Focal laser ablation as clinical treatment of prostate cancer: report from a Delphi consensus project.

PURPOSE: To define the role of focal laser ablation (FLA) as clinical treatment of prostate cancer (PCa) using the Delphi consensus method. METHODS: A panel of international experts in the field of focal therapy (FT) in PCa conducted a collaborative consensus project using the Delphi method. Experts were invited to online questionnaires focusing on patient selection and treatment of PCa with FLA during four subsequent rounds. After each round, outcomes were displayed, and questionnaires were modified based on the comments provided by panelists. Results were finalized and discussed during face-to-face meetings. RESULTS: Thirty-seven experts agreed to participate, and consensus was achieved on 39/43 topics. Clinically significant PCa (csPCa) was defined as any volume Grade Group 2 [Gleason score (GS) 3+4]. Focal therapy was specified as treatment of all csPCa and can be considered primary treatment as an alternative to radical treatment in carefully selected patients. In patients with intermediate-risk PCa (GS 3+4) as well as patients with MRI-visible and biopsy-confirmed local recurrence, FLA is optimal for targeted ablation of a specific magnetic resonance imaging (MRI)-visible focus. However, FLA should not be applied to candidates for active surveillance and close follow-up is required. Suitability for FLA is based on tumor volume, location to vital structures, GS, MRI-visibility, and biopsy confirmation. CONCLUSION: Focal laser ablation is a promising technique for treatment of clinically localized PCa and should ideally be performed within approved clinical trials. So far, only few studies have reported on FLA and further validation with longer follow-up is mandatory before widespread clinical implementation is justified.

Quantitative analysis by liquid chromatography-tandem mass spectrometry of deuterium-labeled and unlabeled vitamin E in biological samples.

A method for quantification of unlabeled alpha-tocopherol and the deuterated tocopherols, RRR-alpha-5-(CD(3))-tocopherol (d(3)RRR) and all rac-alpha-5,7-(CD(3))(2) tocopherol (d(6)all-rac) in plasma by HPLC-tandem mass spectrometry (LC-MS/MS) has been developed. Deuterated and unlabeled alpha-tocopherols were separated by HPLC and were detected by positive ion multiple-reaction monitoring using a triple-quadrupole mass spectrometer equipped with a heated nebulizer-atmospheric pressure chemical ionization interface, following routine extraction of vitamin E from plasma. The accuracy and precision were evaluated by replicate analysis of standards and samples. Human plasma samples, which were obtained at different times after the subject had consumed a capsule containing 1:1 ratio of d(3)RRR and d(6)all rac-alpha-tocopheryl acetates, were analyzed with this method. Plasma deuterated alpha-tocopherols measured by LC-MS/MS followed the same pattern as previously demonstrated by GC-MS measurement, without requiring an extra derivitization step. The detection limit was 10 pmol for each form of alpha-tocopherol injected.

Detection of metabolites using high-performance liquid chromatography and mass spectrometry.

This unit provides a discussion of high-pressure liquid chromatography-atmospheric pressure ionization mass spectrometry (LC-API-MS) for separation, detection, and identification of products from xenobiotic metabolism. It includes an introduction and important technical information for electrospray and atmospheric pressure chemical ionization methods as well as scan modes. Emphasis has been placed on each method as related to phase I and phase II metabolite identification and there are listings of specific applications (and references) to reduce method development time.

alpha,beta-unsaturated aldehydes accelerate oxymyoglobin oxidation.

This study investigates the potential basis for enhancement of oxymyoglobin (OxyMb) oxidation by lipid oxidation products. Aldehydes known to be formed as secondary lipid oxidation products were combined with OxyMb in aqueous solution at 37 degrees C and pH 7.4. Metmyoglobin (MetMb) formation was greater in the presence of alpha,beta-unsaturated aldehydes than their saturated counterparts of equivalent carbon chain length. Additionally, increasing chain length from hexenal through nonenal resulted in increased MetMb formation (P < 0.05). Electrospray ionization mass spectrometry (ESI-MS) revealed that OxyMb incubated with 4-hydroxynonenal (HNE) at pH 7.4 at 37 degrees C yielded myoglobin molecules adducted with one to three molecules of HNE from 0.5 to 2 h of incubation, respectively. A prooxidant effect of HNE was noted at pH 7.4 but was not apparent at pH 5.6 when compared to the control (P < 0.05). This appeared to be due to rapid OxyMb autoxidation at this pH compared to pH 7.4. ESI-MS demonstrated that adduction of HNE to OxyMb occurred at pH 5.6. This research demonstrates that alpha, beta-unsaturated aldehydes accelerate OxyMb oxidation and appear to do so via covalent attachment.

