Magnetic resonance guided focused high frequency ultrasound ablation for focal therapy in prostate cancer – phase 1 trial
- 25.04.2018
- Oncology
Erschienen in:
- Verfasst von
- Sangeet Ghai
- Nathan Perlis
- Uri Lindner
- Eugen Hlasny
- Masoom A. Haider
- Antonio Finelli
- Alexandre R. Zlotta
- Girish S. Kulkarni
- Theodorus H. van der Kwast
- Stuart A. McCluskey
- Walter Kucharczyk
- John Trachtenberg
- Erschienen in
- European Radiology | Ausgabe 10/2018
Abstract
Objectives
To evaluate the feasibility and safety of focal therapy for low–intermediate risk prostate cancer (PCa) with magnetic resonance-guided high frequency focused ultrasound (MRgFUS)
Methods
This IRB-approved phase 1 prospective study enrolled eight patients with prostate specific antigen (PSA) ≤ 10 ng/ml, ≤ cT2a and Gleason score ≤ 7 (4 + 3) disease following informed consent. Under MRI guidance, focused high frequency ultrasound energy was delivered to ablate the target tissue. Treatment-related adverse events were recorded. Oncologic outcomes were evaluated with multiparametric MRI, PSA and TRUS biopsy at 6 months following treatment.
Results
Ten target lesions [six Gleason 6 lesions, two Gleason 7 (3 + 4) and two Gleason 7 (4 + 3)] were treated in eight men (prostate volume range, 25–50 cc; mean MRI time, 248 min per patient; mean sonication duration, 65 min). Mean target volume was 2.7 cc and mean post-treatment non-perfused volume was 4.3 cc. Quality of life parameters were similar between baseline and 6 months in 6/8 patients. All treated regions were negative on MRI; 4/8 patients and 6/10 target lesions (60%) were clear of disease on biopsy. One patient with 2-mm Gleason 8 disease in one of five cores from treatment site (4 + 3 disease at baseline) subsequently underwent prostatectomy with negative surgical margins. Three patients with low volume (5–15%) Gleason 6 residual disease were offered active surveillance. Mean PSA decreased from 5.06 at baseline to 3.4 ng/ml at 6 months.
Conclusion
MRgFUS is a feasible and safe method of noninvasively ablating low–intermediate risk PCa with acceptable short-term oncologic outcomes.
Key Points
• Focal therapy selectively ablates locally confined, clinically significant index lesion with a margin while sparing rest of gland and adjacent vital structures.
• Magnetic resonance-guided focused high frequency ultrasound surgery (MRgFUS) combines MRI with HIFU.
• MRgFUS provides ability to monitor treatments in real time and allows a targeted approach for focal ablation.
• MRgFUS is a feasible, safe method of noninvasively ablating low–intermediate risk PCa.
• MRgFUS provides acceptable oncologic outcomes at 6 months.
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- Titel
- Magnetic resonance guided focused high frequency ultrasound ablation for focal therapy in prostate cancer – phase 1 trial
- Verfasst von
-
Sangeet Ghai
Nathan Perlis
Uri Lindner
Eugen Hlasny
Masoom A. Haider
Antonio Finelli
Alexandre R. Zlotta
Girish S. Kulkarni
Theodorus H. van der Kwast
Stuart A. McCluskey
Walter Kucharczyk
John Trachtenberg
- Publikationsdatum
- 25.04.2018
- Verlag
- Springer Berlin Heidelberg
- Erschienen in
-
European Radiology / Ausgabe 10/2018
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084 - DOI
- https://doi.org/10.1007/s00330-018-5409-z
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