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Geboers B, Meijer D, Counter W, Blazevski A, Thompson J, Doan P, Gondoputro W, Katelaris A, Haynes AM, Delprado W, O'Neill G, Yuen C, Vis AN, van Leeuwen PJ, Ho B, Liu V, Lee J, Donswijk ML, Oprea-Lager D, Scheltema MJ, Emmett L, Stricker PD. Prostate-specific membrane antigen positron emission tomography in addition to multiparametric magnetic resonance imaging and biopsies to select prostate cancer patients for focal therapy. BJU Int 2024; 133 Suppl 4:14-22. [PMID: 37858931 DOI: 10.1111/bju.16207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To evaluate the additional value of prostate-specific membrane antigen positron emission tomography (PSMA-PET) to conventional diagnostic tools to select patients for hemi-ablative focal therapy (FT). PATIENTS AND METHODS We performed a retrospective analysis on a multicentre cohort (private and institutional) of 138 patients who underwent multiparametric magnetic resonance imaging (mpMRI), PSMA-PET, and systematic biopsies prior to radical prostatectomy between January 2011 and July 2021. Patients were eligible when they met the consensus criteria for FT: PSA <15 ng/mL, clinical/radiological T stage ≤T2b, and International Society of Urological Pathology (ISUP) grade 2-3. Clinically significant prostate cancer (csPCa) was defined as ISUP grade ≥2, extracapsular extension >0.5 mm or seminal vesicle involvement at final histopathology. The diagnostic accuracy of mpMRI, systematic biopsies and PSMA-PET for csPCa (separate and combined) was calculated within a four-quadrant prostate model by receiver-operating characteristic and 2 × 2 contingency analysis. Additionally, we assessed whether the diagnostic tools correctly identified patients suitable for hemi-ablative FT. RESULTS In total 552 prostate quadrants were analysed and 272 (49%) contained csPCa on final histopathology. The area under the curve, sensitivity, specificity, positive predictive value and negative predictive value for csPCa were 0.79, 75%, 83%, 81% and 77%, respectively, for combined mpMRI and systematic biopsies, and improved after addition of PSMA-PET to 0.84, 87%, 80%, 81% and 86%, respectively (P < 0.001). On final histopathology 46/138 patients (33%) were not suitable for hemi-ablative FT. Addition of PSMA-PET correctly identified 26/46 (57%) non-suitable patients and resulted in 4/138 (3%) false-positive exclusions. CONCLUSIONS Addition of PSMA-PET to the conventional work-up by mpMRI and systematic biopsies could improve selection for hemi-ablative FT and guide exclusion of patients for whom whole-gland treatments might be a more suitable treatment option.
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Affiliation(s)
- Bart Geboers
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
- Department of Radiology and Nuclear Medicine, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Dennie Meijer
- Department of Urology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - William Counter
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
| | - James Thompson
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
- Department of Urology, St. George Hospital, Sydney, NSW, Australia
| | - Paul Doan
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
| | - William Gondoputro
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
| | - Athos Katelaris
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
| | | | - Gordon O'Neill
- Department of Urology, St. Vincent's Hospital and Private Clinic, Sydney, NSW, Australia
| | - Carlo Yuen
- Department of Urology, St. Vincent's Hospital and Private Clinic, Sydney, NSW, Australia
| | - Andre N Vis
- Department of Urology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bao Ho
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Victor Liu
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Jonathan Lee
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Maarten L Donswijk
- Department of Radiology and Nuclear Medicine, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniela Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Sydney, NSW, Australia
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
- Department of Urology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Phillip D Stricker
- St. Vincent's Prostate Cancer Research Centre, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Hospital and Private Clinic, Sydney, NSW, Australia
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2
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Spisak S, Chen D, Likasitwatanakul P, Doan P, Li Z, Bala P, Vizkeleti L, Tisza V, De Silva P, Giannakis M, Wolpin B, Qi J, Sethi NS. Identifying regulators of aberrant stem cell and differentiation activity in colorectal cancer using a dual endogenous reporter system. Nat Commun 2024; 15:2230. [PMID: 38472198 PMCID: PMC10933491 DOI: 10.1038/s41467-024-46285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Aberrant stem cell-like activity and impaired differentiation are central to the development of colorectal cancer (CRC). To identify functional mediators of these key cellular programs, we engineer a dual endogenous reporter system by genome-editing the SOX9 and KRT20 loci of human CRC cell lines to express fluorescent reporters, broadcasting aberrant stem cell-like and differentiation activity, respectively. By applying a CRISPR screen targeting 78 epigenetic regulators with 542 sgRNAs to this platform, we identify factors that contribute to stem cell-like activity and differentiation in CRC. Perturbation single cell RNA sequencing (Perturb-seq) of validated hits nominate SMARCB1 of the BAF complex (also known as SWI/SNF) as a negative regulator of differentiation across an array of neoplastic colon models. SMARCB1 is a dependency and required for in vivo growth of human CRC models. These studies highlight the utility of biologically designed endogenous reporter platforms to uncover regulators with therapeutic potential.
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Affiliation(s)
- Sandor Spisak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Institute of Molecular Life Sciences, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
| | - David Chen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Pornlada Likasitwatanakul
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paul Doan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
| | - Zhixin Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
| | - Pratyusha Bala
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
| | - Laura Vizkeleti
- Department of Bioinformatics, Faculty of Medicine, Semmelweis University, 1094, Budapest, Hungary
| | - Viktoria Tisza
- Institute of Molecular Life Sciences, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
| | - Pushpamali De Silva
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Marios Giannakis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brian Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jun Qi
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nilay S Sethi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA.
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA.
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Spisak S, Chen D, Likasitwatanakul P, Doan P, Li Z, Bala P, Vizkeleti L, Tisza V, De Silva P, Giannakis M, Wolpin B, Qi J, Sethi NS. Utilizing a dual endogenous reporter system to identify functional regulators of aberrant stem cell and differentiation activity in colorectal cancer. bioRxiv 2024:2023.06.21.545895. [PMID: 38293113 PMCID: PMC10827082 DOI: 10.1101/2023.06.21.545895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Aberrant stem cell-like activity and impaired differentiation are central to the development of colorectal cancer (CRC). To identify functional mediators that regulate these key cellular programs in CRC, we developed an endogenous reporter system by genome-editing human CRC cell lines with knock-in fluorescent reporters at the SOX9 and KRT20 locus to report aberrant stem cell-like activity and differentiation, respectively, and then performed pooled genetic perturbation screens. Constructing a dual reporter system that simultaneously monitored aberrant stem cell-like and differentiation activity in the same CRC cell line improved our signal to noise discrimination. Using a focused-library CRISPR screen targeting 78 epigenetic regulators with 542 sgRNAs, we identified factors that contribute to stem cell-like activity and differentiation in CRC. Perturbation single cell RNA sequencing (Perturb-seq) of validated hits nominated SMARCB1 of the BAF complex (also known as SWI/SNF) as a negative regulator of differentiation across an array of neoplastic colon models. SMARCB1 is a dependency in CRC and required for in vivo growth of human CRC models. These studies highlight the utility of a biologically designed endogenous reporter system to uncover novel therapeutic targets for drug development.
