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In this study, a simplified and effective method was tried to immobilize iron oxide onto a naturally occurring porous diatomite. Experimental resultsfor several physicochemical properties and arsenic edges revealed that iron oxide incorporated into diatomite was amorphous hydrous ferric oxide (HFO). Sorption trends of Fe (25%)-diatomite for both arsenite and arsenate were similar to those of HFO, reported by Dixit and Hering (Environ. Sci. Technol. 2003, 37, 4182-4189). The pH at which arsenite and arsenate are equally sorbed was 7.5, which corresponds to the value reported for HFO. Judging from the number of moles of iron incorporated into diatomite, the arsenic sorption capacities of Fe (25%)-diatomite were comparable to or higher than those of the reference HFO. Furthermore, the surface complexation modeling showed that the constants of [triple bond]SHAsO4- or [triple bond]SAsO4(2-) species for Fe (25%)-diatomite were larger than those reference values for HFO or goethite. Larger differences in constants of arsenate surface species might be attributed to aluminum hydroxyl ([triple bond]Al-OH) groups that can work better for arsenate removal. The pH-controlled differential column batch reactor (DCBR) and small-scale column tests demonstrated that Fe (25%)-diatomite had high sorption speeds and high sorption capacities compared to those of a conventional sorbent (AAFS-50) that is known to be the first preference for arsenic removal performance in Bangladesh. These results could be explained by the fact that Fe (25%)-diatomite contained well-dispersed HFO having a great affinity for arsenic species and well-developed macropores as shown by scanning electron microscopy (SEM) and pore size distribution (PSD) analyses.

Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) detects prostate cancer recurrence at low PSA levels. Radiotherapy with dose escalation to the former prostate bed has been associated with improved biochemical recurrence-free survival (BRFS). Thus, we hypothesized that PSMA PET/CT-guided salvage radiotherapy leads to improved BRFS. A total of 204 consecutive patients were referred for salvage radiotherapy following radical prostatectomy. PSMA PET/CT scans were performed and patients with PSA persistence (109 patients) or evidence of distant metastases (5 patients) were excluded from this analysis. Thus, the following analysis is based on a total of 90 patients who underwent PSMA PET/CT prior to radiotherapy due to biochemical recurrence and received salvage radiotherapy. In case of PET-positive findings, antiandrogen therapy was commenced before initiation of radiotherapy. BRFS (PSA ≤ 0.2 ng/ml) was defined as the study endpoint. PET-positive lesions were detected in 42/90 (47%) patients: 24/42 (27%) fossa recurrence only, 12/42 (13%) pelvic lymph nodes only and 6/42 (7%) fossa and pelvic lymph node recurrence. Median PSA before radiotherapy was 0.44 (0.11 - 6.24). Cumulatively, a total dose of 70.0 Gy (67.2 - 72 Gy) was delivered to local macroscopic tumor, 66 Gy (59.4 - 70.2 Gy) to the prostatic fossa, 60.8 Gy (54 - 66 Gy) to PET-positive lymph nodes and 50.4 Gy (45 - 50.4 Gy) to the lymphatic pathways. After a median follow-up of 23 months, BRFS was 78%. Antiandrogen therapy was ongoing in 4 patients at last follow-up. No significant difference in BRFS between PET-positive (74%) vs. PET-negative patients (82%; p>0.05) was observed at last follow-up. Two patients had late genitourinary toxicity grade 3 and no patient had gastrointestinal toxicity ≥ 3 (NCI-CTCAE v4.03). PSMA PET/CT-guided salvage radiotherapy is an effective and safe local treatment option. No difference in BRFS between PET-positive and PET-negative patients was observed, indicating effective targeting of PET-positive lesions. PSMA PET/CT when readily available should be offered to patients with PSA recurrence for treatment individualization.

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