ABSTRACT
Prostate biopsy, a frequently performed procedure, is not harmless. In rare cases, life-threatening complications occur. We document a potential lethal bacterial meningitis after transrectal biopsy. In addition to our overview of all previously documented cases, we highlight the evidence of prevention of infectious complications when performing a prostate biopsy.
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Background: Phosphate stones can be divided into struvite (7%), apatite (20%), and brushite stones (2%). They often present as large staghorn calculi and, therefore, can be challenging to treat. Moreover, it is crucial to obtain a stone-free patient to prevent recurrence. Therefore, local chemolysis can be an interesting tool when complete surgical removal of the stone is impossible or as an adjuvant treatment for residual stone fragments after surgery. Case Presentation: We present a case of an 84-year old Caucasian man in whom local chemolysis therapy with a citric acid solution resulted in a rapid reduction of the stone load, making less invasive therapy possible. Conclusion: We describe the procedure, (dis)advantages, and possible indications for local chemolysis.
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INTRODUCTION: This paper aims to assess the diagnostic accuracy of an 11C-choline positron emission tomography/computed tomography (PET/CT) scan in the detection of lymph node (LN) metastases in patients with biochemical recurrence after radically treated prostate cancer (PCa), as compared to histology. The secondary goal is to depict spreading patterns of metastatic LNs in recurrent PCa. MATERIAL AND METHODS: A single center retrospective study comprising of 30 patients who underwent retroperitoneal and/or pelvic salvage lymph node dissection (LND) due to 11C-choline PET/CT-positive nodal recurrences after radical treatment (median Prostate Specific Antigen (PSA) 1.5 ng/ml, range 0.2-11.4). Positive nodes on the preoperative PET/CT scans were mapped and compared to post-operative pathology results.LNs were marked as true positive, false positive, true negative and false negative and a patient- and a region-based analysis was performed. Sensitivity, specificity and positive/negative predictive value (PPV/NPV) were calculated. RESULTS: Sixty positive LNs were detected on PET/CT with a median number of two positive nodes per patient (range 1-6). In 29 patients, a super-extended pelvic LND (PLND) was performed combined with a retroperitoneal LND (RPLND) in 13 of those cases. One patient underwent an inguinal LND. One hundred thirty-seven of 644 resected LNs contained metastases. The 11C-choline PET/CT scan correctly predicted 31 positive nodes (55%) while 25 nodes were falsely positive (45%). One hundred and six histologically proven metastatic nodes were not detected on the 11C-choline PET/CT scan (77%). Sensitivity, specificity, PPV and NPV of the 11C-choline PET/CT were 23%, 95%, 55% and 82%, respectively. CONCLUSIONS: 11C-choline PET/CT has a relatively low detection rate and a moderate PPV for metastatic LNs in patients with biochemical recurrence after radically treated PCa.
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BACKGROUND: A 11C-choline positron emission tomography/computed tomography (PET/CT) scan is used for restaging prostate cancer (PCa) patients with biochemical recurrence (BCR). Only a few reports have focused on the correlation between PET/CT and nodal relapse location at pathologic examination. OBJECTIVE: To assess the accuracy of PET/CT in predicting the site of nodal relapses in patients undergoing pelvic and/or retroperitoneal salvage lymph node dissection (sLND). DESIGN, SETTING, AND PARTICIPANTS: Multicentric retrospective study including 106 patients with BCR of PCa after radical treatment; all patients but six had a PET/CT showing at least one nodal recurrence and received sLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: PET/CT results were compared with histologic findings and analyzed in terms of sensitivity, specificity, and accuracy. Multivariable regression analyses were performed. RESULTS AND LIMITATIONS: Overall sensitivity, specificity, negative and positive predictive value, and accuracy of PET/CT for disease location were 61.6%, 79.3%, 66.3%, 75.7%, and 70.2%, respectively. Sensitivity was 75.5% in the lower pelvis with 69.8% specificity. The retroperitoneal region had high specificity (94.7%) but a relatively low sensitivity (58.3%). The sLNDs did not find any positive nodes in 16 patients (15%). According to regression analyses, discriminative accuracy of PET/CT was 70.4% and improved with an increased number of dissected nodes and prostate-specific antigen doubling time <12 mo. Limitations include retrospective design and lack of a standardized sLND template followed for all patients. CONCLUSIONS: The ability of PET/CT to detect nodal relapses is limited by a high false-positive rate, particularly in the iliac-obturator region and, more alarmingly, a high false-negative rate in the common iliac, sacral, and retroperitoneal regions. An extended template including pelvic and retroperitoneal regions should be adopted when sLND is planned for curative intent. PATIENT SUMMARY: The 11C-choline positron emission tomography/computed tomography scan is a commonly used tool to restage prostate cancer patients with biochemical recurrence, showing an overall per patient accuracy >80%; however, its ability to detect the site of nodal relapses remains suboptimal.
