原发性肝癌雄激素受体表达的临床病理研究

 目的探讨原发性肝癌患者雄激素受体的改变对肝癌发生发展的影响.方法应用放射配体结合分析法(RBA)对36例行手术切除的肝癌组织、癌周组织及外周血白细胞雄激素受体(Androgen receptor,AR)的含量进行测定,同时用放射免疫法(RIA)测定肝癌患者及正常人血浆雄激素(睾酮T)的水平,结合临床病理资料进行统计分析.结果(1)癌组织与癌周组织相比,AR含量明显升高(P＜0.01),且与肿瘤直径大小有关;(2)高分化的肝癌组织AR含量明显高于低分化者(P＜0.01);(3)肝癌患者血浆睾酮水平增加不明显(P＞0.05),但白细胞AR表达明显升高(P＜0.01).结论肝癌的发生可能与癌组织中AR含量升高有关,AR的含量与肿瘤的大小及分化程度存在相关性.     

Granulomatous prostatitis: a pitfall in MR imaging of prostatic carcinoma

Granulomatous prostatitis is an uncommon disease that can prostatic carcinoma on both digital rectal examination and transrectal ultrasound. Four patients who underwent magnetic resonance imaging of the prostate had a histological diagnosis of graanulomatous prostatitis; three of them had recent urinary tract infections. The other patient had an associated midline prostatic cyst and a focus of malignancy. T1-and T2-weighted spin-echo images were obtained in all cases. Peripheral zone lesions of decreased signal intensity, suggestive of carcinoma,were found in all four patients on T2-weighted images. Granulomatous prostatitis should be considered in the differential diagnosis of low signal intensity areas with prostatic magnetic resonance imaging. Correspondence to; P.A. Gevenois     

Recovery of serum testosterone following neoadjuvant and adjuvant androgen deprivation therapy in men treated with prostate brachytherapy

AIM: To investigate the time course of testosterone (T) recovery after cessation of androgen deprivation therapy (ADT) in patients treated with brachytherapy.METHODS: One-hundred and seventy-four patients treated between June 1999 and February 2009 were studied. Patients were divided into a short-term usage group (≤ 12 mo, n = 91) and a long-term usage group (≥ 36 mo, n = 83) according to the duration of gonadotropin-releasing hormone agonist therapy. Median follow-up was 29 mo in the short-term group and was 60 mo in the long-term group.RESULTS: Cumulative incidence rates of T recovery to normal and supracastrate levels at 24 mo after cessation were 28.8% and 74.6%, respectively, in the long-term usage group, whereas these values were 96.4% and 98.8% in the short-term usage group. T recovery to normal and supracastrate levels occurred significantly more rapidly in the short-term than in the long-term usage group (P < 0.001 and P < 0.001, respectively). Five years after cessation, 22.6% of patients maintained a castrate T level in the long-term usage group. On multivariate analysis, lower T levels (< 10 ng/dL) at cessation of ADT was significantly associated with prolonged T recovery to supracastrate levels in the long-term usage group (P = 0.002).CONCLUSION: Lower T levels at cessation of ADT were associated with prolonged T recovery in the long-term usage group. Five years after cessation of long-term ADT, approximately one-fifth of patients still had castrate T levels. When determining the therapeutic effect, especially biochemical control, we should consider this delay in T recovery.     

Positron tomographic assessment of 16 alpha-[18F] fluoro-17 beta-estradiol uptake in metastatic breast carcinoma

The positron-emitting estrogenic steroid 16 alpha-[18F]fluoro-17 beta-estradiol (FES) has been shown to exhibit selective uptake in primary breast carcinomas; the uptake of tracer by positron emission tomography (PET) is strongly correlated with the tumor estrogen-receptor concentration. We have now extended the use of this radiopharmaceutical for imaging of metastases of breast carcinoma by PET in 16 patients with clinical or radiographic evidence of metastatic disease. Increased uptake of FES was identified on PET images in 53 of 57 metastatic lesions (93%); only two apparent false-positive foci of FES uptake were seen. In seven of the patients, evaluable PET studies were obtained both before and after initiation of antiestrogen therapy. In all cases, there was a decrease in FES uptake in the tumor deposits after initiation of antiestrogen therapy, and the mean (+/- standard deviation) uptake decreased from 2.22 (+/- 1.23) to 0.80 (+/- 0.42) x 10(3)+ dose/ml. These results indicate that PET with FES has high sensitivity and specificity for detecting metastatic breast carcinoma and provide additional confirmatory evidence that the tumor uptake of this ligand is a receptor-mediated process.     

