underwent a biopsy and/or TURBT. Three of these patients had benign features on pathology (urachal remnant, amyloidosis and inflammation) and the remaining 13 had stage Ta urothelial carcinoma. Seven of these patients had low-grade Ta tumors and six had high-grade Ta tumors. All patients were treated with standard management of TURBT with or without intravesical BCG. There have been no reported cases of recurrence or progression in any of the patients in our cohort at the median follow-up of 26 months (interquartile range,19-40 months)., Conclusion: mpMRI of the prostate may yield incidental findings, such as small bladder tumors. Awareness of the possibility of incidental bladder lesions is important as 65% of lesions reported in the bladder, not attributable to extension of prostate cancer, proved to be bladder cancer. This may allow for early intervention for asymptomatic patients with undetected bladder cancer prior to disease progression.

Purpose of Review: Rhabdomyosarcoma (RMS) is the most common sarcoma diagnosed in the first 20 years of life; bladder/prostate (BP) RMS accounts for 5% of all cases. Through efforts from multiple cooperative study groups, survival has improved significantly. This article aims to review the complex RMS classification system and treatment of BP RMS, with a focus on developing aspects of treatment., Recent Findings: Recent advancements in technology are responsible for most of the progress in RMS treatment. PET-CT scanning has been shown to be superior to conventional metastatic workup. The use of proton beam therapy and brachytherapy to reduce the side effects of radiation is also showing promise. All cooperative oncology groups agree on surgical biopsy for diagnosis and staging of BP RMS. Patients are then grouped and risk classified before receiving chemotherapy. Regardless of local control strategy, oncologic outcomes appear to be similar for BP RMS. Alternative treatment strategies, which remain unproven, include brachytherapy and proton therapy.

Recent advancements in urologic imaging techniques aim to improve the initial detection of urologic malignancies and subsequent recurrence and to more accurately stage disease. This allows the urologist to make better informed treatment decisions. In particular, exciting advances in the imaging of prostate cancer and bladder cancer have recently emerged including the use of dynamic, functional imaging with MRI and PET. In this review, we will explore these imaging modalities, in addition to new sonography techniques and CT, and how they hope to improve the diagnosis and management of prostate and bladder cancer.

FDG PET is known to have a low sensitivity for the detection of prostate and bladder tumors because of high levels of urinary excretion, which potentially obscures sites of disease. Fluoromethylcholine PET has a higher sensitivity for the detection of metastatic prostate cancer compared with F-FDG PET, partly because of lower levels of urinary excretion. We present a case of a patient who underwent F-fluoromethylcholine PET for possible recurrent prostate cancer. The study identified an incidental, avid metachronous bladder tumor. We discuss the potential use of fluoromethylcholine PET in the detection of bladder tumors.

Objective: No data are available on the feasibility of pulsed dose rate (PDR) brachytherapy in very young children. Our experience of PDR brachytherapy for bladder prostate (BP) rhabdomyosarcoma (RMS) is reported, with focus on compliance and dosimetric parameters., Materials and Methods: Treatment parameters and outcome of consecutive BP RMS patients treated in our center were examined. Treatment was carried out as part of a multimodal conservative radio-surgical treatment. Four single leader plastic tubes were implanted under perioperative guidance, encompassing the prostate/bladder neck. Tubes were systematically sutured to the bladder wall. Treatment planning was based on a computed tomography and followed Paris system rules. Continuous hourly pulses of 0.42Gy were delivered, to a total dose of 60Gy., Results: 32 patients were treated, median age 2.6years (10months-12years). Median duration of each pulse was 8.5min (3.8-17.4min). The minimal dose in the most irradiated 1cm 3 of rectum was 44.7Gy α / β =3 (range: 4.1-77.3Gy α / β =3 ). Brachytherapy was conducted without significant compliance concern in all but two patients, 24 and 25months-old, who pulled out plastic tubes before treatment completion. Another child needed re-planning because of slight tube displacement. With median follow-up of 14.4months (15days-75months), all patients were free from any relapse after local treatment. Four grade 3 acute urinary complications were encountered. All long-term side effects were grade 2 or less., Conclusion: PDR brachytherapy is feasible in very young patients, and associated with acceptable acute toxicity rates. Longer follow-up is required to ensure that local control and long-term side effects profile are comparable to the results of low dose rate brachytherapy., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Detailed information is not currently available on the incidence, natural course, and management of asymptomatic abnormal prostate findings incidentally detected by radiologic evaluations after BCG therapy for non-muscle-invasive bladder cancer patients., Methods: We identified 38 patients who were evaluated by contrast-enhanced CT scans before TUR-BT and after BCG therapy between 2006 and 2012. We evaluated the clinical courses of patients with abnormal radiologic findings of the prostate gland after BCG therapy., Results: Abnormal findings on CT scans were found in the prostate glands of 11 of the 38 patients examined (28.9%), none of whom exhibited any sign or symptom associated with prostatitis. Abnormal findings included a low attenuation area (n = 6, 15.8%), contrast enhancement (n = 3, 7.9%), and a low attenuation area and contrast enhancement in the prostate gland (n = 2, 5.3%). During the follow-up, abnormal prostate findings disappeared spontaneously in most cases without any anti-bacterial or anti-tuberculous drug treatments. No significant differences were observed in patient clinical backgrounds, with the exception of post-BCG prostate volumes, between patients with and without abnormal CT findings. Furthermore, no significant differences were noted in the incidence of the adverse effects of BCG therapy, tumor recurrence rates, or progression rates between patients with and without abnormal CT findings of the prostate gland after BCG therapy., Conclusions: Asymptomatic abnormal prostate findings incidentally detected by CT after BCG therapy are not rare, and these disappear over time during the follow-up period without any treatment.

