A phase II randomized trial of Observation versus stereotactic ablative RadiatIon for OLigometastatic prostate CancEr (ORIOLE).

Background: We describe a randomized, non-blinded Phase II interventional study to assess the safety and efficacy of stereotactic ablative radiotherapy (SABR) for hormone-sensitive oligometastatic prostate adenocarcinoma, and to describe the biology of the oligometastatic state using immunologic, cellular, molecular, and functional imaging correlates. 54 men with oligometastatic prostate adenocarcinoma will be accrued. The primary clinical endpoint will be progression at 6 months from randomization with the hypothesis that SABR to all metastases will forestall progression by disrupting the metastatic process.

Prostate Cancer Local Recurrence Detected With Both F-Fluciclovine and PSMA-targeted F-DCFPyL PET/CT.

We present the case of a 79-year-old man with an elevated postprostatectomy prostate-specific antigen level who was sequentially imaged with positron emission tomography/computed tomography (PET/CT) using F-fluciclovine followed by PSMA-targeted F-DCFPyL. Although both imaging tests successfully identified the same pelvic recurrence, each radiotracer had its relative merits. This case highlights the differences between these two PET radiotracers, which are increasingly being used to image men with recurrent prostate cancer.

Imaging of Prostate-Specific Membrane Antigen Using [F]DCFPyL.

Prostate-specific membrane antigen (PSMA) has been explored as a target for molecular imaging of prostate cancer and other malignancies that express PSMA in their tumor-associated neovasculature. Although several PSMA-targeted radiotracers labeled with a variety of radionuclides have been reported, positron-emitting radiotracers labeled with F are of particular interest. One such compound, the small molecule PSMA inhibitor [F]DCFPyL, has demonstrated initial success.

Measurement and Reproducibility of Preserved Ellipsoid Zone Area and Preserved Retinal Pigment Epithelium Area in Eyes With Choroideremia.

Purpose: To identify valid and reproducible methods for quantifying anatomic outcome measures for eyes with choroideremia (CHM) in clinical trials.

Design: Reliability analysis study.

Methods: In this multicenter study, patients with confirmed genetic diagnosis of CHM were enrolled.

Defining the Role of Intraoperative Transesophageal Echocardiography During Radical Nephrectomy With Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma.

Objective: To determine the impact of transesophageal echocardiography on the surgical management of patients undergoing nephrectomy and inferior vena cava tumor thrombectomy for renal cell carcinoma.

Materials And Methods: We retrospectively analyzed intraoperative records of 67 patients with renal cell carcinoma and level II-IV invasion of the inferior vena cava who underwent nephrectomy with tumor thrombectomy between 2007 and 2015. Based on preoperative imaging, patients were categorized according to vena cava thrombus level.

Justifying Clinical Nudges.

The shift away from paternalistic decision-making and toward patient-centered, shared decision-making has stemmed from the recognition that in order to practice medicine ethically, health care professionals must take seriously the values and preferences of their patients. At the same time, there is growing recognition that minor and seemingly irrelevant features of how choices are presented can substantially influence the decisions people make. Behavioral economists have identified striking ways in which trivial differences in the presentation of options can powerfully and predictably affect people's choices.

Clinical Experience with F-Labeled Small Molecule Inhibitors of Prostate-Specific Membrane Antigen.

Prostate cancer (PCa) is the most common noncutaneous malignancy diagnosed in men. Despite the large number of men who will suffer from PCa at some point during their lives, conventional imaging modalities for this important disease (contrast-enhanced computed tomography, bone scan, and MR imaging) have provided only marginal to moderate success in appropriately guiding patient management in certain clinical contexts. In this review, the authors discuss radiofluorinated small molecule radiotracers that have been developed to bind to the transmembrane glycoprotein prostate-specific membrane antigen, a target that is nearly universally overexpressed on PCa epithelial cells.

Clinical Applications of Molecular Imaging in the Management of Prostate Cancer.

At the heart of selecting an optimal management strategy for men with prostate cancer is accurately determining a given patient's clinical stage and extent of disease. Molecular imaging with PET using properly selected radiotracers offers the opportunity for improved contrast resolution over conventional imaging and thus increased sensativity for detecting sites of disease. In addition, molecular imaging provides the prospect of obtaining functional or biological information regarding a patient's cancer.

Genetic risk models: Influence of model size on risk estimates and precision.

Disease risk estimation plays an important role in disease prevention. Many studies have found that the ability to predict risk improves as the number of risk single-nucleotide polymorphisms (SNPs) in the risk model increases. However, the width of the confidence interval of the risk estimate is often not considered in the evaluation of the risk model.

Nucleolin Staining May Aid in the Identification of Circulating Prostate Cancer Cells.

Introduction: Circulating tumor cells (CTCs) have great potential as circulating biomarkers for solid malignancies. Currently available assays for CTC detection rely on epithelial markers with somewhat limited sensitivity and specificity. We found that the staining pattern of nucleolin, a common nucleolar protein in proliferative cells, separates CTCs from white blood cells (WBCs) in men with metastatic prostate cancer.

Defining the Added Value of 99mTc-MIBI SPECT/CT to Conventional Cross-Sectional Imaging in the Characterization of Enhancing Solid Renal Masses.

