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Photoacoustic (PA) imaging is used widely in cancer diagnosis. However, the availability of PA agents has not made great progress due to the limitations of the one currently in use, porphyrin. Porphyrin–Micelle (PM), developed by synthesizing porphyrin and PEG-3.5k, confirmed the amplification of the PA agent signal, and added binding affinity in an LNCaP model by attaching prostate-specific membrane antigen PSMA. Compared to the previously used porphyrin, a superior signal was confirmed, and the potential of PMP was confirmed when it showed a signal superior to that of hemoglobin at the same concentration. In addition, in the in vivo mouse experiment, it was confirmed that the signal in the LNCaP xenograft model was stronger than that in the PC-3 xenograft model, and the PMP signal was about three times higher than that of PM and porphyrin. [ABSTRACT FROM AUTHOR]

Purpose To develop an image-based classification system for seminal vesicle lesions (SVL) to detect seminal vesicle invasion (SVI) in prostate cancer and to evaluate whether pattern analysis of SVL with MR imaging could improve the accuracy of evaluating SVI. Materials and Methods The MR images of 217 patients who had undergone retropubic radical prostatectomy (RRP) due to prostate cancer were retrospectively analyzed by two uroradiologists, focusing on SVL. The SVL on T2-weighted sequences was classified as five classes. In each class the results were correlated with histopathologic findings. Results Fourteen (6.5%) of 217 patients had evidence of SVI at histopathologic evaluation after RRP. Pattern analysis of SVL showed 71.4% sensitivity, 96.6% specificity for predicting SVI. ROC curves for the subjective scoring of SVI showed that reader 1 had an area under the curve (AUC) of 0.69 and reader 2 had an AUC of 0.81. The overall accuracy of pattern analysis was superior to both serum prostate-specific antigen (PSA) level and subjective scoring ( P < 0.01, McNemar test). Conclusion The classification system of SVL on the basis of their imaged morphologic features can provide an objective standard and simplify the abnormal findings to help predict SVI in prostate cancer. Pattern analysis of SVL with MR imaging improves the accuracy of detecting SVI. J. Magn. Reson. Imaging 2008. © 2008 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the effect of intracapsular anesthesia and periprostatic nerve block during transrectal ultrasound guided prostate biopsy. Materials and Methods: In a prospective, randomized, double-blind, placebo controlled study 152 consecutive patients were randomized into 3 groups. Group 1 of 41 patients was administered intraprostatic local anesthesia into the right and left sides with a total of 2 ml 1% lidocaine and a periprostatic injection of 2 ml saline later. Group 2 of 49 patients was administered intraprostatic injection of 2 ml saline, followed by periprostatic local anesthesia with 2 ml 1% lidocaine. Group 3 of 62 patients received intraprostatic and periprostatic local anesthesia with 2 ml 1% lidocaine. Patients were asked to grade the pain level using a 10-point linear visual analog pain scale 1) when the transrectal ultrasound probe was inserted, 2) during anesthesia, 3) during biopsy and 4) 20 minutes after biopsy. One-way ANOVA and the Kruskal-Wallis test with the Tukey post hoc test were used to compare patient characteristics and pain scale responses among the 3 groups. Results: No major complications, including sepsis and severe rectal bleeding, were noted in any patient. There were statistically significant differences in pain scores among groups 1 to 3 during anesthesia (mean ± SD 5.6 ± 2.5, 6.7 ± 2.3 and 4.9 ± 2.1, p = 0.003) and during biopsy (4.3 ± 2.7, 4.5 ± 2.6 and 2.7 ± 2.1, respectively, p = 0.032). There were no differences in pain scores among the 3 groups during probe insertion (p = 0.39). Conclusions: A combination of intracapsular anesthesia and periprostatic nerve block is an effective and useful technique that is well tolerated by the patient. It decreases the level of pain and discomfort associated with the prostatic biopsy procedure. [Copyright &y& Elsevier]

Purpose: We assessed the analgesic effect of additional intrarectal lidocaine gel instillation during transrectal ultrasound guided prostate biopsy and identified the procedural steps that benefit from lidocaine gel instillation. Materials and Methods: A total of 250 consecutive patients scheduled for prostate biopsy were randomized into 2 groups. In the 125 group 1 patients lidocaine gel was instilled intrarectally before periprostatic neurovascular bundle block. The 125 patients in group 2 underwent only periprostatic neurovascular bundle block without lidocaine gel instillation. Of the 250 patients 90 in group 1 and 113 in group 2, in whom 12 systematic cores were obtained, were enrolled for data analysis. Pain was assessed using a visual analog scale during periprostatic neurovascular bundle block (visual analog scale 1), during biopsy (visual analog scale 2) and 20 minutes after biopsy (visual analog scale 3). Differences between the visual analog scale scores of the 2 groups at each procedural step were evaluated using the unpaired t test with p <0.05 considered significant. Results: In terms of pain experienced during the 3 procedural steps scores were significantly different during biopsy (p <0.01). Visual analog scale scores of patients in group 1 showed a tendency to be lower than the scores of patients in group 2 during periprostatic neurovascular bundle block and 20 minutes after biopsy (p = 0.11 and 0.20, respectively). Conclusions: Intrarectal lidocaine gel instillation before periprostatic neurovascular bundle block produces a significant additional analgesic effect during biopsy. The procedure is simple, safe and rapid, and it should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy. [Copyright &y& Elsevier]

Magnetic resonance imaging (MRI) is increasingly important in the detection and localization of prostate cancer. Regarding suspicious lesions on MRI, a targeted biopsy using MRI fused with ultrasound (US) is widely used. To achieve a successful targeted biopsy, a precise registration between MRI and US is essential. The purpose of our study was to show any decrease in errors using a real-time nonrigid registration technique for prostate biopsy. Nineteen patients with suspected prostate cancer were prospectively enrolled in this study. Registration accuracy was calculated by the measuring distance of corresponding points by rigid and nonrigid registration between MRI and US, and compared for rigid and nonrigid registration methods. Overall cancer detection rates were also evaluated by patient and by core. Prostate volume was measured automatically from MRI and manually from US, and compared to each other. Mean distances between the corresponding points in MRI and US were 5.32 ± 2.61 mm for rigid registration and 2.11 ± 1.37 mm for nonrigid registration (p < 0.05). Cancer was diagnosed in 11 of 19 patients (57.9%), and in 67 of 266 biopsy cores (25.2%). There was no significant difference in prostate-volume measurement between the automatic and manual methods (p = 0.89). In conclusion, nonrigid registration reduces targeting errors. [ABSTRACT FROM AUTHOR]

