Oligometastatic Prostate Cancer.

BACKGROUND: With advancements in diagnostic techniques, oligometastatic prostate cancer is diagnosed in patients who were, in the past, considered to have localized disease. Moreover, evidence of the effectiveness of treatment intensification for this disease is increasing, focusing on primary tumors as well as metastatic lesions. Thus, we can delay the start of systemic palliative treatment and improve overall survival. Many questions remain unclear, such as the definition of oligometastasis disease, or which patients should be offered aggressive treatment. Data are limited and come from small retrospective studies but show conclusively the benefits of survival in targeted primary prostate and metastatic prostate cancer therapy with surgery or radiotherapy. Often, stereotactic radiotherapy is used in this indication, with minimal side effects. In retrospective studies, 3-5 metastatic lesions were generally accepted for definition of oligometastatic disease, but patient subgroups were heterogeneous. A recent study attempts to better define oligometastatic disease and find out the right degree of intensification of treatment. When and in which patient to use metastasis-targeted therapy and when the standard systemic treatment is already meaningful. It is already clear that selected patients benefit from targeted personalized treatment. PURPOSE: The purpose of this review is to offer an update of the problem of oligometastatic prostate cancer. The article presents an overview of data from contemporary literature, modern possibilities of diagnostic imaging methods and treatment options of oligometastatic prostate cancer including surgery and radiotherapy.  authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 8. 2. 2019 Accepted: 5. 3. 2019.

PET/CT in giant cell arteritis: High 18F-FDG uptake in the temporal, occipital and vertebral arteries / PET/TC en la arteritis de células gigantes: alta acumulación de 18F-FDG en las arterias temporal, occipital y vertebral

18F-FDG PET/CT imaging is useful in patients with fever of unknown origin and can detect giant cell arteritis in extracranial large arteries. However, it is usually assumed that temporal arteries cannot be visualized with a PET/CT scanner due to their small diameter. Three patients with clinical symptoms of temporal arteritis were examined using a standard whole body PET/CT protocol (skull base - mid thighs) followed by a head PET/CT scan using the brain protocol. High 18F-FDG uptake in the aorta and some arterial branches were detected in all 3 patients with the whole body protocol. Using the brain protocol, head imaging led to detection of high 18F-FDG uptake in temporal arteries as well as in their branches (3 patients), in occipital arteries (2 patients) and also in vertebral arteries (3 patients) (AU)

El estudio con 18F-FDG PET/TC es útil en los pacientes con fiebre de origen desconocido y puede detectar la arteritis de células gigantes en las grandes arterias extracraneales. Sin embargo, por lo general se supone que las arterias temporales no pueden ser visualizadas por medio de PET/TC porque su diámetro es pequeño. Se examinó a tres pacientes con arteritis temporal mediante el protocolo PET/TC estándar de cuerpo completo (base del cráneo - mitad del muslo) seguido del protocolo PET/TC de cabeza para cerebro. En los tres pacientes se observó la alta acumulación de 18F-FDG en la aorta y en algunas arterias. Mediante el protocolo para cerebro se observó la intensa acumulación de 18F-FDG en las arterias temporales y sus ramas (3 pacientes), en las arterias occipitales (2 pacientes) y también en las arterias vertebrales (3 pacientes) (AU)

PET/CT in giant cell arteritis: High 18F-FDG uptake in the temporal, occipital and vertebral arteries.

18F-FDG PET/CT imaging is useful in patients with fever of unknown origin and can detect giant cell arteritis in extracranial large arteries. However, it is usually assumed that temporal arteries cannot be visualized with a PET/CT scanner due to their small diameter. Three patients with clinical symptoms of temporal arteritis were examined using a standard whole body PET/CT protocol (skull base - mid thighs) followed by a head PET/CT scan using the brain protocol. High 18F-FDG uptake in the aorta and some arterial branches were detected in all 3 patients with the whole body protocol. Using the brain protocol, head imaging led to detection of high 18F-FDG uptake in temporal arteries as well as in their branches (3 patients), in occipital arteries (2 patients) and also in vertebral arteries (3 patients).

[Failed preoperative lymphoscintigraphy for sentinel lymph node biopsy in breast cancer, possible causes and implications for the surgery - the analysis of 3014 procedures]. / Neúspesná lymfoscintigrafie pred sentinelovou biopsií u karcinomu prsu, mozné príciny a dusledky pro chirurgický výkon - analýza výsledku 3014 vysetrení

INTRODUCTION: The aim of the study was to review the cases of sentinel lymph node biopsy for breast cancer in which preoperative lymphoscintigraphy had shown no axillary hot spot; to assess the frequency of failed examinations and possible causes of the failure; to analyze subsequent surgical procedures and hence to provide a general recommendation on what to do in such a situation. METHODS: A retrospective overview of 3014 lymphoscintigraphy examinations at the Masaryk Memorial Cancer Institute from 2001 to 2011 with a more detailed analysis of the cases with axillary hot spot visualization failure. RESULTS: The axillary hot spot was not shown in 71 examinations (2.4%). The frequency of failed lymphoscintigraphy during the time period did not change substantially. The possible risk factors of failed lymphoscintigraphy include: previous surgery on the breast or the axilla, obturation of the lymphatic drainage with the cancer, and the absence of the tracer injection site massage. The most common surgical procedures to respond to a failed examination were: the application of patent blue and surgical exploration of the axilla, no axillary surgery, or axillary dissection. CONCLUSION: When repeated scanning with the gamma camera through the first several hours is performed, the frequency of failed lymphoscintigraphy procedures remains very low (2.4%). If there is no axillary hot spot shown, patent blue is to be injected and the axilla should be surgically explored. This solution will be successful in most patients. If the sentinel lymph node cannot be detected even using the combined method, the surgical procedure needs to be selected with regard to the individual clinical context.Key words: breast cancer - sentinel lymph node - sentinel lymph node biopsy - lymphoscintigraphy - failed detection.

[Current trends in using PET radiopharmaceuticals for diagnostics in oncology]. / Soucasné trendy ve vyuzívání PET radiofarmak k onkologické dia-gnostice.

Nuclear medicine is an important field of modern medicine, particularly thanks to its role in in vivo imaging of important processes in human organism. This is possible thanks to the use of radiopharmaceuticals, specific substances labeled by radioactive nuclide, its distribution in the body can be visualized by specialized scanners and, based on the knowledge of physiological patterns, dia-gnosis can be determined. Positron emission tomography (PET) is a modern and in many ways indispensable method of nuclear medicine. The spectrum of radiopharmaceuticals available in recent years is broadening thanks to a coordinated effort of manufacturers of synthesis equipment, chemists and potential users -  physicians. This review focuses on the development in the PET radiopharmaceutical field in the last five years, with an emphasis on oncological applications of PET.

["Technetium crisis" -  causes, possible solutions and consequences for planar scintigraphy and SPECT diagnostics]. / "Techneciová krize" -  príciny, mozná resení a dopad na dia-gnostiku planární scintigrafií a SPECT.

Nuclear medicine is an important field of nuclear medicine, especially thanks to its role in in vivo imaging of important processes in human organism. An overwhelming majority of nuclear medicine examinations comprises of planar scintigraphy and single photon emission computed tomography, for decades relying on the labeling by metastable technetium nuclide (99mTc), used with a great diversity of ligands for various applications. Nuclear medicine departments utilize commercially available molybdenum technetium generators, being able to elute the nuclide at any time and prepare the radiopharmaceutical. The mother nuclide, molybdenum-99 (99Mo), is produced in just a handful of places around the world. The production places are without exception research nuclear reactors working far past their life expectancy. A concurrent temporary shutdown of two of them in the year 2009 caused a critical worldwide shortage of 99mTc. An unavoidable permanent shutdown of part of these capacities in the second decade of the 21st century will cause the second, and this time rather permanent "technetium crisis". The article focuses on history, present, potential future and possible solutions in regard to SPECT diagnostics.

Scale-up and optimization of the low-temperature inducible cspA promoter system.

The performance of the major Escherichia coli cold-shock promoter in directing the synthesis of recombinant proteins at low temperatures was investigated in batch fermentations using a plasmid-encoded transcriptional gene fusion between the cspA promoter region and the lacZ gene. Rapid synthesis of beta-galactosidase was observed when the fermentation broth was chilled to 15 degreesC using a variety of cooling profiles, including one modeling the heat-transfer characteristics of a 60-L pilot plant unit. A linear cooling rate of 0.5 degreesC/min led to optimum recovery yields. For all single-temperature downshift experiments, however, the promoter became repressed 60-120 min after initiation of cooling. Both temperature cycling between 15 and 25 degreesC and stepwise temperature downshifts between 37, 29, 21, and 13 degreesC led to multiple inductions of the cspA promoter. Nevertheless, high-efficiency reinduction was only observed during the first temperature pulse when the former strategy was used and when the cells were held at intermediate temperatures for less than 60 min or more than 120 min in the case of successive downshifts. Promoter repression was abolished in host cells bearing a null mutation in the gene encoding the ribosomal binding factor RbfA, leading to the constitutive and high-level expression of beta-galactosidase for 7 h postshift when shake flask cultures were transferred from 42 to 23 degreesC. The suitability of rbfA cells for cspA-driven recombinant protein production was confirmed in high-density fed-batch fermentations. Our results are consistent with the existence of a cold-shock-induced repressor molecule that must accumulate at a threshold concentration before interfering with the production of proteins placed under cspA transcriptional control.

Expression of aggregation-prone recombinant proteins at low temperatures: a comparative study of the Escherichia coli cspA and tac promoter systems.

The aggregation-prone fusion protein preS2-S'-beta-galactosidase was used as a model system to compare the efficiencies of the IPTG-inducible tac promoter and the low-temperature-inducible cspA promoter in directing the expression of soluble recombinant polypeptides at reduced growth temperatures in Escherichia coli. At 37 degrees C, the fusion protein was produced at high levels from the tac promoter, but aggregated quantitatively in a biologically inactive form. In contrast, little preS2-S'-beta-galactosidase was synthesized from the cspA promoter at this temperature, presumably due to transcript instability. The highest yields of active enzyme were obtained following temperature downshift from 37 to 30 degrees C for the tac promoter and 25 degrees C for the cspA promoter. At 25 degrees C, the kinetics of accumulation of beta-galactosidase activity, ratios of soluble to insoluble fusion protein, and synthesis rates of preS2-S'-beta-galactosidase were virtually identical for both promoters for a period of 2 h postinduction. Thereafter, the cspA promoter became repressed, whereas synthesis of the fusion protein continued with the tac system. Following transfer to 10 degrees C, the tac promoter was almost completely inhibited while the cspA promoter was able to direct the synthesis of soluble preS2-S'-beta-galactosidase for up to 2 h. However, the levels of active enzyme produced were approximately threefold lower than those measured at 25 degrees C. Overexpression of native CspA had no effect on the accumulation of active preS2-S'-beta-galactosidase from the cspA promoter. It is therefore unlikely that CspA acts as it own positive inducer. Our results indicate that the cspA promoter can efficiently substitute for the tac system at 25 degrees C and may be particularly valuable for the expression of highly aggregation-prone or unstable gene products at 10 degrees C.

Recombinant protein expression at low temperatures under the transcriptional control of the major Escherichia coli cold shock promoter cspA.

A transcriptional gene fusion between the cspA promoter and the lacZ gene was constructed to assess the usefulness of cold shock promoters for low-temperature protein expression. Synthesis of beta-galactosidase was efficiently repressed at 37 degrees C but rapidly induced upon transfer to the 15-to-30 degrees C range, leading to a three- to fivefold increase in specific activity relative to control cultures. Although the initial rates of beta-galactosidase accumulation at 20 degrees C were twice those measured at 15 degrees C, prolonged incubation at 20 degrees C, but not 15 degrees C, led to a dilution of activity due to repression of the promoter and cell division.