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Mohamad O, Nicosia L, Mathier E, Riggenbach E, Zamboglou C, Aebersold DM, Alongi F, Shelan M. Focal brachytherapy as definitive treatment for localized prostate cancer: A systematic review and meta-analysis. Brachytherapy 2024; 23:309-320. [PMID: 38431441 DOI: 10.1016/j.brachy.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/06/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE In this systematic review and meta-analysis, we describe the oncologic and toxicity outcomes of definitive focal brachytherapy for prostate cancer. METHODS AND MATERIALS A PROSPERO registered study (CRD42023410170) was conducted following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. PubMed, Embase, and The Cochrane Library were searched for studies between 2000 and 2022. Two authors independently performed the initial search. Biochemical recurrence-free survival (bRFS) was defined as the primary endpoint for the meta-analysis. Generalized linear mixed-effects models were conducted to calculate effect size and quantify heterogeneity. We also describe the side effects and local recurrence patterns of focal brachytherapy. RESULTS Ten studies were identified and included 315 patients treated using focal brachytherapy as a definitive treatment. Mean (SD) age was 67.65 (7.9) years and mean (SD) PSA was 7.15 (2.7) ng/mL. Most patients (n = 236, 75%) underwent LDR Brachytherapy and 25% received HDR brachytherapy. Among the participants, 147 (46.5%) had a Gleason score ≤6, and 169 (53.5%) had a Gleason score ≥7. Only 11 (3.5%) patients received ADT. Overall, bRFS rate at median follow-up 4 years (Range: 1-6.42 years) was 91% (95% confidence interval [CI], 82-95%). Acute Grade ≤ 2 GU and GI toxicities were reported in 22 (7%) and 11 (3.5%) patients, respectively. Late Grade ≤ 2 GU and GI toxicity were reported in 6 (2%) and 14 (4.4%) patients, respectively. One case of prostate hemorrhage due to improper foley removal was noted but otherwise no acute or late Grade 3 or higher GI or GU toxicity related to radiotherapy was reported. CONCLUSION Overall, definitive focal brachytherapy has a favorable toxicity profile. Oncologic outcomes are yet to mature. The evidence is limited by the small number of studies with low patients' number, across study heterogeneity, and possibility of publication bias.
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Affiliation(s)
- Osama Mohamad
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy
| | - Etienne Mathier
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elena Riggenbach
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; German Oncology Center, University Hospital of the European University, Limassol, Cyprus
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fillipo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Carpagnano FA, Eusebi L, Giannubilo W, Fenu F, Safi M, Bartelli F, Guglielmi G. Prostate Multiparametric MRI: Evaluation of Recurrence and Post-treatment Changes. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose of Review
This article reviews all the most common therapeutic strategies of prostate cancer, systemic or local, and all the following morpho-structural alterations, with the aim of helping the radiologist to recognize the signs of recurrence by using mp-MRI.
Recent Findings
According to the most recent evidences, prostate mp-MRI has now become a strong, non-invasive, and valid tool to evaluate all patient treated for prostatic carcinoma across the time, especially in the suspicion of biochemical recurrence.
Summary
The minimal signs of focal recurrence can put a strain on radiologists, especially if they are novice with multi-parametric prostate MRI. Familiarizing themselves with the outcomes of treatment, local or systemic, and its characteristics to MR imaging is indispensable to avoid diagnostic pitfalls and, subsequently, unnecessary reinterventions.
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Di Lalla V, Elakshar S, Anidjar M, Tolba M, Hassan T, Bahoric B, McPherson V, Probst S, Niazi T. Salvage external beam radiotherapy after HIFU failure in localized prostate cancer: A single institution experience. Front Oncol 2022; 12:1028858. [DOI: 10.3389/fonc.2022.1028858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose/objectivesHigh-intensity focused ultrasound (HIFU) remains investigational as primary treatment for localized prostate cancer but is sometimes offered to select patients. At HIFU failure, data guiding salvage treatment is limited to small retrospective series with short follow-up. We evaluated our institutional experience using salvage radiation therapy (SRT) after HIFU failure.Materials/methodsWe conducted a retrospective analysis of patients with local failure post-HIFU who received salvage image-guided external beam radiation therapy (EBRT) delivered via intensity-modulated radiotherapy (IMRT). Our primary endpoint was biochemical failure-free survival (bFFS) defined as prostate-specific antigen (PSA) nadir + 2 ng/mL. Secondary endpoints included metastasis-free survival (MFS) and overall survival (OS). Endpoints were evaluated using Kaplan-Meier analysis.ResultsFrom 2013 to 2018, 12 out of 96 patients treated with primary HIFU received SRT via conventional or moderate hypofractionation. Median time from HIFU to SRT was 13.5 months. Seven patients had stage migration to high-risk disease at the time of SRT. Mean PSA prior to SRT was 8.2ug/L and mean nadir post-SRT was 1.2ug/L. Acute International Prostate Symptom Score (IPSS) as well as International Index of Erectile Dysfunction (IIEF) scores were similar to baseline (p = 0.5 and 0.1, respectively). Late toxicities were comparable to those reported after primary EBRT for localized prostate cancer. At a median follow-up of 46 months, the OS was 100%. The 5-year bFFS and MFS were both 83.3%.ConclusionsTo our knowledge, we report one of the largest series on contemporary SRT post HIFU failure. We show that SRT is feasible, effective and carries no additional acute or delayed toxicity.
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Schaudinn A, Michaelis J, Franz T, Ho-Thi P, Horn LC, Blana A, Hadaschik B, Stumpp P, Stolzenburg JU, Schlemmer HP, Denecke T, Busse H, Ganzer R, Linder N. High-intensity focused ultrasound (HIFU) hemiablation of the prostate: Late follow-up MRI findings in non-recurrent patients. Eur J Radiol 2021; 144:109957. [PMID: 34601322 DOI: 10.1016/j.ejrad.2021.109957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Focal therapy with high-intensity focused ultrasound (HIFU) is an emerging option for the treatment of prostate cancer and often followed up by MRI. Image assessment of treatment failure, however, requires proper knowledge about typical procedure-related changes in prostate MRI, which is sparse, in particular for unilateral HIFU treatment and late follow up (beyond 6 months). The goal of this study was therefore to compile the type and frequency of such MRI findings in selected patients without recurrent cancer 12 months after prostate hemiablation. METHODS Data from a prospective multicenter trial on HIFU hemiablation were reviewed retrospectively. Trial patients have had a late follow-up by MRI (at around 12 months) and either MRI/transrectal ultrasound (TRUS) fusion or standard TRUS-guided biopsy. This work deliberately included patients with non-recurrent cancer in the treated prostate lobe in per-protocol biopsy leaving 30 men with initial International Society of Urological Pathology (ISUP) Grade Group of 1 or 2. Six categories of potential HIFU-related MRI features were assessed by an expert committee and then evaluated by two readers in consensus: 1. shrinkage of the treated lobe, 2. residual prostate tissue, 3. fluid-filled cavity, 4. fibrosis, 5. hematoma residuals (in the prostate or seminal vesicles) and 6. contrast enhancement of the ablated area. RESULTS Shrinkage of the ablated lobe was seen in 93% of the cases with an average percent volume change of -37% (range: -70% to +108%). In the contralateral lobe, the volume remained practically the same (-2% on average, p = 0.804). In the ablated lobe, the frequency of fibrosis was 97%. Residual prostate tissue was seen in 93% of the cases. The frequency for fluid-filled cavities was 97%, with the wide majority (90%) contiguous with the urethra. Hematoma residuals in the prostate and in seminal vesicles were found in 47% and 10% of the patients, respectively. Contrast enhancement was both rim-like (50%) as well as diffuse (33%) within the ablated area. CONCLUSION In our case series of HIFU hemiablation in the prostate, shrinkage, residual prostate tissue, fluid-filled cavities contiguous with the urethra and fibrosis were very common late MRI findings of the ablated lobe in non-recurrent patients. Rim-like contrast enhancement or diffuse one within the ablated area were less frequent.
