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Rao S, Verrill C, Cerundolo L, Alham NK, Kaya Z, O'Hanlon M, Hayes A, Lambert A, James M, Tullis IDC, Niederer J, Lovell S, Omer A, Lopez F, Leslie T, Buffa F, Bryant RJ, Lamb AD, Vojnovic B, Wedge DC, Mills IG, Woodcock DJ, Tomlinson I, Hamdy FC. Intra-prostatic tumour evolution, steps in metastatic spread and histogenomic associations revealed by integration of multi-region whole-genome sequencing with histopathological features. Genome Med 2024; 16:35. [PMID: 38374116 PMCID: PMC10877771 DOI: 10.1186/s13073-024-01302-x] [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: 07/19/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Extension of prostate cancer beyond the primary site by local invasion or nodal metastasis is associated with poor prognosis. Despite significant research on tumour evolution in prostate cancer metastasis, the emergence and evolution of cancer clones at this early stage of expansion and spread are poorly understood. We aimed to delineate the routes of evolution and cancer spread within the prostate and to seminal vesicles and lymph nodes, linking these to histological features that are used in diagnostic risk stratification. METHODS We performed whole-genome sequencing on 42 prostate cancer samples from the prostate, seminal vesicles and lymph nodes of five treatment-naive patients with locally advanced disease. We spatially mapped the clonal composition of cancer across the prostate and the routes of spread of cancer cells within the prostate and to seminal vesicles and lymph nodes in each individual by analysing a total of > 19,000 copy number corrected single nucleotide variants. RESULTS In each patient, we identified sample locations corresponding to the earliest part of the malignancy. In patient 10, we mapped the spread of cancer from the apex of the prostate to the seminal vesicles and identified specific genomic changes associated with the transformation of adenocarcinoma to amphicrine morphology during this spread. Furthermore, we show that the lymph node metastases in this patient arose from specific cancer clones found at the base of the prostate and the seminal vesicles. In patient 15, we observed increased mutational burden, altered mutational signatures and histological changes associated with whole genome duplication. In all patients in whom histological heterogeneity was observed (4/5), we found that the distinct morphologies were located on separate branches of their respective evolutionary trees. CONCLUSIONS Our results link histological transformation with specific genomic alterations and phylogenetic branching. These findings have implications for diagnosis and risk stratification, in addition to providing a rationale for further studies to characterise the genetic changes causally linked to morphological transformation. Our study demonstrates the value of integrating multi-region sequencing with histopathological data to understand tumour evolution and identify mechanisms of prostate cancer spread.
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Affiliation(s)
- Srinivasa Rao
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
- Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucia Cerundolo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Zeynep Kaya
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Miriam O'Hanlon
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alicia Hayes
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Adam Lambert
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Martha James
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Jane Niederer
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Shelagh Lovell
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Altan Omer
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Francisco Lopez
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Tom Leslie
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Boris Vojnovic
- Department of Oncology, University of Oxford, Oxford, UK
| | - David C Wedge
- Manchester Cancer Research Centre, University of Manchester, Manchester, UK
| | - Ian G Mills
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Dan J Woodcock
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Ian Tomlinson
- Department of Oncology, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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2
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Bryant RJ, Yamamoto H, Eddy B, Kommu S, Narahari K, Omer A, Leslie T, Catto JWF, Rosario DJ, Good DW, Gray R, Liew MPC, Lopez JF, Campbell T, Reynard JM, Tuck S, Barber VS, Medeghri N, Davies L, Parkes M, Hewitt A, Landeiro F, Wolstenholme J, Macpherson R, Verrill C, Marian IR, Williams R, Hamdy FC, Lamb AD. Protocol for the TRANSLATE prospective, multicentre, randomised clinical trial of prostate biopsy technique. BJU Int 2023; 131:694-704. [PMID: 36695816 DOI: 10.1111/bju.15978] [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] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Primary objectives: to determine whether local anaesthetic transperineal prostate (LATP) biopsy improves the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology (ISUP) Grade Group ≥2 disease (i.e., any Gleason pattern 4 disease), compared to transrectal ultrasound-guided (TRUS) prostate biopsy, in biopsy-naïve men undergoing biopsy based on suspicion of csPCa. SECONDARY OBJECTIVES to compare (i) infection rates, (ii) health-related quality of life, (iii) patient-reported procedure tolerability, (iv) patient-reported biopsy-related complications (including bleeding, bruising, pain, loss of erectile function), (v) number of subsequent prostate biopsy procedures required, (vi) cost-effectiveness, (vii) other histological parameters, and (viii) burden and rate of detection of clinically insignificant PCa (ISUP Grade Group 1 disease) in men undergoing these two types of prostate biopsy. PATIENTS AND METHODS The TRANSLATE trial is a UK-wide, multicentre, randomised clinical trial that meets the criteria for level-one evidence in diagnostic test evaluation. TRANSLATE is investigating whether LATP biopsy leads to a higher rate of detection of csPCa compared to TRUS prostate biopsy. Both biopsies are being performed with an average of 12 systematic cores in six sectors (depending on prostate size), plus three to five target cores per multiparametric/bi-parametric magnetic resonance imaging lesion. LATP biopsy is performed using an ultrasound probe-mounted needle-guidance device (either the 'Precision-Point' or BK UA1232 system). TRUS biopsy is performed according to each hospital's standard practice. The study is 90% powered to detect a 10% difference (LATP biopsy hypothesised at 55% detection rate for csPCa vs 45% for TRUS biopsy). A total of 1042 biopsy-naïve men referred with suspected PCa need to be recruited. CONCLUSIONS This trial will provide robust prospective data to determine the diagnostic ability of LATP biopsy vs TRUS biopsy in the primary diagnostic setting.