The landscape of the surgical management of urologic malignancies has dramatically changed over the past 20 years. On one side, better diagnostic and prognostic tools allowed better patient selection and more reliable surgical planning. On the other hand, the implementation of minimally invasive techniques and technologies, such as robot-assisted laparoscopy surgery and image-guided surgery, allowed minimizing surgical morbidity. Ultimately, these advances have translated into a more tailored approach to the management of urologic cancer patients. Following the paradigm of "precision medicine", contemporary urologic surgery has entered a technology-driven era of "precision surgery", which entails a range of surgical procedures tailored to combine maximal treatment efficacy with minimal impact on patient function and health related quality of life. Aim of this non-systematic review is to provide a critical analysis of the most recent advances in the field of surgical uro-oncology, and to define the current and future role of "precision surgery" in the management of genitourinary cancers., (Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Purpose: Modern treatment concepts for bladder/prostate rhabdomyosarcoma (BPRMS) are designed to improve survival, to reduce therapy intensity, and to increase bladder preservation rates. Nevertheless, treatment is not optimal. The purpose of this study was to analyze BPRMS patients treated within the CWS-2002P trial regarding outcome, treatment modalities, complications, and to compare the data with the precursor trial CWS-96., Methods: Fifty children with localized embryonal BPRMS were analyzed. Eight patients were excluded. Patients received neoadjuvant chemotherapy. At week 9, reassessment using MRI scan was performed. Depending on tumor size, age, and response, local therapy consisting of radiotherapy and/or surgery was initiated. After local therapy, systemic therapy was continued., Results: Patients' median age was 35.6 months. Median follow-up was 59 months. The 5-year OS was 84.5 % and the 5-year ES 79.9 %. Ten patients underwent combined radiochemotherapy and tumor resection (5-year ES: 87.5 %). Six patients were treated solely with radiochemotherapy (5-year ES: 60 %). Twenty-six patients received preoperative chemotherapy followed by tumor resection (ES: 80.8). One patient was treated with chemotherapy only and survived. The bladder preservation rate was 80.9 %., Conclusions: The outcome within the CWS-2002P trial regarding OS and ES seemed to be better than in the precursor trial CWS-96 due to a reduction of protocol violations, but there was no statistical significant difference possibly due to low numbers. Radiotherapy was used less frequently, and the bladder preservation rate was slightly higher. Novel concepts will be required in the future to improve bladder preservation rates.