A combined transrectal ultrasound and photoacoustic (TRUS–PA) imaging probe was developed for the clear visualization of morphological changes and microvasculature distribution in the prostate, as this is required for accurate diagnosis and biopsy. The probe consisted of a miniaturized 128-element 7 MHz convex array transducer with 134.5° field-of-view (FOV), a bifurcated optical fiber bundle, and two optical lenses. The design goal was to make the size of the TRUS–PA probe similar to that of general TRUS probes (i.e., about 20 mm), for the convenience of the patients. New flexible printed circuit board (FPCB), acoustic structure, and optical lens were developed to meet the requirement of the probe size, as well as to realize a high-performance TRUS–PA probe. In visual assessment, the PA signals obtained with the optical lens were 2.98 times higher than those without the lens. Moreover, the in vivo experiment with the xenograft BALB/c (Albino, Immunodeficient Inbred Strain) mouse model showed that TRUS–PA probe was able to acquire the entire PA image of the mouse tight behind the porcine intestine about 25 mm depth. From the ex vivo and in vivo experimental results, it can be concluded that the developed TRUS–PA probe is capable of improving PA image quality, even though the TRUS–PA probe has a cross-section size and an FOV comparable to those of general TRUS probes. [ABSTRACT FROM AUTHOR]

Cancer immunotherapy has revolutionized the way different neoplasms are treated. Among the different variations of cancer immunotherapy, the checkpoint inhibitors targeting the programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) axis have been validated and are currently used in the clinics. Nevertheless, these therapeutic antibodies are associated with significant side effects and are known to induce immune-related toxicities. To address these issues, we have developed an immune-microbubble complex (IMC) which not only reduces the toxicities associated with the antibodies but also enhances the therapeutic efficacy when combined with focused ultrasound. The concept of IMCs could be applied to any type of antibody-based treatment regimens to maximize their therapeutic potential. [ABSTRACT FROM AUTHOR]

Because chemotherapeutic drugs are often associated with serious side effects, the central topic in modern drug delivery is maximizing the localization of drugs at the target while minimizing non-specific drug interactions at unwanted regions. To address this issue, biocompatible nanoparticles have been developed to enhance the drug half-life while minimizing the associated toxicity. Nevertheless, relying solely on the enhanced half-life and enhanced permeability and retention (EPR) effects has been ineffective, and designing stimulus-sensitive nanoparticles to introduce the precise control of drug release has been desired. In this paper, we introduce a pH-sensitive, reduced albumin nanoparticle in combination with focused ultrasound treatment. Not only did these nanoparticles have superior therapeutic efficacy and toxicity profiles when compared to the free drugs in xenograft mouse models, but we were also able to show that the albumin nanoparticles reported in this paper were more suitable than other types of non-reduced albumin nanoparticles as vehicles for drug delivery. As such, we believe that the albumin nanoparticles presented in this paper with desirable characteristics including the induction of strong anti-tumor response, precise control, and superior safety profiles hold strong potential for preclinical and clinical anticancer therapy. [ABSTRACT FROM AUTHOR]

High doses of chemotherapy agents can cause adverse effects. To address this issue, drug-loaded vesicles with minimum drug loss, guided by an external element for precise delivery, are desired. Combinational therapy of both a focused ultrasound-induced drug delivery method and membrane fusogenic liposomes (MFLs) as drug delivery vehicles can satisfy such premises. In this study, we confirmed that the use of a small quantity of docetaxel-loaded membrane fusogenic liposomes (DTX-MFL) with focused ultrasound can induce better antitumor response in a xenograft mouse model compared to conventional docetaxel monotherapy and DTX-MFL only. [ABSTRACT FROM AUTHOR]

MicroFlow Imaging (MFI) is a newer ultrasonography technique which enables to evaluate low velocity micro circulation such as organ perfusion or flow in small vascular beds. We tried to apply this technique in the evaluation of renal mass and compare ultrasonographic findings with CT enhancement. Between August 2018 to January 2019, fifty-four renal masses in forty-eight patients were retrospectively evaluated. All patients underwent MicroFlow Imaging (MFI) and color doppler imaging (CDI) using EPIQ 7 (Philips, the Netherlands) ultrasound machine and enhanced kidney CT scan including precontrast scan. The degree, distribution and shape of vascularity from MFI and CDI were analyzed. Degree of vascularity was ranged from 0 (absent) to 3 (profound). Distributions of vascularity were marked as peripheral, central and mixed. Shapes were marked as linear, branching and irregular. Incremental enhancement (IE) of CT was calculated by substraction of maximal measured Hounsfield unit (HU) from the HU of baseline precontrast scan. The degree of vascularity from MFI and CDI was correlated with IE of CT scan and mean IEs were compared among different group of the degree, distribution and shape of vascularity. The number of malignant lesions was thirty-two (30 renal cell carcinomas, 2 lymphomas) and the number of benign lesions was twelve (6 angiomyolipomas, 1 oncocytoma, 1 mixed epithelial and stromal tumor, 1 hemangioma, 3 simple cysts). All lesions were confirmed by histopathology (N= 35) or clinical follow-up over two years (N=7). Mean IE of benign solid (N=9) and malignant mass did not show statistical significance (p=0.412). Correlation coefficient (r) of IE between degree of vascularity from MFI and CDI were 0.6768 and 0.5164, respectively. Mean IEs according to different degree of vascularity from MFI and CDI were statistically significant (p < 0.05) by ANOVA, however F-ratio were 15.919 and 6.458, which meant that variability between group means was larger in MFI. For the distribution and shape of vascularity, only MFI showed statistically significant different IEs (p < 0.05). Comparing with CDI, MFI correlates better with contrast enhanced CT scan and predict tumor vascularity more sensitive and accurate. [ABSTRACT FROM AUTHOR]

Image-guided intra-arterial therapies play a key role in the management of hepatic malignancies. However, limited clinical outcomes suggest the need for new multifunctional drug delivery systems to enhance local drug concentration while reducing systemic adverse reactions. Therefore, we developed the albumin-doxorubicin nanoparticle conjugated microbubble (ADMB) to enhance therapeutic efficiency by sonoporation under exposure to ultrasound. ADMB demonstrated a size distribution of 2.33 ± 1.34 µm and a doxorubicin loading efficiency of 82.7%. The echogenicity of ADMBs was sufficiently generated in the 2–9 MHz frequency range and cavitation depended on the strength of the irradiating ultrasound. In the VX2 rabbit tumor model, ADMB enhanced the therapeutic efficiency under ultrasound exposure, compared to free doxorubicin. The intra-arterial administration of ADMBs sufficiently reduced tumor growth by five times, compared to the control group. Changes in the ADC values and viable tumor fraction supported the fact that the antitumor effect of ADMBs were enhanced by evidence of necrosis ratio (over 70%) and survival tumor cell fraction (20%). Liver toxicity was comparable to that of conventional therapies. In conclusion, this study shows that tumor suppression can be sufficiently maximized by combining ultrasound exposure with intra-arterial ADMB administration. [ABSTRACT FROM AUTHOR]