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Affiliation(s)
- Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Jakob Michaelis
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Toni Franz
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Phuc Ho-Thi
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | | | - Andreas Blana
- Department of Urology, Fürth Hospital, Fürth, Germany
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany; Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | | | | | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Roman Ganzer
- Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany
| | - Nicolas Linder
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
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Hanada I, Shoji S, Takeda K, Uchida T, Yuzuriha S, Kuroda S, Ogawa T, Higure T, Nakano M, Kawakami M, Nitta M, Hasegawa M, Kawamura Y, Miyajima A. Significant Impact of the Anterior Transition Zone Portion Treatment on Urinary Function After Focal Therapy with High-Intensity Focused Ultrasound for Prostate Cancer. J Endourol 2021; 35:951-960. [PMID: 33499743 DOI: 10.1089/end.2020.0872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: There is lack of evaluation of the effect of the treated area on the urinary function after focal therapy. The objectives of the study is to evaluate the effects of focal therapy on urinary function in the anterior portion of the transition zone (TZ) with transrectal high-intensity focused ultrasound (HIFU) for localized prostate cancer (PCa). Methods: From 2016 to 2018, patients who were diagnosed as having localized PCa and treated with focal therapy with HIFU, were included prospectively. The urinary function and complications were evaluated separately in the treated regions of the anterior TZ (TZ group) and other portions (other group) for 12 months. Before and after the treatment, the International Prostate Symptom Score (IPSS), IPSS Quality Of Life (QOL), Overactive Bladder Symptom Score (OABSS), and uroflowmetry were evaluated to assess the urinary function. Results: Ninety patients were included in the study. There was no significant differences in the patients' characteristics between the two groups. At 1 month after the treatment, IPSS (p = 0.011), IPSS QOL (p = 0.002), OABSS (p = 0.002), maximum flow rates (p = 0.011), and residual urine volume (p = 0.011) in TZ group were significantly deteriorated compared with the other group. Multivariate logistic regression analysis revealed that anterior TZ treatment (odds ratio, 3.386; p = 0.029) was an independent risk factor for the deterioration with ≥32% of preoperative status of maximum flow rates. Concerning complication, the rates of Grade 2 urinary retention and Grade 3 urethral stricture were 15.4% and 11.5% in the TZ group and 0% and 0% in the other group, respectively. Conclusions: There was a greater risk of urinary dysfunction with treatment in the anterior TZ portion than in the other portion at 1 month after focal therapy with HIFU.
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Affiliation(s)
- Izumi Hanada
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Sunao Shoji
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Kazuma Takeda
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Takato Uchida
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Soichiro Yuzuriha
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Satoshi Kuroda
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Takahiro Ogawa
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Taro Higure
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Mayura Nakano
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Masayoshi Kawakami
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Masahiro Nitta
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Masanori Hasegawa
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yoshiaki Kawamura
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Akira Miyajima
- Departments of Urology, Tokai University School of Medicine, Kanagawa, Japan
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Magnetic resonance imaging of the prostate after focal therapy with high-intensity focused ultrasound. Abdom Radiol (NY) 2020; 45:3882-3895. [PMID: 32447414 DOI: 10.1007/s00261-020-02577-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For clinically significant, locally confined prostate cancer, whole-gland radical prostatectomy and radiotherapy are established effective treatment strategies that, however, come at a cost of significant morbidity related to urinary and sexual side effects. The concept of risk stratification paired with a better understanding of prognostic factors has led to the development of alternative management options including active surveillance and focal therapy for appropriately selected patients with localized disease. High-intensity focused ultrasound (HIFU) is one such minimally invasive, image-guided treatment option for prostate cancer. Due to the relative novelty of HIFU and the increased use of magnetic resonance imaging in prostate cancer, many radiologists are not yet familiar with imaging findings related to HIFU, their temporal evolution as well as imaging appearance of recurrent disease after this type of focal therapy. HIFU induces sharply demarcated, localized coagulative necrosis of a tumor through thermal energy delivered via an endorectal or transurethral ultrasound transducer. In this pictorial review, we aim at providing relevant background information that will guide the reader through the general principles of HIFU in the prostate, as well as demonstrate the imaging appearance of expected post-HIFU changes versus recurrent tumor.
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7
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Liu B, Wang R, Peng Z, Qin L. Identification of Denatured Biological Tissues Based on Compressed Sensing and Improved Multiscale Dispersion Entropy during HIFU Treatment. ENTROPY (BASEL, SWITZERLAND) 2020; 22:E944. [PMID: 33286712 PMCID: PMC7597216 DOI: 10.3390/e22090944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 05/17/2023]
Abstract
Identification of denatured biological tissue is crucial to high-intensity focused ultrasound (HIFU) treatment, which can monitor HIFU treatment and improve treatment efficiency. In this paper, a novel method based on compressed sensing (CS) and improved multiscale dispersion entropy (IMDE) is proposed to evaluate the complexity of ultrasonic scattered echo signals during HIFU treatment. In the analysis of CS, the method of orthogonal matching pursuit (OMP) is employed to reconstruct the denoised signal. CS-OMP can denoise the ultrasonic scattered echo signal effectively. Comparing with traditional multiscale dispersion entropy (MDE), IMDE improves the coarse-grained process in the multiscale analysis, which improves the stability of MDE. In the analysis of simulated signals, the entropy value of the IMDE method has less fluctuation compared with MDE, indicating that the IMDE method has better stability. In addition, MDE and IMDE are applied to the 300 cases of ultrasonic scattered echo signals after denoising (including 150 cases of normal tissues and 150 cases of denatured tissues). The experimental results show that the MDE and IMDE values of denatured tissues are higher than normal tissues. Both the MDE and IMDE method can be used to identify whether biological tissue is denatured. However, the multiscale entropy curve of IMDE is smoother and more stable than MDE. The interclass distance of IMDE is greater than MDE, and the intraclass distance of IMDE is less than MDE at different scale factors. This indicates that IMDE can better distinguish normal tissues and denatured tissues to obtain more accurate clinical diagnosis during HIFU treatment.