AR信号通路与自噬的相关性在前列腺癌治疗中的应用

雄激素受体（androgen receptor,AR）信号传导途径在前列腺癌的发生和进展中起重要作用,基于此,临床上多采取抑制AR信号通路的手段治疗前列腺癌。然而,几乎所有患者经过一段时间的治疗后均逃不过转变为去势抵抗性前列腺癌的结局。目前普遍认为是由于AR信号通路的再激活导致了去势抵抗的发生,部分学者近年来发现自噬在前列腺癌的发生、发展中同样扮演着重要角色,自噬的变化与去势抵抗性前列腺癌的发生呈明显的相关性。作者通过总结近年来有关去势抵抗性前列腺癌的发生机制及研究热点,从AR信号通路和自噬的角度综述二者在前列腺癌的发生、发展及治疗等方面的作用和关联性。     

Variations in patterns of concurrent androgen deprivation therapy use based on dose escalation with external beam radiotherapy vs. brachytherapy boost for prostate cancer

PurposeRetrospective data suggest less benefit from androgen deprivation therapy (ADT) in the setting of dose-escalated definitive radiation for prostate cancer, especially when a combination of external beam radiotherapy (EBRT) and brachytherapy approaches are used. This study aimed to test the hypothesis that patients with prostate cancer with intermediate- or high-risk disease undergoing extreme dose escalation with a brachytherapy boost are less likely to receive ADT.Methods and MaterialsData from the National Cancer Database were extracted for men aged 40–90 years diagnosed with node-negative, non-metastatic prostate cancer from 2004 to 2015. Only patients with intermediate- or high-risk disease who were treated with definitive radiotherapy were included. The association and patterns of care between dose escalated radiotherapy and ADT receipt were assessed using multivariable logistic regression.ResultsPatients with unfavorable intermediate- and high-risk prostate cancer were significantly less likely to receive ADT if they underwent dose escalation with a combination of EBRT and brachytherapy (odds ratio 0.67, p < 0.0001). Over time, this decrease in ADT utilization has widened for patients with unfavorable intermediate-risk disease. There was no difference in ADT utilization when comparing patients treated with non–dose-escalated EBRT to those treated with dose-escalated EBRT (without brachytherapy).ConclusionIn this large national database, patients with unfavorable intermediate- and high-risk prostate cancer were significantly less likely to receive guideline-indicated ADT if they underwent extreme dose escalation with combined radiation modalities. As we await prospective data guiding the utility of ADT with dose escalated radiation, these findings suggest potential underutilization of ADT in patients at higher risk of advanced disease.     

前列腺癌中非编码RNA与雄激素受体信号间调控的研究进展

雄激素受体（androgen receptor,AR）及其下游信号在前列腺癌的发生发展中发挥着关键性的作用。微小RNA（microRNA,miRNA）和长链非编码RNA（long non-coding RNA,lncRNA）等非编码RNA不仅影响AR信号的调控网络,而且参与前列腺癌的发展进程。作者重点就前列腺癌中miRNA、lncRNA与AR信号间调控网络的研究进展进行综述。     

Diffusion-weighted MRI in prostatic lesions: Diagnostic performance of normalized ADC using normal peripheral prostatic zone as a reference

Aim of study

Evaluate the potential value of the normal peripheral zone as a reference organ to normalize prostatic lesion apparent diffusion coefficient (ADC) to improve its evaluation of prostatic lesions.

青年痤疮患者白细胞雄激素受体的测定及意义

 目的 探讨痤疮患者外周血雄激素及白细胞雄激素受体(Anrogen receptor,AR)含量对痤疮发生的影响。方法对35例痤疮患者和35名正常人用放射配体结合分析法测定白细胞雄激素受体含量,同时用放射免疫法检测血清雄激素水平。结果 男性痤疮患者,血浆睾酮仅轻度升高,但其外周血白细胞AR的水平与对照组相比有明显升高(P＜0.05);女性痤疮患者,血浆睾酮水平及外周血白细胞AR水平与对照组相比均明显升高(P＜0.01)。结论 雄激素及其受体含量增高在女性痤疮的发病中可能引起着重要的作用;痤疮的严重程度与睾酮水平及白细胞AR水平密切相关。     