Purpose: This study investigates whether the addition of preoperative Tc-MIBI SPECT/CT can increase the degree of diagnostic confidence in the differentiation of benign from malignant enhancing renal masses.

Patients And Methods: Patients were recruited as part of an institutional review board-approved prospective clinical trial. Forty-eight patients with clinical stage T1 solid renal masses who underwent a Tc-MIBI SPECT/CT before partial or radical nephrectomy were evaluated.

Mortality trends and the impact of lymphadenectomy on survival for renal cell carcinoma patients with distant metastasis.

Introduction: Current treatment paradigms for metastatic renal cell carcinoma (mRCC) invoke a combination of surgical and systemic therapies. We sought to quantify trends in mortality and performance of lymphadenectomy, as well as impact on survival for patients with mRCC.

Methods: The Surveillance, Epidemiology, and End Results registry (SEER) (1988-2011) identified patients with mRCC.

Renal Pseudoaneurysm Mimicking Local Cancer Recurrence After Partial Nephrectomy.

The development of an iatrogenic vascular lesion, such a renal pseudoaneurysm or arteriovenous fistula, is a rare complication of partial nephrectomy. These lesions should be considered in patients presenting with an enhancing mass in the resection bed shortly following partial nephrectomy. Early timing following surgery, large relative size, and the presence of recurrent hematuria suggest the diagnosis of an iatrogenic vascular lesion.

Evaluation of a Large Renal Mass Using 99mTc-MIBI SPECT/CT in a Patient With Chronic Kidney Disease.

The differentiation of benign and indolent renal masses from aggressive tumor histologies cannot be reliably performed by CT or MRI. Additionally, renal mass biopsy risks complications and has a nondiagnostic rate of 10% to 20%. Tc-MIBI SPECT/CT has been shown to allow for the accurate differentiation of benign renal oncocytomas and hybrid oncocytic/chormophobe tumors from other more aggressive renal tumor types.

An Alternative and Validated Injection Method for Accessing the Subretinal Space via a Transcleral Posterior Approach.

Subretinal injections have been successfully used in both humans and rodents to deliver therapeutic interventions of proteins, viral agents, and cells to the interphotoreceptor/subretinal compartment that has direct exposure to photoreceptors and the retinal pigment epithelium (RPE). Subretinal injections of plasminogen as well as recent preclinical and clinical trials have demonstrated safety and/or efficacy of delivering viral vectors and stem cells to individuals with advanced retinal disease. Mouse models of retinal disease, particularly hereditary retinal dystrophies, are essential for testing these therapies.

Surgical histopathology for suspected oncocytoma on renal mass biopsy: a systematic review and meta-analysis.

To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology, a systematic review of MEDLINE, Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [PPV]) was evaluated for patients undergoing surgery by performing a meta-analysis.

A surface tension magnetophoretic device for rare cell isolation and characterization.

The cancer community continues to search for an efficient and cost-effective technique to isolate and characterize circulating cells (CTCs) as a 'real-time liquid biopsy'. Existing methods to isolate and analyze CTCs require various transfer, wash, and staining steps that can be time consuming, expensive, and led to the loss of rare cells. To overcome the limitations of existing CTC isolation strategies, we have developed an inexpensive 'lab on a chip' device for the enrichment, staining, and analysis of rare cell populations.

Identification and population history of CYP4V2 mutations in patients with Bietti crystalline corneoretinal dystrophy.

To identify known and novel CYP4V2 mutations in patients with Bietti crystalline cornea (BCD), expand the spectrum of CYP4V2 mutations, and characterize the population history of the c.802-8_810del17insGC mutation common in Asian populations, genomic DNA was isolated from peripheral blood samples from 58 unrelated patients with clinical diagnoses of BCD. Exons and flanking intronic regions of the CYP4V2 gene were dideoxy DNA sequenced.

Semiquantitative Parameters in PSMA-Targeted PET Imaging with F-DCFPyL: Variability in Normal-Organ Uptake.

F-DCFPyL is a small-molecule inhibitor of the prostate-specific membrane antigen that has shown promise for evaluation of primary and metastatic prostate cancer using PET. Measuring the variability in normal-organ uptake of F-DCFPyL is necessary to understand its biodistribution, aid image interpretation, judge the reliability of scan quantification, and provide a basis for therapeutic monitoring. Sixty-five consecutive F-DCFPyL PET/CT scans from 64 patients with a history of prostate cancer were analyzed.

Partial vs Radical Nephrectomy for T1-T2 Renal Masses in the Elderly: Comparison of Complications, Renal Function, and Oncologic Outcomes.

Objective: To compare outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in patients 65 years and older.

Materials And Methods: Our institutional renal mass registry was queried for patients 65 and older with solitary cT1-T2 renal mass resected by PN or RN. Clinicopathologic features and perioperative outcomes were compared between groups.

Circulating tumour cells as biomarkers of prostate, bladder, and kidney cancer.

Circulating tumour cells (CTCs) have been studied as biomarkers of a number of solid malignancies. Potential clinical applications for CTC analysis include early cancer detection, disease staging, monitoring for recurrence, prognostication, and to aid in the selection of therapy. In the field of urologic oncology, CTCs have been most widely studied as prognostic biomarkers of castration-resistant prostate cancer.