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Affiliation(s)
- Bei Liu
- College of Mathematics and Physics, Hunan University of Arts and Science, Changde 415000, China; (B.L.); (Z.P.)
| | - Runmin Wang
- College of Information Science and Engineering, Hunan Normal University, Changsha 410081, China
| | - Ziqi Peng
- College of Mathematics and Physics, Hunan University of Arts and Science, Changde 415000, China; (B.L.); (Z.P.)
| | - Lingjie Qin
- School of Computer and Information Engineering, Central South University of Forestry and Technology, Changsha 410000, China;
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O'Connor LP, Lebastchi AH, Horuz R, Rastinehad AR, Siddiqui MM, Grummet J, Kastner C, Ahmed HU, Pinto PA, Turkbey B. Role of multiparametric prostate MRI in the management of prostate cancer. World J Urol 2020; 39:651-659. [PMID: 32583039 DOI: 10.1007/s00345-020-03310-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Prostate cancer has traditionally been diagnosed by an elevation in PSA or abnormal exam leading to a systematic transrectal ultrasound (TRUS)-guided biopsy. This diagnostic pathway underdiagnoses clinically significant disease while over diagnosing clinically insignificant disease. In this review, we aim to provide an overview of the recent literature regarding the role of multiparametric MRI (mpMRI) in the management of prostate cancer. MATERIALS AND METHODS A thorough literature review was performed using PubMed to identify articles discussing use of mpMRI of the prostate in management of prostate cancer. CONCLUSION The incorporation of mpMRI of the prostate addresses the shortcomings of the prostate biopsy while providing several other advantages. mpMRI allows some men to avoid an immediate biopsy and permits visualization of areas likely to harbor clinically significant cancer prior to biopsy to facilitate use of MR-targeted prostate biopsies. This allows for reduction in diagnosis of clinically insignificant disease as well as improved detection and better characterization of higher risk cancers, as well as the improved selection of patients for active surveillance. In addition, mpMRI can be used for selection and monitoring of patients for active surveillance and treatment planning during surgery and focal therapy.
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Affiliation(s)
- Luke P O'Connor
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Rahim Horuz
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | | | - M Minhaj Siddiqui
- Division of Urology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christof Kastner
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, 10 Center Drive Room B3B85, Bethesda, MD, USA. .,, 10 Center Drive Room B3B85, Bethesda, MD, 20814, USA.
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Bacchetta F, Martins M, Regusci S, Jichlinski P, Meuwly JY, Lucca I, Valerio M. The utility of intraoperative contrast-enhanced ultrasound in detecting residual disease after focal HIFU for localized prostate cancer. Urol Oncol 2020; 38:846.e1-846.e7. [PMID: 32532530 DOI: 10.1016/j.urolonc.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/08/2020] [Accepted: 05/10/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Focal high intensity focused ultrasound (HIFU) is an emerging treatment for selected men with localized prostate cancer. A limitation of HIFU is the absence of a reliable tool to measure treatment effect intraoperatively. Contrast-enhanced ultrasound (CEUS) has been shown to be a promising modality for assessing the extent and boundaries of tissue ablation. The aim of this study was to assess the value of CEUS immediately after focal HIFU. MATERIALS AND METHODS Retrospective analysis of a prospectively maintained registry including consecutive men undergoing focal HIFU (Focal One). Candidates for focal HIFU were treatment naive men with ≥10 years life expectancy, prostate-specific antigen (PSA) ≤ 20 ng/ml, TNM primary tumor, regional lymph nodes, distant metastasis stage ≤ T2c N0 M0 with a multiparametric MRI (mpMRI) visible lesion concordant with histologically proven prostate cancer. CEUS evaluation was performed immediately at the end of the procedure. Based on the surgeon's estimation of CEUS imaging, re-HIFU was performed, followed by another CEUS evaluation. To test our hypothesis, the results of the CEUS were compared to the results of early mpMRI to rule out clinically significant cancer. The concordance between the 2 tests was measured using the Cohen's kappa. The best model including relevant predictors was calculated with CEUS or with mpMRI to determine their respective added value. RESULTS Of 66 men who underwent HIFU, 32 met eligibility criteria. Bifocal treatment was performed in 1 man, increasing the number of treated lesions to 33. Further ablation based on CEUS was delivered intraoperatively to 13 lesions (39%). The positive biopsy rate for clinically significant cancer in the treated zones was 30% (10/33). The negative predictive value of CEUS and early mpMRI was 71% (95% confidence interval: 59%-82%). Concordance between CEUS and mpMRI was significant with a 72.7% agreement (P = 0.001). The model with CEUS showed the best accuracy with an area under the curve of 0.881. CONCLUSION CEUS has a higher added value compared to early mpMRI in ruling out clinically significant cancer after focal HIFU. It should be evaluated whether the use of CEUS intraoperatively enhances the efficacy of focal HIFU.
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Affiliation(s)
- Frédéric Bacchetta
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
| | | | | | - Patrice Jichlinski
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean-Yves Meuwly
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ilaria Lucca
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Rigo M, Mazzola R, Napoli G, Giaj-Levra N, Figlia V, Nicosia L, Ricchetti F, Tomasini D, Bonù ML, Cuccia F, Bellorofonte C, Alongi F. Post-HIFU locally relapsed prostate cancer: high-dose salvage radiotherapy guided by molecular imaging. Radiol Med 2020; 125:491-499. [PMID: 32077006 DOI: 10.1007/s11547-020-01148-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/06/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate tolerance and biochemical control rates of salvage external beam radiotherapy (EBRT) in patients with local relapse from prostate cancer (PC) after high-intensity focused ultrasound (HIFU) as primary treatment. METHODS Twenty-four patients presented biochemical failure of PC. Salvage EBRT to the residual prostate was performed with moderate hypofractionation schedule (MHRT) in 28 fractions (n = 16) or with extreme hypofractionation schedule (SBRT) in 5 fractions (n = 8) by means of image-guided volumetric modulation arc therapy. In case of MHRT, the median dose was 71.4 Gy, whereas in case of SBRT it was 32.5 Gy. RESULTS The median follow-up was 28 months. The median PSA nadir was 0.26 ng/mL. In case of MHRT, the median PSA nadir was 0.15 ng/mL and occurred within a median time of 19 months. In case of SBRT, the median PSA nadir was 0.64 ng/mL and occurred within a median time of 8 months. No G3 higher acute or late toxicity after EBRT was observed. Only three patients presented with G2 acute GI toxicity (actinic proctitis). Twelve patients experienced acute G1 GU toxicity: 8/16 of men treated with MHRT and 4/8 of men treated with SBRT. Complete local control of disease was achieved in 23/24 patients (96%). CONCLUSIONS Our data confirm the feasibility and the low toxicity of salvage EBRT with both schedules of treatment after HIFU failure. The findings of low acute toxicity and good biochemical control rates are encouraging, but a larger number of patients and a longer follow-up are needed to confirm these results.
