Dokument-ID Dokumenttyp Verfasser/Autoren Herausgeber Haupttitel Abstract Auflage Verlagsort Verlag Erscheinungsjahr Seitenzahl Schriftenreihe Titel Schriftenreihe Bandzahl ISBN Quelle der Hochschulschrift Konferenzname Quelle:Titel Quelle:Jahrgang Quelle:Heftnummer Quelle:Erste Seite Quelle:Letzte Seite URN DOI Abteilungen OPUS4-16577 Dissertation Langhammer, Romy Metabolomic Imaging for Human Prostate Cancer Detection using MR Spectroscopy at 7T BACKGROUND. Prostate cancer (PCa) remains a major health concern in men of the Western World. However, we still lack effective diagnostic tools a) for an effective screening with both high sensitivity and specificity, b) to guide biopsies and avoid histology sampling errors and c) to predict tumor aggressiveness in order to avoid overtreatment. Therefore, a more reliable, highly cancer-specific and ideally in vivo approach is needed. The present study has been designed in order to further develop and test the method of "metabolomic imaging" using magnetic resonance spectroscopy (MRS) at 7T to address those challenges. METHODS. Thirty whole prostates with biopsy-proven PCa were in vitro analyzed with a 7T human MR scanner. A voxel grid containing the spectral information was overlaid with the MR image of the middle transverse cross-sectional plane of each case. Subsequent histopathological evaluation of the prostate specimen followed. After the spectral output was processed, all voxels were compared with a metabolomic PCa profile, which had been established within a preliminary study, in order to create a metabolomic map indicating MRS cancer-suspicious regions. Those regions were compared with the histologically identified tumor lesions regarding location. RESULTS. Sixty-one percent of the histological cancer lesions were detected by metabolomic imaging. Among the cases with PCa on the examined slice, 75% were identified as cancerous. None of the tested features significantly differed between detected and undetected cancer lesions. A defined "Malignancy Index" (MI) significantly differentiated between MRS-suspicious lesions corresponding with a histological cancer lesion and benign lesions (p = 0.006) with an overall accuracy of 70%. The MI furthermore showed a positive correlation with the Gleason grade (p = 0.021). CONCLUSION. A new approach within PCa diagnostics was developed with spectral analysis including the whole measureable metabolome - referred to as "metabolomics" - rather than focusing on single metabolites. The MI facilitates precise tumor detection and may additionally serve as a marker for tumor aggressiveness. Metabolomic imaging might contribute to a highly cancer-specific in vivo diagnostic protocol for PCa. 2018 urn:nbn:de:bvb:20-opus-165772 Institut für diagnostische und interventionelle Radiologie (Institut für Röntgendiagnostik) OPUS4-12399 Wissenschaftlicher Artikel Van Baelen, Anthony; Mottet, Nicolas; Spahn, Martin; Briganti, Alberto; Gontero, Paolo; Joniau, Steven Sense and Nonsense of an Extended Pelvic Lymph Node Dissection in Prostate Cancer Lymph node metastases associated with prostate cancer (PCa) has been shown to be a poor prognostic factor. The role of pelvic lymph node dissection (PLND) itself in relation to survival remains unclear, however. A Medline search was conducted to address this issue. The following conclusions were drawn. Only recently, improved survival due to completion of radical prostatectomy (RP) (compared to abandoning RP) in known or presumed lymph-node-positive patients has been shown. Lymph node sampling can only be considered representative if an adequate number of nodes is removed. While several authors have suggested that a therapeutic benefit in patients undergoing RP is not provided by PLND, the reliability of these studies is uncertain. Contrary to this, several studies have indicated the possibility of long-term survival even in the presence of limited lymph node metastases. The role and timing of initiation of adjuvant androgen deprivation therapy (ADT) in patients who have node-positive disease after RP is controversial. Recent studies suggest that delaying ADT may not adversely impact survival. 2012 Advances in Urology 2012 983058 urn:nbn:de:bvb:20-opus-123990 Urologische Klinik und Poliklinik