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Affiliation(s)
- Sandor Spisak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Institute of Enzymology, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
| | - David Chen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Pornlada Likasitwatanakul
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Paul Doan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
| | - Zhixin Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
| | - Pratyusha Bala
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
| | - Laura Vizkeleti
- Department of Bioinformatics, Faculty of Medicine, Semmelweis University, 1094 Budapest, Hungary
| | - Viktoria Tisza
- Institute of Enzymology, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
| | - Pushpamail De Silva
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Marios Giannakis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brian Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jun Qi
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nilay S. Sethi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard University, Cambridge, MA, USA
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
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Gondoputro W, Doan P, Katelaris A, Scheltema MJ, Geboers B, Agrawal S, Liu Z, Yaxley J, Savdie R, Rasiah K, Frydenberg M, Roberts MJ, Malouf D, Wong D, Shnier R, Delprado W, Emmett L, Stricker PD, Thompson J. 68Ga-PSMA-PET/CT in addition to mpMRI in men undergoing biopsy during active surveillance for low- to intermediate-risk prostate cancer: study protocol for a prospective cross-sectional study. Transl Androl Urol 2023; 12:1598-1606. [PMID: 37969779 PMCID: PMC10643393 DOI: 10.21037/tau-22-708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/13/2023] [Indexed: 11/17/2023] Open
Abstract
Background In active surveillance there is significant interest in whether imaging modalities such as multiparametric magnetic resonance imaging (mpMRI) or 68Gallium prostate-specific membrane antigen positron emission tomography/computerized tomography (68Ga-PSMA-PET/CT) can improve the detection of progression to clinically significant prostate cancer (csPCa) and thus reduce the frequency of prostate biopsies and associated morbidity. Recent studies have demonstrated the value of mpMRI in active surveillance; however, mpMRI does miss a proportion of disease progression and thus alone cannot replace biopsy. To date, prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown additive value to mpMRI in its ability to detect prostate cancer (PCa) in the primary diagnostic setting. Our objective is to evaluate the diagnostic utility of PSMA-PET to detect progression to csPCa in active surveillance patients. Methods We will perform a prospective, cross-sectional, partially blinded, multicentre clinical trial evaluating the additive value of PSMA-PET with mpMRI against saturation transperineal template prostate biopsy. Two hundred and twenty-five men will be recruited who have newly diagnosed PCa which is suitable for active surveillance. Following enrolment, patients will undergo a PSMA-PET and mpMRI within 3 months of a repeat 12-month confirmatory biopsy. Patients who remain on active surveillance after confirmatory biopsy will then be planned to have a further mpMRI and PSMA-PET prior to a repeat biopsy in 3-4 years. The primary outcome is to assess the ability of PSMA-PET to detect or exclude significant malignancy on repeat biopsy. Secondary outcomes include (I) assess the comparative diagnostic accuracies of mpMRI and PSMA-PET alone [sensitivity/specificity/negative predictive value (NPV)/positive predictive value (PPV)] to detect progression on biopsy based on predefined histologic criteria for progression; (II) comparison of index lesion identification by template biopsies vs. MRI targeted lesions vs. PSMA targeted lesions; (III) evaluation of concordance of lesions identified on final histopathology and each imaging modality (PSMA-PET and/or mpMRI) in the subset of patients proceeding to RP. Discussion The results of this trial will define the role of PSMA-PET in active surveillance and potentially reduce the number of biopsies needed to detect progression to csPCa. Trial Registration The current trial was registered with the ANZCTR on the 3/2/2022 with the trial ID ACTRN12622000188730, it is accessible at https://www.anzctr.org.au/.
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Affiliation(s)
- William Gondoputro
- St Vincent’s Prostate Cancer Research Centre, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Paul Doan
- St Vincent’s Prostate Cancer Research Centre, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Athos Katelaris
- St Vincent’s Prostate Cancer Research Centre, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Matthijs J. Scheltema
- St Vincent’s Prostate Cancer Research Centre, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Bart Geboers
- St Vincent’s Prostate Cancer Research Centre, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Shikha Agrawal
- St Vincent’s Prostate Cancer Research Centre, Sydney, Australia
- Department of Urology, St Vincent’s Private Hospital Sydney, Sydney, Australia
| | - Zhixin Liu
- St Vincent’s Prostate Cancer Research Centre, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - John Yaxley
- Department of Urology, Wesley Urology Clinic, Brisbane, Australia
| | - Richard Savdie
- Department of Urology, St Vincent’s Private Hospital Sydney, Sydney, Australia
- Department of Urology, Prince of Wales Hospital, Sydney, Australia
| | - Kris Rasiah
- Department of Urology, Royal North Shore Hospital, Sydney, Australia
| | - Mark Frydenberg
- Department of Urology, Cabrini Hospital Malvern, Melbourne, Australia
| | - Matthew J. Roberts
- Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - David Malouf
- Department of Urology, St George Hospital, Sydney, Australia
| | - David Wong
- I-MED Radiology Network, Sydney, Australia
| | - Ron Shnier
- I-MED Radiology Network, Sydney, Australia
| | | | - Louise Emmett
- Garvan Institute of Medical Research, Sydney, Australia
- Department of Theranostics and Nuclear Medicine, St Vincent’s Hospital Sydney, Sydney, Australia
| | - Phillip D. Stricker
- St Vincent’s Prostate Cancer Research Centre, Sydney, Australia
- Department of Urology, St Vincent’s Private Hospital Sydney, Sydney, Australia
| | - James Thompson
- St Vincent’s Prostate Cancer Research Centre, Sydney, Australia
- Department of Urology, St Vincent’s Private Hospital Sydney, Sydney, Australia
- Department of Urology, St George Hospital, Sydney, Australia
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Kelly BD, Ptasznik G, Roberts MJ, Doan P, Stricker P, Thompson J, Buteau J, Chen K, Alghazo O, O'Brien JS, Hofman MS, Frydenberg M, Lawrentschuk N, Lundon D, Murphy DG, Emmett L, Moon D. A Novel Risk Calculator Incorporating Clinical Parameters, Multiparametric Magnetic Resonance Imaging, and Prostate-Specific Membrane Antigen Positron Emission Tomography for Prostate Cancer Risk Stratification Before Transperineal Prostate Biopsy. EUR UROL SUPPL 2023; 53:90-97. [PMID: 37441340 PMCID: PMC10334234 DOI: 10.1016/j.euros.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 07/15/2023] Open
Abstract
Background Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) can detect multiparametric magnetic resonance imaging (mpMRI)-invisible prostate tumours and improve the sensitivity of detection of prostate cancer (PCa) in comparison to mpMRI alone. Numerous risk calculators have been validated as tools for stratification of men at risk of being diagnosed with clinically significant (cs)PCa. Objective To develop a novel risk calculator using clinical parameters and imaging parameters from mpMRI and PSMA PET/CT in a cohort of patients undergoing mpMRI and PSMA PET/CT before biopsy. Design setting and participants A total of 291 men from the PRIMARY prospective trial underwent mpMRI and PSMA PET/CT before transperineal prostate biopsy with sampling of systematic and targeted cores. Outcome measurements and statistical analysis Novel risk calculators were developed using multivariable logistic regression analysis to predict detection of overall PCa (International Society of Urological Pathology grade group [GG] ≥1) and csPCa (GG ≥2). The risk calculators were then compared with the European Randomised Study of Screening for Prostate Cancer risk calculator incorporating mpMRI (ERSPC-MRI). Resampling methods were used to evaluate the discrimination and calibration of the risk calculators and to perform decision curve analysis. Results and limitations Age, prostate-specific antigen, prostate volume, and mpMRI Prostate Imaging-Reporting and Data System scores were included in the MRI risk calculator, resulting in area under the receiver operating characteristic curve (AUC) values of 0.791 for overall PCa (GG ≥1) and 0.812 for csPCa (GG ≥2). Addition of the maximum standardised uptake value (SUVmax) on PSMA PET/CT for the prostate lesion, and of SUVmax for the mpMRI lesions for the MRI-PSMA risk calculator resulted in AUCs of 0.831 for overall PCa and 0.876 for csPCa (≥ISUP2).The ERSPC-MRI risk calculator had AUCs of 0.758 (p = 0.02) for overall PCa and 0.805 (p = 0.001) for csPCa. Both the MRI and MRI-PSMA risk calculators were superior to the ERSPC-MRI for both overall PCa and csPCa. Conclusions These novel risk calculators incorporate clinical and radiological parameters for stratification of men at risk of csPCa. The risk calculator including PSMA PET/CT data is superior to a calculator incorporating mpMRI data alone. Patient summary We evaluated a new risk calculator that uses clinical information and results from two types of scan to predict the risk of clinically significant prostate cancer on prostate biopsy. This risk model can guide patients and clinicians in shared decision-making and may help in avoiding unnecessary prostate biopsies.
