Mark Wright

The use of Raman spectroscopy to differentiate between different prostatic adenocarcinoma cell lines.

Raman spectroscopy (RS) is an optical technique that provides an objective method of pathological diagnosis based on the molecular composition of tissue. Studies have shown that the technique can accurately identify and grade prostatic adenocarcinoma (CaP) in vitro. This study aimed to determine whether RS was able to differentiate between CaP cell lines of varying degrees of biological aggressiveness. Raman spectra were measured from two well-differentiated, androgen-sensitive cell lines (LNCaP and PCa 2b) and two poorly differentiated, androgen-insensitive cell lines (DU145 and PC 3). Principal component analysis was used to study the molecular differences that exist between cell lines and, in conjunction with linear discriminant analysis, was applied to 200 spectra to construct a diagnostic algorithm capable of differentiating between the different cell lines. The algorithm was able to identify the cell line of each individual cell with an overall sensitivity of 98% and a specificity of 99%. The results further demonstrate the ability of RS to differentiate between CaP samples of varying biological aggressiveness. RS shows promise for application in the diagnosis and grading of CaP in clinical practise as well as providing molecular information on CaP samples in a research setting.

The use of Raman spectroscopy to identify and grade prostatic adenocarcinoma in vitro.

Raman spectroscopy is an optical technique, which provides a measure of the molecular composition of tissue. Raman spectra were recorded in vitro from both benign and malignant prostate biopsies, and used to construct a diagnostic algorithm. The algorithm was able to correctly identify each pathological group studied with an overall accuracy of 89%. The technique shows promise as a method for objectively grading prostate cancer.

The use of Raman spectroscopy to identify and characterize transitional cell carcinoma in vitro

To determine whether Raman spectroscopy can be used to differentiate between normal, inflammatory and malignant bladder pathologies in vitro, and secondly if it can used to grade and stage transitional cell carcinoma (TCC).

Optical diagnostics in urology: current applications and future prospects

Optical diagnostic techniques have the potential to improve on traditional methods in various ways. Some techniques objectively analyse the data generated, and therefore show potential in reducing the variation in reporting. Other techniques show potential for real-time application via minimally invasive routes. This would preclude the absolute need for tissue removal and provide the medical practitioner with the information required to immediately proceed to definitive treatment. This concept has been widely termed ‘the optical biopsy’, although some authors think this an unhelpful term, as biopsy implies tissue removal. The ‘holy grail’ in optical diagnostics has been to develop a technique capable of reliably detecting malignant change at a stage early enough to allow local ablative treatment and avoid more extensive surgery.

Use of picosecond Kerr-gated Raman spectroscopy to suppress signals from both surface and deep layers in bladder and prostate tissue

Raman spectroscopy is an optical technique able to interrogate biological tissues, giving us an understanding of the changes in molecular structure that are associated with disease development. The Kerr-gated Raman spectroscopy technique uses a picosecond pulsed laser as well as fast temporal gating of collected Raman scattered light. Prostate samples for this study were obtained by taking a chip at the transurethral resection of the prostate (TURP), and bladder samples from a biopsy taken at transurethral resection of bladder tumor (TURBT) and TURP. Spectra obtained through the bladder and prostate gland tissue, at different time delays after the laser pulse, clearly show change in the spectra as depth profiling occurs, eventually showing signals from the uric acid cell and urea cell, respectively. We show for the first time, using this novel technique, that we are able to obtain spectra from different depths through both the prostate gland and the bladder. This has major implications in the future of Raman spectroscopy as a tool for diagnosis. With the help of Raman spectroscopy and Kerr gating, it may be possible to pick up the spectral differences from a small focus of adenocarcinoma of the prostate gland in an otherwise benign gland, and also stage the bladder cancers by assessing the base of the tumor post resection.

Renal artery occlusion.

Very occasionally, a patient presents with an acutely unobstructed, nonfunctioning kidney. Renal artery occlusion (RAO) is a rare but signi®cant cause of kidney loss. Renal artery embolism was ®rst described by Traube in 1856 [1] and traumatic occlusion of the renal artery was documented by von Recklinghausen in 1861 [2]. In this review we examine the different mechanisms of presentation of RAO and highlight some of the controversies in its diagnosis and treatment.

Prostate cancer and urinary incontinence

Prostate cancer is the third most common cancer worldwide and an increasing proportion of men are being diagnosed with localised disease. Urinary incontinence is uncommon in healthy men, but may develop as a result of curative treatment for prostate cancer. The optimal therapy remains undefined so the treatment associated morbidity is an important determinant in patient choice. Urinary incontinence may also develop from tumour progression during deferred treatment, sphincter involvement in advanced disease or surgery for symptomatic malignant bladder outlet obstruction. As urinary incontinence is known to have a significant impact on health related quality of life, we have reviewed the literature on incontinence related to prostate cancer and its treatment.

Urological applications of Raman spectroscopy for improved malignant diagnostics

The incidence of both prostate and bladder cancer is high; prostate cancer being the most frequently diagnosed non-cutaneous cancer affecting Western men. At present the gold standard for diagnosis of pathologies within the bladder and the prostate gland is by means of histological examination of biopsies. This is a subjective means of examining tissue and has an element of both inter and intra-observer variability. A large number of specimens have been collected and analysed using both a NIR-Raman spectrometer and histopathology with H&E staining. Multivariate spectral prediction models have been constructed and tested. An evaluation of misclassification cost models and the use of cancer staging data to train the models has been made.

An unusual presentation of metastatic prostate cancer

by bone; the next most common site is the lung, being found frequently at post mortem [1]. After these sites, the bladder, rectum, liver and adrenal glands often have metastases [1]. More unusual presentations include paraneoplastic syndromes, amaurosis fugax as a result of sites in the tuberculum sellae [2], and facial nerve lesions from foci in the parotid [3]. Metastases in the skin have not previously been reported.

Laparoscopic urological surgery: mentor matters

The laparoscopic approach is now the accepted standard of care for simple nephrectomy, pyeloplasty and renal tumours that are not locally advanced. The National Institute for Clinical Excellence (NICE) Interventional Procedure Guidance (IPG) 136 [1] states that current evidence on the safety and efficacy of laparoscopic nephrectomy (including nephroureterectomy) appears adequate to support the use of this procedure. Accordingly, and in anticipation of this conclusion, many urological surgeons and trainees are already going through the training process for this procedure. NICE also commented that training and competence in laparoscopic techniques were important for surgeons undertaking this procedure [1]. Increasingly and rightly so, laparoscopic surgery is spreading from the major pioneer centres in the country, as District General Hospitals are advertising for urological surgeons with laparoscopic interest.