Objective: To identify patients who can safely evade the magnetic resonance imaging fusion-targeted biopsy (MRIFTB) for prostate imaging reporting and data system (PI-RADS) 3 lesion. Materials and methods: Overall, 755 men with PI-RADS 3–5 lesions who underwent MRIFTB were retrospectively analyzed. Univariate and multivariate analyses were performed to determine significant predictors for clinically significant prostate cancer (CSPCa), defined as Gleason grade group ≥ II. Detection rates and negative predictive values of CSPCa were estimated according to various clinical settings. Results: Median age, prostate-specific antigen (PSA), and PSA density of patients were 66.0 years, 7.39 ng/mL, and 0.19 ng/mL, respectively. Overall detection rates of CSPCa according to PI-RADS 3 (n = 347), 4 (n = 260), and 5 (n = 148) lesions were 15.0%, 30.4%, and 80.4%, respectively. The negative predictive value (NPV) of PI-RADS 3 lesion on MRI was 15.0%. On multivariate analysis, age [≥ 65 years, odds ratio (OR) = 0.427], PSA density (≥ 0.20 ng/mL2, OR = 0.234), prior negative biopsy history (OR = 2.231), and PI-RADS score (4, OR = 0.427; 5, OR = 0.071) were independent predictors for the absence of CSPCa by MRIFTB. When assessed according to various conditions, NPVs of PI-RADS 3 lesions were relatively high in subgroups with low PSA density (< 0.20 ng/mL2) regardless of age or prior biopsy history (NPV range 91.1–91.9%). Contrarily, NPVs in subgroups with high PSA density were relatively low and varied according to age or prior biopsy history groups (NPV range 50.0–86.8%). Conclusions: Men with the PI-RADS 3 lesion and low PSA density might safely evade the MRIFTB, regardless of age or prior biopsy history. [ABSTRACT FROM AUTHOR]

Objectives: To examine the diagnostic performance of Vesical Imaging-Reporting and Data System (VIRADS) and to find a quantitative indicator for predicting muscle layer invasion of bladder cancer. Methods: 3-T MRI of 82 patients performed before transurethral resection of bladder tumors or radical cystectomy between July 2018 and June 2019 were retrospectively analyzed. For one index lesion of each patient, two radiologists independently assigned VIRADS score and measured tumor-wall interface (contact length between tumor and bladder wall) on T2-weighted, diffusion-weighted, and dynamic contrast-enhanced MRI. Inter-reader agreement was assessed, and logistic regression analysis was performed to find indicators of muscle layer invasion. Comparison of indicators' diagnostic performance was done with receiver operating characteristic (ROC) curve and generalized linear model analyses. Optimal cutoff point was determined by the Youden index J. Results: Inter-reader agreement was at least substantial for VIRADS categorization (κ 0.77–0.81), and almost perfect for tumor-wall interface (intraclass correlation coefficient 0.88–0.90). Tumor-wall interface (odds ratio [OR] 1.90–2.00) and VIRADS score (OR 8.59–8.89) were independently associated with muscle layer invasion (p ≤ 0.02). For VIRADS, area under the ROC curve (AUROC) was 0.94, and the accuracy was 0.93 at score 3, the optimal threshold for predicting muscle layer invasion. Depending on the MRI sequence, tumor-wall interface showed AUROCs of 0.90–0.92 and accuracy of 0.84–0.90 at suggested thresholds (3 ± 0.3 cm). Tumor-wall interface showed insignificant differences in accuracy compared with VIRADS (p > 0.10), except as measured on diffusion-weighted images (p = 0.01). Conclusions: VIRADS is a good predictor of muscle layer invasion. As an independent quantitative indicator, tumor-wall interface may complement VIRADS to enhance prediction. Key Points: • Vesical Imaging-Reporting and Data System (VIRADS) is a promising predictor of muscle invasion of bladder cancer with good reproducibility, as suggested by previous studies. • VIRADS score and the tumor-wall interface (curvilinear contact length between the tumor and the bladder wall) are independent predictors of muscle layer invasion. • As an easy-to-use quantitative indicator, tumor-wall interface is expected to be used as an indicator complementary to VIRADS, a qualitative indicator. [ABSTRACT FROM AUTHOR]