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Affiliation(s)
- Brian D. Kelly
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Urology, Eastern Health, Melbourne, Australia
| | - Gideon Ptasznik
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Paul Doan
- Garvan Institute of Medical Research, Darlinghurst, Australia
| | | | | | - James Buteau
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging and Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer, Melbourne, Australia
| | - Kenneth Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Omar Alghazo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jonathan S. O'Brien
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael S. Hofman
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging and Prostate Cancer Theranostics and Imaging Centre of Excellence, Peter MacCallum Cancer, Melbourne, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University and Cabrini Institute, Cabrini Health, Melbourne, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Dara Lundon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Declan G. Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital Sydney, Darlinghurst, Australia
| | - Daniel Moon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Geboers B, Scheltema MJ, Blazevski A, Katelaris A, Doan P, Ali I, Agrawal S, Barreto D, Matthews J, Haynes AM, Delprado W, Shnier R, Thompson JE, Stricker PD. Median 4-year outcomes of salvage irreversible electroporation for localized radio-recurrent prostate cancer. BJU Int 2023; 131 Suppl 4:14-22. [PMID: 36594205 DOI: 10.1111/bju.15948] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate the safety, and short to mid-term oncological and quality-of-life (QoL) outcomes of focal irreversible electroporation (IRE) for radio-recurrent prostate cancer (PCa) at a median follow-up of 4 years. PATIENTS AND METHODS This was a single-centre series of men with biopsy-proven radio-recurrent PCa treated with IRE between December 2013 and February 2022, with a minimum follow-up of 6 months. Follow-up included magnetic resonance imaging at 6 months, and standard transperineal saturation template biopsies at 12 months. Further biopsies were guided by suspicion on serial imaging or prostate-specific antigen (PSA) levels. Validated questionnaires were used to measure functional outcomes. Significant local recurrence was defined as any International Society of Urological Pathology (ISUP) score ≥ 2 on biopsies. Progression-free survival was defined as no signs of local or systemic disease on either imaging or template biopsies, or according to the Phoenix criteria for biochemical recurrence. RESULTS Final analysis was performed on 74 men with radio-recurrent PCa (median age 69 years, median PSA level 5.4 ng/mL, 76% ISUP score 2/3). The median (range) follow-up was 48 (27-68) months. One rectal fistula occurred, and eight patients developed urethral sloughing that resolved with transurethral resection. Among patients who returned questionnaires (30/74, 41%), 93% (28/30) had preserved urinary continence and 23% (7/30) had sustained erectile function at 12-month follow-up. Local control was achieved in 57 patients (77%), who needed no further treatment. Biopsy diagnosed 41(55%) patients received follow up template biopsies, in-field recurrences occurred in 7% (3/41), and out-field recurrences occurred in 15% of patients (6/41). The metastasis-free survival rate was 91% (67/74), with a median (interquartile range) time to metastases of 8 (5-27) months. The Kaplan-Meier estimated 5-year progression-free survival rate was 60%. CONCLUSIONS These short- to mid-term safety, oncological and QoL outcome data endorse results from smaller series and show the ability of salvage focal IRE to safely achieve oncological control in patients with radio-recurrent PCa.
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Affiliation(s)
- Bart Geboers
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Athos Katelaris
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Paul Doan
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Imran Ali
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Daniela Barreto
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Jayne Matthews
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | | | | | - James E Thompson
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Phillip D Stricker
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
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7
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Doan P, Katelaris A, Scheltema MJ, Hayen A, Amin A, Siriwardana A, Tran M, Geboers B, Gondoputro W, Haynes AM, Matthews J, Delprado W, Stricker PD, Thompson J. The relationship between biochemical recurrence and number of lymph nodes removed during surgery for localized prostate cancer. BMC Urol 2023; 23:68. [PMID: 37118731 PMCID: PMC10148506 DOI: 10.1186/s12894-023-01228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/28/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE To assess whether completeness of pelvic lymph node dissection (PLND) as measured by lymph node yield reduces biochemical recurrence (BCR) in men undergoing radical prostatectomy (RP) for prostate cancer (PCa), stratified according to Briganti nomogram-derived risk (≥5% vs. < 5%) of lymph node invasion (LNI). METHODS Retrospective study of 3724 men who underwent RP between January 1995 and January 2015 from our prospectively collected institutional database. All men included had minimum five years follow-up and were not given androgen deprivation therapy or radiotherapy prior to BCR. Primary endpoint was time to BCR as defined by PSA > 0.2ng/ml. Patients were analysed according to Briganti Nomogram derived risk of 'low-risk' (< 5%) vs. 'high-risk' (≥ 5%). Extent of PLND was analysed using number of nodes yielded at dissection as a continuous variable as well as a categorical variable: Group 1 (limited, 1-4 nodes), Group 2 (intermediate, 5-8 nodes) and Group 3(extensive, ≥9 nodes). RESULTS Median follow-up in the overall cohort was 79.7 months and 65% of the total cohort underwent PLND. There were 2402 patients with Briganti risk of LNI < 5% and 1322 with a Briganti risk of LNI ≥5%. At multivariate analysis, only PSA (HR1.01, p < 0.001), extracapsular extension at RP (HR 1.86, p < 0.001), positive surgical margin (HR 1.61, p < 0.001) and positive lymph node on pathology (HR 1.52, p = 0.02) were independently associated with BCR. In the high-risk group, increased nodal yield at PLND was associated with reduction in risk of BCR (HR 0.97, 95%CI 0.95-1.00 p = 0.05, Cochran Mantel Haenszel test, p < 0.05: respectively). In the low-risk group increased number of nodes at PLND did not reduce risk of BCR. CONCLUSIONS In this study of extent of PLND at RP, higher nodal yield did not reduce risk of BCR in low-risk men (Briganti risk < 5%), however there was a weak benefit in terms of reduced long-term risk of BCR in high-risk men (Briganti risk ≥5%).
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Affiliation(s)
- Paul Doan
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia.