Unlabelled: The precise utility of positron emission tomography (PET) scanning for urologic cancers is not well defined. We examined the trends of usage in a population-based data set. PET scans were performed in 3.60% of patients with bladder cancer, 1.09% of those with prostate cancer, and 5.32% of those with renal cell carcinoma. This selective usage might be driven by reimbursement constraints or identification of appropriate medical indications., Introduction: Positron emission tomography (PET) scanning is increasingly being used for imaging a variety of cancers, including urologic cancers. The precise utility of PET scanning for bladder cancer, prostate cancer, and renal cell carcinoma (RCC) is not yet well known. We examined the trends in PET scan usage for 3 cancers using a large population-based data set., Materials and Methods: We analyzed all individuals identified with a diagnosis of nonmetastatic bladder cancer, prostate cancer, and RCC from the Surveillance, Epidemiology, and End Results-Medicare data set for 2004 to 2009 with follow-up data available to 2010. Logistic regression analysis and χ(2) and trend tests were performed to determine the predictors of performing PET scanning. Separate models were run for each of the cancer diagnoses. All analyses were performed using SAS, version 9.3, and P < .05 was considered significant., Results: We identified 20,865, 70,414, and 7007 patients with a diagnosis of bladder cancer, prostate cancer, and RCC, respectively, from 2004 to 2009. PET scans had been performed for 3.60% of patients with bladder cancer, 1.09% of those with prostate cancer, and 5.32% of those with RCC. On regression analysis, a more recent year of diagnosis, younger age, and high stage or grade were predictors of PET scan usage for patients with bladder cancer and RCC. A higher Gleason score and higher D'Amico risk group predicted imaging with prostate cancer., Conclusion: The usage of PET scanning for bladder cancer, prostate cancer, and RCC is increasing but still very selective. The selective use might be driven by a combination of reimbursement constraints and careful identification of the appropriate medical indication., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Context: Molecular imaging (MI) entails the visualisation, characterisation, and measurement of biologic processes at the molecular and cellular levels in humans and other living systems. Translating this technology to interventions in real-time enables interventional MI/image-guided surgery, for example, by providing better detection of tumours and their dimensions., Objective: To summarise and critically analyse the available evidence on image-guided surgery for genitourinary (GU) oncologic diseases., Evidence Acquisition: A comprehensive literature review was performed using PubMed and the Thomson Reuters Web of Science. In the free-text protocol, the following terms were applied: molecular imaging, genitourinary oncologic surgery, surgical navigation, image-guided surgery, and augmented reality. Review articles, editorials, commentaries, and letters to the editor were included if deemed to contain relevant information. We selected 79 articles according to the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria and the IDEAL method., Evidence Synthesis: MI techniques included optical imaging and fluorescent techniques, the augmented reality (AR) navigation system, magnetic resonance imaging spectroscopy, positron emission tomography, and single-photon emission computed tomography. Experimental studies on the AR navigation system were restricted to the detection and therapy of adrenal and renal malignancies and in the relatively infrequent cases of prostate cancer, whereas fluorescence techniques and optical imaging presented a wide application of intraoperative GU oncologic surgery. In most cases, image-guided surgery was shown to improve the surgical resectability of tumours., Conclusions: Based on the evidence to date, image-guided surgery has promise in the near future for multiple GU malignancies. Further optimisation of targeted imaging agents, along with the integration of imaging modalities, is necessary to further enhance intraoperative GU oncologic surgery., (Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Prostate cancer (PCa) originating from the prostate base may intrude into the urinary bladder and may be misdiagnosed as bladder cancer. In this retrospective study, we reviewed the clinic data on PCa cases which were initially misdiagnosed as bladder cancer in order to identify diagnostic methods that would allow a better differential diagnosis for PCa., Methods: Out of a total of 455 patients treated for PCa at our hospital between April 2003 and June 2011, 14 patients (3.1%) had been initially misdiagnosed as urinary bladder urothelial cell carcinoma. The clinical data on these 14 cases was retrieved and analyzed., Results: Of the 14 patients, 11 patients were eventually diagnosed with PCa after MRI examination, and seven out of these had PCa with bladder neck invasion. Prostate needle biopsy or transurethral resection of prostate (TURP) revealed that all 14 patients had adenocarcinoma of prostate with Gleason scores ranging from 7 to 9. Nine patients received TURP for hematuria or lower urinary tract blockage. The mean follow-up was 37 months, during which six patients survived., Conclusions: As clinical presentation and in emergency settings, prostate cancer originating from the prostate base can be confused with bladder cancer originating from the neck or the triangle region of the urinary bladder. Serum prostate specific antigen (PSA) levels and digital rectal examination, in combination with transrectal ultrasound (TRUS), MRI, and prostate needle biopsy are valuable tools for definitive differential diagnosis of the basal prostate cancer.

