Um there is a multi parameter Mri, which has evolved in the last couple of years, um the Pirates classification has been introduced, which helps us um segmenting a prostate cancer within a prostate and um. Just to see is that um we didn't see more insignificant cancer, we actually saw less insignificant cancer in that group that received Mri targeted biopsy the conclusion be all to state that Mri bias uh based targeted biopsy is actually superior to conventional biopsy um if you look at uh the same data um and if you uh to solve analysis of three pirates, four and five we can.
We um we can actually do a biopsy, get a report and then we can go back to our day from the fusion device and actually see where um the positive course we're and where not so first people um we sent them to a three Tesla Mri they um the radiologists will perform a segmentation of the prostate and then we go and uh perform a threed ultrasound of uh pro and fuse the.
With a threed prostate um ultrasound performed to biopsy and Prostatitis hipertónia kezelés is important um if you um have a device to be future biopsy is that we have the possibility of tracking that you performed biopsies so that you can actually go back and see which biopsies was taken where which was positive, which one was negative. Um we performed the that's the way we performed.
I have seen and um we can prostate mri neurovascular bundle a quick show you a short video on how this works. This is called semi robotic arm and hideg és a prosztatitis súlyosbodása always have to live ultrasound of uh the uh prostate image and the fused image down here and um and then we can see where the targets uh are within the prostate and performed the biopsies uh so this is one guy we have made prostate biopsy you can see.
Uh up there all these biopsies course that we're taking they were all negative prostate mri neurovascular bundle within this pirates five um lesion down here it was actually just only one positive uh core with the grease and seven um cancer.
I always hear um that people perform. Acts performing focal therapy or against active surveillance. That's absolutely not true. I think if you're able to do active surveillance on a patient, you actually should do that.
- Krónikus prostatitisrel amit gyógynövények
- Откуда и кто может узнать, что нам надо именно .
- И все одновременно говорили яркими цветовыми полосами, украшая замерзшую улицу динамичным потоком разнообразных оттенков.
That's where you should um you could do a focal therapy and if you would then see uh in the follow up uh a recurrence of a small group in six, you can still go on and perform to Prostatitis vérrel if you um have the recurrence with the high score or a larger size concert, you can still do a whole gland there right.
What we're using is the uh device there's move on our devices out there. The other one is uh four one from the company uh which I do both um I know devices are similar in performing focal hypo therapy. I don't know I think there's it's a big difference. There's a limit of technically uh difference and performing the hypo therapy but um whatever you have or whatever you're going to is good.
This is the high for transducer. That's a trans ultrasound, which is a little bit larger than a normal trans probe and and it has diagnostic ultrasound also and uh therapeutic uh ultrasound in as well.
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Uh a different many different kinds, one of the most important ones in my eyes is high for I just try to talk about high for today um the device we use has the focus distance on one side of three centimeter and one of four centimeter. So I always explain to my patients that is sort of a magnifying glass If you introduce the energy through the magnifying glass, you won't feel any.
Directly at the glass, the same with the high food device you can safely introduce energy through the bowel wall and then prostate mri neurovascular bundle a distance of three or four sentiment, it centimeters you can decide that you um have the energy a hit the energy at the rice corn size that will damage the um.
The tissue got heating it all so who is eligible for um uh therapy like that, of course, as with every other um prostate cancer treatment, you should have a life expectancy of more than 10 prostate mri neurovascular bundle um ideally you can you should treat at least score six seven with three plus four people should have a Psa less than fifteen um the lesion should be.
Prosztatagyulladás hatékony kezelése alternatív módszerekkel
CC and Somping that is very important nive you is that the pation onerstands the concept of focuserby. Oder Bart Incations.
Um if you have a large frosted people usually tends to have severe lots, which is not ideal or if it's anterior lesion, you might have problems getting the energy all the way through the process that might not um be able to get the effect so at our hospital we do a focal therapy with high food and position on on general anesthetics uh it takes about.
More or less 2 hours um we uh or our patients stay one night. You can also do that as outpatient um treatment. I think this is not a problem um our patients keep a catheter in for 1 week or two uh prostate swelling, which can lead to urinary tension. So I think that's something good to do you can also do it longer and I know people who.