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Affiliation(s)
- Richard J Bryant
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Hide Yamamoto
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Maidstone, UK
| | - Ben Eddy
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Sashi Kommu
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Krishna Narahari
- Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Altan Omer
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes Hospital, Milton Keynes, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Derek J Rosario
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Daniel W Good
- Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Rob Gray
- Department of Urology, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, High Wycombe, UK
| | - Matthew P C Liew
- Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - J Francisco Lopez
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Teresa Campbell
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - John M Reynard
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Steve Tuck
- Oxfordshire Prostate Cancer Support Group, Oxford, UK
| | - Vicki S Barber
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nadjat Medeghri
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Matthew Parkes
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Aimi Hewitt
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ruth Macpherson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roxanne Williams
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D Lamb
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Abdul Raheem R, Razzaq A, Beraud V, Menzies-Wilson R, Odeh R, Ibiok I, Mulawkar P, Andrews H, Anjum I, Hosny K, Leslie T. Can a prostate biopsy be safely deferred on PI-RADS 1,2 or 3 lesions seen on pre-biopsy mp-MRI? Arab J Urol 2023; 21:10-17. [PMID: 36818375 PMCID: PMC9930831 DOI: 10.1080/2090598x.2022.2119711] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Multi-parametric magnetic resonance imaging (mp-MRI) is currently used to triage patients with suspected prostate cancer, before deciding on prostate biopsies. In our study, we evaluated normal and equivocal pre-biopsy mp-MRIs to see whether it is safe to avoid biopsy with such findings. Methods A retrospective study was conducted at a district general hospital in the UK between August 2017 and July 2018. Patients with negative and equivocal prebiopsy mp-MRI with high clinical suspicion of cancer had proceeded to biopsy. MRI reports with prostate imaging reporting and data system (PI-RADS) scores 1, 2, 3 and normal MRI were evaluated against the transrectal ultrasound-guided prostate biopsy (TRUS-PB) outcomes to demonstrate benign pathology, clinically insignificant or clinically significant cancer (csCa). CsCa was defined as Gleason score (GS) ≥3 + 4. Results Out of 265 mp-MRIs studied, five (1.9%) were PI-RADS 1, 109 (41.1%) and 84 (31.7%) were PI-RADS 2 and 3 lesions respectively; 67 (25.3%) were reported as normal. Seventy-five (27.3%) patients did not have biopsies following their MRI and 73.3% (51/75) of them had benign feeling prostate. Negative MRIs (PI-RADS 1, 2 and normal MRI) showed 8.8% and PI-RADS 3 lesions demonstrated 11.9% csCa. Negative predictive value for normal MRI was 91.2%. Mean PSA density (PSAD) among the benign, GS 3 + 3 and csCa was 0.14, 0.16 and 0.27 ng/ml/ml respectively and this was statistically significant (p < 0.001). The average percentage of cancer found in GS 3 + 3 and csCa was 3.2% and 20.1%, respectively. Conclusion Avoiding TRUS-PB following normal or equivocal mp-MRI should carefully be decided as 18.5% of cancer was demonstrated in this group and 9.8% of those who were diagnosed with cancer were csCa. PSAD and DRE findings provide additional information to help with this decision.
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Affiliation(s)
| | | | | | | | - Rakan Odeh
- Speciality Doctor in Urology, Milton Keynes University Hospital, UK
| | - Imoh Ibiok
- Speciality Doctor in Urology, Milton Keynes University Hospital, UK
| | - Prashant Mulawkar
- Department of Urology, Tirthankar Superspeciality Hospital, Akola, India
| | - Henry Andrews
- Consultant Urologist, Milton Keynes University Hospital, UK
| | - Iqbal Anjum
- Consultant Urological Surgeon, Milton Keynes University Hospital, UK
| | - Khaled Hosny
- Consultant Urological surgeon, St. Helens and Knowsley NHS trust, UK,CONTACT Mr Khaled Hosny Speciality Doctor in Urology, Milton Keynes University Hospital, 6 watermead -Sale -M333UX, UK
| | - Tom Leslie
- Consultant Urological Surgeon, Milton Keynes University Hospital, UK
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Mercader Barrull C, Pika Bissala R, Raslan M, Campbell M, Lopez F, Leslie T, Miah S, Richard B, Freddie H, Alastair L. 10 top tips to be a good robotic assistant. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02277-7] [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: 11/05/2022] Open
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5
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Lopez JF, Campbell A, Omer A, Stroman L, Bondad J, Austin T, Reeves T, Phelan C, Leiblich A, Philippou Y, Lovegrove CE, Ranasinha N, Bryant RJ, Leslie T, Hamdy FC, Brewster S, Bell CR, Popert R, Hodgson D, Elsaghir M, Eddy B, Bolomytis S, Persad R, Reddy UD, Foley C, van Rij S, Lam W, Lamb AD. Local anaesthetic transperineal (LATP) prostate biopsy using a probe-mounted transperineal access system: a multicentre prospective outcome analysis. BJU Int 2021; 128:311-318. [PMID: 33448607 DOI: 10.1111/bju.15337] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/13/2022]
Abstract
OBJECTIVES To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal (TP) access device, and report initial prostate cancer (PCa) detection, infection rates, and tolerability. PATIENTS AND METHODS Observational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: (i) first biopsy in suspected PCa, (ii) confirmatory biopsies for active surveillance, and (iii) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive magnetic resonance imaging-targeted biopsies when needed using the PrecisionPoint™ TP access device. Procedure-related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient-reported outcome measures (PROMs). RESULTS Some 1218 patients underwent LATP biopsies at 10 centres: 55%, 24%, and 21% for each of the three settings, respectively. Any grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients, with a 56% response rate (n = 234). In these men, pain during the biopsy was described as either 'not at all' or 'a little' painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be 'not a problem' and in contrast 8.1% would consider it a 'major problem'. Most of the patients (81%) described the biopsy as a 'minor or moderate procedure tolerable under local anaesthesia', while 5.6% perceived it as a 'major procedure that requires general anaesthesia'. CONCLUSION Our data suggest that LATP biopsy using a TP access system mounted to the ultrasound probe achieves excellent PCa detection, with a very low sepsis rate, and is safe and well tolerated. We believe a randomised controlled trial comparing LATP with transrectal ultrasound-guided biopsy (TRUS) to investigate the relative trade-offs between each biopsy technique would be helpful.
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Affiliation(s)
| | | | - Altan Omer
- Churchill Hospital Cancer Centre, Oxford, UK
| | | | | | - Tom Austin
- Queen Alexandra Hospital, Portsmouth, UK
| | | | | | - Aaron Leiblich
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Yiannis Philippou
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Catherine E Lovegrove
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Nithesh Ranasinha
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Tom Leslie
- Churchill Hospital Cancer Centre, Oxford, UK
| | - Freddie C Hamdy
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Ben Eddy
- Kent and Canterbury Hospital, Canterbury, UK
| | | | | | - Utsav D Reddy
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Wayne Lam
- Department of Surgery, University of Hong Kong, Hong Kong SAR, China
| | - Alastair D Lamb
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Cathcart P, Ribeiro L, Moore C, Ahmed HU, Leslie T, Arya M, Orczyk C, Hindley RG, Cahill F, Prendergast A, Coetzee C, Yogeswaran Y, Tunna K, Sooriakumaran P, Emberton M. Outcomes of the RAFT trial: robotic surgery after focal therapy. BJU Int 2021; 128:504-510. [PMID: 33891378 DOI: 10.1111/bju.15432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To report toxicity of treatment observed in men participating in the Robotic surgery After Focal Therapy (RAFT) clinical trial. PATIENTS AND METHODS Men were eligible for this prospective single group interventional study if they had histologically confirmed recurrent/residual prostate adenocarcinoma following primary FT. The short-form Expanded Prostate Cancer Index Composite (EPIC-26) measured prior to salvage robotic prostatectomy (S-RARP) and 3-monthly post-operatively together with Clavien-Dindo complications (I-IV). Secondary outcomes included biochemical recurrence-free survival (BCFS) following surgery and need for salvage treatment after surgery. This study is registered with ClinicalTrials.gov NCT03011606. RESULTS Twenty-four men were recruited between February 2016 and September 2018. 1 patient withdrew from the trial after consenting and before S-RARP. 23 men completed 12-month post S-RARP follow-up. Median EPIC-26 urinary continence scores initially deteriorated after 3 months (82.4 vs 100) but there was no statistically significant difference from baseline at 12 months (100 vs 100, P = 0.31). Median lower urinary tract symptom scores improved after 12 months compared to baseline (93.8 vs 87.5, P = 0.01). At 12 months, 19/23 (83%) were pad-free and 22/23 (96%) required 0/1 pads. Median sexual function subscale scores deteriorated and remained low at 12 months (22.2 vs 58.3, P < 0.001). Utilising a minimally important difference of nine points, at 12 months after surgery 17/23 (74%) reported urinary continence to be 'better' or 'not different' to pre-operative baseline. The corresponding figure for sexual function (utilising a minimally important difference of 12 points) was 7/23 (30%). There was no statistically significant difference on median bowel/hormonal subscale scores. Only a single patient had a post-operative complication (Clavien-Dindo Grade I). BCFS at 12 months after surgery was 82.6% (95% confidence interval [CI]: 60.1-93.1%) while 4/23 (17%) received salvage radiation. CONCLUSIONS The RAFT clinical trial suggests toxicity of surgery after FT is low, with good urinary function outcomes, albeit sexual function deteriorated overall. Oncological outcomes at 12 months appear acceptable.
