Elsevier

European Urology

Volume 63, Issue 2, February 2013, Pages 395-398
European Urology

Case Series of the Month
Real-time Magnetic Resonance–guided High-intensity Focused Ultrasound Focal Therapy for Localised Prostate Cancer: Preliminary Experience

https://doi.org/10.1016/j.eururo.2012.11.002Get rights and content

Abstract

Five patients with unifocal, biopsy-proven prostate cancer (PCa) evident on multiparametric magnetic resonance imaging (MRI) were treated with magnetic resonance–guided focused ultrasound (MRgFUS) ablation before radical prostatectomy (RP). An endorectal probe featuring a phased-array focused ultrasound transducer was positioned for lesion ablation under MRI guidance. The tissue temperature and accumulation of thermal damage in the target zone was monitored during the procedure by MRI thermometry. Overlap between the ablation area and the devascularisation of the target lesion was evaluated by contrast-enhanced MRI performed immediately after treatment. The procedure was uneventful, and no adverse events were observed. RP was safely performed without significant surgical difficulties in relation to the previous MRgFUS treatment. The histopathology report showed extensive coagulative necrosis, with no residual tumour in the ablated area. Significant bilateral residual tumour, not evident on pretreatment MRI, was observed outside the treated area in two patients. MRgFUS ablation of focal localised PCa is feasible and, if confirmed in appropriate studies, could represent a valid option for the focal treatment of localised PCa.

Section snippets

Case report

After institutional review board approval, we designed a feasibility study of magnetic resonance–guided focused ultrasound (MRgFUS) ablation in patients with localised prostate cancer (PCa; ClinicalTrials.gov ID: NCT01522118). All patients signed a dedicated informed consent. We enrolled a consecutive series of patients (Table 1) who had unifocal, biopsy-proven PCa evident on multiparametric magnetic resonance imaging (MRI). Patients with a Gleason score ≥8, multifocal or bilateral PCa with a

Discussion

Laser, cryoablation, radiofrequency ablation, microwave ablation, and photodynamic therapy have been extensively tested as focal therapies with reduced side-effects for treatment of localised PCa in select patients [3]. PCa ablation has been also successfully performed with high-intensity focused ultrasound under ultrasound guidance [4]. Featuring an accurate delivery of ultrasound energy to planned targets and real-time monitoring of tissue damage, MRgFUS has recently been developed and tested

Conflicts of interest

The authors have nothing to disclose.

EU-ACME question

Please visit www.eu-acme.org/europeanurology to answer the following EU-ACME question online (the EU-ACME credits will be attributed automatically).
Question:
What is the relationship between real-time magnetic resonance–guided focused ultrasound (MRgFUS) focal therapy for localised prostate cancer and radical prostatectomy (RP)?

  • A.

    MRgFUS determines a higher rate of complications following a radical retropubic prostatectomy.

  • B.

    MRgFUS does not influence the RP clinical outcome.

  • C.

    RP is contraindicated

References (6)

  • W.A. Grissom et al.

    Maximum linear-phase spectral-spatial radiofrequency pulses for fat-suppressed proton resonance frequency-shift MR thermometry

    Magn Reson Med

    (2009)
  • J.I. Epstein et al.

    Pathological and clinical findings to predict tumour extent of non palpable (stage T1c) prostate cancer

    JAMA

    (1994)
  • Bozzini G, Colin P, Nevoux P, Villers A, Mordon S, Betrouni N. Focal therapy of prostate cancer: energies and...
There are more references available in the full text version of this article.

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