PURPOSE: Our goal was to compare cancer-specific mortality (CSM) rates between radical prostatectomy (RP) vs external beam radiotherapy (EBRT) in National Comprehensive Cancer Network© (NCCN©) high risk (HR) patients, as well as in Johns Hopkins University (JH) HR and very high risk (VHR) subgroups. MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2010-2016), we identified 24,407 NCCN HR patients, of whom 10,300 (42%) vs 14,107 (58%) patients qualified for JH HR vs VHR, respectively. Overall, 9,823 (40%) underwent RP vs 14,584 (60%) EBRT. Cumulative incidence plots and competing-risks regression addressed CSM after 1:1 propensity score matching (according to age, prostate specific antigen, clinical T and N stages, and biopsy Gleason score) between RP and EBRT patients. All analyses addressed the combined NCCN HR cohort, as well as in JH HR and JH VHR subgroups. RESULTS: In the combined NCCN HR cohort 5-year CSM rates were 2.3% for RP vs 4.1% for EBRT and yielded a multivariate hazard ratio of 0.68 (95% CI 0.54-0.86, p <0.001) favoring RP. In VHR patients 5-year CSM rates were 3.5% for RP vs 6.0% for EBRT, yielding a multivariate hazard ratio of 0.58 (95% CI 0.44-0.77, p <0.001) favoring RP. Conversely, in HR patients no significant difference was recorded between RP vs EBRT (HR 0.7, 95% CI 0.39-1.25, p=0.2). CONCLUSIONS: Our data suggest that RP holds a CSM advantage over EBRT in the combined NCCN HR cohort, and in its subgroup of JH VHR patients.

• MeSH
• analýza přežití MeSH
• brachyterapie statistika a číselné údaje   MeSH
• hodnocení rizik statistika a číselné údaje   MeSH
• kalikreiny krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory prostaty krev   diagnóza   mortalita   terapie   MeSH
• program SEER MeSH
• prostata patologie   účinky záření   chirurgie   MeSH
• prostatektomie statistika a číselné údaje   MeSH
• prostatický specifický antigen krev   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• staging nádorů MeSH
• stupeň nádoru MeSH
• tendenční skóre MeSH
• věkové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

PURPOSE: Although the Prostate Imaging-Reporting and Data System™ version 2 (PI-RADS™ v2) is a reliable diagnostic tool for significant prostate cancer, less is known about the prognostic significance of the structured reporting scheme for estimating oncologic outcomes after treatment. We aimed to synthesize the available evidence regarding the association of PI-RADS v2 score and risk of biochemical recurrence (BCR) among patients undergoing primary definitive treatment for prostate cancer. MATERIALS AND METHODS: We systematically queried the PubMed® and Web of Science™ databases to identify studies addressing the association between the PI-RADS v2 and treatment outcomes. We included studies through November 2020 that assessed the independent prognostic significance of PI-RADS v2. After assessing risk of bias and quality, we conducted a formal meta-analysis to estimate the pooled effects of prostate magnetic resonance imaging (MRI) classification on the risk of BCR. RESULTS: We identified 9 and 7 eligible studies including 2,274 and 1,215 patients for the systematic review and meta-analysis, respectively. Eight were conducted in the context of radical prostatectomy and 1 post-radiation. Among patients treated with radical prostatectomy, higher PI-RADS v2 scores were significantly associated with risk of BCR (pooled HR 3.06, 95% CI 2.16-4.33; p <0.01). There was no significant heterogeneity among studies. For all studies, PI-RADS v2 score remained significantly associated with BCR (pooled HR 3.19, 95% CI 2.28-4.45; p <0.01). CONCLUSIONS: Prostate MRI findings assessed with the PI-RADS v2 classification were independently associated with risk of BCR after definitive local therapy, primarily based on data from radical prostatectomy. These findings support the prognostic significance of MRI, in addition to its role in prostate cancer diagnosis.