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Affiliation(s)
- Paul Cathcart
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Luis Ribeiro
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Caroline Moore
- Department of Urology, University College Hospital London, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals, Oxford, UK
| | - Manit Arya
- Department of Urology, University College Hospital London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Clement Orczyk
- Department of Urology, University College Hospital London, London, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Fidelma Cahill
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Aaron Prendergast
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Carike Coetzee
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Yathushan Yogeswaran
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kirsty Tunna
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Mark Emberton
- Department of Urology, University College Hospital London, London, UK
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7
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Pereira MP, Ziehfreund S, Rueth M, Ewering T, Legat FJ, Lambert J, Elberling J, Misery L, Brenaut E, Papadavid E, Garcovich S, Evers AWM, Halvorsen JA, Szepietowski JC, Reich A, Gonçalo M, Lvov A, Bobko S, Serra-Baldrich E, Wallengren J, Savk E, Leslie T, Ständer S, Zink A. Google search trends for itch in Europe: a retrospective longitudinal study. J Eur Acad Dermatol Venereol 2021; 35:1362-1370. [PMID: 33295009 DOI: 10.1111/jdv.17077] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/10/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Itch is a common symptom in the general population. Affected individuals often do not seek medical consultation and rely on Internet searches to obtain information regarding their itch. OBJECTIVES The aim of this study was to attain insights into common concerns of the general population regarding itch can by analysing itch-related Internet search behaviour. METHODS Google AdWords Keyword Planner was used to assess search volumes for itch-related terms in 15 European countries between September 2014 and August 2018. All identified keywords were qualitatively categorized. Itch-related terms were descriptively analysed and are shown as number of searches/100 000 inhabitants. RESULTS The search volume for the keyword 'itch' per 100 000 inhabitants was highest in Northern Europe, followed by Eastern, Central and Southern Europe. In 4/15 countries, itch was searched for more often in the autumn/winter months compared to in the spring/summer months. Most itch-related terms were related to dermatological conditions such as inflammatory skin diseases (e.g. psoriasis, atopic dermatitis), allergic or immunologic conditions (e.g. urticaria), and infectious diseases or infestations (e.g. scabies). In terms of body location, genitoanal itch dominated the searches. Symptoms and signs related to itch, possible non-dermatological aetiologies, and treatment options were also among the most searched terms. CONCLUSIONS These analyses provided for the first time insights into the search behaviour patterns related to itch across Europe. People from Northern and Eastern Europe are more likely to seek online information regarding itch. Causes for the itch, especially dermatological conditions, and genitoanal itch are the most important concerns for Internet users. This unconventional and inexpensive method identifies medical needs of people beyond the medical setting, including people who do not seek medical consultation. Accordingly, the data could be used to guide public health interventions and manage respective inhabitants' medical needs.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M Rueth
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - T Ewering
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | - J Elberling
- Department of Dermatology, University Hospital Gentofte, Copenhagen, Denmark
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Papadavid
- Department of Dermatology and Venereology, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - S Garcovich
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A W M Evers
- Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Lvov
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | | | - J Wallengren
- Department of Clinical Sciences Lund, Dermatology and Venereology, Lund University, Lund, Sweden.,Skane University Hospital, Lund, Sweden
| | - E Savk
- Department of Dermatology, Aydin Adnan Menderes University, Aydın, Turkey
| | | | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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Gordon N, Aggarwal V, Amos B, Buhler C, Huszar A, McKenzie J, Mitchell J, Moyen N, Mubangizi P, Leslie T. The UK Fleming Fund: Developing AMR surveillance capacity in low- and middle-income countries. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.137] [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: 10/22/2022] Open
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9
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Lovegrove C, Musbahi O, Ranasinha N, Omer A, Campbell A, Bryant R, Leslie T, Bell R, Brewster S, Hamdy F, Wright B, Lamb A. Implications of celebrity endorsement of prostate cancer awareness in a tertiary referral unit: The “Fry-Turnbull” effect. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33949-5] [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: 11/16/2022] Open
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10
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Cathcart P, Moore C, Ahmed H, Leslie T, Arya M, Hindley R, Cahill F, Prendergast A, Coetzee C, Yogeswaran Y, Sooriakumaran P, Emberton M. Functional outcomes from the Robotic surgery After Focal Therapy (RAFT) clinical trial. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33798-8] [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: 11/26/2022] Open
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11
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Lovegrove CE, Musbahi O, Ranasinha N, Omer A, Lopez F, Campbell A, Bryant RJ, Leslie T, Bell R, Brewster S, Hamdy FC, Wright B, Lamb AD. Implications of celebrity endorsement of prostate cancer awareness in a tertiary referral unit - the 'Fry-Turnbull' effect. BJU Int 2020; 125:484-486. [PMID: 31910313 DOI: 10.1111/bju.14992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Affiliation(s)
- Catherine E Lovegrove
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
- University of Oxford Nuffield Department of Surgical Sciences, Oxford, UK
| | - Omar Musbahi
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Nithesh Ranasinha
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
- University of Oxford Nuffield Department of Surgical Sciences, Oxford, UK
| | - Altan Omer
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Francisco Lopez
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Angus Campbell
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Richard J Bryant
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
- University of Oxford Nuffield Department of Surgical Sciences, Oxford, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
- University of Oxford Nuffield Department of Surgical Sciences, Oxford, UK
| | - Richard Bell
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Simon Brewster
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Freddie C Hamdy
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
- University of Oxford Nuffield Department of Surgical Sciences, Oxford, UK
| | - Ben Wright
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Alastair D Lamb
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
- University of Oxford Nuffield Department of Surgical Sciences, Oxford, UK
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Misery L, Brenaut E, Pereira M, Augustin M, Bobko S, Dalgard F, Evers A, Garcovich S, Gieler U, Gonçalo M, Halvorsen J, Lambert J, Legat F, Leslie T, Metz M, Reich A, Savk E, Serra-Baldrich E, Streit M, Szepietowski J, Weisshaar E, Ständer S. Consensus d’experts européens pour la définition, la classification et la terminologie du prurigo chronique. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.477] [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: 10/25/2022]
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13
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Philippou Y, Harriss E, Davies L, Jubber I, Leslie T, Bell RW, Bryant RJ, Hamdy FC, Verrill C, Lamb AD. Prostatic capsular incision during radical prostatectomy has important oncological implications: a systematic review and meta-analysis. BJU Int 2019; 124:554-566. [PMID: 30113754 DOI: 10.1111/bju.14522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/24/2023]
Abstract
INTRODUCTION Prostatic capsular incision (CapI) is an iatrogenic breach of the prostatic capsule during radical prostatectomy (RP) that can cause positive surgical margins (PSMs) in organ-confined (pT2) prostate cancer, or the retention of benign prostatic tissue. We systematically interrogated the literature in order to clarify the definition of CapI, and the implications of this event for rates of PSM and biochemical recurrence (BCR). METHODS A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria using the search terms 'capsular incision' AND 'prostatectomy', and variations of each. In all, 18 studies were eligible for inclusion. RESULTS A total of 51 057 RP specimens were included. The incidence of CapI ranged from 1.3% to 54.3%. CapI definitions varied and included a breach of the prostatic capsule 'exposing both benign or malignant prostate cancer cells', 'malignant tissue only', or 'benign tissue only'. The incidence of PSMs due to CapI ranged from 2.8% to 71.7%. Our meta-analysis results found that when CapI was defined as 'exposing malignant tissue only in organ-confined prostate cancer' there was an increased risk of BCR compared to patients with pT2 disease and no CapI (relative risk 3.53, 95% confidence interval 2.82-4.41; P < 0.001). CONCLUSIONS The absolute impact of CapI on oncological outcomes is currently unclear due to inconsistent definitions. However, the data imply an association between CapI and PSMs and BCR. Reporting of possible areas of CapI on the operation note, or marking areas of concern on the specimen, are critical to assist CapI recognition by the pathologist.