Objectives: To validate how established markers of extraprostatic extension (EPE) are applied to anterior prostate cancers (APCs), and to investigate other novel markers if available.Methods: Among 614 histopathologically confirmed APCs from 2011 to 2016, 221 lesions with PiRADS (verion 2) scores ≥ 4 on 3-T multi-parametric MRI were analyzed retrospectively. Two radiologists independently assessed capsular morphology qualitatively with 5-point scale (normal, thinning, bulging, loss, extracapsular disease), and capsule contact length (arc), tumor dimension, and their ratio (arc-dimension ratio) quantitatively. Reproducibility in measurement was assessed with κ and intra-class correlation coefficients (ICCs). Logistic regression analysis was done to find meaningful indicators of EPE. Diagnostic performance of markers was compared to one another with generalized linear model and multi-reader multi-case ROC analysis.Results: Reproducibility was moderate to substantial (κ 0.45-0.73) for qualitative, and moderate to almost perfect (ICC 0.50-0.87) for quantitative features of EPE. Capsular morphology (odds ratio [OR] 1.818), capsule contact length (OR 1.115), tumor dimension (OR 1.035), and arc-dimension ratio (OR 1.846) were independently associated with EPE (p ≤ 0.019). Capsular bulging and capsule contact length of 10 mm as thresholds of EPE demonstrated sensitivity/specificity of 0.58/0.85 and 0.77/0.68, respectively. Capsule contact length yielded greatest AUC (0.784), followed by capsular morphology (0.778), arc-dimension ratio (0.749), and tumor dimension (0.741). Diagnostic performance of capsular morphology, capsule contact length, and arc-dimension ratio was comparable in predicting EPE.Conclusions: Existing markers of EPE applicable regardless of locations of tumors apply similarly to APCs. Arc-dimension ratio may be a novel marker of EPE of APCs.Key Points: • Existing imaging markers of extraprostatic extension (EPE) which have been applied regardless of locations of tumors are reflected similarly to anterior prostate cancers (APCs). • Measuring tumor dimension without capsular assessment may result in insufficient pre-operative prediction of EPE of APCs. • Arc-dimension ratio (capsule contact length divided by tumor dimension) exhibited highest OR and comparable performance to existing features in predicting EPE of APCs. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the usefulness of prostate health index (PHI) as an indicator for recommending magnetic resonance imaging (MRI) in patients with prostate-specific antigen (PSA) gray zone level < 10 ng/mL. Methods: 443 patients who underwent prostate biopsy (PB) after serum PHI test and MRI between April 2019 and December 2022 were enrolled. For patients with visible lesion on MRI with Prostate Imaging Reporting and Data System Score (PI-RADS) ≥ 3, MRI-targeted PB was performed in addition to systematic 12-core PB. Results: The optimal cutoff value of PHI for predicting PI-RADS ≥ 3 lesions was 39.6, which was significantly associated with overall prostate cancer (OR 3.07, p = 0.018) and clinically significant prostate cancer (csPCa) (OR 4.15, p = 0.006) at MRI-targeted PB cores. When MRI was restricted to patients with PHI ≥ 39.6 alone, 28.7% of unnecessary MRI could be saved at the cost of missing 13.6% of csPCa. When omitting MRI for patients with PHI < 39.6 and PSAD < 0.12 ng/mL2, unnecessary MRI could be reduced by 20.1% with the risk of missing 6.2% of csPCa. With addition of systematic PB, 21.0% of patients with negative MRI-targeted PB were diagnosed as csPCa. Conclusions: For patients in PSA gray zone, PHI of 39.6 might be an indicator for MRI and further MRI-targeted PB in additional to PSAD of 0.12 ng/mL2, reducing 20.1% of unnecessary MRI with the minimal risk of missing 6.2% of csPCa. To maximize csPCa detection, combining both MRI-targeted and systematic PB should be also considered. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic performance of the tumor contact length (TCL) in the prediction of MIBC (muscle-invasive bladder cancer) in lesions corresponding to the vesical imaging-reporting and data system (VIRADS) score 2–3. Methods: This is a single institution, retrospective study targeting 191 consecutive patients assigned of VIRADS score 2–3, who had pre-transurethral resection MRI from July 2019 to September 2021. Logistic regression analyses were performed to determine meaningful predictors of MIBC for this score group, and a nomogram was plotted with those variables. The diagnostic performance of each predictor was compared at predefined thresholds (VIRADS score 3 and TCL 3 cm) using the generalized linear model and ROC analysis. Results: Both VIRADS score and TCL remained independent predictors of MIBC for this score group (odds ratio 7.3 for VIRADS score, and 1.3 for TCL, p < 0.01 for both). The contribution of TCL to the probability of MIBC in the nomogram was greater than that of the VIRADS score. VIRADS score had a sensitivity of 0.54 (14/26), specificity of 0.92 (203/221), and diagnostic accuracy of 0.88 (217/247), and TCL showed a sensitivity of 0.89 (23/26), specificity of 0.95 (209/221), and diagnostic accuracy of 0.94 (232/247). The difference in sensitivity (p = 0.03) and accuracy (p = 0.04) was statistically significant. The AUC was also significantly wider for TCL than for VIRADS (0.97 vs. 0.73, p < 0.01). Conclusion: A simple index, TCL, may be helpful in further risk stratification for MIBC in patients with a score of VIRADS 2–3. Clinical relevance statement: For bladder cancer patients with insufficient qualitative evidence of muscle layer invasion using VIRADS categorization, TCL, a simple quantitative indicator defined as the curvilinear contact length between the bladder wall and the tumor, may be helpful in risk stratification. Key Points: • Even when only lesions with score 2–3 were targeted, VIRADS was still a meaningful indicator of MIBC. • With a predefined threshold of 3 cm applied, TCL outperformed VIRADS in the score 2–3 group, in predicting MIBC. • A longer TCL for a lesion with a VIRADS score 2 may warrant an additional warning for MIBC, whereas a shorter TCL for a lesion with a score 3 may indicate a lower risk of MIBC. [ABSTRACT FROM AUTHOR]

Conventional chemotherapy methods have adverse off-target effects and low therapeutic efficiencies of drug release in target tumors. In this study, we proposed a combination therapy of doxorubicin (DOX)-loaded ultrasound (US)-sensitive liposomal nanocarriers (IMP301), microbubbles (MBs) under focused US exposure using convex acoustic lens-attached US (LENS) to tumor treatment. The therapeutic effects of each treatment in a murine melanoma model were evaluated using contrast-enhanced US (CEUS) and micro-computed tomography (micro-CT) imaging, bioluminescence and confocal microscopy imaging, and liquid chromatography–mass spectroscopy (LC/MS) analysis. Tumor-bearing mice were randomly assigned to one of the following groups: (1) G1: IMP301 only (n = 9); (2) G2: IMP301 + LENS (n = 9); (3) G3: IMP301 + MB + LENS (n = 9); (4) G4: DOXIL only (n = 9); and (5) G5: IMP301 without DOXIL group as a control group (n = 4). Ten days after tumor injection, tumor-bearing mice were treated according to each treatment strategy on 10th, 12th, and 14th days from the day of tumor injection. The CEUS images of the tumors in the murine melanoma model clearly showed increased echo signal intensity from MBs as resonant US scattering. The relative tumor volume of the G2 and G3 groups on the micro-CT imaging showed inhibited tumor growth than the reference baseline of the G5 group. DOX signals on bioluminescence and confocal microscopy imaging were mainly located at the tumor sites. LC/MS showed prominently higher intratumoral DOX concentration in the G3 group than in other treated groups. Therefore, this study effectively demonstrates the feasibility of the synergistic combination of IMP301, MBs, and LENS-application for tumor-targeted treatment. Thus, this study can enable efficient tumor-targeted treatment by combining therapy such as IMP301 + MBs + LENS-application. [ABSTRACT FROM AUTHOR]