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Affiliation(s)
- Michele Rigo
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy.
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Giuseppe Napoli
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Davide Tomasini
- Radiation Oncology Department, University of Brescia, Brescia, Italy
| | | | - Francesco Cuccia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | | | - Filippo Alongi
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, 37034, Verona, Negrar, Italy.,Radiation Oncology Department, University of Brescia, Brescia, Italy
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Abstract
Prostate cancer is the fifth leading cause of death worldwide. A variety of treatment options is available for localized prostate cancer and may range from active surveillance to focal therapy or whole gland treatment, that is, surgery or radiotherapy. Serum prostate-specific antigen levels are an important tool to monitor treatment success after whole gland treatment, unfortunately prostate-specific antigen is unreliable after focal therapy. Multiparametric magnetic resonance imaging of the prostate is rapidly gaining field in the management of prostate cancer and may play a crucial role in the evaluation of recurrent prostate cancer. This article will focus on postprocedural magnetic resonance imaging after different forms of local therapy in patients with prostate cancer.
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Apfelbeck M, Chaloupka M, Schlenker B, Stief C, Clevert DA. Follow-up after focal therapy of the prostate with high intensity focused ultrasound (HIFU) using contrast enhanced ultrasound (CEUS) in combination with MRI image fusion. Clin Hemorheol Microcirc 2019; 73:135-143. [DOI: 10.3233/ch-199222] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- M. Apfelbeck
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M. Chaloupka
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - B. Schlenker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - C.G. Stief
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - D.-A. Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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van der Poel H, Grivas N, van Leeuwen P, Heijmink S, Schoots I. The role of MRI for detection and staging of radio- and focal therapy-recurrent prostate cancer. World J Urol 2019; 37:1485-1490. [DOI: 10.1007/s00345-019-02677-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/06/2019] [Indexed: 10/27/2022] Open
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Burger IA, Müller J, Donati OF, Ferraro DA, Messerli M, Kranzbühler B, Ter Voert EEGW, Muehlematter UJ, Rupp NJ, Mortezavi A, Eberli D. 68Ga-PSMA-11 PET/MR Detects Local Recurrence Occult on mpMRI in Prostate Cancer Patients After HIFU. J Nucl Med 2019; 60:1118-1123. [PMID: 30683764 DOI: 10.2967/jnumed.118.221564] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/19/2018] [Indexed: 01/25/2023] Open
Abstract
High-intensity focused ultrasound (HIFU) is a promising new modality for the treatment of localized prostate cancer (PCa). Follow-up of patients is recommended with biopsies and multiparametric MRI (mpMRI). However, mpMRI in the postinterventional setting is often false-negative. It was our aim to investigate if the new tracer targeting the prostate-specific membrane antigen (68Ga-PSMA-11) could be used to localize recurrent disease with PET/MR in patients with discrepant findings between mpMRI and template biopsies. Methods: Interim analysis was performed of the first 10 patients scanned between September 2016 and May 2018 with positive template biopsy and negative mpMRI after HIFU from an ongoing clinical trial (NCT02265159). All patients underwent 68Ga-PSMA-11 PET/MRI within 3 mo. Four prostatic quadrants were defined, and for every quadrant suspicion for recurrence was rated on a 5-point Likert scale from definitely no recurrence (1) to highly suspected of recurrence (5), with 4 used as a cutoff for suspected disease based on PET/MRI by a masked reader. 68Ga-PSMA-11 uptake of suspected lesions and background areas was measured with the SUVmax The apparent diffusion coefficient values of lesions and background were given for each segment. PET/MRI scans were compared with the template biopsy results, including corresponding Gleason scores (GS), number of positive cores, and tumor length. Results: The quadrant-based sensitivity, specificity, and positive and negative predictive values for PET/MRI were 55%, 100%, 100%, and 85%, respectively. Patient-based PET/MRI was negative in 4 cases with GS 3 + 4 and a tumor length between 0.1 and 3 mm. All tumor lesions with GS 4 + 3 or higher were detected on PET/MRI. Conclusion: Our preliminary results indicate that 68Ga-PSMA-11-PET/MR has the potential to localize PCa recurrence after HIFU occult on mpMRI.
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Affiliation(s)
- Irene A Burger
- Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland
| | - Julian Müller
- Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland
| | - Olivio F Donati
- Institute of Diagnostic and Interventional Radiology, University Hospital Zürich, Zürich, Switzerland
| | - Daniela A Ferraro
- Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland
| | | | - Edwin E G W Ter Voert
- Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland; and
| | - Urs J Muehlematter
- Department of Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
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Ashrafi AN, Nassiri N, Gill IS, Gulati M, Park D, de Castro Abreu AL. Contrast-Enhanced Transrectal Ultrasound in Focal Therapy for Prostate Cancer. Curr Urol Rep 2018; 19:87. [DOI: 10.1007/s11934-018-0836-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Update on the ICUD-SIU consultation on multi-parametric magnetic resonance imaging in localised prostate cancer. World J Urol 2018; 37:429-436. [DOI: 10.1007/s00345-018-2395-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/28/2018] [Indexed: 11/26/2022] Open
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17
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Lotte R, Lafourcade A, Mozer P, Conort P, Barret E, Comperat E, Ezziane M, de Guibert PHJ, Tavolaro S, Belin L, Boudghene F, Lucidarme O, Renard-Penna R. Multiparametric MRI for Suspected Recurrent Prostate Cancer after HIFU:Is DCE still needed? Eur Radiol 2018; 28:3760-3769. [DOI: 10.1007/s00330-018-5352-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/23/2018] [Indexed: 01/28/2023]
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18
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18F-Choline PET/MR Can Detect and Delineate Local Recurrence After High-Intensity Focused Ultrasound Therapy of Prostate Cancer. Clin Nucl Med 2018; 43:e111-e112. [DOI: 10.1097/rlu.0000000000001987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Mazaheri Y, Akin O, Hricak H. Dynamic contrast-enhanced magnetic resonance imaging of prostate cancer: A review of current methods and applications. World J Radiol 2017; 9:416-425. [PMID: 29354207 PMCID: PMC5746645 DOI: 10.4329/wjr.v9.i12.416] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/03/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
In many areas of oncology, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has proven to be a clinically useful, non-invasive functional imaging technique to quantify tumor vasculature and tumor perfusion characteristics. Tumor angiogenesis is an essential process for tumor growth, proliferation, and metastasis. Malignant lesions demonstrate rapid extravasation of contrast from the intravascular space to the capillary bed due to leaky capillaries associated with tumor neovascularity. DCE-MRI has the potential to provide information regarding blood flow, areas of hypoperfusion, and variations in endothelial permeability and microvessel density to aid treatment selection, enable frequent monitoring during treatment and assess response to targeted therapy following treatment. This review will discuss the current status of DCE-MRI in cancer imaging, with a focus on its use in imaging prostate malignancies as well as weaknesses that limit its widespread clinical use. The latest techniques for quantification of DCE-MRI parameters will be reviewed and compared.