Purpose: The potential of keV cone beam computed tomography (CBCT) for guiding adaptive replanning is well-known. There are impediments to this, one being CBCT number accuracy. The purpose of this study was to investigate CBCT number correction methods and the affect of residual inaccuracies on dose deposition. Four different correction strategies were applied to the same patient data to compare performance and the sophistication of correction-method needed for acceptable dose errors., Methods and Materials: Planning CT and CBCT reconstructions were used for 12 patients (6 brain, 3 prostate, and 3 bladder cancer patients). All patients were treated using Elekta linear accelerators and XVI imaging systems. Two of the CBCT number correction methods investigated were based on an algorithm previously proposed by the authors but only previously applied to phantoms. Two further methods, based on an approach previously suggested in the research literature, were also examined. Dose calculations were performed using scans of a "worst" subset of patients using the Pinnacle³ version 9.0 treatment planning system and the patients' clinical plans., Results: All mean errors in CBCT number were <50 HU, and all correction methods performed well or adequately in dose calculations. The worst single dose discrepancy identified for any of the examined methods or patients was 3.0%. Mean errors in the doses to treatment volumes or organs at risk were negatively correlated with the mean error in CT number. That is, a mean CT number that was too large, averaged over the entire CBCT volume, implied an underdosing in a volume-of-interest and vice versa., Conclusions: Results suggest that (1) the correction of CBCT numbers to within a mean error of 50 HU in the scan volume provides acceptable discrepancies in dose (<3%) and (2) this is achievable with even quite unsophisticated correction methods., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: To define setup variations in the radiation treatment (RT) of anal cancer and to report the advantages of image-guided RT (IGRT) in terms of reduction of target volume and treatment-related side effects., Methods and Materials: Twelve consecutive patients with anal cancer treated by combined chemoradiation by use of helical tomotherapy from March 2007 to November 2008 were selected. With patients immobilized and positioned in place, megavoltage computed tomography (MVCT) scans were performed before each treatment and were automatically registered to planning CT scans. Patients were shifted per the registration data and treated. A total of 365 MVCT scans were analyzed. The primary site received a median dose of 55 Gy. To evaluate the potential dosimetric advantage(s) of IGRT, cases were replanned according to Radiation Therapy Oncology Group 0529, with and without adding recommended setup variations from the current study., Results: Significant setup variations were observed throughout the course of RT. The standard deviations for systematic setup correction in the anterior-posterior (AP), lateral, and superior-inferior (SI) directions and roll rotation were 1.1, 3.6, and 3.2 mm, and 0.3°, respectively. The average random setup variations were 3.8, 5.5, and 2.9 mm, and 0.5°, respectively. Without daily IGRT, margins of 4.9, 11.1, and 8.5 mm in the AP, lateral, and SI directions would have been needed to ensure that the planning target volume (PTV) received ≥95% of the prescribed dose. Conversely, daily IGRT required no extra margins on PTV and resulted in a significant reduction of V15 and V45 of intestine and V10 of pelvic bone marrow. Favorable toxicities were observed, except for acute hematologic toxicity., Conclusions: Daily MVCT scans before each treatment can effectively detect setup variations and thereby reduce PTV margins in the treatment of anal cancer. The use of concurrent chemotherapy and IGRT provided favorable toxicities, except for acute hematologic toxicity., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Inflammatory myofibroblastic tumor (IMT) is a rare borderline tumor. The nomenclature of this disease is confused in the literature., Case Report: In this report, the case of a 62-year-old man with IMT recurrence of bladder secondary to prostate is presented. The possible etiology of IMT is discussed, along with its clinical manifestation and pathological features. The patient received a laparoscopic bladder radical resection. The pathology finding demonstrated the diagnosis of IMT and no regional lymph node involvement., Conclusions: IMT is a borderline tumor and unlikely to metastasize to regional lymph nodes. The patient has been observed for 2 years without recurrence.

