[en] To evaluate the safety and effectiveness of the combined photoselective vaporization of the prostate (PVP) and bipolar transurethral resection of the prostate (TURP) in high-risk symptomatic patients with large prostates. Between January 2007 and January 2010, a prospective study was performed in Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, China. One hundred and one patients presenting with various kinds of systematic diseases, and with an American Society of Anesthesiologists score of 3 or greater underwent PVP plus bipolar TURP for severe lower urinary tract symptoms due to benign prostatic hyperplasia with prostatic volume greater than 80 ml. The International Prostate Symptom Score (IPSS) and quality-of-life questionnaire (IPPS-QoL), maximum flow rates (Qmax), postvoid urine residues (PVR), and MRI prostatic volumes were recorded. Perioperative data, functional outcome, and complications were evaluated. Patients were reassessed at 3, 6, and 12 months. The mean operation time was 68.5 +/- 23.9 minutes. The mean pre- and post- operative prostate volumes were 102.2+/-33.1 ml and 40.4+/-15.6 ml. No severe complications were observed. Significant differences in IPSS, Qmax, and PVR values were recorded within the follow-up period. The results of our study show that PVP plus bipolar TURP have an excellent efficiency and low morbidity in high-risk patients with large prostates (Author).

[en] A 38-year-old male patient presented with symptoms of bladder outflow obstruction. Rectal palpation revealed a giant prostate. Sonography only confirmed the enlarged prostate. Magnetic resonance imaging showed, on both T1- and T2-weighted sequences, a large, inhomogenously hypointense, encapsulated prostate tumor encompassing the entire prostate. No capsular penetration or seminal vesicle invasion was seen. Transurethral biopsy of the prostate was performed. Histology demonstrated a prostate metastasis of colorectal carcinoma. (orig.)

[en] A novel fluence map optimization model incorporating leaf sequencing constraints is proposed to overcome the drawbacks of the current objective inside smoothing models. Instead of adding a smoothing item to the objective function, we add the total number of monitor unit (TNMU) requirement directly to the constraints which serves as an important factor to balance the fluence map optimization and leaf sequencing optimization process at the same time. Consequently, we formulate the fluence map optimization models for the trailing (left) leaf synchronized, leading (right) leaf synchronized and the interleaf motion constrained non-synchronized leaf sweeping schemes, respectively. In those schemes, the leaves are all swept unidirectionally from left to right. Each of those models is turned into a linear constrained quadratic programming model which can be solved effectively by the interior point method. Those new models are evaluated with two publicly available clinical treatment datasets including a head-neck case and a prostate case. As shown by the empirical results, our models perform much better in comparison with two recently emerged smoothing models (the total variance smoothing model and the quadratic smoothing model). For all three leaf sweeping schemes, our objective dose deviation functions increase much slower than those in the above two smoothing models with respect to the decreasing of the TNMU. While keeping plans in the similar conformity level, our new models gain much better performance on reducing TNMU.

[en] Objective: To determine the limits for the amount of tunical fluid enough to be termed as hydrocele by using extended-field of view US technology and to define hydrocele for the first time with standard numerical criteria. Methods: A total of 60 patients were evaluated in this prospective study. Group 1 consisted of 20 patients with unilateral clinical hydrocele. Group 2 included 20 patients referred for scrotal US for reasons other than hydrocele. Group 3 comprised 20 male controls with no scrotal complaints. Testis volume (V_t), scrotum volume (V_s) and V_t/V_s ratio were calculated for each subject by dimensions measured in longitudinal and tranverse planes. Results: Mean V_t/V_s ratio was 0.28 ± 0.17 (range, 0.07-0.57), 0.69 ± 0.08 (range, 0.53-0.80) and 0.71 ± 0.07 (range, 0.61-0.85) for groups 1, 2 and 3, respectively. Mean V_t/V_s for group 1 was significantly lower than those for groups 2 and 3, respectively (p < 0.001 for each). Based on the ROC curve analysis, 0.55 for V_t/V_s ratio was determined as the optimal cut-off point below which the US diagnosis of hydrocele could be made (sensitivity 95.0% and specificity 97.5%). Conclusions: We propose a novel US parameter of V_t/V_s ratio below 0.55 for a standard distinction between hydrocele and physiological amount of scrotal fluid

[en] We realized a device called aileron which receives the bound grains after cut from a needle of transfer in the classic tip and to align the axis of this last one with the axis of the needle implanted Mick. Guaranteeing besides a better radiation protection, this aileron allowed us to find very low rates of irradiation of our personal dosemeters at least comparable to the rates previously raised in the exclusive free gains technique. (N.C.)

[en] Interfraction prostate motion must be compensated by increased safety margins. If filling status of rectum and bladder is constant, motion should be reduced. We attempted to reduce interfraction motion errors by proper patient instruction. In 38 patients pairs of radio-opaque fiducial markers were implanted prior to definitive radiotherapy. Patients were positioned either according to skin marks or infrared body marker. We measured prostate displacement, i.e. pelvic bones versus intraprostatic marker position, via ExacTrac (two orthogonal radiographies) in 1252 fractions. Systematic and random setup and displacement errors were determined and safety margins estimated. In our study interfraction prostate displacement is < 1 mm in RL direction, and < 2 mm in AP and SI direction. Systematic errors are slightly below random errors (< 1.5 mm). Positioning according skin marks results in higher inaccuracies of ±1.5 – 2 mm in RL and ±2 – 2.5 mm in AP/SI direction. In case of appropriate patient instructions (constant organ filling) the positioning via bone fusion requires CTV-PTV margins of 2 mm in RL, 4 mm in AP, and 5 mm in SI direction. Studies without any description of patient instruction found much higher margins of > 1 cm in AP and SI direction

