Faculty Bibliography

OBJECTIVES: To analyze the outcomes of serial delayed interval biopsy (DIBx) in men with isolated high-grade prostatic intraepithelial neoplasia (HGPIN). The natural history of isolated HGPIN is poorly defined. Since January 2000, we have monitored men with isolated HGPIN using DIBx every 3 years, regardless of the change in prostate-specific antigen (PSA) level. METHODS: The institutional biopsy records from 1996 onward were reviewed to identify the men with isolated HGPIN found on 12-core needle biopsy specimens who had undergone a minimum of 1 DIBx in our follow-up strategy. Patient age, biopsy and prostatectomy pathologic outcomes, and longitudinal PSA measurements were recorded. RESULTS: A total of 112 men had undergone a first DIBx and 47 had undergone a second DIBx at the last follow-up examination at a mean of 34.4 and 66.2 months after the HGPIN diagnosis, respectively. Prostate cancer was found in 25 (22.3%) of 112 men and 11 (23.4%) of 47 men at DIBx-1 and DIBx-2, respectively. The PSA velocity was not predictive of cancer during short-term follow-up. Of the men diagnosed with cancer, 63.6% had a Gleason score of >/=7, and 9 (81.8%) of 11 men had clinically significant disease (Gleason score of >/=7 and/or >5% cancer volume) at surgery. All cancers were organ confined at and surgery. CONCLUSIONS: Men with isolated HGPIN have a continued risk of developing prostate cancer during long-term follow-up, regardless of the changes in the serum PSA level. Collectively, the relatively high likelihood of organ confinement and clinically significant cancer suggest empiric DIBx every 2-3 years could be a valuable tool in the follow-up of men with isolated HGPIN found by extended core biopsy

Renal replacement lipomatosis is a rare benign entity in which extensive fibrofatty proliferation of the renal sinus is associated with marked renal atrophy. In this report, we present a case of massive renal replacement lipomatosis demonstrated on MRI. The presentation was atypical given an absence of associated renal calculus disease, and an initial CT scan was interpreted as suspicious for a liposarcoma. The differential diagnosis and key MRI findings that served to establish this specific diagnosis are reviewed. Histopathological correlation is also presented, as the patient underwent nephroureterectomy

OBJECTIVE: The purpose of our study was to compare the visibility of prostate cancer on trace diffusion-weighted (DW) images and the apparent diffusion coefficient (ADC) map. MATERIALS AND METHODS: In this retrospective study, 45 patients with prostate cancer underwent preoperative MRI, including DW imaging (DWI) (b values 0, 500, and 1,000 s/mm(2)). A single observer reviewed the images in conjunction with tumor maps constructed from prostatectomy. For 132 peripheral zone (PZ) tumor foci, the visibility and contrast relative to benign PZ were recorded for T2-weighted imaging, trace DWI b500 images, trace DWI b1,000 images, and ADC maps. Trace DWI b1,000 images and ADC maps were compared in terms of Gleason score, size, normalized T2 signal intensity, ADC, and normalized ADC of visible tumors. RESULTS: For each image set, the percentage of visible tumor foci and contrast relative to benign PZ were as follows: T2-weighted imaging, 80.3% and 0.411; trace DWI b500, 26.5% and 0.131; trace DWI b1,000, 46.2% and 0.119; and ADC maps, 62.1% and 0.309. Forty-seven tumor foci were visible on both trace DWI b1,000 images and ADC maps, 14 only on trace DWI b1,000 images, 35 only on ADC maps, and 36 on neither image set. There was no significant difference in Gleason score, size, normalized T2 signal intensity, ADC, or normalized ADC between tumors visible only on trace DWI b1,000 images and those visible only on ADC maps. CONCLUSION: Given a greater proportion of tumors visible on the ADC map than trace DWI and greater contrast relative to benign PZ on the ADC map, we suggest that, when performing DWI of the prostate, careful attention be given to the ADC map for tumor identification

Squamous cell carcinoma of the prostate is a rare tumor, making up 0.5% to 1% of all prostate carcinomas. It is typically described as an aggressive cancer, with a median postdiagnosis survival of 14 months. Presented here is a case of primary squamous cell carcinoma of the prostate, with a complicated presentation of metastatic disease. Due to the extent of the patient's disease, he was treated with palliative radiation therapy using a four-field technique (AP/PA and left and right lateral fields) with 18 mV photons prescribed to the 100% isodose line. The prescription dose was 4000 cGy in 16 fractions of 250 cGy per fraction. No definitive treatment of squamous cell carcinoma of the prostate exists but varying approaches including surgical intervention, chemotherapy, and radiation therapy have been implemented without durable response. However, multimodal treatments appear to be the most promising with longer durations of survival