- Department of Urology
Mayo Clinic
200 First Street SW
Rochester, MN USA 55905 - 507 284 2511
Lance A Mynderse
Mayo Clinic, Department of Urology, Faculty Member
- I am a Board Certified Urologic Surgeon with particular interest in Image Guided treatment of newly diagnosed and recurrent prostate cancer.edit
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Research Interests: Algorithms, Enzyme Inhibitors, Medicine, Medical History, Humans, and 15 moreMale, Urodynamics, Prostate, Hyperplasia, Benign Prostatic Hyperplasia, Urinary System, Physical examination, Finasteride, Urinary retention, Prostate Specific Antigen, Mayo Clinic Proceedings, Benign Prostate Hyperplasia, Lower Urinary Tract Symptoms, Medical and Health Sciences, and Prostatic hyperplasia
Research Interests: Fluorescence, Medicine, Canada, Bladder Cancer, Prospective studies, and 15 moreHumans, Europe, United States, Female, Male, Differential Diagnosis, Clinical Sciences, Aged, Neoplasm Invasiveness, Morbidity, Time Factors, Reproducibility of Results, Cystoscopy, Aminolevulinic Acid, and Neoplasm staging
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INTRODUCTION AND OBJECTIVES: Histopathology of bladder cancer is pivotal for assessment of the stage and grade of the disease. Despite its paramount impact, reliability is uncertain, as decisive restrictions of inter-observer-reliability... more
INTRODUCTION AND OBJECTIVES: Histopathology of bladder cancer is pivotal for assessment of the stage and grade of the disease. Despite its paramount impact, reliability is uncertain, as decisive restrictions of inter-observer-reliability and quasicultural biases between the US and the EU have been reported. This aspect is of even greater interest, as the abundance of retroand prospective trials refer to initial histopathological results. The present analysis evaluates histopathology in an intercontinental prospective trial with both initial local and rigorous central histopathological review. METHODS: Twenty-eight centers (19 USA/CAN; 9 EU) prospectively randomized 814 patients with suspected bladder cancer to white light or fluorescence guided transurethral resection of the bladder with Hexaminolevulinate (Photocure ASA, Oslo, Norway). All biopsies were analyzed both by a local pathologist and by a panel of 3 US central pathologists blinded to local decisions. The central pathology read was a consensus read using prospectively defined consensus criteria. Flat lesions were graded according to WHO 1998 and papillary lesions according to WHO 1973, respectively. Correlation between local and central pathology reads were evaluated by Spearman’s correlation coefficient and Exact Rank Test. RESULTS: In the whole data set correlation coefficients of stage were 0.735 and of stage-adjusted grade 0.213 (Ta) and 0.581 (T1), respectively (p 0.001). While Correlation coefficients did not differ significantly between countries or continents, local stage and grade did not correlate with central reads in 2/28 and 13/28 centres, respectively. CONCLUSIONS: While histopathology reads are generally comparable concerning stage, grading varies considerably between local pathologists warranting central review in multicenter studies and respective care in the clinical management of bladder cancer.
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OBJECTIVETo assess recent utilization patterns of radiotherapy (RT) relative to cystectomy for muscle-invasive bladder cancer (MIBC) and evaluate survival trends over time in patients receiving RT.MATERIALS AND METHODSThe surveillance,... more
OBJECTIVETo assess recent utilization patterns of radiotherapy (RT) relative to cystectomy for muscle-invasive bladder cancer (MIBC) and evaluate survival trends over time in patients receiving RT.MATERIALS AND METHODSThe surveillance, epidemiology, and end results program (SEER) was used to identify patients diagnosed between 1992 and 2013 with localized MIBC. Patients with a prior history of non-bladder malignancy, who received no treatment, or did not have available treatment information, were excluded. Treatment utilization patterns were assessed using Cochran-Armitage tests for trend, and patient characteristics were compared using chi-square tests. Overall survival (OS) and cause-specific survival (CSS) were estimated using the Kaplan-Meier method. All-cause (ACM) and cause-specific mortality (CSM) were evaluated with multivariable Cox proportional hazards regression.RESULTSOf 16175 patients analyzed, 11917 (74%) underwent cystectomy, and 4258 (26%) were treated with RT. Patients who received RT were older (median age 79 vs. 68, P < 0.01). Over time, the proportion of patients receiving RT relative to cystectomy increased (24% 1992–2002 vs. 28% 2003–2013, P < 0.01), despite median patient age throughout the study period remaining unchanged (71 for each 1992–2002 and 2003–2013, P = 0.41). For RT, compared with patients diagnosed earlier, those diagnosed from 2010–2013 showed improved OS (64% vs. 60% at 1 year, P < 0.01; 38% vs. 29% at 3 years, P < 0.01) and CSS (71% vs. 67% at 1 year, P = 0.01; 51% vs. 40% at 3 years, P < 0.01). On multivariable analysis, diagnosis from 2010–2013 was associated with a lower estimated risk of ACM (hazard ratio 0.77; 95% confidence interval 0.66–0.89, P < 0.001) and CSM (hazard ratio 0.81; 95% confidence interval 0.67–0.97, P = 0.02).CONCLUSIONUtilization of RT for localized MIBC increased relative to cystectomy from 1992 to 2013, despite the median age of treated patients remaining unchanged. More recent survival outcomes for patients receiving RT were improved, supporting continued use of bladder preservation strategies utilizing RT.
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AIM To determine the operational characteristics of pelvic magnetic resonance imaging (MRI) prior to salvage radiation therapy (SRT) for biochemically recurrent prostate cancer following radical prostatectomy. METHODS AND MATERIALS We... more
AIM To determine the operational characteristics of pelvic magnetic resonance imaging (MRI) prior to salvage radiation therapy (SRT) for biochemically recurrent prostate cancer following radical prostatectomy. METHODS AND MATERIALS We reviewed the medical records of 386 patients who underwent MRI prior to SRT. We assessed associations of pre-SRT MRI findings with biochemical recurrence (BCR), distant metastasis (DM), prostate cancer-specific mortality (PCSM), and salvage androgen deprivation therapy (ADT) use following SRT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI for detecting local recurrence were also calculated. RESULTS Pre-SRT MRI was positive for local recurrence in 216 patients (56%), indeterminate in 46 (12%), and negative in 124 (32%). On univariate analysis, BCR following SRT was significantly less likely for patients with positive (HR: 0.58, 95% CI: 0.42-0.8) or indeterminate (HR: 0.6: 0.36-1) MRI findings, compared to patients with negative imaging (p=.003). These associations remained significant on multivariate analysis (p<0.05) and across pre-SRT PSA groups. For the entire cohort, the sensitivity of MRI for local recurrence was 61.0% (53.5%-68.1%), specificity 60.0% (44.3%-73.0%), PPV 86.1% (78.9-91.5%) and NPV 27.6% (19.0-37.5%). Sensitivity of MRI was better in men with higher pre-SRT PSA (80.0% for PSA >1.0), and specificity was improved with lower pre-SRT PSA (73.9% for PSA 0.1-0.5). CONCLUSIONS Positive or indeterminate MRI findings prior to SRT were associated with improved biochemical control following SRT, across PSA levels. The sensitivity and specificity of MRI for local recurrence were 61% and 58.7%, respectively.
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PURPOSE The aim of the study was to determine the incidence of local displacement, distant seed migration to the chest, and seed loss after permanent prostate brachytherapy (PPB) with stranded seeds (SSs) using sequential two-dimensional... more
PURPOSE The aim of the study was to determine the incidence of local displacement, distant seed migration to the chest, and seed loss after permanent prostate brachytherapy (PPB) with stranded seeds (SSs) using sequential two-dimensional fluoroscopic pelvic and chest x-rays. METHODS AND MATERIALS Between October 2010 and April 2014, a total of 137 patients underwent PPB and 4-month followup pelvic and chest x-ray imaging. All patients had exclusively SSs placed and an immediate postimplant fluoroscopic image of the seed cluster. Followup x-ray images were evaluated for the number, location, and displacement of seeds in comparison to Day 0 fluoroscopic images. Significant seed displacement was defined as seed displacement >1 cm from the seed cluster. Followup chest x-rays were evaluated for seed migration to the chest. RESULTS Seed migration to the chest occurred in 3 of the 137 patients (2%). Seed loss occurred in 38 of the 137 patients (28%), with median loss of one seed (range, 1-16), and total seeds loss of 104 of 10,088 (1.0%) implanted. Local seed displacement was seen in 12 of the 137 patients (8.8%), and total seeds displaced were 0.15% (15/10,088). CONCLUSIONS SS placement in PPB is associated with low rates of substantial seed loss, local displacement, or migration to the chest. Comparing immediate postimplant fluoroscopic images to followup plain x-ray images is a straightforward method to supplement quality assurance in PPB and was found to be useful in identifying cases where seed loss was potentially of clinical significance.