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia.
| | - Athos Katelaris
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Matthijs J Scheltema
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
- Departments of Urology and Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, University of Technology, Sydney, NSW, Australia
| | - Amer Amin
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Amila Siriwardana
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Minh Tran
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Bart Geboers
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
- Departments of Urology and Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - William Gondoputro
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Anne Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
| | - Jayne Matthews
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | | | - Phillip D Stricker
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - James Thompson
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, 384 Victoria St, 2010, NSW, Australia
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8
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Bala P, Rennhack JP, Aitymbayev D, Morris C, Moyer SM, Duronio GN, Doan P, Li Z, Liang X, Hornick JL, Yurgelun MB, Hahn WC, Sethi NS. Aberrant cell state plasticity mediated by developmental reprogramming precedes colorectal cancer initiation. Sci Adv 2023; 9:eadf0927. [PMID: 36989360 PMCID: PMC10058311 DOI: 10.1126/sciadv.adf0927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/28/2023] [Indexed: 05/12/2023]
Abstract
Cell state plasticity is carefully regulated in adult epithelia to prevent cancer. The aberrant expansion of the normally restricted capability for cell state plasticity in neoplasia is poorly defined. Using genetically engineered and carcinogen-induced mouse models of intestinal neoplasia, we observed that impaired differentiation is a conserved event preceding cancer development. Single-cell RNA sequencing (scRNA-seq) of premalignant lesions from mouse models and a patient with hereditary polyposis revealed that cancer initiates by adopting an aberrant transcriptional state characterized by regenerative activity, marked by Ly6a (Sca-1), and reactivation of fetal intestinal genes, including Tacstd2 (Trop2). Genetic inactivation of Sox9 prevented adenoma formation, obstructed the emergence of regenerative and fetal programs, and restored multilineage differentiation by scRNA-seq. Expanded chromatin accessibility at regeneration and fetal genes upon Apc inactivation was reduced by concomitant Sox9 suppression. These studies indicate that aberrant cell state plasticity mediated by unabated regenerative activity and developmental reprogramming precedes cancer development.
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Affiliation(s)
- Pratyusha Bala
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Jonathan P. Rennhack
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Daulet Aitymbayev
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Clare Morris
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sydney M. Moyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Gina N. Duronio
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul Doan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zhixin Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Xiaoyan Liang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jason L. Hornick
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Matthew B. Yurgelun
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastrointestinal Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - William C. Hahn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Nilay S. Sethi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
- Division of Gastrointestinal Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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9
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Scheltema MJ, Geboers B, Blazevski A, Doan P, Katelaris A, Agrawal S, Barreto D, Shnier R, Delprado W, Thompson JE, Stricker PD. Median 5-year outcomes of primary focal irreversible electroporation for localised prostate cancer. BJU Int 2022. [PMID: 36495481 DOI: 10.1111/bju.15946] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate longer-term oncological and functional outcomes of focal irreversible electroporation (IRE) as primary treatment for localised clinically significant prostate cancer (csPCa) at a median follow-up of 5 years (up to 10 years). PATIENTS AND METHODS All patients that underwent focal IRE as primary treatment for localised PCa between February 2013 and August 2021 with a minimum 12 months of follow-up were analysed. Follow-up included 6-month magnetic resonance imaging (MRI) and standardised transperineal saturation template ± targeted biopsies at 12 months, and further biopsies in the case of clinical suspicion on serial imaging and/or prostate-specific antigen (PSA) levels. Failure-free survival (FFS) was defined as no progression to radical treatment or nodal/distant disease. Local recurrence was defined as any International Society of Urological Pathology Grade of ≥2 on biopsy. RESULTS A total of 229 patients were analysed with a median (interquartile range [IQR]) follow-up of 60 (40-80) months. The median (IQR) age was 68 (64-74) years, the median (IQR) PSA level was 5.9 (4.1-8.2) ng/mL, and 86% harboured intermediate-risk disease and 7% high-risk disease. In all, 38 patients progressed to radical treatment (17%), at a median (IQR) of 35 (17-53) months after IRE. Kaplan-Meier FFS rates were 91% at 3 years, 84% at 5 years and 69% at 8 years. Metastasis-free survival was 99.6% (228/229), PCa-specific and overall survival were 100% (229/229). Residual csPCa was found in 24% (45/190) during follow-up biopsy and MRI showed a complete ablation in 82% (186/226). Short-term urinary continence was preserved (98%, three of 144 at baseline, 99%, one of 131 at 12 months) and erections sufficient for intercourse decreased by 13% compared to baseline (71% to 58%). CONCLUSION Longer-term follow-up confirms our earlier findings that focal IRE provides acceptable local and distant oncological control in selected men with less urinary and sexual toxicity than radical treatment. Long-term follow-up and external validation of these findings, is required to establish this new treatment paradigm as a valid treatment option.
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Affiliation(s)
- Matthijs J Scheltema
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.,Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Bart Geboers
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.,Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.,Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Paul Doan
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.,Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Athos Katelaris
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.,Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.,Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Daniela Barreto
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.,Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | | | | | - James E Thompson
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.,Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Phillip D Stricker
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia.,Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
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10
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Blazevski A, Geboers B, Scheltema MJ, Gondoputro W, Doan P, Katelaris A, Agrawal S, Baretto D, Matthews J, Haynes AM, Delprado W, Shnier R, van den Bos W, Thompson JE, Lawrentschuk N, Stricker PD. Salvage irreversible electroporation for radio-recurrent prostate cancer - the prospective FIRE trial. BJU Int 2022. [PMID: 36495482 DOI: 10.1111/bju.15947] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To prospectively assess the safety, functional- and oncological-outcomes of irreversible electroporation (IRE) as salvage therapy for radio-recurrent focal prostate cancer in a multicenter setting. PATIENTS AND METHODS Men with focal recurrent PCa after external beam radiation or brachytherapy without metastatic disease on staging imaging and co-registration between mpMRI and biopsies were prospectively included in this multicenter trial. Adverse events were reported following the Clavien-Dindo classification. Validated questionnaires were used for patient-reported functional outcomes. Follow-up consisted of 3 monthly prostate specific antigen (PSA) levels, a 6-month mpMRI and standardised transperineal template mapping biopsies at 12-months. Thereafter follow-up was guided by MRI and/or PSMA-PET/CT and PSA. Local recurrence was defined as any ISUP score ≥2 on biopsies. RESULTS 37 patients were analysed with a median (interquartile range (IQR)) follow up of 29 (22-43) months. Median age was 71 (53-83), median PSA was 3.5 ng/mL (2.7-6.1). 28 (75.5%) patients harboured intermediate risk and 9 patients (24.5%) high risk PCa. Seven patients (19%) reported self-limiting urgency, frequency, or hematuria (grade 1-2). Seven patients (19%) developed a grade 3 AE; urethral sludge requiring transurethral resection. At 12 months post treatment 93% of patients remained continent and erectile function sufficient for intercourse deteriorated from 35% to 15% (4/27). Local control was achieved in 29 patients (78%) and 27 patients (73%) were clear of local and systemic disease. Four (11%) patients had local recurrence only. Six (16%) patients developed metastatic disease with a median time to metastasis of 8 months. CONCLUSION The FIRE trial shows that salvage IRE after failed radiation therapy for localised PCa is safe with minimal toxicity, and promising functional and oncological outcomes. Salvage IRE can offer a possible solution for notoriously difficult to manage radio recurrent prostate tumours.