(18)F-fluorodeoxyglucose (FDG) is the most common positron emission tomography (PET) radiotracer used in prostate and bladder cancer evaluation, but its role is hampered by a generally low glucose metabolic rate in primary prostate carcinoma, and physiological excretion of FDG through the urinary system masking FDG uptake in primary bladder and prostate carcinoma. FDG-PET may have a role in selected patients for staging and restaging advanced prostate cancer, particularly in patients with an increasing prostatic-specific antigen (PSA) level. The use of diuresis strategies facilitates the identification of primary bladder cancer, and may be useful in staging extravesical spread of disease. FDG-PET may also be useful in patients with ureteric and urethral cancers. New PET tracers are showing promise in the staging and biological characterization of prostate cancer, which can assist with therapeutic decision making in patients undergoing radiotherapy of primary disease, and in the assessment of metastatic disease., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Daily organ motion occurring during the course of radiotherapy in the pelvic region leads to uncertainties in the doses delivered to the tumour and the organs at risk. Motion patterns include both volume and shape changes, calling for deformable image registration (DIR), in approaches involving dose accumulation and adaptation. In this study, we tested the performance of a DIR application for contour propagation from the treatment planning computed tomography (pCT) to repeat cone-beam CTs (CBCTs) for a set of prostate cancer patients., Material and Methods: The prostate, rectum and bladder were delineated in the pCT and in six to eight repeat CBCTs for each of five patients. The pCT contours were propagated onto the corresponding CBCT using the Multi-modality Image Registration and Segmentation application, resulting in 36 registrations. Prior to the DIR, a rigid registration was performed. The algorithm used for the DIR was based on a 'demons' algorithm and the performance of it was examined quantitatively using the Dice similarity coefficient (DSC) and qualitatively as visual slice-by-slice scoring by a radiation oncologist grading the deviations in shape and/or distance relative to the anatomy., Results: The average DSC (range) for the DIR over all scans and patients was 0.80 (0.65-0.87) for prostate, 0.77 (0.63-0.87) for rectum and 0.73 (0.34-0.91) for bladder, while the corresponding DSCs for the rigid registrations were 0.77 (0.65-0.86), 0.71 (0.55-0.82) and 0.64 (0.33-0.87). The percentage of propagated contours of good/acceptable quality was 45% for prostate; 20% for rectum and 33% for bladder. For the bladder, there was an association between the average DSC and the different scores of the qualitative evaluation., Conclusions: DIR improved the performance of pelvic organ contour propagation from the pCT to CBCTs as compared to rigid registration only. Still, a large fraction of the propagated rectum and bladder contours were unacceptable. The image quality of the CBCTs was sub-optimal and the usability of CBCTs for dose accumulation and adaptation purposes is therefore likely to benefit from improved image quality and improvements of the DIR algorithm.

Background and Purpose: Uncorrelated motion of targets and large deformations of organs at risk represent challenges for image-guidance in simultaneous integrated boost (SIB) radiotherapy (RT) of pelvic tumour sites. This study aims to evaluate the robustness towards geometrical uncertainties in prostate cancer using two image-guided RT (IGRT) set-up strategies for two SIB delivery methods. Secondly, we evaluate the ability of geometrical parameters to predict when the applied margins are insufficient, resulting in target underdosage (TUD)., Material and Methods: The study included nine patients with eight to nine repeat computed tomography (CT)-scans evenly distributed throughout their treatment course. The prostate target (CTV-p) and the lymph node target including seminal vesicles (CTV-ln/sv) were delineated in all scans. SIB treatment plans for intensity-modulated RT and volumetric modulated arc therapy were generated on the planning CT and transferred to the repeat CTs for dose re-calculation using registration based on either anatomy or intra-prostatic fiducial markers. Receiving operator characteristic analysis was used to deduce the ability of the parameters to predict TUD., Results: The dosimetric differences between the two positioning strategies were small for all parameters evaluated and significant only for the dose to rectum. Anatomy based registration resulted in inferior target coverage with a larger number of TUDs, mostly seen in the seminal vesicles. For both targets the highest sensitivity and specificity of predicting TUD was seen for the relative volume and the lowest was found for the displacement vector., Conclusions: Positioning based on fiducials gave the best trade-off between coverage of the targets although resulting in the highest dose to rectum. Target underdosage occurred mostly in the seminal vesicles. For both targets, the best parameter to predict TUD was the relative volume.

