Gregory P. Thibault

Efficacy of one dose fluoroquinolone before prostate biopsy

OBJECTIVES To demonstrate the efficacy of a simple preparation for prostate biopsy (PBX) and to determine its potential cost savings. METHODS One hundred fifty consecutive PBXs were performed using a Fleet enema and a single oral dose (300 mg) of ofloxacin as the pre-PBX preparation. RESULTS Of the 150 PBXs we performed, only 1 (0.67%) patient developed a urinary tract infection. CONCLUSIONS A simple and inexpensive pre-PBX preparation proved to be successful in preventing infectious complications and is presented as a potential model for inclusion in clinical pathways for diagnosing adenocarcinoma of the prostate.

Use of step-section histopathology to evaluate 18F-fluorocholine PET sextant localization of prostate cancer.

To assess positron emission tomography (PET) with fluorine-18 fluorocholine for sextant localization of malignant prostate tumors. Histopathologic analysis was performed on step-sectioned whole-mounted prostate specimens from 15 patients who underwent PET with fluorocholine prior to radical prostatectomy. The maximum standardized uptake value (SUVmax) corresponding to prostate sextants on PET was measured by region of interest analysis and compared with histopathologic results. Histopathology demonstrated malignant involvement in 61 of 90 prostate sextants. The mean total tumor volume per specimen was 4.9 mL (range 0.01–28.7 mL). Mean SUVmax was 6.0 ± 2.0 in malignant sextants and 3.8 ± 1.4 in benign sextants (p < .0001). The area under the receiver operating characteristic curve was 0.82 for sextant detection of malignancy based on SUVmax measurement. Tumor diameter directly correlated with sextant SUVmax in malignant sextants (r = .54, p < .05). In 13 subjects, the largest tumor in the specimen corresponded to the sextant with the highest SUVmax. Fluorocholine PET can serve to localize dominant areas of malignancy in patients with prostate cancer. However, PET with fluorocholine may fail to identify sextants with smaller volumes of malignancy.

Perceived stress and quality of life among prostate cancer survivors

A convenience sample of 136 prostate cancer survivors participated in this study that assessed their perception of stress and quality of life (QOL). Data were collected via an anonymous questionnaire consisting of the Perceived Stress Scale, the UCLA Prostate Cancer Index Short Form, and demographic variables. The findings revealed low levels of stress with marginal reports of QOL. Significant differences were found in organ-specific functioning (p < 0.001), with respondents indicating that they were experiencing a disproportionately higher rate of sexual problems (sexual performance and sexual satisfaction) compared to bowel and bladder problems. These complaints were highest among patients who had undergone prostatectomy and lowest among patients who had selected watchful waiting. No association was found between stress and QOL, but significantly higher rates of stress were reported by patients who felt they had not received sufficient information before treatment (p < 0.05).

Primary Adenocarcinoma of the Rete Testis: Improved Staging Accuracy With CT-PET

A case of adenocarcinoma of the rete testis in a 54-year-old man is presented. Most such patients harbor metastatic disease, even in clinically localized presentations. CT-PET may provide improved diagnostic sensitivity over conventional CT in this setting.

Incidence and clinical significance of arterial injury in varicocele repair

Study Type – Therapy (case series) 
Level of Evidence 4

Registration methods for histological slides and ex vivo MRI of prostate

A methodology for registering histological slides and ex vivo MRI of prostate is proposed. After such registration is performed, spatial correspondence between histology slides and ex vivo MRI is established, thus histological truth can be propagated to the ex vivo MRI space. We employ the well established registration approach based on mutual information (MI) and thin-plate splines (TPS), which is automatic after users initial placement of control points. Directly registering histology slides onto ex vivo MRI is challenging because 1) it is a difficult 2D (slice) to 3D (volume) registration problem and 2) there is a big difference in information content as histology slides are typically taken at much higher resolution than ex vivo MRI. Here we propose to overcome this challenge by breaking the difficult direct registration task into easier registration sub-tasks. For this purpose, we acquire digital photographs of prostate specimen as it is sectioned, which are referred to as block face photos. First, we register histology slides onto block face photos and then register block face photos onto ex vivo MRI. Results from two registrations tasks are combined to establish registration between histology slides and ex vivo MRI. Before the second registration task, we stack the block face photos into a volume so that registration onto the ex vivo MRI is a more stable 3D (volume) to 3D (volume) registration.

Dealing with non-cancerous findings on prostate biopsy

Most prostate biopsies do not show malignancy. The proper management of non-cancerous pathologic findings of the prostate is controversial. For this article, we reviewed the current literature for indications for repeat prostate biopsy after initial biopsies demonstrated noncancerous prostatic tissue or benign prostatic hyperplasia. This review includes discussions of management of asymptomatic prostatitis and how it may affect prostate-speci.c antigen, and also the management of several potentially premalignant lesions such as atrophy, atypical small acinar proliferation, and high-grade prostatic intraepithelial neoplasia. There is a paucity of randomized trials in this area and, considering the high number of biopsies with nonmalignant findings, we conclude that more investigation is warranted in this area.