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Affiliation(s)
- Alexandar Blazevski
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Bart Geboers
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - William Gondoputro
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Paul Doan
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Athos Katelaris
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Daniela Baretto
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Jayne Matthews
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Warick Delprado
- Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
| | - Ron Shnier
- I-MED Radiology, Sydney, New South Wales, Australia
| | - Willemien van den Bos
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - James E Thompson
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Melbourne, Victoria, Australia
- EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, Victoria, Australia
| | - Phillip D Stricker
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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11
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Bala P, Rennhack JP, Morris C, Aitymbayev D, Moyer SM, Duronio GN, Doan P, Hahn WC, Sethi NS. Abstract B023: Sox9 drives an aberrant transcriptional program impeding intestinal differentiation in colorectal cancer initiation. Cancer Res 2022. [DOI: 10.1158/1538-7445.crc22-b023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Abstract
Despite the implementation of screening and preventative strategies, colorectal cancer (CRC) remains the second most deadly cancer worldwide and is responsible for an alarming trend of increasing prevalence among younger patients. Inappropriate WNT activation is the initiating step in sporadic CRC development, typically through deleterious mutations in the pathway negative regulator Adenomatous polyposis coli (APC). WNT pathway hinders whereas transforming growth factor (TGF-β)/bone morphogenetic protein (BMP) signaling supports differentiation of progenitors into mature enterocytes, establishing a crypt-villus gradient. Genomic alterations that dysregulate intestinal stem cell differentiation are central to CRC development. Impairment of differentiation and inappropriate Sox9 overexpression are conserved events in CRC initiation based on the evaluation of two genetically engineered mouse models, two carcinogen-induced mouse models, and a patient with familial adenomatous polyposis (FAP), a hereditary polyposis syndrome in which a mutant copy of APC is inherited. Single cell RNA-sequencing (scRNA-seq) of adenomas from an ApcKO mouse model and FAP sample implicates an aberrant stem cell-like program (herein referred to as AbSC) as a key aspect of CRC initiation. The AbSc program is characterized by selective intestinal stem cell activity, indiscriminate attenuation of differentiated lineages, and aberrant activation of genes associated with fetal intestinal development. Histopathology and scRNA-seq of adenomas and derivative organoids from a patient with FAP demonstrated a partial block in differentiation and confirmed reactivation of genes reserved for intestinal development. Assay for Transposase-Accessible Chromatin with high-throughput sequencing (ATAC-seq) of APCKO epithelial cells revealed increased chromatin accessibility at fetal intestinal genes. Genetic inactivation of Sox9 prevented adenoma formation in ApcKO mice and induced differentiation of ApcKO organoids, obstructing the emergence of the ApcKO transcriptional state, including reactivation of a fetal-like intestinal program, restored multi-lineage differentiation, and markedly reduced the gained chromatin accessibility at developmental genes in neoplasia. These studies indicate that an aberrant transcriptional state hindering intestinal differentiation mediated by Sox9 is an early conserved event in CRC and carry important implications for developing therapeutics directed at inducing intestinal differentiation.
Citation Format: Pratyusha Bala, Jonathan P. Rennhack, Clare Morris, Daulet Aitymbayev, Sydney M. Moyer, Gina Nicole Duronio, Paul Doan, William C. Hahn, Nilay S. Sethi. Sox9 drives an aberrant transcriptional program impeding intestinal differentiation in colorectal cancer initiation [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer; 2022 Oct 1-4; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;82(23 Suppl_1):Abstract nr B023.
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Affiliation(s)
| | | | | | | | | | | | - Paul Doan
- 1Dana-Farber Cancer Institute, Boston, MA,
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12
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Doan P, Counter W, Papa N, Sheehan‐Dare G, Ho B, Lee J, Liu V, Thompson JE, Agrawal S, Roberts MJ, Buteau J, Hofman MS, Moon D, Lawrentschuk N, Murphy D, Stricker PD, Emmett L. Synchronous versus independent reading of
PSMA‐PET
and
MRI
to improve diagnosis for prostate cancer. BJU Int 2022; 131:588-595. [PMID: 36371669 DOI: 10.1111/bju.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To identify whether synchronous reading of multiparametric magnetic resonance imaging (mpMRI) and 68 Ga-PSMA-11 positron emission tomography (PET)/computed tomography (prostate-specific membrane antigen [PSMA-PET]) images can improve diagnostic performance and certainty compared with mpMRI/PSMA-PET reported independently and synthesized, while also assessing concordance between imaging modalities and agreement with histopathology. METHODS This was a retrospective analysis of 100 patients randomly selected from the PRIMARY trial, a prospective Phase II multicentre imaging trial. Three dual-trained radiologist/nuclear medicine physicians re-reported the mpMRI and PSMA-PET both independently and synchronously for the same patients in random order, blinded to previous results. Diagnostic performance was assessed for mpMRI/PSMA-PET images read synchronously or independently and then synthesized. Agreement between imaging results and histopathology was examined. 'Concordance' between imaging modalities was defined as overlapping lesions. Reporting certainty was evaluated by the individual reporters for each modality. RESULTS International Society of Urological Pathology Grade Group ≥2 cancer was present in 60% of patients on biopsy. Synchronous reading of mpMRI/PSMA-PET increased sensitivity compared to mpMRI or PSMA-PET alone (93% vs 80% vs 88%, respectively), although specificity was not improved (63% vs 58% vs 78%, respectively). No significant difference in diagnostic performance was noted between mpMRI/PSMA-PET read synchronously and mpMRI or PSMA-PET reported independently and then synthesized. Most patients had concordant imaging (60%), while others had discordant lesions only (28%) or a mixture (concordant and discordant lesions; 12%). When mpMRI/PSMA-PET findings were concordant and positive, 95% of patients had clinically significant prostate cancer (csPCa). When PSMA-PET alone was compared to synchronous PSMA-PET/MRI reads, there was an improvement in reader certainty in 20% of scans. CONCLUSION Synchronous mpMRI/PSMA-PET reading improves reader certainty and sensitivity for csPCa compared to mpMRI or PSMA-PET alone. However, synthesizing the results of independently read PSMA-PET and mpMRI reports provided similar diagnostic performance to synchronous PSMA-PET/MRI reads. This may provide greater flexibility for urologists in terms of referral patterns, reducing healthcare system costs and improving efficiencies in prostate cancer diagnosis.