The Catherine for 10 days in 2 weeks and we uh put all our passion into a registry. You have a small device that cools the water the run. Through the probe, the patient is positioned in position and the trans Pro was introduced trans and is held by a so called Stepper where I can um precisely uh adapt the area where I wanna put my uh device and first of all I will perform a threed ultrasound of the prostate uh and then our.
Um look where actually I want to uh introduce my energy. I plan that also if you're want by fusing my Mri that I've performed before I can choose a marching around my area um prostate mri neurovascular bundle I want to do that uh so this whole planning and introducing to uh the pro will take quite a while and then we can go on. And perform the energy application once we have plan that we can actually just push a button and then um the probe goes and performs the um high full step by prostate mri neurovascular bundle which will um for every step take about uh 15 minutes the whole um energy application of a normal um operational be a total of.
More or less 30 minutes. Um No II have a small problem. Okay, um what a very important is that you perform a close? That's a follow up schedule a little bit complicated, but you can see that we we do uh a Psa uh test regularly.
We also give questionnaire to the patients um and what is important. I think is that you do uh template biopsies and also Mri once in a while we uh. Do an Mri after 1 week just to see if everything went well, I think you don't have to do that um then, but what is important to me? I think is that you perform um uh an Mri after 6 months months with biopsy after 12 months and we do uh another Mri and biopsy after 36 months of after procedure.
Ablation prostate mri neurovascular bundle uh song here on the left side and if you do it uh 6 months later, you can see a shrinkage of this whole song.
If you compare that here with the with the with the other side, you can see a nice shrinkage so of the main protagonists that introduced focal therapy for localized prostate cancer, of course, prostate mri neurovascular bundle mark and the uh Prostatitis és kezelés diagram of UC um. Also uh introduced the idea of treating an index which is controversial, but it's interesting um if you do like a true focal therapy uh you prostate mri neurovascular bundle um like let's say at least and score six prostate cancers on one side, you would decide just treat this uh area with a small uh but sometimes you see patients prostate mri neurovascular bundle have Alec course seven um area on one side at night, have a small gleason score six on the.
Side so you can decide to uh treat the index the significant prostate cancer and just leave the Gleason score of the small business score six uh in not treat that area um and just perform uh act surveillance and so that's um whole concept around the index Le treatment you can go up to the Hemi ablation to uh a blade half of the prostate many people like to do.
So called hockey stick um uh where they do the dorsal part of the um I think that's something reasonable put you to do what you should not do is a whole high that this has been done 15 years ago and um functional conscious wasn't good.
Therapies one of the most important landmark papers uh up to date, is from the use of age group uh in London, where they have introduced uh over patients um from up to was published in and you can see that they are totally did or biopsies uh but once.
Prostate MRI: An Update
Ten patients um received uh or metastatic disease um interesting is to see the free survival uh especially if you look at Gleason score if you have scored six or seven and you look up the prostate mri neurovascular bundle for survival after 5 years, you can see ninety-two. Gleason score eight or more, let's say um aggressive cancer it is um absolutely worst. Uh which you have to say they have two faces in the very very early beginning uh beforeI think and one needed uh operation and one healed by itself um so they conclude that focal therapy for selected patients with a clinically significant non metastatic prostate cancer isn't effective in medium turn and has a low probability of side effects.
Um more recent Akár urethritis elment a prosztatitishez update of this um study and also go with other um study with over thousand patients. If you look at.
Posztoperatív prosztata adenoma
Plus three or more, it was um significantly less with only Therapy and only a patients received radical um it's not only the the law group that presented a high for data there is um uh one one paper there.
Dayton, which actually were very nice with hundred patients from to nineteen and um we can look at what they found they have a 2 year survival fee um treatment for treatment failure, which was seventy-three uh the survival of free from great group.
Also, this group only performed um biopsies on this hundred patients. They had some you know, retention and infection. They have no major complication and office um last would just like to um show you two more day. I think interesting Prostatitis és anémia data.
Which have not been published yet, so these are posters from the meeting held last year in London. I think this is very interesting and I'm looking forward to um prostate mri neurovascular bundle reading the uh the publication soon uh again the poster from the focal meeting last year have was a very interesting um topic and this is not a focal.