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Affiliation(s)
- Yousef Mazaheri
- Department of Medical Physics and Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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Renard-Penna R, Sanchez-Salas R, Barret E, Cosset JM, de Vergie S, Sapetti J, Ingels A, Gangi A, Lang H, Cathelineau X. [Evaluation and results of ablative therapies in prostate cancer]. Prog Urol 2017; 27:887-908. [PMID: 28939336 DOI: 10.1016/j.purol.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/04/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To perform a state of the art about methods of evaluation and present results in ablative therapies for localized prostate cancer. METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 102 articles were analysed. RESULTS Analyse the results of ablative therapies is presently difficult considering the heterogeneity of indications, techniques and follow-up. However, results from the most recent and homogeneous studies are encouraging. Oncologically, postoperative biopsies (the most important criteria) are negative (without any tumor cells in the treated area) in 75 to 95%. Functionally, urinary and sexual pre-operative status is spared (or recovered early) in more than 90% of the patients treated. More and more studies underline also the correlation between the results and the technique used considering the volume of the gland and, moreover, the "index lesion" localization. CONCLUSION The post-treatment pathological evaluation by biopsies (targeted with MRI or, perhaps in a near future, with innovative ultrasonography) is the corner stone of oncological evaluation of ablative therapies. Ongoing trials will allow to standardize the follow-up and determine the best indication and the best techniques in order to optimize oncological and functional results for each patient treated.
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Affiliation(s)
- R Renard-Penna
- Service d'imagerie, hôpitaux Tenon-Pitié Salpêtrière, AP-HP, UPMC université Paris VI, 75013 Paris, France
| | - R Sanchez-Salas
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - E Barret
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - J M Cosset
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - S de Vergie
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - J Sapetti
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France
| | - A Ingels
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Gangi
- Service de radiologie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut mutualiste Montsouris, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France.
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Loblaw A, Souter LH, Canil C, Breau RH, Haider M, Jamnicky L, Morash R, Surchin M, Matthew A. Follow-up Care for Survivors of Prostate Cancer - Clinical Management: a Program in Evidence-Based Care Systematic Review and Clinical Practice Guideline. Clin Oncol (R Coll Radiol) 2017; 29:711-717. [PMID: 28928084 DOI: 10.1016/j.clon.2017.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 07/11/2017] [Accepted: 07/19/2017] [Indexed: 11/26/2022]
Abstract
AIMS This clinical practice guideline was developed to provide evidence-based guidance on the frequency by which prostate-specific antigen (PSA) levels should be tested in men after curative-intent treatment for prostate cancer and to define the most appropriate diagnostic testing if biochemical recurrence occurs. MATERIALS AND METHODS An electronic search using OVID was used to systematically search the MEDLINE and EMBASE databases for systematic reviews and primary literature. A systematic review and practice guideline was written, reviewed and approved by the Guideline Development Group (GDG) and Program in Evidence-Based Care Report Approval Panel. External review by three prostate experts was completed, as well as an online consultation with healthcare professionals who were intended users of the guideline. RESULTS Three systematic reviews and seven primary studies were included in the evidence base. All identified literature reported on diagnostic imaging properties of diagnostic tests following biochemical recurrence. CONCLUSIONS Due to a lack of empirical research, few evidenced-based recommendations could be made with respect to a follow-up schedule of PSA testing for prostate cancer survivors following curative-intent treatment, or detailing diagnostic testing upon detection of biochemical recurrence. Accordingly, the GDG focused substantial effort on critical examination of the identified evidence, existing clinical practice guidelines and on obtaining clinical expertise consensus using a modified Delphi method. Overall, the recommendations embedded in this guideline reflect the best practice to date for the efficient and effective clinical follow-up care of prostate cancer survivors.
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Affiliation(s)
- A Loblaw
- Odette Cancer Centre, Toronto, Ontario, Canada
| | - L H Souter
- Program in Evidence-Based Care, Cancer Care Ontario, Toronto, Ontario, Canada; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - C Canil
- Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - R H Breau
- Ottawa Hospital Research Institution, Ottawa, Ontario, Canada
| | - M Haider
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L Jamnicky
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - R Morash
- Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | | | - A Matthew
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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Kongnyuy M, Halpern DM, Liu CC, Kosinski KE, Habibian DJ, Corcoran AT, Katz AE. 3-T multiparametric MRI characteristics of prostate cancer patients suspicious for biochemical recurrence after primary focal cryosurgery (hemiablation). Int Urol Nephrol 2017; 49:1947-1954. [PMID: 28799121 DOI: 10.1007/s11255-017-1670-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/25/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION We aimed to report on multiparametric MRI (mpMRI) characteristics of post-primary focal cryosurgery (PFC) patients suspected of biochemical recurrence (BCR) by the Phoenix criteria. METHODS We retrospectively reviewed all patients at our institution who had undergone PFC. Prostate-specific antigen nadir was determined using 2 or more post-PFC values. Suspicion of BCR was determined using the Phoenix criteria (nadir + 2 ng/ml). At the discretion of the physician, pre-and post-PFC 3-T mpMRIs were obtained and in a few cases biopsies were performed. RESULTS Ninety (58.4%) of 154 consecutive patients who underwent PFC were included in our analysis and had a median (range) age and prostate volume of 66.5 (48-82) years and 40.5 (16-175) ml, respectively. Of those suspected of BCR (37/90, 41.1%), with a median time to BCR of 19.9 (7.0-38.5) months, 27 patients (73.0%) underwent a post-PFC mpMRI. Twenty-two (81.5%) of these mpMRIs were found with 24 suspicious lesions. A considerable number (9/24, 37.5%) of these lesions were located in the central gland of the prostate. Seven of 24 lesions exhibited adverse mpMRI characteristic; 4 (16.7%) had capsular contact, 2 (8.2%) showed frank extracapsular extension, and 1 (4.2%) showed seminal vesicle invasion. Five (45.5%) of 11 patients with positive post-PFC mpMRIs were positive on biopsy (4/5, 80% were clinically significant prostate cancer). CONCLUSION Post-PFC mpMRI, at Phoenix suspicion of BCR, may help identify a significant number of patients failing post-PFC.