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Affiliation(s)
- Paul Doan
- Garvan Institute of Medical Research Sydney Australia
- St Vincent's Prostate Cancer Research Centre Australia
| | - William Counter
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney Australia
| | - Nathan Papa
- School of Public Health and Preventive Medicine Monash University Australia
| | - Gemma Sheehan‐Dare
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney Australia
| | - Bao Ho
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney Australia
| | - Jonathan Lee
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney Australia
| | - Victor Liu
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney Australia
| | - James E Thompson
- St Vincent's Prostate Cancer Research Centre Australia
- St Vincent's Private Hospital Sydney Australia
| | - Shikha Agrawal
- St Vincent's Prostate Cancer Research Centre Australia
- St Vincent's Private Hospital Sydney Australia
| | - Matthew J Roberts
- Royal Brisbane and Women's Hospital, Brisbane; University of Queensland Centre for Clinical Research, Faculty of Medicine Brisbane Australia
| | - James Buteau
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC); Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Melbourne Australia
| | - Michael S Hofman
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC); Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Melbourne Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Australia
| | - Daniel Moon
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Nathan Lawrentschuk
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Declan Murphy
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Phillip D Stricker
- St Vincent's Prostate Cancer Research Centre Australia
- St Vincent's Private Hospital Sydney Australia
| | - Louise Emmett
- Garvan Institute of Medical Research Sydney Australia
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney Australia
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Geboers B, Gondoputro W, Thompson JE, Reesink DJ, van Riel LAMJG, Zhang D, Blazevski A, Doan P, Agrawal S, Matthews J, Haynes AM, Liu Z, Delprado W, Shnier R, de Reijke TM, Lawrentschuk N, Stijns PEF, Yaxley JW, Scheltema MJ, Stricker PD. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Detect Residual Prostate Cancer Following Irreversible Electroporation-A Multicenter Validation Study. Eur Urol Focus 2022; 8:1591-1598. [PMID: 35577751 DOI: 10.1016/j.euf.2022.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/15/2022] [Accepted: 04/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Accurate monitoring following focal treatment of prostate cancer (PCa) is paramount for timely salvage treatment or retreatment. OBJECTIVE To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) to detect residual PCa in the short-term follow-up of focal treatment with irreversible electroporation (IRE) using transperineal or transrectal template ± targeted biopsies. DESIGN, SETTING, AND PARTICIPANTS A retrospective international multicenter study of men with biopsy-proven PCa, treated with focal IRE, and followed by mpMRI (index-test) and template biopsies (reference-test) between February 2013 and January 2021, was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI were calculated for in- and outfield residual disease based on two definitions of significant PCa: University College London (UCL) 1-International Society of Urological Pathology (ISUP) ≥3 or ISUP ≥1 with maximum cancer core length (MCCL) ≥6 mm, and UCL2-ISUP ≥2 or ISUP ≥1 with MCCL ≥4 mm. RESULTS AND LIMITATIONS A total of 303 patients from five focal therapy centers were treated with primary IRE. The final analysis was performed on 217 men (median age 67, median prostate-specific antigen 6.2, 81% ISUP 2/3) who underwent both mpMRI and template biopsies. Multiparametric MRI missed 38/57 (67%) positive biopsy locations (UCL1) in 22 patients. Sensitivity, specificity, PPV, and NPV of mpMRI to detect whole gland residual disease (UCL1) were 43.6% (95% confidence interval [CI]: 28-59), 80.9% (95% CI: 75-86), 33.3% (95% CI: 21-47), and 86.7% (95% CI: 81-91), respectively. Based on UCL2, sensitivity, specificity, PPV, and NPV were 35.8% (95% CI: 25-48), 82.0% (95% CI: 75-88), 47.1% (95% CI: 34-61), and 74.1% (95% CI: 67-80), respectively. Limitations are the retrospective nature and short follow-up. CONCLUSIONS The diagnostic accuracy of mpMRI to detect residual clinically significant PCa following IRE was low. Follow-up template biopsies should be performed, regardless of mpMRI results. PATIENT SUMMARY We investigated the accuracy of magnetic resonance imaging (MRI) to detect residual prostate cancer after treatment with irreversible electroporation. The accuracy of MRI is insufficient, and we emphasize the importance of confirmatory prostate biopsies.
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Affiliation(s)
- Bart Geboers
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location VUmc), Free University, Amsterdam, The Netherlands.
| | - William Gondoputro
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - James E Thompson
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Daan J Reesink
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Luigi A M J G van Riel
- Department of Urology, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network The Netherlands, Amsterdam, The Netherlands
| | - David Zhang
- Department of Urology, E.J. Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Paul Doan
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Jayne Matthews
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
| | - Zhixin Liu
- Department of Biostatistics, University of New South Wales, NSW, Australia
| | | | | | - Theo M de Reijke
- Department of Urology, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Nathan Lawrentschuk
- Department of Urology, E.J. Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC, Australia
| | - Pascal E F Stijns
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - John W Yaxley
- Department of Urology, The Wesley Hospital, Brisbane, QLD, Australia
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network The Netherlands, Amsterdam, The Netherlands
| | - Phillip D Stricker
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
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Gondoputro W, Scheltema MJ, Blazevski A, Doan P, Thompson JE, Amin A, Geboers B, Agrawal S, Siriwardana A, Van Leeuwen PJ, van Oosterom MN, Van Leeuwen FW, Emmett L, Stricker PD. Robot-Assisted Prostate-Specific Membrane Antigen-Radioguided Surgery in Primary Diagnosed Prostate Cancer. J Nucl Med 2022; 63:1659-1664. [PMID: 35241483 PMCID: PMC9635675 DOI: 10.2967/jnumed.121.263743] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/17/2022] [Indexed: 01/20/2023] Open
Abstract
The objective of this study was to evaluate the safety and feasibility of 99mTc-based prostate-specific membrane antigen (PSMA) robot-assisted-radioguided surgery to aid or improve the intraoperative detection of lymph node metastases during primary robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa). Methods: Men with primary high-risk PCa (≥ cT3a, International Society of Urological Pathology (ISUP) grade group ≥ 3 or prostate-specific antigen of ≥ 15 ng/mL) with potential lymph node metastasis (Briganti nomogram risk > 10% or on preoperative imaging) were enrolled in the study. Patients underwent staging 68Ga-PSMA PET/CT scanning. Preoperatively, a 99mTc-labeled PSMA ligand (99mTc PSMA I&S; 500 MBq) was administered followed by SPECT/CT. A RARP including extended pelvic lymph node dissection was performed, with intraoperative tracing of PSMA-avid tissues using a prototype DROP-IN γ-probe. Resected specimens were also measured ex vivo. Histopathologic concordance with probe findings was evaluated. A radiotracer count of ≥ 1.5 times the background reference (in vivo), and ≥ 10 (absolute count) in the ex vivo setting, was considered positive. Results: Twelve patients were included (median age, 68 y, and prostate-specific antigen, 9.15 ng/mL). Most of the patients harbored ISUP 5 PCa (75%) and had avid lymph nodes on preoperative PSMA PET (64%). The DROP-IN probe aided resection of PSMA-avid (out-of-template) lymph nodes and residual disease at the prostate bed. Eleven metastatic lymph nodes were identified by the probe that were not observed on preoperative 68Ga-PSMA PET/CT. Of the 74 extraprostatic tissue specimens that were resected, 22 (29.7%) contained PCa. The sensitivity, specificity, positive predictive value, and negative predictive value of inpatient use of the γ-probe were 76% (95% CI, 53%-92%), 69% (95% CI, 55%-81%), 50%, and 88%, respectively. Ex vivo, the diagnostic accuracy was superior: 76% (95% CI, 53%-92%), 96% (95% CI, 87%-99%), 89%, and 91%, respectively, for sensitivity, specificity, positive predictive value, and negative predictive value. Of the missed lymph nodes in vivo (n = 5) and ex vivo (n = 5), 90% were micrometastasis (≤3 mm). No complications greater than Clavien-Dindo Grade I occurred. Conclusion: Robot-assisted 99mTc-based PSMA-radioguided surgery is feasible and safe in the primary setting, optimizing the detection of nodal metastases at the time of RARP and extended pelvic lymph node dissection. Further improvement of the detector technology may optimize the capabilities of robot-assisted 99mTc-based PSMA-radioguided surgery.