• MeSH
• brachyterapie MeSH
• hodnocení rizik metody   MeSH
• kalikreiny krev   MeSH
• lidé MeSH
• lokální recidiva nádoru krev   diagnóza   epidemiologie   prevence a kontrola   MeSH
• magnetická rezonanční tomografie * MeSH
• nádory prostaty krev   diagnóza   epidemiologie   terapie   MeSH
• prognóza MeSH
• prostata diagnostické zobrazování   účinky záření   chirurgie   MeSH
• prostatektomie MeSH
• prostatický specifický antigen krev   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

INTRODUCTION: Extreme hypofractionated radiotherapy for prostate cancer is a common modality in photon therapy. Pencil beam scanning (PBS) in similar fractionation allows better dose distribution and makes proton therapy more available for such patients. The purpose of this study is the feasibility of extreme proton hypofractionated radiotherapy and publication of early clinical results. METHODS: Two hundred patients with early-stage prostate cancer were treated with IMPT (intensity-modulated proton therapy), extreme hypofractionated schedule (36.25 GyE in five fractions) between February 2013 and December 2015. Mean age of the patients was 64.3 years, and the mean value of prostate-specific antigen (PSA) before treatment was 6.83 μg/L (0.6-17.3 μg/L). Ninety-three patients (46.5%) were in the low-risk group. One hundred and seven patients (53.5%) were in the intermediate-risk group. Twenty-nine patients (14.5%) had neoadjuvant hormonal therapy, and no patients had adjuvant hormonal therapy. Acute toxicity, late toxicity and short-term results were evaluated. RESULTS: All patients finished radiotherapy without interruptions. The median follow-up time was 36 months. The mean treatment time was 9.5 days (median 9 days). Acute toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0 was (gastrointestinal toxicity) GI (grade) G1-17%, G2-3.5%; (genitourinary toxicity) GU G1-40%, G2-19%; and no G3 toxicity was observed. Late toxicity was GI G1-19%, G2-5.5%; GU G1-17%, G2-4%; and no G3 toxicity was observed. PSA relapse was observed in one patient (1.08%) in the low-risk group (pelvic lymph node involvement was detected) and in seven patients (6.5%) in the intermediate-risk group (three lymph node metastases, two lymph node and bone metastases, two PSA relapses). No patient died of prostate cancer, and three patients died from other reasons. No local recurrence of cancer in the prostate was observed. CONCLUSIONS: Proton beam radiotherapy for prostate cancer is feasible with a low rate of acute toxicity and promising late toxicity and effectivity.

• MeSH
• celková dávka radioterapie MeSH
• hypofrakcionace při ozařování * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory prostaty radioterapie   MeSH
• prostata účinky záření   MeSH
• protonová terapie škodlivé účinky   metody   MeSH
• radiační poranění prevence a kontrola   MeSH
• studie proveditelnosti MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: BrachyView is a novel in-body imaging system which aims to provide LDR brachytherapy seeds position reconstruction within the prostate in real-time. The first prototype is presented in this study: the probe consists of a gamma camera featuring three single cone pinhole collimators embedded in a tungsten tube, above three, high resolution pixelated detectors (Timepix). METHODS: The prostate was imaged with a TRUS system using a sagittal crystal with a 2.5mm slice thickness. Eleven needles containing a total of thirty 0.508U(125)I seeds were implanted under ultrasound guidance. A CT scan was used to localise the seed positions, as well as provide a reference when performing the image co-registration between the BrachyView coordinate system and the TRUS coordinate system. An in-house visualisation software interface was developed to provide a quantitative 3D reconstructed prostate based on the TRUS images and co-registered with the LDR seeds in situ. A rigid body image registration was performed between the BrachyView and TRUS systems, with the BrachyView and CT-derived source locations compared. RESULTS: The reconstructed seed positions determined by the BrachyView probe showed a maximum discrepancy of 1.78mm, with 75% of the seeds reconstructed within 1mm of their nominal location. An accurate co-registration between the BrachyView and TRUS coordinate system was established. CONCLUSIONS: The BrachyView system has shown its ability to reconstruct all implanted LDR seeds within a tissue equivalent prostate gel phantom, providing both anatomical and seed position information in a single interface.

• MeSH
• brachyterapie přístrojové vybavení   MeSH
• celková dávka radioterapie MeSH
• dávka záření * MeSH
• fantomy radiodiagnostické * MeSH
• gely MeSH
• lidé MeSH
• nádory prostaty diagnostické zobrazování   radioterapie   MeSH
• počítačové zpracování obrazu MeSH
• prostata diagnostické zobrazování   účinky záření   MeSH
• radioterapie řízená obrazem přístrojové vybavení   MeSH
• rektum * MeSH
• ultrasonografie přístrojové vybavení   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The results of morphological ivestigation of prostate tissue after vaporization prostatectomy by Laser Dornier Medilas D UroBeam and transurethral prostate resection in patients with benigh prostatic hyperplasia is shown. We found that the successive use laser Dornier Medilas D Urobeam at power 175-250 W and transurethral resectionof prostate provides diminishing of area of coagulative necrosis which prevents formation of massive scab. At the same time the photoselective to haemoglobin as a result of vaporization draws coagulative necrosis of content of vessels in areas with unchanged stroma and prevents bleeding.