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Affiliation(s)
- Yiannis Philippou
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Lucy Davies
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ibrahim Jubber
- Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - Tom Leslie
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Richard W Bell
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Churchill Hospital Cancer Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
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14
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Pereira MP, Zeidler C, Nau T, Bobko S, Evers AWM, Garcovich S, Gonçalo M, Halvorsen JA, Lambert J, Legat FJ, Leslie T, Metz M, Misery L, Nordlind K, Reich A, Schneider G, Ständer H, Streit M, Szepietowski JC, Wallengren J, Weisshaar E, Ständer S. Position Statement: Linear prurigo is a subtype of chronic prurigo. J Eur Acad Dermatol Venereol 2018; 33:263-266. [PMID: 30288812 DOI: 10.1111/jdv.15275] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic prurigo (CPG) is a distinct disease characterized by chronic pruritus, history and/or signs of prolonged scratching and multiple pruriginous lesions. It may present with various clinical manifestations, including papules, nodules, plaques or umbilicated lesions. Some patients with chronic pruritus show pruriginous linear and scaring scratch lesions (LSSL) and it is unclear whether these lesions belong to the spectrum of CPG. OBJECTIVE To achieve a consensus on the classification of pruriginous LSSL and establish criteria to differentiate them from similar appearing conditions of different nature. METHODS Members of the Task Force Pruritus (TFP) of the European Academy of Dermatology and Venereology participated in the consensus conference, discussing representative clinical cases. Using the Delphi method, consensus was reached when ≥75% of members agreed on a statement. RESULTS Twenty-one members of the TFP with voting rights participated in the meeting. It was consented that LSSL occurs due to chronic pruritus and prolonged scratching, and share common pathophysiological mechanisms with CPG. LSSL were thus considered as belonging to the spectrum of CPG and the term 'linear prurigo' was chosen to describe this manifestation. CONCLUSION Considering linear prurigo as belonging to the spectrum of CPG has important clinical implications, since both the diagnostic and therapeutic approach of these patients should be performed as recommended for CPG. Importantly, linear prurigo should be differentiated from self-inflicted skin lesions as factitious disorders or skin picking syndromes. In the latter, artificial manipulation rather than pruritus itself leads to the development of cutaneous lesions, which can show clinical similarities to linear prurigo.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - T Nau
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - A W M Evers
- Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - S Garcovich
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, Antwerp, Belgium
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - T Leslie
- Department of Dermatology, Royal Free Hospital, London, UK
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - K Nordlind
- Dermatology and Venereology Unit, Department of Medicine, Karolinska University Hospital, Solna, Sweden
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - G Schneider
- Department of Psychosomatics and Psychotherapy, Münster University Hospital, Münster, Germany
| | - H Ständer
- Dermatological Practice, Bad Bentheim and Department of Dermatology, Klinikum Dortmund GmbH, Dortmund, Germany
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - J Wallengren
- Department of Dermatology and Venereology, Skåne University Hospital SUS Lund, Lund University, Lund, Sweden
| | - E Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Burns R, Wolstenholme J, Leslie T, Hamdy F. Enhancing prostate cancer trial design by incorporating robust economic analysis: Lessons learned from the UK part feasibility study. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.557] [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: 10/17/2022] Open
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16
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Bellangino M, Verrill C, Leslie T, Bell RW, Hamdy FC, Lamb AD. Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy. Curr Urol Rep 2017; 18:99. [PMID: 29116405 PMCID: PMC5676800 DOI: 10.1007/s11934-017-0745-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW Bladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck sparing radical prostatectomy. EVIDENCE ACQUISITION We carried out a systematic review of the literature using Pubmed, Scopus and Cochrane library databases in May 2017 using medical subject headings and free-text protocol according to PRISMA guidelines. We used the following search terms: bladder neck preservation, prostate cancer, radical prostatectomy and surgical margins. Studies focusing on positive surgical margins (PSM) in bladder neck sparing RP pertinent to the objective of this review were included. EVIDENCE SYNTHESIS Overall, we found 15 relevant studies reporting overall and site-specific positive surgical margins rate after bladder neck sparing radical prostatectomy. This included two RCTs, seven prospective comparative studies, two retrospective comparative studies and four case series. All studies were published between 1993 and 2015 with sample sizes ranging between 50 and 1067. Surgical approaches included open, laparoscopic and robot-assisted radical prostatectomy. The overall and base-specific PSM rates ranged between 7-36% and 0-16.3%, respectively. Mean base PSM was 4.9% in those patients where bladder neck sparing was performed, but only 1.85% in those without sparing. Bladder neck preservation during radical prostatectomy may increase base-positive margins. Further studies are needed to better investigate the impact of this technique on oncological outcomes. A future paradigm could include modification of intended approach to bladder neck dissection when anterior base lesions are identified on pre-operative MRI.
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Affiliation(s)
- Mariangela Bellangino
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Clare Verrill
- Department of Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Leslie
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard W. Bell
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Freddie C. Hamdy
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D. Lamb
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Burns R, Wolstenholme J, Leslie T, Hamdy F. Enhancing prostate cancer trial design by incorporating robust economic analysis: Lessons learned from the UK PART feasibility study. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.10.159] [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] Open
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Ahmed HU, Berge V, Bottomley D, Cross W, Heer R, Kaplan R, Leslie T, Parker C, Relton C, Stephens R, Sydes MR, Turnbull L, van der Meulen J, Vickers A, Wilt T, Emberton M. Corrigendum: Can we deliver randomized trials of focal therapy in prostate cancer? Nat Rev Clin Oncol 2017:nrclinonc.2017.86. [PMID: 28895571 DOI: 10.1038/nrclinonc.2017.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This corrects the article DOI: 10.1038/nrclinonc.2014.44.
