Prostate cancer is the most common non-cutaneous malignancy in men. It is generally considered a cancer of the elderly, and the median age of presentation is 68 years. However 10% of new diagnoses in the USA occur in men aged ≤ 55 years. This may be due to more prevalent screening nowadays, and may also reflect the diagnosis of an increasingly recognized but underappreciated entity, i.e. early-onset prostate cancer. Patients with early onset prostate cancer pose unique challenges. Current data suggest that early-onset prostate cancer is a distinct phenotype—from both an etiological and clinical perspective— that deserves further attention. We present a case of a 28-year-old man who presented with lower urinary tract symptoms and was diagnosed with advanced stage prostate cancer.
Purpose:To evaluate the technical and clinical success of radiofrequency ablation of osteoid osteoma and analyze the factors responsible for clinical success. We also tried to investigate the role of follow-up computed tomography (CT) imaging.Materials and Methods:This is a prospective study approved by the institute's ethics committee involving 87 patients with appendicular osteoid osteoma. CT-guided radio frequency ablation was performed using a bipolar ablation system. Patients were followed up over 15.4 (4–24) months for pain, and clinical success/failure was determined using established criteria. Patients with clinical failure were taken for repeat ablation. Follow-up CT was obtained at 6 months and correlated with clinical success. Procedural scans were later reviewed for technical success in a blinded manner and correlated with clinical success along with other imaging and patient characteristics.Results:Mean pre-procedure visual analog scale (VAS) score was 7.0 ± 0.8. Primary success rate after single session was 86.2%(75/87 patients), and overall success rate after one/two sessions was 96.6%(84/87). No major complications were noted. Technical success rate was 89.7%(78/87). All 9 patients who had a suboptimal needle positioning had recurrence where as three patients had recurrence despite technical success. None of the imaging characteristics or history of prior intervention was significantly associated with clinical success. Follow-up CT showed advanced bone healing in 48 lesions, and was confined to the treatment success group. Alternately, minimal/absent bone healing was seen in all (12) patients of primary treatment failure and 27 patients with treatment success.Conclusions:CT-guided percutaneous radio frequency ablation is a safe and highly effective treatment for osteoid osteomas even in recurrent and residual cases. Technical success is the most important parameter affecting the outcome. Post radio frequency ablation CT findings have a good positive but a poor negative predictive value in prognostication.
To assess the impact of adding thin-section CT-derived semiquantitative fibrotic score to gender, age, and physiology (GAP) model for predicting survival in idiopathic pulmonary fibrosis (IPF).
Materials and Methods:In this retrospective study of 194 patients with IPF, primary outcome was transplant-free survival. Two thoracic radiologists visually estimated the percentage of reticulation and honeycombing at baseline thin-section CT, which were added to give fibrotic score. For analysis, fibrotic score cutoff (x) determined by using receiver operating characteristic analysis categorized patients into group A (,x) and group B (x). Another categorization based on GAP score created group 1 (score 0-3) and group 2 (score 3). Combining the above categories gave four groups (A1, A2, B1, B2). Kaplan-Meier survival analysis was performed with comparison statistics (log-rank test), and hazard ratios were calculated by using the Cox model.
Results:The study patients included 141 men (72.7%), with average age of 66.1 years 6 9.1 (standard deviation). Eighty-four patients (43.3%) has stage I disease with a median follow up of 3.3 years. The interobserver agreement for thin-section CT fibrotic score was substantial (83.3%; k = 0.64). The optimal cutoff for fibrotic score was 25% (x), with area under the curve of 0.654 (95% confidence interval [CI]: 0.569, 0.74). Survival for group A1 was significantly better than in the other three groups (P < .001). The hazard ratios for respective groups were as follows: B1 was 4.03 (95% CI: 2.02, 8.07), A2 was 4.10 (95% CI: 1.89, 8.87), and B2 was 5.62 (95% CI: 2.86, 11.06) (P , .001 for all). Within the group with GAP score less than or equal to 3 (A1, B1), participants with higher fibrotic score (B1) had four times the increased risk of death or transplantation (P , .001).
Conclusion:Incorporating semiquantitative fibrotic score from thin-section CT to GAP score provides an improved prediction model for survival in idiopathic pulmonary fibrosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.