Positron emission tomography is a functional imaging technique that allows the detection of the regional metabolic rate, and is often coupled with other morphological imaging technique such as computed tomography. The rationale for its use is based on the clearly demonstrated fact that functional changes in tumor processes happen before morphological changes. Its introduction to the clinical practice added a new dimension in conventional imaging techniques. This review presents the current and proposed indications of the use of positron emission/computed tomography for prostate, bladder and testes, and the potential role of this exam in radiotherapy planning., (Copyright © 2011 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Introduction: Helical tomotherapy (HT) is an innovative approach to the delivery of intensity-modulated radiation therapy which combines the imaging elements of helical computed tomography (CT) with megavoltage linear accelerator treatment. The purpose of this report is to describe our experience with the clinical implementation of HT for genitourinary malignancies., Materials and Methods: All patients treated with a primary genitourinary malignancy were included in this study cohort. Descriptive statistics for various demographic and treatment-related parameters such as patient age, primary site of disease, site of radiotherapy, goal of treatment, dose/fractionation, immobilization and clinical trial enrolment were calculated., Results: A total of 57 patients diagnosed with a primary genitourinary malignancy were treated on the helical tomotherapy unit during the study period. Median age was 69 years (range 45 to 83 years) and 56 (98.2%) patients were male. Prostate cancer was the most frequently treated genitourinary cancer in this cohort of 57 (94.7%) cases. Ten patients (17.5%) were treated with palliative intent, 46 (80.7%) with radical intent (including full dose prostate bed adjuvant/salvage RT), and one (1.8%) patient was treated in a purely adjuvant manner (high risk postop bladder)., Conclusions: HT is a technology that can be utilized in both radical and palliative genitourinary treatment situations in order to deliver precise conformal IMRT therapy with unique localization and critical structure avoidance properties.

Positron emission computed tomography (PET) is a functional, noninvasive method for imaging regional metabolic processes that is nowadays most often combined to morphological imaging with computed tomography (CT). Its use is based on the well-founded assumption that metabolic changes occur earlier in tumors than morphologic changes, adding another dimension to imaging. This article will review the established and investigational indications and radiopharmaceuticals for PET/CT imaging for prostate cancer, bladder cancer and testicular cancer, before presenting upcoming applications in radiation therapy.

A total of 33 11C-choline positron emission tomography scans for 23 patients with prostate cancer were performed to elucidate the localization of primary site within the prostate gland (primary group) and of recurrent site after radical treatment (recurrent group) from 2000 to 2005. As a control group, one scan for benign prostate hyperplasia and 3 scans for bladder cancer were also studied. Mean PSA values of 14 scans in the primary group and 19 scans in the recurrent group were 39.8 ng/ml (range 1.6-150) and 5.0 ng/ml (range < 0.2-11), respectively. The primary cancer could be visualized as a hot spot within the prostate gland in 10 out of 14 scans and histopathological analysis of biopsy and prostatectomy specimens verified the correct laterality. Positive scans were demonstrated in 2 out of 4 local recurrent sites, 4 out of 4 lymph node recurrent sites and 4 out of 4 bone recurrent sites with a mean PSA value of 6.22 ng/ml (range 2.3-11). Four scans with a PSA value of 2.3 ng/ml or less, no positive spot was demonstrated. These 4 scans consisted of 2 false negative and 2 true negative studies. 11C-choline PET seems to be useful to detect primary prostate cancer and could play a complementary role for conventional imaging methods in recurrent site staging.

Purpose of Review: Traditional morphologically based imaging modalities in uro-oncology are now being complemented by the functional and molecular imaging technique positron emission tomography (PET). This review highlights the most important recent developments., Recent Findings: Prostate cancer: PET imaging with the new radiotracers 11C-choline, 18F-fluorocholine, and 11C-acetate show promising results. The role of anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid remains to be elucidated further. 18F-fluoride PET is useful for the detection of bone metastases. Bladder cancer: 18F-fluorodeoxyglucose (FDG) PET/CT with delayed images after a diuretic and oral hydration may improve detection of locally recurrent or residual bladder tumours. Both 18F-FDG PET and 11C-choline PET may be useful for staging of bladder cancer. Renal cancer: 18F-FDG PET has a role in staging and restaging of the disease. Recently, 124I-cG250 PET has shown promising results in the detection of clear-cell renal carcinoma. Testicular cancer: 18F-FDG PET is useful in staging and follow-up after treatment. There are no important recent developments with new radiopharmaceuticals in testicular cancer., Summary: The utility of PET molecular imaging in uro-oncology expanded due to the new metabolic PET tracers with more favourable properties.