Co-delivery of microbubbles (MBs) with anticancer drugs is a promising theranostic approach that can enhance both the ultrasound contrast and local extravasation of drugs with the sonoporation effect. The simultaneous administration of MBs and hydrophobic drugs, however, is still challenging due to the limitations in drug loading or undesirable stabilization of MBs. In this research, MB-self-aggregate complexes (MB-SAs) were newly fabricated for the encapsulation of hydrophobic drugs, and their theranostic properties are investigated in vitro and in vivo. Glycol chitosan self-aggregates (GC-SAs) loaded with hydrophobic drugs or dyes were chemically conjugated on the surface MBs. Their conjugation ratio was determined to be 73.9%, and GC-SAs on MBs did not affect the stability of MBs. GC-SA attached MBs (GC@MBs) were successfully visualized with low-intensity insonation and showed enhanced cellular uptake via the sonoporation effect. In vivo biodistribution of GC@MBs was examined with tumor-bearing mice, confirming that their accumulation at the tumor site increased by 1.85 times after ultrasound irradiation. The anticancer drug-loaded GC@MBs also exhibited 10% higher cytotoxicity under ultrasound flash. In conclusion, it was expected that GC@MBs could be used both as an ultrasound contrast agent and a drug carrier even with conventional ultrasonic devices. [ABSTRACT FROM AUTHOR]

Nanoliposomes are important carriers capable of packaging drugs for various delivery applications through passive targeting tumor sites by enhancing permeability and retention effect. Radiolabeled liposomes have potential applications in radiotherapy and diagnostic imaging. However, the physico-chemical instability of liposomes during manufacturing and storage limits their extensive application. Therefore, considerable numbers of studies have been made on the stability of liposomes over the last few years in order to overcome this problem. In this study, we attempted to prepare polymer-coated liposomes using water-soluble chitosan in order to enhance the stability of rhenium(III) chloride-incorporated liposomes. They were characterized by an electrophoretic light-scattering spectrophotometer, Fourier transform infrared spectroscopy (FT-IR), UV-Vis spectrometer, and phase-contrast microscopy. The chitosan-coated liposomes are spherical and the particle size is about 800-850 nm. Incorporation of chitosan into the liposome bilayer decreased rhenium(III) chloride release from the liposome due to an increased rigidity of the liposome membrane structure. Chitosan-coated liposomes showed a higher stability compared with the stability of non-coated liposomes. The release characteristics of rhenium(III) chloride encapsulated in the liposome were taken as a measure of stability of the liposome membrane. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To investigate the impact of the variations in the shape of the prostatic apex observed on preoperative magnetic resonance imaging (MRI) on patients’ status regarding urinary continence after undergoing radical retropubic prostatectomy, as well as the prevalence of such variations. Methods: We performed a retrospective analysis of 156 patients who had undergone preoperative MRI of the prostate and were followed up postoperatively by review of the records. For our analyses, patients were categorized into four different groups according to the shape of the prostatic apex shown on the midsagittal MRI scan. Patient status, including early (within 3 months after surgery) recovery of urinary continence, was also assessed. Results: Group 1 was the largest with 59 patients (37.8%), group 2 had 39 patients (25%), group 3 had 24 (15.3%), and group 4 had 34 patients (21.8%). Group 4 was composed of patients with the prostatic apex not overlapping with membranous urethra either anteriorly or posteriorly on MRI and had a significantly greater percentage (83.3% versus 66.7%) of patients with an early return of urinary continence after radical retropubic prostatectomy compared with the other groups (P = 0.014). On multivariate analysis of the predictive factor for the early return of urinary continence, anterior or posterior overlapping of the membranous urethra with the prostatic apex as shown on preoperative MRI was the only variable significantly associated with an early return of continence. Conclusions: The results of our study provide objective evidence that variations in the shape of the prostatic apex in relation to the membranous urethra may significantly affect early recovery of urinary continence after radical retropubic prostatectomy. [Copyright &y& Elsevier]

Purpose: To assess the feasibility of the combined sorafenib (SOR) and doxorubicin-loaded microbubble-albumin nanoparticle complex (DOX-MAC) treatment effect in an orthotopic rat model of hepatocellular carcinoma (HCC). Materials and methods: Sixty-two rats with N1-S1 hepatoma were divided into four groups according to the treatment methods, i.e. G1 (SOR and DOX-MAC; n = 12), G2 (SOR; n = 15), G3 (DOX-MAC; n = 12), G4 (DOX; n = 11), and G5 (normal saline; n = 12). We performed the theragnostic, contrast-enhanced ultrasound examination and treatment at the baseline, one-week, and two-weeks. Tumor volume and perfusion parameters were compared at each time point and the differences between all of the groups over time were analyzed using repeated measures ANOVA. We also analyzed the apoptotic index and microvessel density (MVD) per each tumor specimen in all of the groups. Results: The tumors increased from the beginning in all of the groups to the final follow-up, whereas the tumor growth in the G1 group and the G2 group was inhibited during the treatment period compared to the baseline tumor volume (P = 0.016 and P = 0.031). The G1 group resulted in tumor growth inhibition compared to the control group (P = 0.008). The G1 group showed that the peak enhancement and wash-in area under the curve were lower than that of the G4 group (P = 0.010 and 0.022). However, there was no difference in perfusion parameters in the other treated group compared to control group. The MVD of the G1 group tumor was lower than that of the G4 group (P =.016). Conclusion: Our results suggest that the combination therapy of SOR and DOX-MAC can cause inhibition of tumor growth after treatment and that this therapy can be adequately monitored using the theragnostic DOX-MAC agent. [ABSTRACT FROM AUTHOR]