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Affiliation(s)
- William Gondoputro
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Matthijs J. Scheltema
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia
| | - Alexander Blazevski
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Paul Doan
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - James E. Thompson
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Amer Amin
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Bart Geboers
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Amila Siriwardana
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia
| | - Pim J. Van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - Matthias N. van Oosterom
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands;,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, The Netherlands; and
| | - Fijs W.B. Van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands;,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, The Netherlands; and
| | - Louise Emmett
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia;,Department of Theranostics and Nuclear Medicine, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia
| | - Phillip D. Stricker
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
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Geboers B, Gondoputro W, Thompson J, Reesink D, Van Riel L, Zhang D, Blazevski A, Doan P, Agrawal S, Mathews J, Haynes AM, Liu Z, Delprado W, Shnier R, De Reijke T, Lawrentschuk N, Stijns P, Yaxley J, Scheltema M, Stricker P. Multicenter validation of the diagnostic accuracy of multiparametric magnetic resonance imaging to detect residual prostate cancer in the follow-up of focal therapy with irreversible electroporation. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Doan P, Graham P, Lahoud J, Remmers S, Roobol MJ, Kim L, Patel MI. A comparison of prostate cancer prediction models in men undergoing both magnetic resonance imaging and transperineal biopsy: Are the models still relevant? BJU Int 2021; 128 Suppl 3:36-44. [PMID: 34374190 DOI: 10.1111/bju.15554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To externally validate and compare the performance of the European Randomized Study of Screening for Prostate Cancer risk calculator 3/4 (ERSPC-RC3/4), the Prostate Biopsy Collaborative Group risk calculator (PBCG-RC) and the van Leeuwen model to determine which prediction model would perform the best in a contemporary Australian cohort undergoing transperineal (TP) biopsy. MATERIALS AND METHODS A retrospective review identified all patients undergoing TP biopsy across two centres. Of the 797 patients identified, 373 had the data required to test all three risk calculators. The probability of high-grade prostate cancer, defined as International Society of Urological Pathology Grade Group >1, was calculated for each patient. For each prediction model discrimination was assessed using area under the receiver-operating characteristic curve (AUC), calibration using numerical and graphical summaries, and net benefit using decision curve analysis. RESULTS Assessment of model discrimination for detecting high-grade prostate cancer showed AUCs of 0.79 (95% confidence interval [CI] 0.74-0.84) for the ERSPC-RC3/4, 0.81 (95% CI 0.77-0.86) for the van Leeuwen model, and 0.68 (95% CI 0.63-0.74) for the PBCG-RC, compared to 0.58 (95% CI 0.52-0.65) for prostate-specific antigen alone. The ERSPC-RC3/4 was the best calibrated in the moderate-risk range of 10-40%, whilst the van Leeuwen model was the best calibrated in the low-risk range of 0-10%. The van Leeuwen model demonstrated the greatest net benefit from 10% risk onwards, followed closely by the ERSPC-RC3/4 and then the PBCG-RC. CONCLUSION The ERPSC-RC3/4 demonstrated good performance and was comparable to the van Leeuwen model with regard to discrimination, calibration and net benefit for an Australian population undergoing TP prostate biopsy. It is one of the most accessible risk calculators with an easy-to-use online platform, therefore, we recommend that Australian urologists use the ERSPC-RC3/4 to predict risk in the clinical setting.
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Affiliation(s)
- Paul Doan
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | - Petra Graham
- Macquarie Business School, Macquarie University, Sydney, NSW, Australia
| | - John Lahoud
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia
| | | | | | - Lawrence Kim
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia.,Specialty of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Westmead, NSW, Australia.,Specialty of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Lahoud J, Doan P, Kim L, Patel MI. Perilesional Biopsies Increase Detection of Significant Prostate Cancer in Men with PI-RADS 4/5 Lesions: Validation of the PI-RADS Steering Committee Recommendation. Eur Urol 2021; 80:260-261. [PMID: 33593652 DOI: 10.1016/j.eururo.2021.01.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022]
Affiliation(s)
- John Lahoud
- Department of Urology, Westmead Hospital, Westmead, Australia
| | - Paul Doan
- Department of Urology, Westmead Hospital, Westmead, Australia
| | - Lawrence Kim
- Department of Urology, Westmead Hospital, Westmead, Australia; Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Westmead, Australia; Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia.
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Doan P, Lahoud J, Kim L, Patel MI. Identifying prostate cancer in men with non-suspicious multi-parametric magnetic resonance imaging of the prostate. ANZ J Surg 2021; 91:578-583. [PMID: 33475230 DOI: 10.1111/ans.16583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/30/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND To formulate clinical pathways for identifying clinically significant prostate cancer (csPC) and avoiding insignificant prostate cancer (isPC) in those without suspicious regions of interest on multi-parametric magnetic resonance imaging (mpMRI) of the prostate. METHODS A retrospective review identified patients with negative mpMRI who underwent subsequent transperineal prostate biopsy across two centres. Patient characteristics and association with biopsy results were evaluated using univariate and multivariate regression analyses. RESULTS A total of 144 patients were identified as having negative mpMRI and undergoing subsequent transperineal prostate biopsy; 18% (25/144) of the cohort were found to have csPC. Logistic regression analysis failed to identify statistically significant predictive factors. In this cohort, if all patients with prostate-specific antigen > 3.0 were biopsied the least amount of csPC is missed, at 20% (5/25) however all isPC would be diagnosed. The least amount of isPC is diagnosed with a biopsy threshold of >15% from the European Randomized Study of Screening for Prostate Cancer calculator with 20% (5/25) of isPC diagnoses made however only 10.5% (2/19) csPC would be diagnosed. A biopsy threshold of >5% risk reduces the number of csPC missed to 37% (7/19) however increases isPC diagnoses to 54% (13/24) of the population. CONCLUSION False-negative rates of prostate MRI for csPC are significant within our cohort at 18%. The decision to biopsy should be made in conjunction with a risk profile acceptable by the patient and clinician. The current study demonstrates that there is a need to balance the risk of missing csPC and harm of diagnosing isPC.
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Affiliation(s)
- Paul Doan
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia
| | - John Lahoud
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lawrence Kim
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Lahoud J, Doan P, Kim LH, Patel MI. Transperineal systematic biopsies in addition to targeted biopsies are important in the detection of clinically significant prostate cancer. ANZ J Surg 2021; 91:584-589. [PMID: 33400371 DOI: 10.1111/ans.16524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study aimed to determine whether the addition of transperineal systematic biopsies (SB) to targeted biopsies (TB) improved clinically significant prostate cancer (csPC) detection rates without high increase in insignificant prostate cancer detection rates in an Australian population. METHODS In this retrospective review, a total of 254 patients who had a Prostate Imaging-Reporting and Data System score between 3 and 5, and a transperineal TB and SB between 2014 and 2019 from two centres were included in this study. The primary outcome of this study was to determine csPC rates on TB and SB. The secondary outcome was a comparison of the Gleason Grade Group between TB and SB. csPC was defined as an International Society of Urological Pathology Gleason Grade Group of 2 or greater. RESULTS SB alone detected more csPC overall compared to TB (152/254 (60%) versus 128/254 (51%), respectively). An additional 40 of 254 (16%) csPC cases were diagnosed with the addition of SB. Furthermore, the cost of diagnosing insignificant prostate cancer by SB when TB were negative was an additional 13/254 (5.1%). CONCLUSION A combination of TB and SB provides the best outcomes for detecting csPC and is especially warranted for patients with a higher Prostate Imaging-Reporting and Data System score on multiparametric magnetic resonance imaging.
