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Abstract. Microwave thermal ablation (MWTA) could be considered in the future for treating small solid renal masses. The aim of the present study was to determine both the tolerability of the new Amica-probe applicator-induced MWTA used in vivo on patients with solid renal masses and the effects of heating on renal tumors and normal renal parenchyma. Fourteen patients with renal masses eligible for open radical nephrectomy were enrolled in this phase I study. All patients underwent MWTA of renal masses during the open surgery procedure before clamping of renal vascular pedicle. The effects of MWTA on patients' coagulation and tumor/renal vasculature were investigated. The histological effects of MWTA on the tumor and intralesional vital tumor cell skipping were also evaluated. The MWTA-induced lesion diameters were measured to calculate both the overall ablation volume and the lesion sphericity index (SI). The Clavien-Dindo classification was used. In all patients the RENAL score was 9.4 (8-12) and the Charlson comorbidity index was 4.8 (3-7). MWTA-induced lesion size was 44.14 mm (±22.59). Mean SI was 1.08 (±0.2). No significant differences among coagulation clinical parameters were found. No local bleeding after MWTA treatment was reported. According to the ClavienDindo classification, there were two grade II perioperative complications due to the tumor extent but not related with the MWTA treatment. No residual vital tumor cells inside the MWTA-induced lesions were found. Telephone interview at 27.4 (±4.2) months mean follow-up did not find any long-term adverse events due to previous MWTA treatment. AmicaProbe applicator-induced MWTA is a safe and reproducible method to treat solid renal masses. IntroductionPrevalence of small solid renal masses in adult population recently increased probably due to the large number of people that daily undergo preventive diagnostic investigations such as ultrasonography and computed tomography (CT) scan for unrelated symptoms, resulting in incidental tumor detection (1). Patients' comorbidities, such as cardiovascular or respiratory diseases, could represent limiting factors for planning adequate subsequent surgical approaches although conservative laparoscopy surgery is now considered the gold standard treatment, particularly for tumors <3-4 cm (2). Minimally invasive procedures, such as cryoablation (CryA) and radiofrequency ablation (RFA), have been recently proposed by different authors as alternative methods of treatment to conservative surgery with satisfactory results in terms of perioperative complications such as hemorrhage episodes or metabolic problems related to prolonged period of general anaesthesia (3). Some doubts remain on the efficacy of these methods on tumor complete eradication due to the high prevalence of tumor local recurrences due to persistent vital tumor cells in the context of the ablated tissue (tumor skipping) (4). Both CryA and RFA are based on the application of physical means (cold and heat respectively) at the centre of the lesion to induce...

Recent evidence has shown that positive results may be observed for fluorodeoxyglucose-positron emission tomography (FDG-PET) in undifferentiated, biologically aggressive and metastatic tumors. The present study describes a case series of six patients with normal prostate-specific antigen (PSA) serum levels who underwent FDG-PET due to other causes. Positive PET results were observed at the prostate and the patients were subsequently diagnosed with high-risk prostate cancer. Clinical, anamnestic, laboratory and instrumental data were collected from six asymptomatic patients with total serum PSA levels of <4 ng/ml who had undergone FDG-PET due to other causes. The FDG-PET and prostate biopsy were positive for prostate cancer. All the patients were treated with radical intent. The median age was 66 years (range, 52–72 years), the median total PSA value was 2.4 ng/ml (range, 1.5–3.9 ng/ml) and the body mass index was 26.4 (range, 21.8–30.2). Three of the six patients underwent FDG-PET due to a clinical suspicion of multiple myeloma, while three patients were examined for other oncological diseases. The pathological analysis at the prostate biopsy revealed three patients with a Gleason score of 6, two with a score of 7 (4+3) and one with a score of 8 (4+4). Five of the six patients were treated by radical prostatectomy and one by radiotherapy. The pathological analysis revealed one patient of pT2a stage, three of pT2c and one of pT3b. No patients demonstrated lymph node invasion. The definitive Gleason score was 3+3 in one patient, 4+3 in one patient, 4+4 in two patients and 5+3 in one patient. Following a median follow-up time of six months (range, 1–12 months), five of the six patients underwent FDG-PET again, which revealed negative results. At the end of this study, these patients were alive without evidence of disease. By contrast, one patient demonstrated positive FDG-PET results. In conclusion, FDG-PET has been used to characterize prostate cancers in patients with apparently normal PSA levels.