The synergistic effects of a doxorubicin (Dox)-loaded microparticle-microbubble complex (DMMC) and focused ultrasound (FUS) with a short duty cycle (5%) were evaluated in a pancreatic cancer xenograft model established by inoculating immunodeficient mice with CFPAC-1 cells. The efficacy of the DMMC with FUS (study 1), the effect of conjugating the particles as opposed to mixing them (study 2) and the levels of tumor apoptosis and intracellular Dox (study 3) were evaluated. The DMMC with FUS exhibited the lowest tumor growth rate (30.8 mm3/wk) and the highest intracellular Dox uptake (8.8%) and tumor cell apoptosis rate (58.7%) among all treatments. DMMC had a significantly lower growth rate than the mixture of Dox-loaded microparticles and microbubbles (44.2 mm3/wk, p < 0.01) when they were combined with FUS. In conclusion, DMMC with short-duty-cycle FUS holds promise for tumor growth suppression, which may be attributed to high intracellular Dox uptake. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate risk factors for bacillus Calmette–Guerin-induced prostatitis in patients with non-muscle invasive bladder cancer following bacillus Calmette–Guerin therapy. Clinical findings from patients with non-muscle invasive bladder cancer who underwent multi-parametric magnetic resonance imaging before transurethral resection of bladder tumor and post-bacillus Calmette–Guerin therapy from March 2004 to August 2018 were evaluated. The population was grouped into patients with or without newly developed lesions on multi-parametric magnetic resonance imaging performed 3 months after bacillus Calmette–Guerin instillation. Patients with prostate-specific antigen levels ≥ 4 ng/mL or prostate cancer were excluded. Univariable and multivariable analyses were performed to determine the predictors of prostate lesions in patients with prior bacillus Calmette–Guerin exposure. Post bacillus Calmette–Guerin-induced prostatitis was found in 50 of the 194 patients (25.8%). No significant differences were observed between the groups except for prostate volumes (33.8 mL vs. 30.8 mL, P = 0.012) and body mass index (25.2 kg/m2 vs. 24.1 kg/m2, P = 0.044). After bacillus Calmette–Guerin exposure, no significant differences in prostate-specific antigen levels, international prostate symptom scores, or post-voiding residual volume were noted. Multivariable regression analysis showed that body mass index (odds ratio, OR = 1.115, P = 0.038) and prostate volume (OR = 3.080, P = 0.012) were significant predictors of post-bacillus Calmette–Guerin prostate lesions. Body mass index and prostate volume may be clinical predictors of prostate lesions after bacillus Calmette–Guerin exposure. Awareness of potential risk factors for this entity should contribute to the clinical decision-making process for patients following bacillus Calmette–Guerin therapy. [ABSTRACT FROM AUTHOR]

The application of nanoparticles in cancer treatment allows precise tumor treatment by enhancing drug delivery to the tumor area. To overcome limitations in the drug delivery system, we report carbon‐based nanospheres (CSs) that have high drug loading capacity as well as anti‐cancer effects. Monodisperse and size‐tunable (170–583 nm) CSs with excellent surface area up to 2619 m2/g provided high drug loading capacity in four different types of drugs (doxorubicin, gemcitabine, docetaxel, and paclitaxel), and demonstrated strong anti‐cancer effects against MDA‐MB‐231 human breast carcinoma cells. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the characteristics and histological outcomes in patients with Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions undergoing magnetic resonance imaging-guided fusion-targeted biopsy (MRIFTB). Methods: We retrospectively reviewed 138 patients with PI-RADS category 3 lesions classified using multiparametric MRI who underwent MRIFTB between May 2016 and March 2018. The study population included biopsy-naïve and patients with prior negative biopsy. Univariate and multivariate analyzes were performed to determine significant predictors of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). The definition of csPCa was set at Gleason score ≥ 3 + 4. Results: Overall, 114 (82.6%) biopsied lesions were benign and 24 (17.4%) were identified as prostate cancer. Of these 24 lesions, 14 (58.3%) harbored csPCa. Peripheral zone (PZ) lesions were more likely to be associated with malignant disease than transition zone lesions (13.7 vs. 6.2%). Multivariate logistic analysis revealed that age, PZ location, and prostate-specific antigen (PSA) density (P < 0.05) were independent predictors of both PCa and csPCa. Conclusions: A non-negligible number of PI-RADS 3 patients harbor csPCa. Moreover, age, lesion location, and PSA density could be potential clinical predictors of PCa and csPCa. Physicians should be aware of the cancer prevalence of PI-RADS 3 lesions, as the use of the aforementioned factors can help in the decision-making process for these patients. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effectiveness of an antibiotic regimen for prostate biopsy by analyzing patients who were hospitalized because of complications after transrectal ultrasound-guided prostate biopsy.Methods: We reviewed retrospectively the medical records of 10,339 patients who underwent transrectal ultrasound-guided prostate biopsy at our institution from May 2003 to April 2017. We excluded patients with low quality data. All patients underwent urine culture before transrectal ultrasound-guided prostate biopsy and received intravenous antibiotic agents 30-60 minutes before biopsy. Patients were either given prophylactic quinolone or cephalosporin (second or third generation). Clinicopathologic factors including patient age, antibiotic regimen, number of biopsy cores, body mass index, prostate specific antigen, prostate volume, and infection-related complications that required hospitalization were subsequently analyzed.Results: A total of 9,487 patients were included in the final analysis, of whom 33 patients (0.35%) were hospitalized because of infection-related complications. Infection-related hospitalization rates were lower in patients who received cephalosporin (0.2%) than in patients who received quinolone (1.59%). At our institution, cephalosporin has been used predominantly to prevent post-biopsy infections since February 2013. Only five patients (0.12%) developed infection-related complications of the 3,863 patient who underwent transrectal ultrasound-guided prostate biopsy since February 2013. Multivariable analysis revealed that use of second- or third-generation cephalosporin was the only independent predictor of infection-related complications.Conclusion: Implementing an effective antibiotic prophylaxis regimen at our institution by using second- or third-generation cephalosporin could reduce infection-related complications after transrectal ultrasound-guided prostate biopsy. [ABSTRACT FROM AUTHOR]

Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? It has been reported that patients with Gleason 6 prostate cancer detected in a single microfocal positive core may actually harbour more aggressive disease. Meanwhile, several studies analyzing cases of single microfocal prostate cancer included a significant number of patients with serum PSA ≥ 10 ng/mL. Also, significant proportions of currently available published data on actual pathological characteristics of prostate cancer with favourable biopsy features were obtained from patients who underwent prostate biopsies performed in non-systematic fashion at different institutions and/or via non-contemporary scheme, such as sextant biopsy. Although PSA density can be considered an independent predictor of pathologically insignificant tumour among the patients with PSA ≤ 10 ng/mL and only a single microfocal tumour detected via multi (≥12)-core biopsy, clinical and biopsy-related parameters currently available have limited value in predicting pathologically insignificant or unfavourable prostate cancer in such patients. OBJECTIVE • To examine potential predictors of pathological outcomes for a single microfocal (≤3 mm) positive prostate cancer detected via contemporary biopsy scheme in patients presenting with prostate-specific antigen (PSA) ≤10 ng/mL. PATIENTS AND METHODS • We reviewed the data of 119 patients who had prebiopsy PSA ≤ 10 ng/mL and a single microfocal (≤3 mm) Gleason ≤6 prostate cancer identified via multicore (≥12) biopsy and who subsequently underwent radical prostatectomy (RP). • We assessed the rates of insignificant prostate cancer (organ-confined and pathological Gleason ≤6 with tumour volume <0.5 mL) and unfavourable prostate cancer (upstaging and/or upgrading) by analysing pathological findings. • Potential preoperative predictors of insignificant or unfavourable prostate cancer were analysed. Multivariable models for predicting insignificant and unfavourable tumours were devised and evaluated. RESULTS • Overall rates of insignificant and unfavourable prostate cancer were 44.5% and 24.4%, respectively. In multivariate analysis, only PSA density was an independent predictor of insignificant prostate cancer. • Predictive accuracies of multivariable models for predicting insignificant prostate cancer did not exceed 68.2%. No significant predictor for pathologically unfavourable tumour was found in multivariate analysis. • All versions of the multivariable model devised for prediction of unfavourable tumour showed predictive accuracies ≤66.9%. CONCLUSION • Although PSA density can be considered an independent predictor of pathologically insignificant tumour among patients with PSA ≤10 ng/mL and only a single microfocal tumour detected via multicore (≥12) biopsy, the clinical and biopsy-related parameters that are currently available have limited value in predicting pathologically insignificant or unfavourable prostate cancer in such patients. [ABSTRACT FROM AUTHOR]