Endorectal surface coil MR imaging of prostatic carcinoma with the inversion-recovery sequence

The value of inversion-recovery (IR) sequences in the diagnosis and staging of prostatic carcinoma with magnetic resonance (MR) imaging was studied. Twenty-six patients with carcinoma of the prostate were imaged at 1.5 T with an endorectal surface coil and with a variety of IR sequences and a set of spin-echo (SE) sequences for comparison. Ex vivo prostate specimens were imaged again at the same field strength. The two images were correlated with histologic sections. Cancer was identified with MR imaging in 96% of patients. Of the tumors more than 4 mm in diameter, 87% were identified on T2-weighted SE images, whereas only 26% were identified on IR images. However, IR images may be more useful in local staging of carcinoma. Gross capsular infiltration was present in only two patients; however, it was detectable (and excluded in five other patients) by means of IR images. It was not detectable on SE images. The high quality of images obtained with the endorectal coil was confirmed. The authors conclude that addition of the IR sequence to MR imaging with the endorectal coil may improve the usefulness of this examination.     

COVID-19 vaccination simulating lymph node progression in a patient with prostate cancer

Several cases of cancer patients with 18-fluorodeoxyglucose (¹⁸FDG) Positron Emission Tomography/Computed Tomography (PET/CT) evidence of metabolically active axillary lymph nodes after COVID-19 vaccination have been described, creating a diagnostic dilemma and sometimes leading to further unnecessary examinations. A 62-year-old male, diagnosed with prostate cancer, treated with hormone-therapy and radiotherapy of the prostate 2 years before, underwent fluorine-18 choline (F-FCH) PET/CT for restaging purpose, less than 3 weeks after he had received the second dose of the Pfizer BioNTech-BNT162b2 mRNA COVID-19 vaccine. This exam showed an increased F-FCH uptake and an enlargement of the left axillary, paratracheal, para-aortic, subcarinal, and hilar bilateral lymph nodes. Fourteen weeks later, the patient underwent a new F-FCH PET-CT scan, displaying an almost complete regularization of the FCH uptake in all the previously involved regions. The patient was not treated after the first PET-CT scan, thus, the aforementioned PET/CT findings represented inflammatory vaccine-related lymph nodes. This case highlights the significance of knowing vaccination history to correctly interpret imaging findings and to avoid false-positive reports.     

Implementation of high-dose-rate brachytherapy for prostatic carcinoma in an unshielded operating room facility

PurposeThe purpose of the study was to describe our approach towards safe delivery of single-fraction high-dose-rate (HDR) brachytherapy (BT) boost in patients with prostate cancer in the setting of an unshielded operating room (OR).Methods and MaterialsA total of 95 patients received 15 Gy HDR BT boost. The procedure involved transrectal ultrasound–based catheter insertion and planning in the OR, after which the patient was moved to a shielded treatment room for radiation. This required three vital components: (1) an OR table capable of transporting the patient in lithotomy position, (2) robust motion management checks to ensure reproducibility of prostate and catheter positions in the treatment room before radiation delivery, (3) remote monitoring of patient vitals while under anesthesia, during the radiation. Initial viability of this approach was confirmed by assessing acute toxicities using the Common Terminology Criteria for Adverse Events v4.0 and American Urologic Association symptom scores.ResultsWe found good stability in prostate and catheter position, with less than 1 mm shifts in each direction due to patient transfer. The median baseline American Urologic Association score was 7 (3–11), which increased to 12 (7–17) at 4 weeks and 9 (5–14) at 3 months (p = 0.003). Common Terminology Criteria for Adverse Events ≥ grade 2 genitourinary and gastrointestinal toxicities were experienced by 7% and 0% patients, respectively, at 3 months posttreatment completion.ConclusionsSingle-fraction HDR prostate BT can be delivered safely in an unshielded OR facility with a distant shielded treatment room using rigorous motion management checks and supplementary procedural equipment.     

