Innovative Sonographie beim Prostatakarzinom

Zusammenfassung Zur Früherkennung und Stadieneinteilung des Prostatakarzinoms wird heutzutage fast ausschließlich die sog. systematische Mehrfachbiopsie eingesetzt. Hierbei tritt das bildgebende Verfahren – der transrektale Ultraschall – als Diagnostikum mehr und mehr in den Hintergrund und dient fast ausschließlich zur Führung der Biopsienadel in spezifische anatomische Regionen. Doch selbst bei multiplen systematischen Biopsien wird eine hohe Zahl klinisch signifikanter Karzinome übersehen. Diese Tatsache hat zu einer drastischen Steigerung der Anzahl von Gewebeproben geführt. So finden sich Zentren, in denen 6, 10, 12, ja bis zu 143 Gewebeproben in einer Sitzung entnommen werden. Diese immer invasivere heterogene Vorgehensweise bestätigt den Bedarf an Verbesserung in der Ultraschalldiagnostik. Neue und innovative bildgebende Verfahren in der Prostatasonographie werden vorgestellt mit dem Ziel, die diagnostische Aussagekraft bei Erstdiagnose sowie in der Stadienvorhersage zu verbessern. Eine verbesserte Bildgebung bei Diagnosestellung und in der Stadieneinteilung würde zu einer erheblichen Verbesserung bei den Therapieentscheidungen führen.Dieser Beitrag ist dem kürzlich verstorbenen Pathologen J. E. McNeal gewidmet, der die zonale Anatomie der Prostata erstbeschrieben hat.     

累及移行带前列腺癌的诊断分析

目的分析累及移行带前列腺癌的临床特征,提高移行带前列腺癌的诊断率。方法回顾我院收治的77例前列腺癌患者,一组44例仅限于外周带;另一组33例已累及移行带。分析两组的临床表现、直肠指检、移行指数、前列腺移行带特异性抗原密度、前列腺特异性抗原、经直肠前列腺超声以及前列腺穿刺活检。结果两组患者的年龄、排尿期和储尿期症状、直肠指检阳性率、移行指数、前列腺移行带特异性抗原密度、前列腺特异性抗原以及病理分级没有显著性差异。移行带肿瘤存在泌尿系转移的风险。经直肠超声为移行带可疑病灶的定位提供了重要的参考,而对可疑病灶穿刺活检则能提高累及移行带前列腺癌的诊断率。结论经直肠超声行移行带可疑病灶的穿刺活检是诊断累及移行带前列腺癌的有效手段。     

A comparison of treatment planning techniques for low-dose-rate (LDR) prostate brachytherapy

PurposeThe purpose of this study was to compare low-dose-rate prostate brachytherapy treatment plans created using three retrospectively applied planning techniques with plans delivered to patients.Methods and MaterialsTreatment plans were created retrospectively on transrectal ultrasound (TRUS) scans for 26 patients. The technique dubbed 4D Brachytherapy was applied, using TRUS and MRI to obtain prostatic measurements required for the associated webBXT online nomogram. Using a patient's MRI scan to create a treatment plan involving loose seeds was also explored. Plans delivered to patients were made using an intraoperative loose seed TRUS-based planning technique. Prostate V₁₀₀ (%), prostate V₁₅₀ (%), prostate D₉₀ (Gy), rectum D_0.1cc (Gy), rectum D_2cc (Gy), urethra D₁₀ (%), urethra D₃₀ (%), and prostate volumes were measured for each patient. Statistical analysis was used to assess and compare plans.ResultsProstate volumes measured by TRUS and MRI were significantly different. Prostate volumes calculated by the webBXT online nomogram using TRUS- and MRI-based measurements were not significantly different. Compared with delivered plans, TRUS-based 4D Brachytherapy plans showed significantly lower rectum D_0.1cc (Gy) values, MRI-based 4D Brachytherapy plans showed significantly higher prostate V₁₀₀ (%) values and significantly lower rectum D_0.1cc (Gy), urethra D₁₀ (%), and urethra D₃₀ (%) values, and loose seed MRI-based plans showed significantly lower prostate V₁₀₀ (%), prostate D₉₀ (Gy), rectum D_0.1cc (Gy), rectum D_2cc (Gy), urethra D₁₀ (%), and urethra D₃₀ (%) values.ConclusionsTRUS-based 4D Brachytherapy plans showed similar dosimetry to delivered plans; rectal dosimetry was superior. MRI can be integrated into the 4D Brachytherapy workflow. The webBXT online nomogram overestimates the required number of seeds.     

Derivation of in vivo source tracking error thresholds for TRUS-based HDR prostate brachytherapy through simulation of source positioning errors

PurposeThe purpose of this study was to simulate treatment planning source positioning errors in transrectal ultrasound–based real-time high-dose-rate prostate brachytherapy treatments and determine appropriate in vivo source tracking error thresholds.Methods and MaterialsTreatment planning source positioning errors were simulated for 20 patient plans in the brachytherapy treatment planning system by manually adjusting the dwell position coordinates within selected catheters without plan reoptimization. The change in dose-volume histogram (DVH) indices was calculated as a function of the source positioning error. The magnitude of the change in the DVH indices was then used to derive appropriate in vivo source tracking error thresholds.ResultsSource positioning error thresholds to prevent potentially significant changes in prostate (target) DVH metrics ranged from 2 to 5 mm, dependent on the direction of the source positioning error, as well as the relative weight of the dwell position within the plan, and its position relative to the patient anatomy. Source positioning error thresholds to prevent potentially clinically significant changes in organ at risk DVH metrics were found to be complex and patient-dependent.ConclusionsIn vivo source tracking error thresholds for transrectal ultrasound–based real-time high-dose-rate prostate brachytherapy were investigated via the simulation of treatment planning source positioning errors. These error thresholds were found to be dependent not only on the direction of the error, but also on the endpoint. There is still the potential for larger changes in DVH indices to occur for catheter shifts smaller than the proposed threshold levels in this study.     