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Affiliation(s)
- Michael Kongnyuy
- Department of Urology, NYU-Winthrop University, 1300 Franklin Ave, Garden City, Mineola, NY, USA.
| | - Daniel M Halpern
- Department of Urology, NYU-Winthrop University, 1300 Franklin Ave, Garden City, Mineola, NY, USA
| | - Corinne C Liu
- Department of Radiology, NYU-Winthrop University, Mineola, NY, USA
| | - Kaitlin E Kosinski
- Department of Urology, NYU-Winthrop University, 1300 Franklin Ave, Garden City, Mineola, NY, USA
| | - David J Habibian
- St George's University School of Medicine, St. George's, Grenada
| | - Anthony T Corcoran
- Department of Urology, NYU-Winthrop University, 1300 Franklin Ave, Garden City, Mineola, NY, USA
| | - Aaron E Katz
- Department of Urology, NYU-Winthrop University, 1300 Franklin Ave, Garden City, Mineola, NY, USA
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23
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Gordetsky J, Rais-Bahrami S, Epstein JI. Pathological Findings in Multiparametric Magnetic Resonance Imaging/Ultrasound Fusion-guided Biopsy: Relation to Prostate Cancer Focal Therapy. Urology 2017; 105:18-23. [DOI: 10.1016/j.urology.2017.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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Wysock JS, Lepor H. Multi-parametric MRI imaging of the prostate-implications for focal therapy. Transl Androl Urol 2017; 6:453-463. [PMID: 28725587 PMCID: PMC5503978 DOI: 10.21037/tau.2017.04.29] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The primary goal of a focal therapy treatment paradigm is to achieve cancer control through targeted tissue destruction while simultaneously limiting deleterious effects on peri-prostatic structures. Focal therapy approaches are employed in several oncologic treatment protocols, and have been shown to provide equivalent cancer control for malignancies such as breast cancer and renal cell carcinoma. Efforts to develop a focal therapy approach for prostate cancer have been challenged by several concepts including the multifocal nature of the disease and limited capability of prostate ultrasound and systematic biopsy to reliably localize the site(s) and aggressiveness of disease. Multi-parametric MRI (mpMRI) of the prostate has significantly improved disease localization, spatial demarcation and risk stratification of cancer detected within the prostate. The accuracy of this imaging modality has further enabled the urologist to improve biopsy approaches using targeted biopsy via MRI-ultrasound fusion. From this foundation, an improved delineation of the location of disease has become possible, providing a critical foundation to the development of a focal therapy strategy. This chapter reviews the accuracy of mpMRI for detection of “aggressive“ disease, the accuracy of mpMRI in determining the tumor volume, and the ability of mpMRI to accurately identify the index lesion. While mpMRI provides a critical, first step in developing a strategy for focal therapy, considerable questions remain regarding the relationship between MR identified tumor volume and pathologic tumor volume, the accuracy and utility of mpMRI for treatment surveillance and the optimal role and timing of follow-up mpMRI.
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Affiliation(s)
- James S Wysock
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
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25
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Catalá V, Vilanova J, Gaya J, Algaba F, Martí T. Multiparametric magnetic resonance imaging and prostate cancer: What's new? RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Resonancia magnética multiparamétrica y cáncer de próstata: ¿qué hay de nuevo? RADIOLOGIA 2017; 59:196-208. [DOI: 10.1016/j.rx.2016.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/20/2022]
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Salvage robotic prostatectomy following whole gland high-intensity focused ultrasound with a Sonablate 500 device: technical feasibility and safety. J Robot Surg 2016; 11:217-221. [PMID: 27995543 DOI: 10.1007/s11701-016-0649-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
High-intensity focused ultrasound (HIFU) has been used to treat localized prostate cancers. Similar to all forms of ablation, including radiation and cryoablation, there is a local persistence rate. Salvage robotic prostatectomy has been utilized but published series are multi-institutional, multi-surgeon, and do not segregate the different HIFU devices. The results are also grouped with other forms of ablation. This series describes the technical results of a single surgeon performing salvage robotic prostatectomy on only HIFU patients, and only after whole gland ablation on a Sonablate 500 device. A retrospective hospital and office chart review was performed of nine consecutive patients. Results of the surgical cases reveal an acceptable mean OR time of 130 min, mean estimated blood loss of 125 cc with no intraoperative or post-operative transfusions, and mean length of hospital stay of 2.4 days. Urinary catheters were removed after 7-10 days. All patients were pad free no longer than 35 days later. There was no surgical field or systemic complications in any patient. Intraoperative findings include diffuse fibrosis of the periprostatic tissues including the endopelvic and lateral pelvic fascia. The thermal changes make the surgery more tedious, particularly for nerve sparing. These cases support the stance that robotic salvage prostatectomy can be safely performed in this patient cohort with immediate surgical results similar to non-salvage cases.
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28
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Juho YC, Wu ST, Cha TL, Sun GH, Yu DS, Kao CC. Single session of high-intensity focused ultrasound therapy for the management of organ-confined prostate cancer: A single-institute experience. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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29
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Wahab SA, Verma S. Review of Prostate Imaging Reporting and Data System version 2. Future Oncol 2016; 12:2479-2494. [DOI: 10.2217/fon-2016-0285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Prostate MRI has been a hot topic in recent years in large part due to the high incidence of prostate cancer worldwide. Advances in technology have allowed multiparametric MRI to improve lesion detection and characterization in prostate imaging. Additionally, prostate MRI has shown great promise in the detection of clinically significant cancer. In 2012, the European Society of Urogenital Radiology established clinical guidelines for multiparametric MRI of the prostate to facilitate a greater level of standardization and consistency, which became known as the Prostate Imaging Reporting and Data System (PI-RADS). Subsequently, the American College of Radiology, European Society of Urogenital Radiology and the AdMeTech Foundation jointly created PI-RADS version 2. This article focuses on summarizing the key points of PI-RADS version 2.
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Affiliation(s)
- Shaun A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
- Department of Urology, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
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30
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McCammack KC, Raman SS, Margolis DJA. Imaging of local recurrence in prostate cancer. Future Oncol 2016; 12:2401-2415. [DOI: 10.2217/fon-2016-0122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Diagnosis of prostate cancer (PCa) recurrence after therapy with curative intent currently depends primarily on biochemical serum analyses. When recurrence is suspected, further treatment decisions rely heavily on the confirmation of disease presence and determination of its extent. This is complicated by the fact that benign conditions can mimic biochemical recurrence, and serum studies do not reliably discriminate between local and distant recurrence. This review discusses the contemporary imaging paradigm for the evaluation of local PCa recurrence. The multidisciplinary implications for urologists, radiation oncologists and radiologists are examined. Emerging techniques and future directions of PCa imaging research are discussed.