MicroPET assessment of androgenic control of glucose and acetate uptake in the rat prostate and a prostate cancer tumor model

PET has been used to monitor changes in tumor metabolism in breast cancer following hormonal therapy. This study was undertaken to determine whether PET imaging could evaluate early metabolic changes in prostate tumor following androgen ablation therapy. Studies were performed comparing two positron-emitting tracers, ¹⁸F-FDG and ¹¹C-acetate, in Sprague-Dawley male rats to monitor metabolic changes in normal prostate tissue. Additional studies were performed in nude mice bearing the CWR22 androgen-dependent human prostate tumor to evaluate metabolic changes in prostate tumor. In rats, for the androgen ablation pretreatment, 1 mg diethylstilbestrol (DES) was injected subcutaneously 3 and 24 hours before tracer injection. For androgen pretreatment, 500 μg dihydrotestosterone (DHT) was injected intraperitoneally 2 and 6 hours before tracer injection. The rats were divided into three groups, Group A (no-DES, no-DHT, N = 18), Group B (DES, no-DHT, N = 18) and Group C (DES, DHT, N = 18). In each group, 10 animals received ¹⁸F-FDG, whereas the remaining eight animals were administered ¹¹C-acetate. Rats were sacrificed at 120 min post-injection of ¹⁸F-FDG or 30 min post-injection of ¹¹C-acetate. Pretreatment of the mouse model using DHT (200 μg of DHT in 0.1 mL of sunflower seed oil) or DES (200 μg of DES in 0.1 mL of sunflower seed oil) was conducted every 2 days for one week. Mice were imaged with both tracers in the microPET scanner (Concorde Microsystems Inc.). DES treatment caused a decrease in acetate and glucose metabolism in the rat prostate. Co-treatment with DHT maintained the glucose metabolism levels at baseline values. In the tumor bearing mice, similar effects were seen in ¹⁸F-FDG study, while there was no significant difference in ¹¹C-acetate uptake. These results indicate that changes in serum testosterone levels influence ¹⁸F-FDG uptake in the prostate gland, which is closely tied to glucose metabolism, within 24 hours of treatment and in the prostate tumor within 1 week. These early metabolic changes could enable monitoring metabolic changes in prostate tumor following treatment by imaging using ¹⁸F-FDG PET. Further studies are needed to clarify the reason for the insensitivity of ¹¹C-acetate for measuring metabolic change in prostate tumor.     

Magnetic resonance spectroscopic imaging of benign prostatic tissue: findings at 3.0 T compared to 1.5 T-initial experience

In a retrospective study of 71 voxels of benign peripheral zone tissue from 3 men who underwent endorectal magnetic resonance (MR) spectroscopic imaging of the prostate at both 1.5 and 3 T, 21 voxels that appeared more malignant at 3 T to either of two readers demonstrated significantly higher levels of choline and polyamines at 3 T compared to 1.5 T using a Wilcoxon ranked-sum test; awareness of this selective amplification of these metabolic signals at high field strength may help avoid overdiagnosis of prostate cancer.     

Gd-DTPA MRI增强对前列腺癌的诊断价值

目的　评价Gd DTPA磁共振增强对前列腺癌的诊断价值。资料与方法　回顾性分析经手术病理证实的前列腺癌患者 33例 ,术前均行快速自旋回波序列横断位平扫T2 WI、T1 WI及增强T1 WI横断、冠状、矢状位成像。将增强后T1 WI分别与T2 WI及平扫T1 WI对照 ,比较肿瘤定位及范围的显示、肿瘤穿破包膜及精囊腺受侵犯的显示情况。结果　与平扫T1 WI比较 ,T1 WI增强对肿瘤定位及范围的显示、肿瘤穿破包膜及精囊腺受侵犯的显示能力有提高 (P <0 .0 5 ) ,但总体优势不如T2 WI。结论　Gd DTPA磁共振增强对观察某些前列腺癌患者的肿瘤定位及范围、肿瘤穿破包膜及精囊腺受侵犯的情况有一定的帮助     

Positron emission tomographic findings in a tuberculous brain abscess

Several case reports and studies have described the positron emission tomographic (PET) findings of intracranial tuberculomas and bacterial brain abscesses. However, to our knowledge, the PET pattern of a tuberculous brain abscess has not been previously described. We report the case of a diabetic heavy drinker with a left parietal tuberculous abscess. ¹⁸F-fluoro-2-deoxyglucose (FDG)-PET scans showed intense FDG uptake at the abscess periphery, where contrast enhancement was observed on a magnetic resonance image. FDG uptake was reduced within the abscess cavity and in the adjacent cerebral cortex. The possibility of a tuberculous brain abscess should be considered when FDG accumulates at the periphery of a ring-enhancing lesion in a chronically ill or immunocompromised patient.