经直肠超声检查前列腺增生症的优势及其特异性参数的临床价值

目的判定经直肠超声检查前列腺增生(PH)的优势并分析各项参数的临床价值。方法选取2017年8月至2020年8月在延边大学附属医院泌尿外科进行PH手术治疗的患者120例作为研究对象,所有患者术前均行經廈墮(TAS)和经直肠(TRUS)两种超声检查,术中测量前列腺实际大小并结合病理诊断,比较并分析两种检查方式的不同。结果TRUS检出率为90.83%,高于TAS的75.83%,差异有统计学意义(P<005)。TRUS检查上下、前后及左右各径线的结果与术中测量结果比较,差异无统计学意义(P>0.05);TAS检查上下、前后及左右各径线的结果与术中测量结果比较,差异有统计学意义(P<0.05);患者年龄与TPV .TZV .121存在相关性(P<0.05),其中TZH的相关性最明显(P<0.01)。结论TRUS比TAS对PH患者的检出率更高,测量结果更准确,能够提供更多的有效信息。TRUS测定的特异參数与患者年龄的增长呈正相关,其中移行带指数(TZH)的相关性最为显著。     

Transrectal ultrasound biopsy of the prostate: does it still have a role in prostate cancer diagnosis?

Transrectal ultrasound (TRUS) guided biopsy of the prostate has been a standard diagnostic approach for prostate cancer over the past thirty years. Today, the role of TRUS biopsy is being challenged by transperineal (TP) prostate biopsy due to concerns over the safety and diagnostic yield of TRUS biopsy. TRUS biopsy still offers a convenient, reliable and accessible tool for diagnosing prostate cancer in the majority of patients. It continues to play a role in prostate cancer diagnosis, especially where hospital resource allocation is limited, including the public sector. TRUS biopsy has low rates of severe complications, although there remains room for improvement in current practice to improve the tolerability and reduce the incidence of post-biopsy infection.     

A patient with seminal vesiculitis prior to acute chlamydial epididymitis

This is the first report of a case of seminal vesiculitis prior to acute chlamydial epididymitis. At the first visit to the clinic, the patient wished to check whether he had Chlamydia trachomatis in his genital tract, because his wife had been diagnosed as having chlamydial cervicitis. He had no specific symptoms at that time; however, transrectal ultrasonograpy (TRUS) revealed swelling of seminal vesicles, which suggested the presence of seminal vesiculitis. Two days after the first visit, he had high-grade fever and was diagnosed as having acute epididymitis caused by C. trachomatis. We had previously reported that seminal vesiculitis was always complicated with acute epididymitis, so this case could provide important evidence that seminal vesiculitis might precede acute epididymitis. It suggested that acute epididymitis could be affected by seminal vesiculitis via the retrograde transmission route.     

Role of ultrasound in the assessment of male infertility

The use of ultrasonography has become an important component in the evaluation and treatment of male reproductive tract disorders. From the use of color flow Doppler ultrasonography for the assessment of varicoceles to transrectal ultrasonography combined with seminal vesiculography for the evaluation of ejaculatory duct obstruction, ultrasonography has practical clinical applications. In this article, the authors review the indications and use of ultrasonography in the assessment and treatment of the infertile male. The recent advances in diagnostic transrectal ultrasonography for ejaculatory duct obstruction, in particular, are emphasized. © 1996 John Wiley & Sons, Inc.     

MRI-based preplanning in low-dose-rate prostate brachytherapy

PURPOSE: To compare the dosimetric results between MRI-based and TRUS-based preplanning in permanent prostate brachytherapy, and to estimate the accuracy of MRI-based preplanning by comparing with CT/MRI fusion-based postimplant dosimetry. METHODS AND MATERIALS: Twenty-one patients were entered in this prospective study with written informed consent. MRI-based and TRUS-based preplanning were performed. The seed and needle locations were identical according to MRI-based and TRUS-based preplanning. MRI-based and TRUS-based preplanning were compared using DVH-related parameters. Following brachytherapy, the accuracy of the MRI-based preplanning was evaluated by comparing it with CT/MRI fusion-based postimplant dosimetry. RESULTS: Mean MRI-based prostate volume was slightly underestimated (0.73 cc in mean volume) in comparison to TRUS-based volume. There were no significant differences in the mean DVH-related parameters except with rectal V(100)(cc) between TRUS-based and MRI-based preplanning. Mean rectal V(100)(cc) was 0.74 cc in TRUS-based and 0.29 cc in MRI-based preplanning, respectively, and the values demonstrated a statistical difference. There was no statistical difference in mean rectal V(150)(cc), and rectal V(100)(cc) between MRI-based preplanning and CT/MRI fusion-based postimplant dosimetry. CONCLUSION: Prostate volume estimation and DVH-related parameters in MRI-based preplanning were almost identical to TRUS-based preplanning. From the results of CT/MRI fusion-based postimplant dosimetry, MRI-based preplanning was therefore found to be a reliable and useful modality, as well as being helpful for TRUS-based preplanning. MRI-based preplanning can more accurately predict postimplant rectal dose than TRUS-based preplanning.