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Leslie T, Davies L, Elliott D, Brewster S, Sooriakumaran P, Rosario D, Catto J, Dudderidge T, Ahmed H, Emberton M, Hindley R, Donovan J, Gray R, Hamdy F. PD56-08 THE PART TRIAL - A PHASE III STUDY COMPARING PARTIAL PROSTATE ABLATION VERSUS RADICAL PROSTATECTOMY (PART) IN INTERMEDIATE RISK PROSTATE CANCER – EARLY DATA FROM THE FEASIBILITY STUDY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gillies MJ, Lyon PC, Wu F, Leslie T, Chung DY, Gleeson F, Cranston D, Bojanic S. High-intensity focused ultrasonic ablation of sacral chordoma is feasible: a series of four cases and details of a national clinical trial. Br J Neurosurg 2016; 31:446-451. [PMID: 27936948 DOI: 10.1080/02688697.2016.1267330] [Citation(s) in RCA: 2] [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] [Indexed: 10/20/2022]
Abstract
High-intensity focused ultrasound describes the use of high-intensity focused ultrasound (HIFU) to ablate tumours without requiring an incision or other invasive procedure. This technique has been trialled on a range of tumours including uterine fibroids, prostate, liver and renal cancer. We describe our experience of using HIFU to ablate sacral chordoma in four patients with advanced tumours. Patients were treated under general anaesthetic or sedation using an ultrasound-guided HIFU device. HIFU therapy was associated with a reduction in tumour volume over time in three patients for whom follow up scans were available. Tumour necrosis was reliably demonstrated in two of the three patients. We have established a national trial to assess if HIFU may improve long-term outcome from sacral chordoma, details are given.
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Affiliation(s)
- Martin J Gillies
- a Department of Neurosurgery , West Wing, John Radcliffe Hospital , Oxford , UK.,b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK
| | - Paul C Lyon
- b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK
| | - Feng Wu
- b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK.,c HIFU Unit , Churchill Hospital , Headington, Oxford , UK
| | - Tom Leslie
- b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK
| | - Daniel Y Chung
- d Department of Radiology , Churchill Hospital , Oxford , UK
| | - Fergus Gleeson
- d Department of Radiology , Churchill Hospital , Oxford , UK
| | - David Cranston
- b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK.,c HIFU Unit , Churchill Hospital , Headington, Oxford , UK
| | - Stana Bojanic
- a Department of Neurosurgery , West Wing, John Radcliffe Hospital , Oxford , UK
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Ling T, Clayton T, Crawley J, Exton L, Goulden V, Ibbotson S, McKenna K, Mohd Mustapa M, Rhodes L, Sarkany R, Dawe R, McHenry P, Hughes J, Griffiths M, McDonagh A, Buckley D, Nasr I, Swale V, Duarte Williamson C, Levell N, Leslie T, Mallon E, Wakelin S, Hunasehally P, Cork M, Ungureanu S, Donnelly J, Towers K, Saunders C, Davis R, Brain A, Exton L, Mohd Mustapa M. British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015. Br J Dermatol 2016; 174:24-55. [DOI: 10.1111/bjd.14317] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 01/28/2023]
Affiliation(s)
- T.C. Ling
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - T.H. Clayton
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - J. Crawley
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - V. Goulden
- Department of Dermatology Leeds Teaching Hospitals NHS Trust Leeds LS7 4SA U.K
| | - S. Ibbotson
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
| | - K. McKenna
- Department of Dermatology Belfast City Hospital Belfast BT9 7AB U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - L.E. Rhodes
- Dermatology Research Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - R. Sarkany
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - R.S. Dawe
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
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Ständer S, Zeidler C, Riepe C, Steinke S, Fritz F, Bruland P, Soto‐Rey I, Storck M, Agner T, Augustin M, Blome C, Dalgard F, Evers A, Garcovich S, Gonçalo M, Lambert J, Legat F, Leslie T, Misery L, Raap U, Reich A, Şavk E, Streit M, Serra‐Baldrich E, Szepietowski J, Wallengren J, Weisshaar E, Dugas M. European
EADV
network on assessment of severity and burden of Pruritus (PruNet): first meeting on outcome tools. J Eur Acad Dermatol Venereol 2015; 30:1144-7. [DOI: 10.1111/jdv.13296] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Ständer
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - C. Zeidler
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - C. Riepe
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - S. Steinke
- Department of Dermatology, Competence Center for Chronic Pruritus University Hospital of Münster Münster Germany
| | - F. Fritz
- Institute of Medical Informatics University of Münster Münster Germany
| | - P. Bruland
- Institute of Medical Informatics University of Münster Münster Germany
| | - I. Soto‐Rey
- Institute of Medical Informatics University of Münster Münster Germany
| | - M. Storck
- Institute of Medical Informatics University of Münster Münster Germany
| | - T. Agner
- Department of Dermatology University of Copenhagen Copenhagen Denmark
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - C. Blome
- Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - F. Dalgard
- Department of Dermatology Oslo University Hospital Oslo Norway
| | - A.W.M. Evers
- Department of Health, Medical and Neuropsychology Institute of Psychology Leiden University Leiden The Netherlands
| | - S. Garcovich
- Catholic University of the Sacred Heart, Milano Lombardy Italy
| | - M. Gonçalo
- Department of Dermatology University Hospital and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - J. Lambert
- Department of Dermatology University Hospital of Antwerp Antwerp Belgium
| | - F.J. Legat
- Department of Dermatology Medical University of Graz Graz Austria
| | - T. Leslie
- Royal Free London and St John's Institute of Dermatology Guy's & St Thomas’ Hospital London United Kingdom
| | - L. Misery
- Department of Dermatology University Hospital of Brest Brest France
| | - U. Raap
- Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - A. Reich
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - E. Şavk
- Department of Dermatology Adnan Menderes University Aydın Turkey
| | - M. Streit
- Department of Dermatology Kantonsspital Aarau Aarau Switzerland
| | - E. Serra‐Baldrich
- Cutaneous Allergy Unit Department of Dermatology Hospital Sant Pau Universitat Autònoma Barcelona Barcelona Spain
| | - J. Szepietowski
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - J. Wallengren
- Department of Dermatology and Venereology University Hospital of Lund Lund Sweden
| | - E. Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology University of Heidelberg Heidelberg Germany
| | - M. Dugas
- Institute of Medical Informatics University of Münster Münster Germany
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Donaldson IA, Alonzi R, Barratt D, Barret E, Berge V, Bott S, Bottomley D, Eggener S, Ehdaie B, Emberton M, Hindley R, Leslie T, Miners A, McCartan N, Moore CM, Pinto P, Polascik TJ, Simmons L, van der Meulen J, Villers A, Willis S, Ahmed HU. Focal therapy: patients, interventions, and outcomes--a report from a consensus meeting. Eur Urol 2015; 67:771-7. [PMID: 25281389 PMCID: PMC4410301 DOI: 10.1016/j.eururo.2014.09.018] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/11/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Focal therapy as a treatment option for localized prostate cancer (PCa) is an increasingly popular and rapidly evolving field. OBJECTIVE To gather expert opinion on patient selection, interventions, and meaningful outcome measures for focal therapy in clinical practice and trial design. DESIGN, SETTING, AND PARTICIPANTS Fifteen experts in focal therapy followed a modified two-stage RAND/University of California, Los Angeles (UCLA) Appropriateness Methodology process. All participants independently scored 246 statements prior to rescoring at a face-to-face meeting. The meeting occurred in June 2013 at the Royal Society of Medicine, London, supported by the Wellcome Trust and the UK Department of Health. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Agreement, disagreement, or uncertainty were calculated as the median panel score. Consensus was derived from the interpercentile range adjusted for symmetry level. RESULTS AND LIMITATIONS Of 246 statements, 154 (63%) reached consensus. Items of agreement included the following: patients with intermediate risk and patients with unifocal and multifocal PCa are eligible for focal treatment; magnetic resonance imaging-targeted or template-mapping biopsy should be used to plan treatment; planned treatment margins should be 5mm from the known tumor; prostate volume or age should not be a primary determinant of eligibility; foci of indolent cancer can be left untreated when treating the dominant index lesion; histologic outcomes should be defined by targeted biopsy at 1 yr; residual disease in the treated area of ≤3 mm of Gleason 3+3 did not need further treatment; and focal retreatment rates of ≤20% should be considered clinically acceptable but subsequent whole-gland therapy deemed a failure of focal therapy. All statements are expert opinion and therefore constitute level 5 evidence and may not reflect wider clinical consensus. CONCLUSIONS The landscape of PCa treatment is rapidly evolving with new treatment technologies. This consensus meeting provides guidance to clinicians on current expert thinking in the field of focal therapy. PATIENT SUMMARY In this report we present expert opinion on patient selection, interventions, and meaningful outcomes for clinicians working in focal therapy for prostate cancer.