Be um primary localized prostate cancer, but this was formed and a foal therapy on prostate cancer after radio therapy so they call that fast for focal a salvage therapy for prostate cancer after occurrence and um the data is very good so they performed up between and um with over. Focal high food therapy is not totally experimental and more.
Clinical Research News
Of course, I know long term data they um uh there are awaited but um at least we have nice data to know um it is a safe um therapy I think focal therapy is here to stay it is based on Mri and targeted by este a good um. Patient is somebody who has a small score three plus four um tumor on a purchase so if you have patients that have anterior lesions in a in a large prostate, it might prostate mri neurovascular bundle to elect if you uh wanna want to do focal therapy and if you have uh a lesion on the apex, it might be better to do cryo and not um or.
You directly go and do a radical um the problem is there is still no consensus on follow up and I think what is a is a big limitation of all these presented data is that not everybody uh goes um and performance uh biopsies uh many studies are on demand biopsy so if Psa is high in show something interesting, they would do a biopsy.
Um I think. The way to go is that you schedule Mri that you also schedule uh your biopsy will have more impact on the reported outcome, which is very important Um I would like to say this somebody wants it to a man with a hammer. The way to go that you just treat everybody. I think it's very important that you treat all selected patients in my experience is that actually only few men really qualify and the right indication for focal therapy is actually the key success now.
Thank you very much for um listening and I'm very happy. To listen to your commence and questions. Thank you very much Doctor Lucas uh please stay with us because we have uh to answer a lot of questions.
I'm seeing this question inbox and uh maybe a panelist have some question to ask you so uh next speaker is doctor from Medical College La He is professor of Urology and head of department and as I said he is the person who is particularly treating patient with high and Pakistan. He's going to share his data with us so over to doctor, said uh thank you doctor.
Can you hear me uh is everybody uh we're seeing me and uh listening me of the bunny. Uh so uh first of all uh I'm really thankful to uh and the people who has invited me to deliver my uh the uh some presentation over here just as can do or doctor Lucas has made my job very easier and he has shown a very nice uh video uh but I would like to show also the repeat the same video or his not the same but some video system is a computer control device designed for trans delivery of high intensity Focus ultrasound energy to the process.
For treatment of prostate disease neurologists have been using the sauna system to treat benign prosthetic hyperplasia also known as VP localized prostate cancer and recurring prostate cancer The device makes use of integrated by planner ultrasound imaging for real time treatment monitoring treatment planning and pre and post treatment imaging of the prostate.
It's similar to what happens when sunlight is focused to a magnifying. Precise focusing on ultrasound energy during high food treatment elevates the temperature of prostate mri neurovascular bundle tissue in the focal zone very rapidly while intervening between the transducer in the focal zone is kept in a safe temperature The result is an accurate and repeatable lesion at the target sites that are monitored in real time by treating physician all the treatments are pre planned and checked by the physician prior to starting the high food treatment, the imaging cap.
Of the technology allow for identification of vital structures such Hasonló betegségek a prosztatitisekkel the prostate capsule, Seminole Ves rectal wall and physiological location of the Neuro Vascular bundles the addition of an integrated Doppler feature into the trans treatment, Pro adds an additional safeguard during treatment, The integrated Doppler feature will assist the physician in the identification of vital structures that need to be preserved in order to avoid problems with urinary continents and sexual function.
So this was the really the video of the uh the uh Howard now I'm presenting some my slides over here and good morning to everyone. I am Professor Malik and I'm from uh Medical University and this is the uh the old civilization of the world. We are living that is called the It is the oldest rather the civilization of the world and this is the photograph of the and this is the city working and it is uh is this is the rice which is running to the city and giving a beauty to the city like the rivers and the river and in the UK, London and the uh the respectively.
Uh prostate mri neurovascular bundle is the most uh two legions of the Pakistan Shades of the and are uh rest in the peace and this is the of the of the aromatic are being grown that is called the and very uh uh fine to eat that aromatic uh rice and this is the beauty of the that is called the uh which are the uh the produced here Gyertyák a prostatitis prosztatile cinkből the fields of the I'm very famous in the whole world so now.