Purpose: We developed a multiple logistic regression model, an artificial neural network (ANN), and a support vector machine (SVM) model to predict the outcome of a prostate biopsy, and compared the accuracies of each model.Method: One thousand and seventy-seven consecutive patients who had undergone transrectal ultrasound (TRUS)-guided prostate biopsy were enrolled in the study. Clinical decision models were constructed from the input data of age, digital rectal examination findings, prostate-specific antigen (PSA), PSA density (PSAD), PSAD in transitional zone, and TRUS findings. The patients were divided into the training and test groups in a randomized fashion. Areas under the receiver operating characteristic (ROC) curve (AUC, Az) were calculated to summarize the overall performance of each decision model for the task of prostate cancer prediction.Results: The Az values of the ROC curves for the use of multiple logistic regression analysis, ANN, and the SVM were 0.768, 0.778, and 0.847, respectively. Pairwise comparison of the ROC curves determined that the performance of the SVM was superior to that of the ANN or the multiple logistic regression model.Conclusion: Image-based clinical decision support models allow patients to be informed of the actual probability of having a prostate cancer. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between prostate-specific antigen (PSA) and prostate volume in a histologically defined subset of Korean men confirmed to have benign prostatic hyperplasia (BPH) only from multicore biopsy of prostate. Methods: A total of 707 Korean men with a PSA level of 10 ng/mL or lower who were shown to have stromoglandular hyperplasia only from transrectal ultrasound (TRUS)-guided multicore biopsy of prostate were included in the study. We analyzed PSA and total prostate volume (TV) measured through TRUS by stratified age cohorts. We used Pearson correlation coefficient (r) and linear regression model to describe the relationship between variables. Results: Serum PSA level significantly correlated with TV in all stratified age cohorts, with r ranging from 0.29 to 0.47 (all P <0.001). Meanwhile, the degree of correlation appeared to increase with age. The slope of linear regression showing an association of PSA and TV was 3.68. The PSA increase per unit prostate volume decreased with the advancing cohort of age when we excluded subjects 70 years or older. Conclusions: Although PSA was significantly correlated with TV, the exact nature of the relationship between PSA and TV in Korean men with biopsy-proven BPH may be different from that in other races. Further basic research on the pathophysiology of BPH is needed to explain such a racial difference. [Copyright &y& Elsevier]

Objectives: To investigate the association of prostate size with aggressiveness of prostate cancer in Korean men who received radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. Methods: We evaluated the association of RRP specimen weight and prostate volume measured by transrectal ultrasound (TRUS) with pathologic tumor grade, extraprostatic extension of disease, surgical margin status, and seminal vesicle invasion by reviewing data of 346 consecutive patients who underwent RRP for clinically localized prostate cancer at our institution without receiving preoperative radiation or hormonal treatment. Results: A strong correlation was observed between RRP specimen weight and TRUS-measured prostate volume (Spearman r = 0.76; P <0.001). After adjustment for multiple variables including age, body mass index, and preoperative prostate-specific antigen level, RRP specimen weight was observed to be significantly associated with presence of Gleason pattern 4 or greater at RRP in an inverse fashion (P = 0.03). Regarding other adverse pathologic features, prostate weight was also significantly inversely associated with extraprostatic extension of prostate cancer (P = 0.04) and surgical margin positivity (P = 0.002). When TRUS-measured prostate volume was applied in place of RRP specimen weight, results were the same. Conclusions: Our data indicate that prostate size may be a useful predictor of tumor aggressiveness in Korean men with clinically localized prostate cancer. Further efforts should be made to elucidate actual mechanisms behind the association of prostate size and/or in vivo androgenicity with aggressiveness of prostate cancer. [Copyright &y& Elsevier]

Objectives: To investigate the impact of variations in bony pelvic dimensions observed from preoperative magnetic resonance imaging on operative time, intraoperative blood loss, and surgical margin status on performing open radical retropubic prostatectomy. Methods: A prospective study was undertaken in which preoperative magnetic resonance imaging was performed in 190 patients who were diagnosed with clinically localized prostate cancer before radical retropubic prostatectomy. Using the magnetic resonance image findings, various bony pelvic dimensions were measured. The associations of the measured pelvic dimensions and various clinicopathologic factors with the operative time, estimated blood loss, and surgical margin status were analyzed on multivariate analyses. Results: For operative time, none of the individual pelvic dimensions measured demonstrated significant associations on univariate analysis. In contrast, only the newly developed parameter, the pelvic dimension index, approached significance (P = 0.095). Only body mass index (BMI) proved to be independently associated with the operative time on multivariate analysis (P = 0.030). Also, only the prostate volume (P = 0.015) was independently associated with the estimated blood loss. For the surgical margin status, the preoperative PSA level (P = 0.041), pathologic Gleason score (P = 0.015), and BMI (P = 0.020), along with the pelvic dimension index (P = 0.048), demonstrated significant associations on univariate analyses. However, only the PSA level (P = 0.071) and BMI (P = 0.059) approached significance on multivariate analysis. Conclusions: Our results have demonstrated that variations in the bony pelvic dimensions might have some impact, but not significantly so, on open radical retropubic prostatectomy compared with other patient-related baseline factors such as the BMI or prostate volume. [Copyright &y& Elsevier]