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Affiliation(s)
- Ian A Donaldson
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK.
| | - Roberto Alonzi
- Department of Clinical Oncology, Royal Marsden Hospital, London, UK
| | - Dean Barratt
- Centre for Medical Image Computing, University College London, London, UK
| | - Eric Barret
- Department of Urology, L'Institut Mutualiste Montsouris, Paris, France
| | - Viktor Berge
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Simon Bott
- Department of Urology, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - David Bottomley
- Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Scott Eggener
- Section of Urology, University of Chicago Medical Center, Chicago, IL, USA
| | - Behfar Ehdaie
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Richard Hindley
- Department of Urology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil McCartan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas J Polascik
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Lucy Simmons
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Arnauld Villers
- Department of Urology, Hôpital Huriez, CHRU Lille, Lille, France
| | - Sarah Willis
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Hashim U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, UCLH NHS Foundation Trust, London, UK
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Ritchie R, Collin J, Coussios C, Leslie T. Attenuation and de-focusing during high-intensity focused ultrasound therapy through peri-nephric fat. Ultrasound Med Biol 2013; 39:1785-1793. [PMID: 23932273 DOI: 10.1016/j.ultrasmedbio.2013.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/01/2013] [Accepted: 04/11/2013] [Indexed: 06/02/2023]
Abstract
High-intensity focused ultrasound (HIFU) is an attractive therapy for kidney cancer, but its efficacy can be limited by heat deposition in the pre-focal tissues, notably in fat around the kidney (peri-nephric fat), the acoustic properties of which have not been well characterized. Measurements of attenuation were made using a modified insertion-loss technique on fresh, unfixed peri-nephric fat obtained from patients undergoing kidney surgery for cancer. The de-focusing effect of changing the position of the fat layers was also investigated using fresh subcutaneous fat from euthanized pigs. The mean attenuation of human peri-nephric fat was found to be 11.9 ± 0.9 Np/m (n = 10) at 0.8 MHz, the frequency typically used for HIFU ablation of kidney tumors, with a frequency dependence of f(1.2). A typical 2- to 4-cm thickness of peri-nephric fat would result in a de-rated intensity of 3% - 62% at 0.8 MHz compared with a hypothetical patient with no peri-nephric fat. Through the use of freshly excised porcine subcutaneous fat, the presence of fat 100 mm in front of the focus was found to have a de-focusing effect of approximately 1 mm in both transverse directions, which corresponds to a full HIFU beam width off-target. Peri-nephric fat may significantly affect both the intensity and accuracy of HIFU fields used for the ablation of kidney cancer.
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Affiliation(s)
- Robert Ritchie
- Nuffield Department of Surgical Sciences, Oxford University Hospitals, Oxford, UK.
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Leslie T, Ritchie R, Illing R, Ter Haar G, Phillips R, Middleton M, Bch B, Wu F, Cranston D. High-intensity focused ultrasound treatment of liver tumours: post-treatment MRI correlates well with intra-operative estimates of treatment volume. Br J Radiol 2012; 85:1363-70. [PMID: 22700259 DOI: 10.1259/bjr/56737365] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess the safety and feasibility of high-intensity focused ultrasound (HIFU) ablation of liver tumours and to determine whether post-operative MRI correlates with intra-operative imaging. METHODS 31 patients were recruited into two ethically approved clinical trials (median age 64; mean BMI 26 kg m(-2)). Patients with liver tumours (primary or metastatic) underwent a single HIFU treatment monitored using intra-operative B-mode ultrasound. Follow-up consisted of radiology and histology (surgical trial) or radiology alone (radiology trial). Radiological follow-up was digital subtraction contrast-enhanced MRI. RESULTS Treatment according to protocol was possible in 30 of 31 patients. One treatment was abandoned because of equipment failure. Transient pain and superficial skin burns were seen in 81% (25/31) and 39% (12/31) of patients, respectively. One moderate skin burn occurred. One patient died prior to radiological follow-up. Radiological evidence of ablation was seen in 93% (27/29) of patients. Ablation accuracy was good in 89% (24/27) of patients. In three patients the zone of ablation lay ≤2 mm outside the tumour. The median cross-sectional area (CSA) of the zone of ablation was 5.0 and 5.1 cm(2) using intra-operative and post-operative imaging, respectively. The mean MRI:B-mode CSA ratio was 1.57 [95% confidence interval (CI)=0.57-2.71]. There was positive correlation between MRI and B-mode CSA (Spearman's r=0.48; 95% CI 0.11-0.73; p=0.011) and the slope of linear regression was significantly non-zero (1.23; 95% CI=0.68-1.77; p<0.0001). CONCLUSIONS HIFU ablation of liver tumours is safe and feasible. HIFU treatment is accurate, and intra-operative assessment of treatment provides an accurate measure of the zone of ablation and correlates well with MRI follow-up.