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Affiliation(s)
- Kevin C McCammack
- Department of Radiology, University of California Los Angeles Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Steven S Raman
- Department of Radiology, University of California Los Angeles Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Daniel JA Margolis
- Department of Radiology, University of California Los Angeles Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA
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31
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Scheltema MJ, Tay KJ, Postema AW, de Bruin DM, Feller J, Futterer JJ, George AK, Gupta RT, Kahmann F, Kastner C, Laguna MP, Natarajan S, Rais-Bahrami S, Rastinehad AR, de Reijke TM, Salomon G, Stone N, van Velthoven R, Villani R, Villers A, Walz J, Polascik TJ, de la Rosette JJMCH. Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project. World J Urol 2016; 35:695-701. [PMID: 27637908 PMCID: PMC5397427 DOI: 10.1007/s00345-016-1932-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/06/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose To codify the use of multiparametric magnetic resonance imaging (mpMRI) for the interrogation of prostate neoplasia (PCa) in clinical practice and focal therapy (FT). Methods An international collaborative consensus project was undertaken using the Delphi method among experts in the field of PCa. An online questionnaire was presented in three consecutive rounds and modified each round based on the comments provided by the experts. Subsequently, a face-to-face meeting was held to discuss and finalize the consensus results. Results mpMRI should be performed in patients with prior negative biopsies if clinical suspicion remains, but not instead of the PSA test, nor as a stand-alone diagnostic tool or mpMRI-targeted biopsies only. It is not recommended to use a 1.5 Tesla MRI scanner without an endorectal or pelvic phased-array coil. mpMRI should be performed following standard biopsy-based PCa diagnosis in both the planning and follow-up of FT. If a lesion is seen, MRI-TRUS fusion biopsies should be performed for FT planning. Systematic biopsies are still required for FT planning in biopsy-naïve patients and for patients with residual PCa after FT. Standard repeat biopsies should be taken during the follow-up of FT. The final decision to perform FT should be based on histopathology. However, these consensus statements may differ for expert centers versus non-expert centers. Conclusions The mpMRI is an important tool for characterizing and targeting PCa in clinical practice and FT. Standardization of acquisition and reading should be the main priority to guarantee consistent mpMRI quality throughout the urological community. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1932-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J Scheltema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
| | - K J Tay
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A W Postema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - D M de Bruin
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - J Feller
- Desert Medical Imaging, Indian Wells, CA, USA
| | - J J Futterer
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - A K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - R T Gupta
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - F Kahmann
- Urologische Praxis Dr. Henkel and Dr. Kahmann, Berlin, Germany
| | - C Kastner
- CamPARI Prostate Cancer Clinic, Cambridge University Hospitals Trust, Cambridge, UK
| | - M P Laguna
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - S Natarajan
- Department of Urology, Surgery and Bioengineering, University of California, Los Angeles, CA, USA
| | - S Rais-Bahrami
- Department of Urology and Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - A R Rastinehad
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T M de Reijke
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - G Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - N Stone
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R van Velthoven
- Department of Urology, Institut Jules Bordet, Brussels, Belgium
| | - R Villani
- Department of Radiology, North Shore University Hospital, Northwell Health, NY, USA
| | - A Villers
- Department of Urology, Lille University Medical Center, Lille, France
| | - J Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - T J Polascik
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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32
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Rosset R, Bratan F, Crouzet S, Tonoli-Catez H, Mège-Lechevallier F, Gelet A, Rouvière O. Can pre- and postoperative magnetic resonance imaging predict recurrence-free survival after whole-gland high-intensity focused ablation for prostate cancer? Eur Radiol 2016; 27:1768-1775. [DOI: 10.1007/s00330-016-4491-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/31/2016] [Accepted: 06/22/2016] [Indexed: 12/18/2022]
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Shah TT, Peters M, Kanthabalan A, McCartan N, Fatola Y, van der Voort van Zyp J, van Vulpen M, Freeman A, Moore CM, Arya M, Emberton M, Ahmed HU. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. Prostate Cancer Prostatic Dis 2016; 19:311-6. [PMID: 27431499 PMCID: PMC4983180 DOI: 10.1038/pcan.2016.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 12/03/2022]
Abstract
Background: Treatment options for radio-recurrent prostate cancer are either androgen-deprivation therapy or salvage prostatectomy. Whole-gland high-intensity focussed ultrasound (HIFU) might have a role in this setting. Methods: An independent HIFU registry collated consecutive cases of HIFU. Between 2005 and 2012, we identified 50 men who underwent whole-gland HIFU following histological confirmation of localised disease following prior external beam radiotherapy (2005–2012). No upper threshold was applied for risk category, PSA or Gleason grade either at presentation or at the time of failure. Progression was defined as a composite with biochemical failure (Phoenix criteria (PSA>nadir+2 ng ml−1)), start of systemic therapies or metastases. Results: Median age (interquartile range (IQR)), pretreatment PSA (IQR) and Gleason score (range) were 68 years (64–72), 5.9 ng ml−1 (2.2–11.3) and 7 (6–9), respectively. Median follow-up was 64 months (49–84). In all, 24/50 (48%) avoided androgen-deprivation therapies. Also, a total of 28/50 (56%) achieved a PSA nadir <0.5 ng ml−1, 15/50 (30%) had a nadir ⩾0.5 ng ml−1 and 7/50 (14%) did not nadir (PSA non-responders). Actuarial 1, 3 and 5-year progression-free survival (PFS) was 72, 40 and 31%, respectively. Actuarial 1, 3 and 5-year overall survival (OS) was 100, 94 and 87%, respectively. When comparing patients with PSA nadir <0.5 ng ml−1, nadir ⩾0.5 and non-responders, a statistically significant difference in PFS was seen (P<0.0001). Three-year PFS in each group was 57, 20 and 0%, respectively. Five-year OS was 96, 100 and 38%, respectively. Early in the learning curve, between 2005 and 2007, 3/50 (6%) developed a fistula. Intervention for bladder outlet obstruction was needed in 27/50 (54%). Patient-reported outcome measure questionnaires showed incontinence (any pad-use) as 8/26 (31%). Conclusions: In our series of high-risk patients, in whom 30–50% may have micro-metastases, disease control rates were promising in PSA responders, however, with significant morbidity. Additionally, post-HIFU PSA nadir appears to be an important predictor for both progression and survival. Further research on focal salvage ablation in order to reduce toxicity while retaining disease control rates is required.
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Affiliation(s)
- T T Shah
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, Whittington Hospital NHS Trust, London, UK
| | - M Peters
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Kanthabalan
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - N McCartan
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Y Fatola
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - J van der Voort van Zyp
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M van Vulpen
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Freeman
- Department of Histopathology, UCLH NHS Foundation Trust, London, UK
| | - C M Moore
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK.,NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
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Catalá V, Salas D, Esquena S, Mateu S, Algaba F, Palou J, de la Torre P. Questions and answers on prostate multiparameter magnetic resonance imaging: Everything a urologist should know. Actas Urol Esp 2016; 40:339-52. [PMID: 26920095 DOI: 10.1016/j.acuro.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 01/23/2023]
Abstract
CONTEXT For many years, the detection of prostate cancer (PC) and the management of its therapy have been based primarily on prostate-specific antigen, rectal examination and prostate biopsy. However, these parameters have known limitations. Multiparametric magnetic resonance imaging (mpMRI) for prostate cancer has undergone extensive development in recent years, providing morphological and functional information. The aim of this study is to present an updated review of the scope and limitations of prostatic mpMRI for PC, in the framework of a multidisciplinary vision. ACQUISITION OF EVIDENCE We conducted a literature review (in PubMed) of articles referencing "mpMRI/staging/ PC/detection/active surveillance/therapy planning/post-therapy". We included 4 systematic reviews and other articles published in high impact-factor journals within the field of radiology and urology. SUMMARY OF THE EVIDENCE MpMRI provides morphological and functional information concerning PC. This information is integrated into the Prostate Imaging Report and Date System, classifying the probability of clinically significant carcinoma on a scale from 1 to 5. The usefulness of mpMRI is currently being established for patients with high prostate-specific antigen levels and prior negative prostate biopsy; tumour staging in selected cases; assessment of patients who are candidates for active surveillance; the planning of focal treatments; and the assessment of tumour persistence and recurrence. CONCLUSIONS MpMRI currently fills a relevant role in the diagnosis and therapeutic decision-making of PC. More widespread use of the technique requires a cost/benefit analysis.
