ABSTRACT
METHODS:: We analysed results of 142 males with staging PSMA prior to radical prostatectomy (RP). Data collected included PSMA PET/CT, bone scan (30/142), mpMRI (112/142), and pathological T stage (pT) stage, Gleason score, surgical margins and lymph node status at RP. Prostate-specific antigen (PSA) was documented at staging scan, and following surgery (median 45 days (interquartile range 38-59). A PSA of < 0.03 ng ml-1 was classified as surgical response (SR). Logistic regression was performed for association of pre-operative clinical variables and SR. RESULTS:: 97.9% (139/142) of males had positive intraprostatic findings on PSMA. 14.1 % (20/142) of males had further sites of extra prostatic disease identified on PSMA PET. In males with disease confined to the prostate, 82.9 % (92/111) achieved an SR, compared to 28.6 % (4/14) in males with extraprostatic disease identified (lymph node positive and distant metastatic disease) (p < 0.001). On binary logistic regression PSMA had a superior predictive value for SR than Gleason score, PSA (at time of imaging) or pT stage. MRI was less sensitive and more specific for SVI, and less sensitive for nodal involvement. CONCLUSION:: Extraprostatic disease identified on staging pre-operative PSMA PET is independently predictive of a poor surgical response to RP, and may indicate a need for a multimodality approach to treatment. ADVANCES IN KNOWLEDGE:: This is one of the first studies to correlate the PSMA PET's staging capacity to prostate cancer patient's outcomes to radical prostatectomy and indicates it's potential in predicting which patients will benefit from radical prostatectomy.
Subject(s)
Edetic Acid/analogs & derivatives , Neoplasm Recurrence, Local/diagnostic imaging , Oligopeptides/administration & dosage , Positron Emission Tomography Computed Tomography/methods , Prostatectomy/methods , Prostatic Neoplasms/diagnostic imaging , Aged , Edetic Acid/administration & dosage , Gallium Isotopes , Gallium Radioisotopes , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Staging/methods , Predictive Value of Tests , Prostate/diagnostic imaging , Prostate/pathology , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Retrospective StudiesABSTRACT
The authors describe the case of a 13-year-old male with a Salter-Harris II fracture-subluxation of the fibula. Open reduction and internal fixation with a posterior antiglide plate achieved mortise stability and avoided penetration of the fibular physis by fixation devices. After searching the Medline, EMBASE, CINAHL, and the Cochrane Library databases, to our knowledge, there have been no published reports describing the advantages associated with the use of a posterior antiglide plate for fixation of the immature fibula.