• Klíčová slova
• koagulační nekróza,
• MeSH
• cévy patologie   účinky záření   MeSH
• hyperplazie prostaty * patologie   terapie   chirurgie   MeSH
• laserová terapie * metody   MeSH
• lidé MeSH
• nekróza patologie   MeSH
• prostata * chirurgie   patologie   účinky záření   MeSH
• Check Tag
• lidé MeSH

Úspěšnost radioterapie (RT) karcinomu prostaty můžeme hodnotit pomocí sledování prostatického specifického antigenu (PSA). Další možnost poskytuje biopsie prostaty pod ultrasonografickou kontrolou s časovým odstupem od RT. Otázkou zůstává význam tohoto vyšetření v klinické praxi. Histologické nálezy po RT karcinomu prostaty získáme buď ze systematické biopsie prostaty s časovým odstupem po ozáření nebo z materiálu po záchranné radikální prostatektomii („salvage“ radikální prostatektomii – SRP) po RT nebo z endoresekátu po transuretrální prostatektomii (TURP). Hodnocení histologických nálezů patologem je značně obtížné, ozářená tkáň postupně prochází morfologickými změnami, které jsou mnohdy nenápadné. V tomto terénu ani přítomnost karcinomu neznamená s jistotou přítomnost vitální nádorové tkáně. Změny od pozitivního nálezu karcinomu k nálezu negativnímu jsou postupné, i pozitivní histologický nález se s časovým odstupem může stát negativním. V rámci sledování, zda radioterapie eradikovala celý nádor či nikoliv, zůstává tedy nejpřínosnější vyšetření PSA a vyšetření per rectum (digital rectal examination – DRE). Pokud nezvažujeme indikaci SRP, biopsie prostaty dle této rešerše není indikována. Biopsie prostaty má přínos v predikci rizika progrese onemocnění před SRP. Významnou prediktivní úlohu z hlediska prognózy ve vzorcích po SRP má stanovení DNA ploidity a Gleasonova skóre (GS).

The effectiveness of radiation therapy can be evaluated by monitoring the PSA level. Another option given to us is an ultrasound guided prostate needle biopsy after radiotherapy with a time delay from radiotherapy. This work deals with an issue of clinical significance of these histological findings. Histological specimens after radiotherapy can be obtained by the systemic biopsy with time delay from radiotherapy, from the salvage prostatectomy specimen or transurethral prostatectomy. Evaluation of these findings is quite difficult. Irradiated tissue undergoes continuous morphological changes that are partially inconspicuous. The presence of prostate carcinoma in these specimen cannot confirm the vital tumor tissue with certainty. Even positive histological finding can later convert to negative. PSA level and digital rectal exam remains the best ways to follow up the patient after radiotherapy. If we do not consider the indication of salvage radical prostatectomy (SRP), we do not need to indicate the prostate biopsy. Nevertheless, the prostate biopsy is helpful in prediction of disease progression before SRP. Evaluation of DNA ploidity and Gleason Score has significant predictive power after salvage prostatectomy.

• Klíčová slova
• PSA, salvage prostatektomie,
• MeSH
• adenokarcinom epidemiologie   mortalita   terapie   MeSH
• adjuvantní radioterapie statistika a číselné údaje   trendy   MeSH
• biopsie metody   statistika a číselné údaje   trendy   MeSH
• brachyterapie statistika a číselné údaje   trendy   MeSH
• celková dávka radioterapie MeSH
• histologické techniky metody   MeSH
• lidé MeSH
• lokální recidiva nádoru diagnóza   MeSH
• nádory prostaty patologie   radioterapie   MeSH
• prognóza MeSH
• prostata účinky záření   MeSH
• prostatický specifický antigen krev   MeSH
• radioterapie metody   MeSH
• staging nádorů metody   MeSH
• výsledek terapie MeSH
• záchranná terapie metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• přehledy MeSH

Purpose: This study aimed to evaluate prostate volume changes and prostate motions during radiotherapy.Methods: In 2010, twenty-five patients were treated for prostate cancer by external beam radiotherapy with implanted fiducial markers. Coordinates of three gold markers on kilovoltage images were calculated daily. Volume changes in target structure were observed through changes in intermarker distances. Differences in patient position between laser-tattoo alignment and gold marker localization were evaluated. Intrafraction motion was assessed by measuring marker displacement on kilovoltage images acquired before and after fraction delivery. Results: Prostate shrinkage was observed in 60% of patients. The average shrinkage was 7% of the prostate’s initial volume. Corrections after laser-tattoo alignment remained mostly below 1 cm. The difference between marker centroid position on the actual images and the planning images was 2 ± 1 mm on average. The extension of intrafraction movements was 7.6 ± 0.2 mm on average. Conclusions: In our retrospective study, the possibility for prostate volume changes during radiotherapy was revealed. Intrafraction movements turned out to be the limiting factor in safety margin reduction.