[en] Reduced expression of both classical and desmosomal cadherins has been associated with different types of carcinomas, including prostate cancer. This study aims to provide a comprehensive view of the role and regulation of cell–cell adhesion in prostate cancer aggressiveness by examining the functional implications of both E-cadherin and Desmoglein 2 (DSG2). E-cadherin expression was first examined using immunofluorescence in 50 normal prostate tissues and in a cohort of 414 prostate cancer patients. Correlation and survival analyses were performed to assess its clinical significance. In primary prostate cancer patients, reduced expression of both E-cadherin and DSG2 is significantly associated with an earlier biochemical recurrence. Transgenic DU145 E-cadherin knockdown and constitutively active AKT overexpression lines were generated. Functional implications of such genetic alterations were analyzed in vitro and in vivo, the latter by using tumorigenesis as well as extravasation and metastatic tumor formation assays. We observed that loss of E-cadherin leads to impaired primary and metastatic tumor formation in vivo, suggesting a tumor promoter role for E-cadherin in addition to its known role as a tumor suppressor. Activation of AKT leads to a significant reduction in E-cadherin expression and nuclear localization of Snail, suggesting a role for the PI3K/AKT signaling pathway in the transient repression of E-cadherin. This reduced expression may be regulated by separate mechanisms as neither the loss of E-cadherin nor activation of AKT significantly affected DSG2 expression. In conclusion, these findings illustrate the critical role of cell–cell adhesion in the progression to aggressive prostate cancer, through regulation by the PI3K pathway

[en] Taxoids are anti-cancer drugs frequently used to treat solid tumors, but they are sometimes ineffective and tumors may become resistant to their action. Here, we examined the involvement of sphingolipid metabolic enzymes in paclitaxel (PTX) resistance using a human prostate cancer cell line, PC3, and its PTX-resistant subline, PC3-PR. PTX (20 nM) suppressed cell proliferation and increased various ceramide species in PC3, but not PC3-PR, cells. PC3-PR contained higher S1P levels than did PC3, regardless of PTX treatment. Western blotting revealed that PC3-PR cells expressed higher levels of sphingosine kinase 1 (SPHK1) and glucosylceramide synthase (GCS) but lower levels of acid sphingomyelinase (ASMase) and neutral sphingomyelinase 2 than did PC3 cells. Inhibition of SPHK1 using siRNA or a pharmacological inhibitor decreased S1P levels in PC3-PR cells and inhibited proliferation in the presence or absence of PTX, suggesting that SPHK1 is at least partially responsible for PTX resistance. Similarly, GCS inhibitors (PDMP and PPMP) increased cellular ceramides and suppressed the proliferation of PC3-PR. However, inhibition of proteasome function or histone deacetylase activity increased SMase and ceramide levels and suppressed PC3-PR proliferation. These results suggest that modulation of metabolic enzyme expression and alteration of the sphingolipid rheostat protects cancer cells against PTX. - Highlights: • S1P levels are higher in paclitaxel-resistant PC3-PR cells than in PC3 cells. • SPHK1 and GCS expression is higher in PC3-PR cells than in PC3 cells. • ASMase and NSMase2 expression is lower in PC3-PR cells than in PC3 cells. • SPHK1 and GCS inhibition blocks proliferation and increases ceramides in PC3-PR cells. • MG132 and TSA induce ASMase and NSMase2 expression and increase cellular ceramides.

[en] Recent use of HDR has increased while planning has become more complex often necessitating 3D image-based planning. While many guidelines for the use of HDR exist, they have not kept pace with the increased complexity of 3D image-based planning. Furthermore, no comprehensive document exists to describe the wide variety of current HDR clinical indications. This educational session aims to summarize existing national and international guidelines for the safe implementation of an HDR program. A summary of HDR afterloaders available on the market and their existing applicators will be provided, with guidance on how to select the best fit for each institution’s needs. Finally, the use of checklists will be discussed as a means to implement a safe and efficient HDR program and as a method by which to verify the quality of an existing HDR program. This session will provide the perspective of expert HDR physicists as well as the perspective of a new HDR user. Learning Objectives: Summarize national and international safety and staffing guidelines for HDR implementation Discuss the process of afterloader and applicator selection for gynecologic, prostate, breast, interstitial, surface treatments Learn about the use of an audit checklist tool to measure of quality control of a new or existing HDR program Describe the evolving use of checklists within an HDR program

[en] Recent use of HDR has increased while planning has become more complex often necessitating 3D image-based planning. While many guidelines for the use of HDR exist, they have not kept pace with the increased complexity of 3D image-based planning. Furthermore, no comprehensive document exists to describe the wide variety of current HDR clinical indications. This educational session aims to summarize existing national and international guidelines for the safe implementation of an HDR program. A summary of HDR afterloaders available on the market and their existing applicators will be provided, with guidance on how to select the best fit for each institution’s needs. Finally, the use of checklists will be discussed as a means to implement a safe and efficient HDR program and as a method by which to verify the quality of an existing HDR program. This session will provide the perspective of expert HDR physicists as well as the perspective of a new HDR user. Learning Objectives: Summarize national and international safety and staffing guidelines for HDR implementation Discuss the process of afterloader and applicator selection for gynecologic, prostate, breast, interstitial, surface treatments Learn about the use of an audit checklist tool to measure of quality control of a new or existing HDR program Describe the evolving use of checklists within an HDR program