Oral and topical absorption, disposition kinetics, and the metabolic fate of trans-methyl styryl ketone in the male Fischer 344 rat.

trans-Methyl styryl ketone (MSK; trans-4-phenyl-3-buten-2-one) is a beta-unsaturated ketone that has a wide range of uses in industry and is present in numerous consumer products. Although MSK has been shown to be positive in several in vitro mutagenic assays, it does not seem to be overtly toxic in animal models. This lack of toxicity may relate to its poor absorption and/or rapid elimination. However, little is known about the fate of MSK in the body. Studies were conducted to characterize the absorption, and disposition kinetics of MSK after intravenous, oral, and topical administration to male Fischer 344 rats. After intravenous administration of [14C]MSK (20 mg/kg, 120 microCi/kg), blood concentration-time data could be characterized with a biexponential equation and apparent first-order elimination kinetics. The following pharmacokinetic parameter values were obtained (mean +/- SD): terminal disposition half-life, 17.7 +/- 0.08 min; apparent steady-state volume of distribution, 0.89 +/- 0.14 liters/kg; systemic body clearance, 68.9 +/- 10.0 ml/kg *min; and mean residence time, 13.1 +/- 2.2 min. Within 48 hr, 95.5% of the dose was excreted in the urine and 2.7% in the feces. The major blood metabolite after intravenous administration was identified by GC/MS as the 4-phenyl-3-buten-2-ol (methyl styryl carbinol). After oral administration of [14C]MSK (200 mg/kg, 100 microCI/kg), approximately 96.6% of the dosed radioactivity was recovered in the urine and 4.8% in the faces within 48 hr. Major urinary metabolites identified by LC-MS/MS and quantified by HPLC radioassay were N-phenylacetyl-L-glycine (64.9% of dose) and N-benzyl-L-glycine (9.9% of dose). Parent compound could not be detected in the blood after oral administration, and 14C-equivalents in the blood never exceeded 1.3% of the dose. Results suggest near-total presystemic elimination of the oral dose. After topical application of [14C]MSK (250 mg/kg, 50 microCi/kg), > 60% of the dose was absorbed, and the majority of the dose was excreted into the urine (55% of dose) in the form of metabolites. Urinary metabolites were similar to those described after oral administration. 14C-equivalents were not detected in the blood at any time after topical administration. These results indicate that MSK is almost totally metabolized before systemic distribution after oral or topical administration. The systemic exposure dose of MSK seems to be exceedingly low at the doses studied herein.

Absorption, disposition kinetics, and metabolic pathways of cyclohexene oxide in the male Fischer 344 rat and female B6C3F1 mouse.

Cyclohexene oxide (CHO) is a monomer intermediate used in the synthesis of pesticides, pharmaceuticals, and perfumes. Although CHO has a variety of industrial uses where direct human exposure is possible, very little is known about its fate in the body. Therefore, the objectives of this study were to determine the absorption, distribution, metabolism, and excretion of cyclohexene oxide after oral, intravenous, and dermal exposure in male Fischer 344 rats and female B6C3F, mice. After intravenous administration of [14C]CHO (50 mg/kg), CHO was rapidly distributed, metabolized, and excreted into the urine. Plasma concentrations of CHO rapidly declined and were below the limit of detection within 60 min. Average (+/- SD) values for terminal disposition half-life, apparent volume of distribution at steady-state, and systemic body clearance were: 19.3 +/- 1.6 min; 0.44 +/- 0.08 liter/kg; and 31.3 +/- 0.5 ml/kg * min, respectively. After oral administration of [14C]CHO (10 and 100 mg/kg), it was found that 14C-equivalents were rapidly excreted in the urine of both species. At 48 hr, the majority of the dose (73-93%) was recovered in urine, whereas fecal elimination accounted for only 2-5% of the dose. At no time after oral administration was parent CHO detected in the blood. However, its primary metabolite cyclohexane-1,2-diol was present for different lengths of time depending on the dose. Four metabolites were detected and identified in mouse urine by MS: cyclohexane-1,2-diol; cyclohexane-1,2-diol-O-glucuronide; N-acetyl-S-(2-hydroxycyclohexyl)-L-cysteine; and cyclohexane-1,2-diol-O-sulfate. The sulfate conjugate was not present in rat urine. Topical application of [14C]CHO (60 mg/kg) provided poor absorption in both species. The majority of 14C-equivalents applied dermally were recovered from the charcoal skin trap (approximately 90% of the dose). Only 4% of the dose was absorbed, and the major route of elimination was via the urine. To evaluate the toxicity of CHO, animals were given daily doses of CHO orally and topically for 28 days. No statistically significant changes in final body weights or relative organ weights were noted in rats or mice treated orally with CHO up to 100 mg/kg or up to 60 mg/kg when given topically. Very few lesions were found at necropsy, and none were considered compound related. In conclusion, regardless of route, CHO is rapidly eliminated and excreted into the urine. Furthermore, after either oral or dermal administration, it is unlikely that CHO reaches the systemic circulation intact due to its rapid metabolism, and is therefore unable to cause toxicity in the whole animal under the test conditions used in this study.

Antioxidant reactions of beta-carotene: identification of carotenoid-radical adducts.

beta-Carotene and other carotenoids are thought to exert disease preventive actions by scavenging reactive free radicals, but the mechanisms of these reactions are poorly understood. We detected products formed by reaction of beta-carotene with alkoxyl, and alkylperoxyl free radicals generated by thermolysis of azobis(2,4-dimethylvaleronitrile) (AMVN) in benzene. Analyses by atmospheric pressure chemical ionization mass spectrometry identified two previously unknown classes of beta-carotene oxidation products. Substitution products contain one AMVN-derived radical adduct group and result from hydrogen transfer from the carotenoid polyene followed by radical recombination. Addition products contain two AMVN-derived adduct groups and result instead from sequential radical additions to the polyene. These product structures provide the first mechanistic explanation for the radical scavenging reactions of carotenoids.

A rapid method for profiling the products of antioxidant reactions by negative ion chemical ionization mass spectrometry.

The antioxidant nutrients beta-carotene and alpha-tocopherol are thought to prevent oxidation of important biomolecules in vivo by trapping reactive free radicals. Conventional analytical methods for analyzing antioxidants and their products rely on time consuming chromatographic isolation followed by spectroscopic characterization. This approach is complicated by the instability of many of these products and the large amount of time required for isolation and characterization of multiple products. We have developed a negative ion chemical ionization mass spectrometry method to detect beta-carotene, alpha-tocopherol, and their reaction products. The method involves minimal sample handling and does not require compound isolation. Direct probe negative ion chemical ionization produces molecular anions with little or no fragmentation. Each ion signal in the resulting mass spectrum represents a compound or group of isomeric compounds in the original reaction mixture. Thus, a rapid "snapshot" of the reaction product profile is obtained within seconds. Application of this methodology to the analysis of beta-carotene oxidation in model chemical reaction systems and in microsomal membranes in vitro identified intact chain beta-carotene oxygenation products, carbonyl-containing chain cleavage products, and their oxygenation products. Similar analyses of alpha-tocopherol oxidations identified 8a-substituted tocopherones, alpha-tocopherolquinone and alpha-tocopherolquinone epoxides. Full-scan detection limits for the antioxidants and their products are in the picogram range. This method offers the first means for comprehensively profiling the fate of antioxidants in tissue samples.

Urinary excretion of modified nucleosides as biological marker of RNA turnover in patients with cancer and AIDS.