• MeSH
• lidé MeSH
• nádory prostaty radiografie   radioterapie   MeSH
• plánování radioterapie pomocí počítače MeSH
• počítačová rentgenová tomografie MeSH
• polohování pacienta MeSH
• prostata patologie   radiografie   účinky záření   MeSH
• velikost orgánu účinky záření   MeSH
• zaměřovací značky pro radioterapii MeSH
• zlato MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

PURPOSE: To compare acute and late toxicity after three-dimensional conformal radiotherapy to the prostate to 74 Gy (3D-CRT) with intensity-modulated radiotherapy to 78 Gy (IMRT 78) and IMRT using simultaneous integrated boost to 82 Gy (IMRT/SIB 82). PATIENTS AND METHODS: 94 patients treated with 3D-CRT to the prostate and base of seminal vesicles to 74 Gy represented the first group. The second group consisted of 138 patients subjected to IMRT covering the prostate and base of seminal vesicles to 78 Gy. The last group was treated with IMRT using SIB. The prescribed doses were 82 Gy and 73.8 Gy in 42 fractions to the prostate and seminal vesicles. Late toxicity was prospectively scored according to the RTOG/FC-LENT scale. RESULTS: Acute gastrointestinal toxicity >or= grade 2 occurred in 35.1% of patients treated with 3D-CRT, in 16% subjected to IMRT 78, and in 7.7% receiving IMRT/SIB 82. Acute genitourinary toxicity >or= grade 2 was observed in 26.6% (3D-CRT), 33% (IMRT 78), and 30.7% (IMRT/SIB 82). At 3 years, the estimated cumulative incidence of grade 3 late gastrointestinal toxicity was 14% for 3D-CRT, 5% for IMRT 78, and 2% for IMRT/SIB 82. The difference became significant (log rank p = 0.02). The estimated cumulative incidence of grade 3 late genitourinary toxicity was 9% (3D-CRT), 7% (IMRT 78), and 6% (IMRT/SIB 82) without statistical differences (log rank p = 0.32) CONCLUSION: SIB enables dose escalation up to 82 Gy with a lower rate of gastrointestinal toxicity grade 3 in comparison with 3D-CRT up to 74 Gy.

• MeSH
• akutní nemoc MeSH
• frakcionace dávky záření MeSH
• gastrointestinální nemoci epidemiologie   etiologie   MeSH
• gastrointestinální trakt účinky záření   MeSH
• incidence MeSH
• kombinovaná terapie MeSH
• konformní radioterapie škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské urogenitální nemoci epidemiologie   etiologie   MeSH
• nádory prostaty patologie   radioterapie   MeSH
• následné studie MeSH
• prospektivní studie MeSH
• prostata účinky záření   MeSH
• průřezové studie MeSH
• radiační poranění epidemiologie   etiologie   MeSH
• radioterapie s modulovanou intenzitou metody   MeSH
• rizikové faktory MeSH
• semenné váčky účinky záření   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů MeSH
• urogenitální systém účinky záření   MeSH
• vztah dávky záření a odpovědi MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND AND PURPOSE: The shrinking effect of androgen deprivation therapy (ADT) on prostate volume is a known finding, but data on volume changes during radiotherapy are inconsistent. We examined patients with and without ADT undergoing intensity modulated radiotherapy (IMRT) and performed follow-up examinations to study volume changes before and after radiotherapy.

• MeSH
• antagonisté androgenů terapeutické užití   MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• následné studie MeSH
• prostata patologie   účinky léků   účinky záření   MeSH
• radioterapie s modulovanou intenzitou metody   MeSH
• velikost orgánu MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH

• MeSH
• kontrastní látky * diagnostické užití   MeSH
• lidé MeSH
• nádory prostaty * radioterapie   MeSH
• odchylka pozorovatele MeSH
• postura těla MeSH
• prostata * účinky záření   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH