Howard M. Pollack

Bio: Howard M. Pollack is an academic researcher from University of Pennsylvania. The author has contributed to research in topics: Magnetic resonance imaging & Ureter. The author has an hindex of 42, co-authored 157 publications receiving 5033 citations. Previous affiliations of Howard M. Pollack include Georgetown University & Thomas Jefferson University Hospital.

Prostate cancer: local staging with endorectal surface coil MR imaging.

Abstract: Endorectal surface coil magnetic resonance (MR) imaging was used to stage the local extent of prostate cancer in 22 patients. The endorectal coil images were acquired with a 10-12-cm field of view and a 4-mm section thickness. All pathologic specimens were reviewed by one pathologist. Endorectal surface coil MR imaging was 82% accurate in the differentiation of stage B from stage C cancer. One case was overestimated, and three cases were underestimated. The three underestimated cases consisted of two cases of microscopic capsular invasion and one case of minimal seminal vesicle invasion. In a comparison of retrospective, blinded readings of endorectal coil and body coil images, there was an average improvement in accuracy of 16% in staging prostate cancer with endorectal coil images.

Prostate: MR imaging with an endorectal surface coil.

Abstract: An endorectal surface coil has been developed to obtain high-resolution magnetic resonance images of the prostate. The probe consists of a surface coil mounted on the inner surface of a balloon. The balloon is concave to ensure tight seating against the prostate. The coil has been used in 15 patients with biopsy-proved prostatic carcinoma and in two healthy volunteers. The axial images were obtained with a 12-16-cm field of view and a 3-mm section thickness. Compared with images obtained with a body coil, the surface coil images better demonstrate prostatic anatomy and pathologic conditions.

Current role of MR imaging in the staging of adenocarcinoma of the prostate.

Abstract: Surgical cure of adenocarcinoma of the prostate (ACP) is possible in over 80% of cases when the disease is confined to the gland capsule. The endorectal probe for magnetic resonance (MR) imaging has increased resolution of the prostate gland and capsule, which has improved the sensitivity and specificity for staging ACP (.65 sensitivity, .69 specificity for body coil; .87 sensitivity, .85 specificity for the endorectal coil). Normal glandular regions in the peripheral zone and central zone have significantly higher citrate levels than ACP and fibromuscular and fibrous benign prostatic hyperplasia at proton spectroscopy. ACP has a higher phosphomonoester-phosphocreatine ratio than normal glandular tissue at phosphorus spectroscopy. The combination of endorectal coil MR imaging for local spread, and body coil MR imaging for advanced disease, makes MR imaging the premier imaging modality for the preoperative staging of ACP.

Kidney changes after extracorporeal shock wave lithotripsy: CT evaluation.

Abstract: Computed tomography (CT) was performed in 50 patients before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Bilateral treatments were performed in three patients. Post-ESWL scans demonstrated subcapsular hematomas in eight (15%) patients (two large, six small, none symptomatic) and intrarenal hematomas in two (4%) patients. In three (6%) patients small subcapsular fluid collections of uncertain cause were seen. Treated kidneys showed a statistically significant mean increase in size (9%) after ESWL, as measured at the axial level of the major stone fragment. Perinephric soft-tissue stranding and fascial thickening were seen in 37 (70%) of 53 treated renal fossae, with the changes ranging from mild to severe. The authors conclude that while most patients undergoing ESWL will show some posttreatment abnormality on CT scans, the procedure appears to be associated with a low frequency of serious renal trauma.

Prostatic carcinoma and benign prostatic hyperplasia: correlation of high-resolution MR and histopathologic findings.

Abstract: High-resolution magnetic resonance (MR) imaging of 24 fresh radical prostatectomy specimens was performed on an experimental 1.9-T system. Direct correlation between the findings in 7-micron-thick macrosections and their corresponding MR images was possible. Fourteen patients had macroscopic evidence of cancer. In all 14 cases, the carcinoma nodules appeared as areas of low signal intensity on images obtained with a repetition time of 2,500 msec and an echo time of 80 msec. Ten of 14 nodules had well-defined margins and consisted of densely packed glandular elements, which displaced the surrounding normal glandular material of higher signal intensity. Ten specimens displayed benign prostatic hyperplasia (BPH). The MR characteristics of this entity were quite variable but relatively predictable, depending on the distribution and size of the glandular elements, as well as the composition of the surrounding stroma. In BPH, the changes began in the central portion of the gland. The areas of highest signal int...

Renal cell carcinoma.

Abstract: Renal cell carcinoma (RCC) denotes cancer originated from the renal epithelium and accounts for >90% of cancers in the kidney. The disease encompasses >10 histological and molecular subtypes, of which clear cell RCC (ccRCC) is most common and accounts for most cancer-related deaths. Although somatic VHL mutations have been described for some time, more-recent cancer genomic studies have identified mutations in epigenetic regulatory genes and demonstrated marked intra-tumour heterogeneity, which could have prognostic, predictive and therapeutic relevance. Localized RCC can be successfully managed with surgery, whereas metastatic RCC is refractory to conventional chemotherapy. However, over the past decade, marked advances in the treatment of metastatic RCC have been made, with targeted agents including sorafenib, sunitinib, bevacizumab, pazopanib and axitinib, which inhibit vascular endothelial growth factor (VEGF) and its receptor (VEGFR), and everolimus and temsirolimus, which inhibit mechanistic target of rapamycin complex 1 (mTORC1), being approved. Since 2015, agents with additional targets aside from VEGFR have been approved, such as cabozantinib and lenvatinib; immunotherapies, such as nivolumab, have also been added to the armamentarium for metastatic RCC. Here, we provide an overview of the biology of RCC, with a focus on ccRCC, as well as updates to complement the current clinical guidelines and an outline of potential future directions for RCC research and therapy.

Guidelines on Prostate Cancer

Abstract: The introduction of an effective blood test, prostate specific antigen (PSA), has made it possible to diagnose more and more men in an earlier stage where they can be offered potentially curative treatments. The other side of the coin is that if effective diagnostic procedures are used unselectively in elderly men with a short life expectancy, a problem with over diagnosis and over treatment might occur. Thus the same stage of prostate cancer may need different treatment strategies, pending on the patient’s life expectancy. This, and many other issues regarding the disease, is the subject of the EAU guidelines on prostate cancer. G UI DE LI N ES O N P RO ST AT E CA N CE R 10

Carcinoma of the Prostate

Abstract: IN the 12 years since the topic was last reviewed in the Journal,1 prostatic cancer has become the most common newly diagnosed cancer in men It is the cause of death in more than 28,000 men per year, accounting for 11 percent of cancer deaths, third in men after lung and colon cancer2 Important questions remain about the cause and prevention of prostatic cancer, but new advances permit earlier diagnosis and more accurate staging Curative therapy is possible for localized disease with much less morbidity than previously In advanced disease, androgen-deprivation therapy remains the mainstay of treatment Biology and