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Objective. Detrusor overactivity (DO) is a urodynamic observation characterized by fluctuations in detrusor pressure (P det) of the bladder. Although detecting DO is important for the management of bladder symptoms, the invasive nature of... more
Objective. Detrusor overactivity (DO) is a urodynamic observation characterized by fluctuations in detrusor pressure (P det) of the bladder. Although detecting DO is important for the management of bladder symptoms, the invasive nature of urodynamic studies (UDS) makes it a source of discomfort and morbidity for patients. Ultrasound bladder vibrometry (UBV) could provide a direct and noninvasive means of detecting DO, due to its sensitivity to changes in elasticity and load in the bladder wall. In this study, we investigated the feasibility and applying UBV toward detecting DO. Approach. UBV and urodynamic study (UDS) measurements were collected in 76 neurogenic bladder patients (23 with DO). Timestamped group velocity squared ( c g 2 ) data series were collected from UBV measurements. Concurrent P det data series were identically analyzed for comparison and validation. A processing approach is developed to separate transient fluctuations in the data series from the larger trend of the data and a DO index is proposed for characterizing the transient peaks observed in the data. Main Results. Applying the DO index as a classifier for DO produced sensitivities and specificities of 0.70 and 0.75 for c g 2 data series and 0.70 and 0.83 for P det data series respectively. Significance. It was found that DO can be feasibly detected from data series of timestamped UBV measurements. Collectively, these initial results are promising, and further refinement to the UBV measurement process is likely to improve and clarify its capabilities for noninvasive detection of DO.
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Introduction: To evaluate the ability of endorectal coil (e-coil) magnetic resonance imaging (MRI) to identify early prostatic fossa recurrence after radical prostatectomy. Materials and methods: We identified 187 patients from 2005-2011... more
Introduction: To evaluate the ability of endorectal coil (e-coil) magnetic resonance imaging (MRI) to identify early prostatic fossa recurrence after radical prostatectomy. Materials and methods: We identified 187 patients from 2005-2011 who underwent e-coil MRI with dynamic gadolinium-contrast enhancement followed by transrectal ultrasound (TRUS) guided prostatic fossa biopsy for possible local prostate cancer recurrence. For analysis, local recurrence was defined as a negative evaluation for distant metastatic disease with a positive prostatic fossa biopsy, decreased prostate-specific antigen (PSA) following salvage radiation therapy, or increased lesion size on serial imaging. Results: Local recurrence was identified in 132 patients, with 124 (94%) detected on e-coil MRI. The median PSA was 0.59 ng/mL (range < 0.1-13.1), and median lesion size on MRI was 1 cm. The sensitivity of MRI was 91%, with a specificity of 45%. The positive predictive value was 85%, with a negative predictive value of 60%. For patients with a PSA < 0.4 ng/mL the sensitivity of e-coil MRI was 86%. When a lesion was identified on MRI, the positive biopsy rate was 65% and lesion size was a significant predictor of positive biopsies. The positive biopsy rates were 51%, 74%, and 88% when the lesion was < 1 cm, 1 cm-2 cm, or > 2 cm, respectively (p = 0.0006). Conclusions: E-coil MRI has a high level of sensitivity in identifying local recurrence of prostate cancer following radical prostatectomy, even at low PSA levels. E-coil MRI should be considered as the first imaging evaluation for biochemical recurrence for identifying patients suitable for localized salvage therapy.
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A non-invasive method for measurement of the bladder wall nonlinear elastic behavior is presented. The method is based on acoustoelasticity modeling of the elasticity changes in bladder tissue modulus at different volumetric strain... more
A non-invasive method for measurement of the bladder wall nonlinear elastic behavior is presented. The method is based on acoustoelasticity modeling of the elasticity changes in bladder tissue modulus at different volumetric strain levels. At each volume, tissue strain is obtained from the real-time ultrasound images. Using acoustic radiation force, a transient Lamb wave is excited on the bladder wall and instantaneous modulus of shear elasticity is obtained from the 2-D Fourier analysis of the spatial-temporal dispersion maps. Measured elasticity and strain data are then used in an acoustoelasticity formulation to obtain the third order elastic coefficient, referred to as nonlinearity parameter A, and initial resting elasticity μ0. The method was tested in ex vivo porcine bladder samples (N = 9) before and after treatment with formalin. The estimated nonlinearity parameter, A, was significantly higher in the treated samples compared to intact (p < 0.00062). The proposed method w...