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Affiliation(s)
- T Leslie
- Oxford Clinical HIFU Unit, Churchill Hospital, Oxford, UK
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Jensen CR, Ritchie RW, Gyöngy M, Collin JRT, Leslie T, Coussios CC. Spatiotemporal monitoring of high-intensity focused ultrasound therapy with passive acoustic mapping. Radiology 2011; 262:252-61. [PMID: 22025731 DOI: 10.1148/radiol.11110670] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To demonstrate feasibility of monitoring high-intensity focused ultrasound (HIFU) treatment with passive acoustic mapping of broadband and harmonic emissions reconstructed from filtered-channel radiofrequency data in ex vivo bovine tissue. MATERIALS AND METHODS Both passive acoustic emissions and B-mode images were recorded with a diagnostic ultrasound machine during 180 HIFU exposures of five freshly excised, degassed bovine livers. Tissue was exposed to peak rarefactional pressures between 3.6 and 8.0 MPa for 2, 5, or 10 seconds. The B-mode images were analyzed for hyperechoic activity, and threshold levels were determined for the harmonic (1.17 mJ) and broadband (0.0137 mJ) components of the passively reconstructed source energy to predict tissue ablation. Both imaging methods were compared with tissue lesions after exposure to determine their spatial accuracy and their capability to help predict presence of ablated tissue. Performance of both methods as detectors was compared (matched-pair test design). RESULTS Passive mapping successfully aided prediction of the presence of tissue ablation more often than did conventional hyperechoic images (49 of 58 [84%] vs 31 of 58 [53%], P < .001). At 5.4-6.3-MPa exposures, sensitivity, specificity, negative predictive value, and positive predictive value of the two methods, respectively, were 15 of 20 versus five of 21 (P = .006), eight of nine versus eight of nine (P = .72), 15 of 16 versus five of six (P = .53), and eight of 13 versus eight of 24 (P = .011). Across HIFU exposure amplitude ranges, passive acoustic mapping also aided correct prediction of the visually detected location of ablation following tissue sectioning in 42 of 45 exposures for which the harmonic and broadband threshold levels for tissue ablation were exceeded. Early cavitation activity indicated the focal position within the tissue before irreversible tissue damage occurred. CONCLUSION Passive acoustic mapping significantly outperformed the conventional hyperecho technique as an ultrasound-based HIFU monitoring method, as both a detector of lesion occurrence and a method of mapping the position of ablated tissue.
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Affiliation(s)
- Carl R Jensen
- Institute of Biomedical Engineering, Department of Engineering, University of Oxford, Old Road Campus Research Bldg, Headington, Oxford, OX3 7DQ, England.
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Abstract
Renal cell carcinomas (RCCs) account for 3% of all solid neoplasms, with an increased incidence after renal transplantation. In transplant recipients, RCCs predominantly occur in the patient's native kidneys. Herein is reported a case of a localized RCC of recipient origin that developed in the donor allograft and was detected 8 years after renal transplantation. Treatment with high-intensity focussed ultrasound followed by partial nephrectomy was successful, averting the need for dialysis therapy.
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Affiliation(s)
- A Chakera
- Oxford Kidney Unit, Churchill Hospital, Headington, Oxford, England.
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Ritchie RW, Leslie T, Phillips R, Wu F, Illing R, ter Haar G, Protheroe A, Cranston D. Extracorporeal high intensity focused ultrasound for renal tumours: a 3-year follow-up. BJU Int 2010; 106:1004-9. [PMID: 20230379 DOI: 10.1111/j.1464-410x.2010.09289.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether primary extracorporeal high-intensity focused ultrasound (HIFU) is safe, feasible and effective for managing small renal tumours. PATIENTS AND METHODS Although surgery currently remains the standard treatment for localized renal cell carcinoma (RCC), the increasing incidence of small renal cancers has led to a shift towards nephron-sparing surgery, with associated morbidity in 20-25% of cases, and minimally invasive ablative therapies present an alternative management. HIFU results in 'trackless' homogenous tissue ablation and when administered via an extracorporeal device, is entirely noninvasive. The study comprised 17 patients (mean tumour size 2.5 cm) with radiologically suspicious renal tumours who underwent extracorporeal HIFU using the Model-JC System (Chongqing HAIFU™, China), under general anaesthesia with one overnight hospital stay. Real-time diagnostic ultrasonography was used for targeting and monitoring. Patients were followed with a clinical review and gadolinium-enhanced magnetic resonance imaging at 12 days and every 6 months for a mean of 36 months. The outcomes measures were patient morbidity and oncological efficacy of HIFU treatment. RESULTS Of the 17 patients, 15 were treated according to protocol; two procedures were abandoned due to intervening bowel. There were no major complications related to HIFU. Radiological evidence of ablation was apparent at 12 days in seven of the 15 patients. Before the 6-month follow-up one patient had surgery due to persisting central enhancement. Fourteen patients were evaluated at the 6-month follow-up; eight tumours had involuted (mean 12% decrease in tumour area). Four patients had irregular enhancement on imaging and had alternative therapies. Ten patients remain on follow-up at a mean (range) of 36 (14-55) months after HIFU (mean 30% decrease in tumour area). There was central loss of enhancement in all. CONCLUSIONS Renal HIFU achieves stable lesions in two-thirds of patients, with minimal morbidity, and might be appropriate in selected cases. Further trials with accurate histological follow-up are essential to fully evaluate this novel technique.
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Affiliation(s)
- Robert W Ritchie
- Nuffield Department of Surgery, University of Oxford, Oxford, UK.
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Leslie T, Brewster S. High-intensity focused ultrasound for localized prostate cancer: initial experience with a 2-year follow-up. BJU Int 2010; 105:726-7. [PMID: 20149207 DOI: 10.1111/j.1464-410x.2010.09264_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mendis R, Leslie T, McBain V, Lois N. Combined therapy for retinal angiomatous proliferation with intravitreal triamcinolone and argon laser photocoagulation. Br J Ophthalmol 2008; 92:1154-6. [DOI: 10.1136/bjo.2007.122119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
This paper discusses the calibration of Capintec radionuclide calibrators for the measurement of (18)F in the pharmacy and clinic. In support of a planned regional comparison, a secondary laboratory was set up at Oak Ridge National Laboratories in Oak Ridge, TN. The laboratory was used to prepare 1mL (18)F-fluorodeoxyglucose sources in 3mL plastic BD syringes (Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA) and to determine dial settings in three models of radionuclide calibrators. Measurements were verified by comparing radionuclide calibrator measurements of a 5mL ampoule source with previous results. The CIEMAT/NIST method of tritium efficiency tracing was used for activity determinations.
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Affiliation(s)
- J T Cessna
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA.