Using boronate gel affinity chromatography and reversed-phase high-performance liquid chromatography (RP-HPLC), a method for the simultaneous determination of 12 urinary modified nucleosides has been developed. The RP-HPLC fractions were identified by gas chromatography/mass spectrometry analysis. The HPLC quantitation of urinary nucleoside levels before and after surgery of cancer patients suggested that urinary 5'-deoxy-5'-methylthioadenosine and N-[(9-beta-D-ribofuranosyl-9H-purine-6-yl) carbamoyl]-L-threonine (t6A) levels were helpful in monitoring therapeutic effects in cancer patients. From the fact that molar ratios of urinary N2,N2-dimethylguanosine (m2 2G)pseudouridine (psi) and t6A/psi in cancer patients were lower than those of normal or post-surgical cancer patients, the increase of rRNA content in cancer tissues growing rapidly was estimated using the stoichiometric relationship between the ratio of the number of residues of their modified nucleoside in RNAs and the proportion of rRNA to total RNAs in average tissues of whole body. Furthermore, from the estimation of RNA turnover using urinary nucleoside levels, it was found that the half-lives of rRNA rather than tRNA of patients with cancer and those of both RNAs in the case of acquired immunodeficiency syndrome (AIDS) were extremely short compared with those of the normal. Thus, we discovered that the selected urinary modified nucleosides were very useful as a biological marker of whole-body RNA turnover in patients with cancer and AIDS.

Gas chromatography/mass spectrometric analysis of urinary nucleosides in cancer patients; potential of modified nucleosides as tumour markers.

Analysis of urine from cancer patients by capillary gas chromatography/mass spectrometry positively identified 14 urinary nucleosides including several modified nucleosides. Levels of the modified nucleosides 1-methyl-adenosine, 2-methylguanosine, N2,N2-dimethylguanosine and 1-methylinosine as well as the total nucleoside level were elevated in the urine when a malignant tumour was present; the levels of N2,N2-dimethylguanosine were found to correlate with the stage of the cancer.

The mass spectrometry of taxol.

The antitumor agent taxol has been examined by electron ionization, chemical ionization, and fast atom bombardment mass spectrometry. Three ion series are observed: (1) the M-series, characteristic of the intact molecule; (2) the T-series, with fragments derived from the taxane ring; and (3) the S-series representing the C-13 side chain. Neutral losses dominate each series of ions and serve to verify the presence and number of functionalities in each portion of the molecule. Fragmentation pathways and mechanisms of ion formation are proposed on the basis of product ion analysis and accurate mass measurements.

Isolation and identification of urinary nucleosides. Applications of high-performance liquid chromatographic methods to the synthesis of 5'-deoxyxanthosine and the simultaneous determination of 5,6-dihydrouridine and pseudouridine.

Modified nucleosides from pooled normal human urine were extracted using a boronate affinity gel column and fractionated by reversed-phase high-performance liquid chromatography (RP-HPLC). The major constituents in each of the 30 RP-HPLC fractions were determined by gas chromatography-mass spectrometry of the trimethylsilyl derivatives of the fractions. The same RP-HPLC method was used in the synthesis of 5'-deoxyxanthosine from authentic 5'-deoxyadenosine. In addition, the simultaneous determination of urinary 5,6-dihydrouridine (D) and pseudouridine (psi) was carried out by RP-HPLC using two ODS columns in series. The level of D in pooled normal urine was 4.87 nmol/mumols creatinine. The RP-HPLC method was applied to the measurement of D and psi levels in urines collected before and after surgery from four patients with gastrointestinal cancer. A large decline in both nucleoside levels in urines after surgery was observed in three of the four cancer patients.

Differentiation of isomeric 2'-, 3'- and 5'-deoxynucleosides by electron ionization and chemical ionization-linked scanning mass spectrometry.

A comparative mass spectral examination of the trimethylsilyl (TMS) derivatives of 2'-, 3'- and 5'-deoxyadenosine, 2'-, 3'- and 5'-deoxyguanosine, 2'-, 3'- and 5'-deoxyxanothosine and 2'- and 5'-deoxy-2-fluoroadenosine is presented. A general compilation of the major fragment ions found in the low-resolution electron ionization (EI) spectra of the eleven deoxynucleosides is given. Chemical ionization (CI)-collisional activation (CA) daughter ion spectra are reported using the deoxyadenosines as model compounds. Ion structures and fragmentation pathways are proposed for those ions characteristic of each of the isomers. Significant differences in fragmentation exist between the isomeric 2'-, 3'- and 5'-purine deoxynucleosides. The formation and structures of ten ions important in this differentiation are discussed. The CI-CA linked scan spectra provide complementary structural information relative to the EI mass spectra.