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Affiliation(s)
- John Lahoud
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Paul Doan
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Lawrence H Kim
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Bhoopathy V, Doan P, Smith G. Outcome reporting in bladder exstrophy – a systematic review, and proposal of reporting template. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kamimura A, Al-Obaydi S, Nguyen H, Trinh H, Mo W, Doan P, Franchek-Roa K. Intimate partner violence education for medical students in the USA, Vietnam and China. Public Health 2015; 129:1452-8. [DOI: 10.1016/j.puhe.2015.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 12/21/2014] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
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Himburg H, Daher P, Russell L, Doan P, Quarmyne M, Meadows S, Herradon G, Chao N, Chute J. Pleiotrophin Signaling Is Necessary for Hematopoietic Stem Cell Self Renewal and Is Regulated by the Bone Marrow Microenvironment. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Himburg H, Daher P, Meadows S, Russell J, Doan P, Chao N, Chute J. Systemic Administration Of Pleiotrophin Induces Hematopoietic Stem Cell (HSC) Regeneration in vivo. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Doan P, Gasparetto C, Chute J, Horwitz M, Rizzieri D, Sullivan K, Edwards J, Jacobson R, Corbet K, Chao N, Long G. Long Term Survival Following High Dose Sequential Chemotherapy With Autologous Hematopoietic Cell Rescue For Multiple Myeloma. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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LaChance-Galang KJ, Doan P, Clarke MJ, Rao U, Yamano A, Hoffman BM. EPR and NMR Spectra as Probes of Spin-Density Distributions in Heterocyclic Ligands Coordinated in trans-[L(Im)(NH3)4RuIII]: Crystal Structure of trans-[(Im)2(NH3)4Ru]Cl3.cntdot.H2O. J Am Chem Soc 2002. [DOI: 10.1021/ja00117a022] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Previously, we have shown that inhibition of the glycine site associated with the N-methyl-D-aspartate (NMDA) receptor is another viable approach to blocking morphine tolerance. In the present study, we sought to investigate the involvement of the NMDA receptor/glycine site in kappa-opioid receptor-mediated antinociception and tolerance in CD-1 mice. In antinociception studies, mice were injected with 5-nitro-6,7-dimethyl-1,4-dihydro-2, 3-quinoxalinedione (ACEA-1328), a systemically bioavailable NMDA receptor/glycine site antagonist, or the vehicle (Bis-Tris, 0.2 M) and then immediately with trans-(+/-)-3, 4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl)-cyclohexyl]-benzeneacetamid e methanesulfonate (U50,488H), a kappa-opioid receptor agonist. Thirty minutes later, mice were tested for changes in nociceptive responses in the tail flick assay. ACEA-1328, per se, prolonged tail flick latencies with an ED(50) of approximately 50 mg/kg. Concurrent administration of ACEA-1328, at doses that did not produce antinociception, with U50,488H increased the potency of U50,488H in a dose-dependent manner. In tolerance studies, mice were treated, either once a day for 9 days or twice daily for 4 days, with the vehicle or ACEA-1328. Immediately after the initial injection, mice then received an injection of saline or U50,488H. On the test day, mice were injected with U50,488H alone and tested for antinociception 30 min later. Chronic treatment with U50,488H by either method produced tolerance. Unlike the acute effect of the drug, chronic treatment with ACEA-1328 decreased the antinociceptive potency of U50,488H. Taken together, the data suggest that acute and chronic administration of ACEA-1328 differentially affected the antinociceptive effect of U50,488H. Furthermore, the decreased in the potency of U50,488H induced by chronic treatment with ACEA-1328 also confounded the interpretation of the tolerance data.
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Affiliation(s)
- K Lutfy
- Department of Pharmacology, College of Medicine, University of California, Irvine, CA 92717, USA.
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Lutfy K, Doan P, Weber E. ACEA-1328, a NMDA receptor/glycine site antagonist, acutely potentiates antinociception and chronically attenuates tolerance induced by morphine. Pharmacol Res 1999; 40:435-42. [PMID: 10527659 DOI: 10.1006/phrs.1999.0538] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The effect of ACEA-1328, a competitive and systemically bioavailable NMDA receptor/glycine site antagonist, was studied on morphine-induced antinociception and tolerance in CD-1 mice using the tail flick test. To study the effect of acute administration of ACEA-1328 on morphine-induced antinociception, mice were injected with either ACEA-1328 (1, 5, and 10 mg kg(-1)) or Bis-Tris (0.2 m) immediately followed by an injection of morphine and tested for antinociception 30 min later. ACEA-1328 significantly increased the antinociceptive potency of morphine. To study the effect of chronic administration of ACEA-1328 on morphine-induced antinociception and tolerance, mice were treated, either once per day for 9 days or twice daily for 4 days, with ACEA-1328 or with the vehicle. Mice were then, within 1 min, injected daily with either morphine or saline. On the day of the test, mice were injected with only morphine and tested for antinociception 30 min later. In comparison to the acute effect of ACEA-1328, chronic treatment with the NMDA receptor/glycine site antagonist did not affect the antinociceptive potency of morphine. Chronic treatment with morphine, by both methods, produced a significant degree of tolerance. Concurrent administration of ACEA-1328 with the opioid analgesic completely blocked morphine tolerance. Our results demonstrate that acute, but not chronic, treatment with ACEA-1328 increased the antinociceptive potency of morphine. Furthermore, co-administration of the NMDA receptor antagonist with morphine abolished the development of tolerance. Overall, the data support a growing body of evidence showing that activation of the NMDA receptor plays a functional role in opioid-induced antinociception and tolerance.
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Affiliation(s)
- K Lutfy
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Neuropsychiatric Institute, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
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Abstract
The effect of 5-nitro-6,7-dimethyl-1,4-dihydro-2,3-quinoxalinedione (ACEA-1328), a competitive and systemically bioavailable NMDA receptor/glycine site antagonist, was examined on opioid-induced antinociception in the tail flick test. Swiss Webster mice were injected with ACEA-1328 either alone or in combination with morphine or (+/-)-trans-U-50488 methanesulfonate (U50,488H), a mu- and a kappa-opioid receptor agonist, respectively, and tested for antinociception. Systemic administration of ACEA-1328 alone increased the tail flick latencies with an ED50 of approximately 45 mg kg-1. Concurrent administration of ACEA-1328 with morphine, or U50,488H, at doses that did not affect tail flick latencies, potentiated the antinociceptive effect of the opioid analgesics and vice versa. Naloxone, an opioid receptor antagonist, while not modifying the effect of ACEA-1328, did block the augmentation, suggesting that opioid receptors might be involved in the latter effect. 5-Aza-7-chloro-4-hydroxy-3-(m-phenoxyphenyl)quinoline-2(1H)-one (ACEA-0762), a selective NMDA receptor/glycine site antagonist, also showed enhancement of the antinociceptive effect of morphine and U50,488H. However, concurrent administration of 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzol[f]quinoxaline (NBQX), a selective non-NMDA receptor antagonist, with morphine did not alter the antinociceptive potency of the opioid analgesic. Overall, the data suggest that ACEA-1328 may increase the potency of the opioid analgesics by antagonising the glycine site associated with the NMDA receptor.
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Affiliation(s)
- K Lutfy
- Department of Pharmacology, College of Medicine, University of California, Irvine 92717, USA
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