Purpose: Appropriate imaging in uro-oncology is a crucial component at primary diagnosis, followup and recurrence to achieve an accurate assessment of the disease and determine the most effective treatment. We summarize recent developments in positron emission tomography and positron emission tomography/computerized tomography for prostate, bladder and renal cancer., Materials and Methods: The recent published literature on positron emission tomography and positron emission tomography/computerized tomography in uro-oncology was searched and reviewed., Results: For prostate cancer 18F-fluorodeoxyglucose is not highly effective for primary diagnosis but it has a limited role in staging and recurrence detection. Promising results have been shown by 11C-choline, 18F-fluorocholine, 11C-acetate and 18F-fluoride. The role of 11C-methionine, 18F-fluoro-5-alpha-dihydrotestosterone and anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid remains to be elucidated. For bladder cancer 18F-fluorodeoxyglucose positron emission tomography is useful for identifying distant metastases but not for detecting primary tumors due to the urinary excretion of 18F-fluorodeoxyglucose. The role of 11C-choline and 11C-methionine remains to be evaluated further in clinical studies. For renal cancer 18F-fluorodeoxyglucose is of limited use for primary diagnosis but it has a role in staging and restaging of the disease. More clinical data are needed to investigate the roles of 18F-fluoromisonidazole and 18F-fluorothymidine., Conclusions: Several advances in positron emission tomography and positron emission tomography/computerized tomography for urological cancer have been made in recent years. However, larger clinical trials are needed to establish the role of this imaging method for urological malignancy. In the near future the new radiotracers and further advancement in this imaging technique are expected to improve the performance of positron emission tomography/computerized tomography in uro-oncology.

Background and Purpose: Current IGRT protocols only correct for organ motion through a 3D translational movement of the treatment couch. The aim of this study was to quantify the relative importance of rotational vs. translational corrections in bladder and prostate IGRT., Materials and Methods: The data available consisted of a set of 9 bladder cancer patients each having a planning CT scan and between 3 and 8 repeat CT scans throughout their treatment course, with the bladder and prostate (for 5 of the 6 male patients) outlined on all scans. An algorithm was written to determine both the optimum translation and rotation angles required to align the repeat CTVs with their planning CTV. Angles considered were those possible through couch roll, rotation and tilt. The optimum shifts and angles were determined as those that minimised the volume of the repeat scan CTV lying outside the volume of the planning CTV. Two different situations were investigated: 1) 3D translation only (3 degrees of freedom (DoF)) and 2) rotation after applying the optimum 3D translation (6 DoF). Those repeat scans where rotation provided the greatest increase in CTV coverage were further investigated by determining the effect of rotation on the size of the treatment margins required and the volume of the resulting PTV., Results: For the bladder, the overall average volume percentage (across scans and patients) of the repeat CTV included in the planning scan CTV was increased from 85.7% without IGRT to 89.5 and 90.1% with 3 DoF and 6 DoF, respectively. The corresponding results for the prostate were 79.4, 86.9 and 87.5%. The resulting decrease in treatment margins required was determined for the 3 bladder and 3 prostate situations where including rotation had the largest impact. In 2 of the 6 situations the resulting PTV volume was reduced by approximately 20% when using an isotropic margin, but this reduction was considerably less when the margins were individually optimised., Conclusion: When treating either the bladder or prostate alone, translational IGRT correction was by far the most important action necessary to ensure alignment of the repeat CTV with the planning CTV.

Positron emission tomography (PET) with the use of ((18)F)2-fluoro-D: -2-desoxyglucose (FDG) has been investigated to be a highly sensitive and specific imaging modality in the diagnostic of primary and recurrent tumors and in the control of therapies in numerous non-urologic cancers. The aim of this review is to validate the significance of PET as a diagnostic tool in malignant urological tumors of the small pelvis. A systematic review of the current literature concerning the role of PET for malignant prostate, testicular and bladder tumors was carried out. The data indicate no additional role for PET in comparison with conventional imaging in tumor detection and local staging for prostate, bladder or testicular cancer. Tumor recurrence in prostate cancer seems to be more effectively identified with acetate and choline than with FDG, but this effect is more pronounced with higher PSA values. The value of PET in the identification of metastatic disease in either tumor entity can not be finally outlined as the clinical data are partly missing, controversial or in the process of evaluation. FDG-PET can be regarded as accepted imaging modality in the restaging of seminomatous germ cell tumors after chemotherapy.