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Kennedy J, Leslie T, Brewster S, Sullivan M. High-intensity focused ultrasound for the treatment of low-risk organ confined prostate cancer: Initial experience from a single UK centre. Urology 2005. [DOI: 10.1016/j.urology.2005.06.037] [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: 11/24/2022]
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Leslie T, Lois N, Christopoulou D, Olson JA, Forrester JV. Photodynamic therapy for inflammatory choroidal neovascularisation unresponsive to immunosuppression. Br J Ophthalmol 2005; 89:147-50. [PMID: 15665342 PMCID: PMC1772526 DOI: 10.1136/bjo.2004.046623] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To report on visual and angiographic outcomes of a consecutive series of patients with inflammatory choroidal neovascular membranes (CNV) unresponsive to systemic immunosuppression treated with photodynamic therapy (PDT). METHODS The medical records of six consecutive patients with inflammatory CNVs that failed to respond to systemic immunosuppression and that later underwent PDT were retrospectively reviewed. Patient demographics, visual acuity, and fluorescein angiographic findings were evaluated. RESULTS There were five females and one male with a mean age of 40.8 years (range 35-58 years). Four patients had clinical features consistent with punctate inner choroidopathy and two with presumed ocular histoplasmosis. In all cases clinical signs of CNV activity, including subretinal fluid, subretinal blood, hard exudates, and/or recent decrease in visual acuity were present prior to PDT. All patients had been treated with high dose systemic immunosuppressants, which failed to induce regression of the CNV and/or to improve vision. The CNVs were subfoveal in five patients and juxtafoveal in one; all were classified as predominantly classic. Following PDT an improvement in vision occurred in all cases (median improvement of 18 letters, range 3-42 letters). At last follow up, signs of decreased activity in the CNV were detected in all cases. Patients were followed for a median of 10 months (range 9-20 months). CONCLUSION PDT appears to be a useful option in the management of patients with inflammatory CNVs unresponsive to immunosuppressive therapies.
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Affiliation(s)
- T Leslie
- Retina Service, Ophthalmology Department, Aberdeen University Hospital, Foresterhill, Aberdeen AB25 2ZN, Scotland, UK
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Abstract
AIM To examine residual debris within sterilised instruments prior to cataract surgery. METHODS (i) Flushings from 32 sets of phacoemulsification instruments, sterilised according to hospital routine protocols, were taken preoperatively and analysed by scanning electron microscopy (SEM). (ii) A total of 16 sets of flushings from a different institute were collected-with separation of samples collected from phacoemulsification and those from irrigation-aspiration (IA) instruments-and analysed in the same way. (iii) A total of 15 sets of flushings were collected from instruments where an automated flushing system was used prior to sterilisation. RESULTS (i)In the first study, 62% were clean, 16% were moderately contaminated and 22% were severely contaminated. Various contaminants were identified including lens capsule and cells, man-made fibres, squamous cells, bacteria, fungal elements, diatoms, red blood cells and proteinaceous material. (ii) In the second study, the results were similar and contamination of both phacoemulsification and IA instruments was shown. (iii) The third study showed that although a decrease in contamination followed automated flushing, contamination was not completely eliminated. CONCLUSIONS Although all equipment had been sterilised, pyrogenic material was still present. These findings emphasise the importance of meticulous cleaning of all surgical equipment in which biological debris can remain.
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Affiliation(s)
- T Leslie
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.
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Leslie T, Duncan C. Going Dutch. Nurs Stand 2001; 15:16. [PMID: 12240588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Acland KM, Leslie T, Dowd PM. Panniculitis associated with subcutaneous apomorphine. Hosp Med 1998; 59:413-4. [PMID: 9722396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- K M Acland
- Department of Dermatology, Hammersmith Hospital, London
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Leslie T. Skin biopsy: how to do it. Br J Hosp Med (Lond) 1997; 58:341-2. [PMID: 9509057] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article explains how to perform a skin biopsy with details about instruments and equipment. The patient's consent should always be obtained for the procedure. The wound margins should be marked out along the skin crease lines. The specimen should always be sent for analysis.
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Affiliation(s)
- T Leslie
- Wellhouse NHS Trust, Barnet Hospital, Herts
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Abstract
Pain is normally evoked only by stimuli that are sufficiently intense to activate high-threshold A(delta) and C sensory fibres, which relay the signal to the spinal cord. Peripheral inflammation leads to profoundly increased pain sensitivity: noxious stimuli generate a greater response and stimuli that are normally innocuous elicit pain. Inflammation increases the sensitivity of the peripheral terminals of A(delta) and C fibres at the site of inflammation. It also increases the excitability of spinal cord neurons, which now amplify all sensory inputs including the normally innocuous tactile stimuli that are conveyed by low-threshold A(beta) fibres. This central sensitization has been attributed to the enhanced activity of C fibres, which increase the excitability of their postsynaptic targets by releasing glutamate and the neuropeptide substance P. Here we show that inflammation results in A(beta) fibres also acquiring the capacity to increase the excitability of spinal cord neurons. This is due to a phenotypic switch in a subpopulation of these fibres so that they, like C-fibres, now express substance P. A(beta) fibres thus appear to contribute to inflammatory hypersensitivity by switching their phenotype to one resembling pain fibres, thereby enhancing synaptic transmission in the spinal cord and exaggerating the central response to innocuous stimuli.
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Affiliation(s)
- S Neumann
- Department of Anatomy and Developmental Biology, University College London, UK
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Goldsmith P, Bunker C, Leslie T, Foreman J, Dowd PM. The effect of topical steroid on the actions of vasoconstrictor and vasodilator peptides in human skin. Skin Pharmacol 1996; 9:289-97. [PMID: 8990503 DOI: 10.1159/000211427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The effect of topical application of clobetasol propionate ointment (0.05% w/v) on the vascular changes induced by intradermal injections of histamine, calcitonin gene-related peptide, substance P, endothelin-1 and compound 48/80 was studied. Clobetasol propionate ointment was applied topically under occlusion to the forearm skin of healthy volunteers and vehicle base was applied to the contralateral forearm. The intradermal injections were made 4 h or, in a separate study, 72 h after topical steroid application. Responses were measured by planimetry and laser Doppler flowmetry. Four hours application of steroid did not significantly alter the responses to any of the vasoactive substances. After 72 hours application, clobetasol propionate significantly increased the size of the endothelin-1-induced area of vasoconstriction (p < 0.02) and significantly reduced the size of the flares induced by endothelin-1 (p < 0.02), substance P (p < 0.009) and compound 48/80 (p < 0.05). We conclude that the most likely explanation of our data is an inhibition by the steroid of cutaneous mast cell function.
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Affiliation(s)
- P Goldsmith
- Department of Dermatology, University College London Medical School, UK
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Abstract
A MAP kinase activity assay was developed to determine whether the LHRH receptor could activate this enzyme (particularly during LHRH priming). In anterior pituitary tissue from prooestrous rats LHRH caused concentration-dependent activation of MAP kinase after 5-10 min and continued for up to 60 min of incubation. The magnitude of this response correlated with that of LHRH priming on various days of the oestrous cycle but not with the magnitude of 1st hour (unprimed) LHRH-induced LH release. The response to LHRH was mimicked by a phorbol ester but not by ionomycin and was blocked with high potency by GF 109203X but not by H7 (in a similar manner to the PKC species that mediates LHRH priming). Neither the tyrosine kinase inhibitor lavendustin A nor the protein synthesis inhibitor cycloheximide blocked LHRH-induced MAP kinase activation. The possible functional significance of MAP kinase activation in gonadotrophs is considered with respect to LHRH priming.
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Affiliation(s)
- R Mitchell
- MRC Brain Metabolism Unit, Edinburgh, UK
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Khanarian G, Che T, DeMartino RN, Haas D, Leslie T, Man HT, Sansone M, Stamatoff JB, Teng CC, Yoon HN. Characterization Of Polymeric Nonlinear Optical Materials. ACTA ACUST UNITED AC 1988. [DOI: 10.1117/12.941963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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