Prostate cancer is the most common malignancy and represents the second leading cause of cancer death in men of western countries. Mortality of this tumor is particularly high beyond ten years. For patients with more than 10 years of life expectancy, curative treatment, if available, is mandatory. For the others, observation and differed hormonal palliative treatment is a reasonable alternative. Radical prostatectomy is the gold standard for treatment of clinically localized prostatic cancer. Cure rate is very high when the tumor histologically is strictly confined to the prostate. Morbidity has been reduced with the development of the anatomical approach. Our experience suggests that this reduced morbidity can also be achieved in urology clinics with relatively low recruitment. In addition, our results show that chances for cure are still very high for tumors reaching or even penetrating the prostatic capsule, as long as the seminal vesicles are not invaded. Early screening of the Prostate diagnoses a vast majority of tumors before the stage of seminal vesicle invasion. Early screening may thus be recommended for patients with 10 years or more of life expectancy.
Abstract Objectives To determine the diagnostic accuracy of 3T multiparametric magnetic resonance imaging (mpMRI) for detecting and locating prostate cancer (PCa) on Dickinson's 27‐sector map, using histopathology specimens from radical prostatectomy (RP) as the reference standard. Patients and methods The authors studied a continuous series of 140 patients who underwent RP over three consecutive years. Prior to RP, all patients had mpMRI for detection and localization of PCa and further assessment by biopsy. To minimize the potential of disease progression, 25 patients were excluded because the interval between mpMRI and RP exceeded 6 months, which left 115 patients eligible for analysis. The mpMRI findings were reported using the Prostate Imaging‐Reporting and Data System (PI‐RADS) v2, considering PI‐RADS ≥ 3 to indicate PCa. The histopathology findings from RP specimens were graded using the Gleason scoring system, considering Gleason ≥ 6 to indicate PCa. The location of the tumors was mapped on Dickinson's 27‐sector map for both mpMRI and histopathology and compared by rigid sector‐by‐sector matching. Results The cohort of 115 patients eligible for analysis was aged 66.5 ± 6.0 years at RP. Of the 3105 sectors analyzed, there were 412 true positives (13%), 28 false positives (1%), 68 false negatives (2%), and 2597 true negatives (84%). Across the 27 sectors of the prostate, mpMRI sensitivity ranged from 50% to 100% and specificity from 96% to 100%, while PPV ranged from 50% to 100%, and NPV from 91% to 100%. For the anterior prostate, mpMRI had a sensitivity of 80% (CI, 71%‐86%), specificity of 99% (CI, 99%‐100%), PPV of 91% (CI, 83%‐95%), and NPV of 99% (CI, 98%‐99%). For the posterior prostate, mpMRI had a sensitivity of 88% (CI, 84%‐91%), specificity of 98% (CI, 97%‐99%), PPV of 94% (CI, 92%‐96%), and NPV of 96% (CI, 94%‐97%). Overall, mpMRI had a sensitivity of 86%, specificity of 99%, PPV of 94%, and NPV of 97%. Conclusions The accuracy of mpMRI in detecting and locating prostate tumors depends on the affected region, but its high NPV across all sectors suggests that negative findings may not need corroboration by other techniques.
The Nd:YAG/KTP laser offers to the surgeon two wavelengths that can be used to coagulate and vaporize. Our objective was to investigate the combined effect of both wavelengths and to determine the irradiation parameters allowing the largest lesion volume. Chicken breast was irradiated ex vivo. 1064 nm and 532 nm Nd:YAG/KTP laser irradiations were performed sequentially at different combinations with variable fluence and compared to isofluent single wavelengths 40 W irradiation. Although the mean total lesion volume showed no difference between the different wavelengths combinations a significant enhancement of the maximum lesion depth was found under combined irradiation in the 20W/20W conditions. Dual wavelengths irradiation with the Nd:YAG/KTP laser thus induces a specific denaturation process which is more directional and results in an increased total lesion depth. This may represent a ne approach to increase the depth of coagulation necrosis and thus the total lesion volume, thereby improving long term results.
Zielsetzung: Natural Cycle IVF (NC-IVF) wird von vielen Frauen bevorzugt aufgrund der Einfachheit, der niedrigen Kosten und der geringen psychologischen Belastung. Meist wird der Follikel gespült. Da unklar ist, ob dies die Funktion des Corpus luteum reduziert, wird meistens eine Lutealphasenunterstützung durchgeführt, die bei 10 – 50% der Frauen zu Nebenwirkungen führt. Untersucht wurde deswegen, ob die Follikelspülung die Lutealphase nachteilig beeinflusst.