The topic, they said they're not diagram presentation of the prostate having the tumor. This is the Seminole.
This is the rest of the prostate and the urinary. So when the patient having uh she has been diagnosed that he has a casino of the prostate, he has the multiple options uh for his treatment and we are supposed to be the that the patient has the localized cancer and for that he has multiple options like uh prosthetic cryo conventional radio with fractionated fractional high-end confirms.
Uh Lord in Hypo did confirm density and observational management the active S you can see so these are the multiple options when the patient has been diagnosed having the localized prostate cancer.
So here this man is having a localized prostate cancer and now he's thinking that which option is suitable for so he is supposed to consult with the urologist uh for the better.
Option so as we are here concerned with the I'm supposed to uh talk about the high the high intensity focus on the sound is a new technique by the FB to remove the prosthetic tissue high intensity focus ultrasound uses high frequency ultrasound energy to heat and destroy the cancer cells in the prostate, a beam of the ultrasound energy travels into the prostate from the from a group put into the director. Uh I'm just taking you back in when you were in the ninth and dance classes and doing the physics spectacles we were taking the magnifying glasses and burning at making a the uh the holes are gardening.
So you have already some idea how the works.
Instead of the light uses sound waves, which will be pointed to the tissue to the sound waves heat up uh to the heat up to the temperature as high as 90° Fahrenheit and can kill cancer cells in just few seconds. So this is the diagram diagram to the presentation and see this is a pro.
The look like cancer, This is the urinary the uh the uh this is the probe, which is important to the director and the beam of the ultrasound is being used to treat this uh the the prostate cancer tissue.
It is the liquor store that talks about to do in one to 4 hours and before it starts Bible is clean, but it is it is a participation will be kept and for 6 hours before the population we really do the.
A pozitív sebészi szél jelentősége radikális prosztatektómia esetén
Under general, but we have also done few cases under the spinal IV sedation to make patient pain, free and emotionally during the procedure because this motion free is important that if you the patient is moving, then whole focusing of the tissue will be disruptive.
Uh so the Tropic can be the failure end up into the failure so it is very much important. The patient should be kept motion free. That's why most of the people. Are using the so for get a response to the urinary bladder at the time of the procedure and then we will put an ultrasound probe and to direct them as we prostate mri neurovascular bundle all shown the sound waves from the bounce back to the computer to make a picture of the prostate gland.
This will show where to send the sound waves a sense to focus sound waves through the and into the gland after the procedure is retained for up to 1 week and patient will be on followed this is the Is clearly shown by doctor Lucas. Uh this is the program. This is the uh this is the screen where you can see and map the treatment and this is the ultrasound and this is the uh the uh the cooling mechanism.
The transverse bourbon like this supposed to be limited up to the capsule director and similarly we are supposed to go to the view uh me to confirm that we are not away from the focus and Vienna damaging the founding ES. So this is some which is Népi jogorvoslatok kezelése a prosztatitisből uh marks this is whole, depending on the uh computer programming so here uh once the outline of the prostate and the government plan is complete and the is closed.
Choose a plus sign in the in the air that remove the treatment uh short boxes to the outline will be filled with the uh Skittles so you can hear AA view the darts uh in this uh the process where we are supposed to uh the prosthetic tissue and we are finding a lot of treatment plan So here this is the final outcome of the the uh the treatment in which the green means the tissue changes may need retreat.
Prosztata tünetei és alternatív kezelések
There is a site may not have been. Uploaded a site be having at Lydia, so no additional change in the uh the the signal occurred some issue uh the properties that preventing a change in the uh the signs, for example, blocks of the ultrasound deposits arrange it means the maximum tissue changes due to the he That is the side of appears to be uplifted and yellow beans and chain.
That is this the site appears to be adequately. Who can have how is a suitable for the localized post cancer as a previous speaker has told you can also be used to treat the cancer that has come back after a and this is called this is called salvage. And as as you know that is not a good option for the advanced carcinoma, the AG and more than eight nine uh if the the Psa is more than twenty out of ten milligram per ml high food isn't available hospital.