Objectives: To investigate the significance of variations in neurovascular bundle (NVB) formation observed on preoperative magnetic resonance imaging (MRI) regarding postoperative potency after nerve-sparing radical retropubic prostatectomy (RRP). Methods: Preoperative MRI was performed in 93 patients who underwent bilateral nerve-sparing RRP for clinically localized prostate cancer and were followed up for at least 12 months after surgery. Judging from the MRI scans, patients were categorized into three groups: group 1, patients with no definite NVB observed on MRI, group 2, those with probable NVB formation observed on MRI but not definite, and group 3, those with NVB more definitely observed on MRI. Patients’ erectile function status was assessed preoperatively and postoperatively using the International Index Erectile Function 5-item (IIEF-5) questionnaire. Results: Of the 93 patients, 40.9% were in group 1, 21.5% in group 2, and 37.6% in group 3 according to the MRI findings. The patient characteristics, including age, serum prostate-specific antigen, pathologic Gleason score, and preoperative IIEF-5 scores, were not significantly different among the three groups. However, the changes in the IIEF-5 scores after bilateral nerve-sparing RRP demonstrated a significantly larger decrease for group 1 compared with groups 2 and 3. Similar trends were observed when patients 60 years old or younger and those older than 60 years were analyzed separately. Conclusions: In patients with no definite NVB formation observed on MRI, the nerves associated with erectile function may run along both sides of the prostate and spread more anteriorly than those with the NVB more definitely observed. Thus, to preserve the NVBs completely at all times, it would be important to widely dissect the lateral aspects of the prostate during nerve-sparing RRPs. [Copyright &y& Elsevier]

Publish consent withheld [ABSTRACT FROM AUTHOR]

Background: We investigated the tumor suppression effect of an ultrasound-sensitive doxorubicin-loaded liposome-based nanoparticle, IMP301, to enhance the synergistic effect with focused ultrasound (FUS) in an animal model of pancreatic cancer., Methods: Thirty nude mice with xenografts of PANC-1 human pancreatic cancer cells were randomly and prospectively allocated to 6 different groups (5 per group) each for Study-1 (dose-response test) and Study-2 (synergistic effect test). Study-1 consisted of control, gemcitabine, Doxil with FUS, and three different doses of IMP301 (2, 4, 6 mg/kg) with FUS groups. Study-2 consisted of control, FUS only, gemcitabine, Doxil with FUS, and IMP301 (4 mg/kg) with or without FUS groups. Differences in tumor volume and growth rate were evaluated by one-way ANOVA and Student-Newman-Keuls test., Results: In Study-1, 4 mg/kg or greater IMP301 with FUS groups showed lower tumor growth rates of 14 ± 4 mm 3 /day (mean ± standard deviation) or less, compared to the control, gemcitabine, and Doxil with FUS groups with rates exceeding 28 ± 5 (p < 0.050). The addition of FUS in Study-2 decreased the tumor growth rate in the IMP301-treated groups from 36 ± 17 to 9 ± 6, which was lower than the control, FUS only, gemcitabine, and Doxil with FUS groups (p < 0.050)., Conclusions: IMP301 combined with FUS exhibited higher tumor growth suppression compared to the use of a conventional drug alone or the combination with FUS. The present study showed the potential of IMP301 to enhance the synergistic effect with FUS for the treatment of pancreatic cancer., Relevance Statement: This article aims to evaluate the synergistic effect of FUS and ultrasound-responsive liposomal drug in tumor growth suppression by using xenograft mouse model of pancreatic ductal adenocarcinoma. FUS-induced ultrasound-sensitive drug release may be a potential noninvasive repeatable treatment option for patients with locally advanced or unresectable pancreatic cancer., Key Points: • Modification of conventional drugs combined with FUS would maximize tumor suppression. • IMP301 with FUS had higher tumor suppression effect compared to conventional chemotherapy. • This image-guided drug delivery would enhance therapeutic effects of systemic chemotherapy., (© 2024. The Author(s).)

Purpose: To evaluate association between computer tomography (CT)-based features of renal cell carcinoma (RCC) and survival outcomes., Methods: Data of 958 patients with clinical T1b-T2 RCC who underwent partial/radical nephrectomy from June 2003 to March 2022 were retrospectively evaluated. CT images of patients were reviewed by two radiologists for texture analysis of tumor heterogeneity and shape analysis of tumor contour. Patients were divided into three groups according to patterns of CT-based features: (1) favorable feature group (n = 117); (2) intermediate feature group (n = 606); and (3) unfavorable feature group (n = 235). Kaplan-Meier survival analysis and multivariate Cox regression analysis were performed to evaluate overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS)., Results: RCCs with unfavorable CT-based feature showed larger size on CT, higher nuclear grade, higher rate of histologic necrosis, and higher rate of capsular invasion than those in the other two groups (all p < 0.001). Unfavorable feature was associated with poorer OS (p = 0.001), CSS (p < 0.001), and RFS (p < 0.001) on Kaplan-Meier analysis. In multivariate analysis, intermediate and unfavorable features were independent predictors for recurrence (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.09-5.79, p = 0.031 and HR 3.71, 95% CI 1.58-8.73, p = 0.003, respectively), but not for overall death or RCC-specific death., Conclusions: A combination of irregular tumor contour feature with heterogeneous tumor texture feature on CT is associated with poor RFS in clinical T1b-T2 RCC preoperatively., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The objective of this study was to evaluate pain and image quality associated with the use of two different ultrasound transducers., Methods: Fifty healthy male participants aged 30 years or older were prospectively enrolled. All ultrasound procedures were performed using a V8 machine (Samsung Medison, Seoul, Korea) equipped with EA2-11 (conventional) and miniER7 (small-caliber) transrectal transducers, operated by a single genitourinary radiologist. To minimize bias, one group of volunteers underwent ultrasonography with the conventional transducer first, followed by the small transducer. For the remaining participants, the examinations were performed in the opposite order. Ultrasonography, including the measurement of total prostate and transitional zone volumes, was conducted in accordance with standard practice. After testing with both probes, participants were asked to rate their pain on a 10-point numerical rating scale (NRS). A radiologist then evaluated the quality of the images acquired with each probe using a 5-point numeric scale and compared the prostate volume measurements obtained by each method., Results: The mean NRS scores associated with the conventional and small transducers were 4.7±1.8 and 2.7±1.2, respectively (P<0.05). The mean ultrasound image qualities from the two transducers were statistically similar (4.78 and 4.74, P>0.05). The whole prostate gland volume as measured with the conventional transducer (mean±standard deviation, 24.2±9.1 mL) was greater than the measurement (22.1±8.7 mL) obtained with the small-caliber transducer (P<0.05). However, only two of the 50 whole gland volume measurements differed by more than two standard deviations., Conclusion: The use of a small transrectal probe significantly reduced pain without compromising image quality.