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35
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Hoogenboom M, Eikelenboom D, den Brok MH, Veltien A, Wassink M, Wesseling P, Dumont E, Fütterer JJ, Adema GJ, Heerschap A. In vivo MR guided boiling histotripsy in a mouse tumor model evaluated by MRI and histopathology. NMR IN BIOMEDICINE 2016; 29:721-31. [PMID: 27061290 DOI: 10.1002/nbm.3520] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/02/2016] [Accepted: 02/22/2016] [Indexed: 05/11/2023]
Abstract
Boiling histotripsy (BH) is a new high intensity focused ultrasound (HIFU) ablation technique to mechanically fragmentize soft tissue into submicrometer fragments. So far, ultrasound has been used for BH treatment guidance and evaluation. The in vivo histopathological effects of this treatment are largely unknown. Here, we report on an MR guided BH method to treat subcutaneous tumors in a mouse model. The treatment effects of BH were evaluated one hour and four days later with MRI and histopathology, and compared with the effects of thermal HIFU (T-HIFU). The lesions caused by BH were easily detected with T2 w imaging as a hyper-intense signal area with a hypo-intense rim. Histopathological evaluation showed that the targeted tissue was completely disintegrated and that a narrow transition zone (<200 µm) containing many apoptotic cells was present between disintegrated and vital tumor tissue. A high level of agreement was found between T2 w imaging and H&E stained sections, making T2 w imaging a suitable method for treatment evaluation during or directly after BH. After T-HIFU, contrast enhanced imaging was required for adequate detection of the ablation zone. On histopathology, an ablation zone with concentric layers was seen after T-HIFU. In line with histopathology, contrast enhanced MRI revealed that after BH or T-HIFU perfusion within the lesion was absent, while after BH in the transition zone some micro-hemorrhaging appeared. Four days after BH, the transition zone with apoptotic cells was histologically no longer detectable, corresponding to the absence of a hypo-intense rim around the lesion in T2 w images. This study demonstrates the first results of in vivo BH on mouse tumor using MRI for treatment guidance and evaluation and opens the way for more detailed investigation of the in vivo effects of BH. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Martijn Hoogenboom
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dylan Eikelenboom
- Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martijn H den Brok
- Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andor Veltien
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Melissa Wassink
- Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pieter Wesseling
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik Dumont
- Image Guided Therapy, Pessac, Bordeaux, France
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Gosse J Adema
- Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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36
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Prostate Focused Ultrasound Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:21-41. [PMID: 26486330 DOI: 10.1007/978-3-319-22536-4_2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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37
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Jacobs I, Hectors SJCG, Schabel MC, Grüll H, Strijkers GJ, Nicolay K. Cluster analysis of DCE-MRI data identifies regional tracer-kinetic changes after tumor treatment with high intensity focused ultrasound. NMR IN BIOMEDICINE 2015; 28:1443-1454. [PMID: 26390040 DOI: 10.1002/nbm.3406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 07/27/2015] [Accepted: 08/14/2015] [Indexed: 06/05/2023]
Abstract
Evaluation of high intensity focused ultrasound (HIFU) treatment with MRI is generally based on assessment of the non-perfused volume from contrast-enhanced T1-weighted images. However, the vascular status of tissue surrounding the non-perfused volume has not been extensively investigated with MRI. In this study, cluster analysis of the transfer constant K(trans) and extravascular extracellular volume fraction ve , derived from dynamic contrast-enhanced MRI (DCE-MRI) data, was performed in tumor tissue surrounding the non-perfused volume to identify tumor subregions with distinct contrast agent uptake kinetics. DCE-MRI was performed in CT26.WT colon carcinoma-bearing BALB/c mice before (n = 12), directly after (n = 12) and 3 days after (n = 6) partial tumor treatment with HIFU. In addition, a non-treated control group (n = 6) was included. The non-perfused volume was identified based on the level of contrast enhancement. Quantitative comparison between non-perfused tumor fractions and non-viable tumor fractions derived from NADH-diaphorase histology showed a stronger agreement between these fractions 3 days after treatment (R(2) to line of identity = 0.91) compared with directly after treatment (R(2) = 0.74). Next, k-means clustering with four clusters was applied to K(trans) and ve parameter values of all significantly enhanced pixels. The fraction of pixels within two clusters, characterized by a low K(trans) and either a low or high ve , significantly increased after HIFU. Changes in composition of these clusters were considered to be HIFU induced. Qualitative H&E histology showed that HIFU-induced alterations in these clusters may be associated with hemorrhage and structural tissue disruption. Combined microvasculature and hypoxia staining suggested that these tissue changes may affect blood vessel functionality and thereby tumor oxygenation. In conclusion, it was demonstrated that, in addition to assessment of the non-perfused tumor volume, the presented methodology gives further insight into HIFU-induced effects on tumor vascular status. This method may aid in assessment of the consequences of vascular alterations for the fate of the tissue.
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Affiliation(s)
- Igor Jacobs
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Stefanie J C G Hectors
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthias C Schabel
- Imaging Research Center, Oregon Health and Science University, Portland, OR, USA
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA
| | - Holger Grüll
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Oncology solutions, Philips Research, Eindhoven, The Netherlands
| | - Gustav J Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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38
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Barrett T, Turkbey B, Choyke PL. PI-RADS version 2: what you need to know. Clin Radiol 2015; 70:1165-76. [PMID: 26231470 PMCID: PMC6369533 DOI: 10.1016/j.crad.2015.06.093] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/17/2015] [Accepted: 06/25/2015] [Indexed: 12/01/2022]
Abstract
Prostate cancer is the second most prevalent cancer in men worldwide and its incidence is expected to double by 2030. Multi-parametric magnetic resonance imaging (MRI) incorporating anatomical and functional imaging has now been validated as a means of detecting and characterising prostate tumours and can aid in risk stratification and treatment selection. The European Society of Urogenital Radiology (ESUR) in 2012 established the Prostate Imaging-Reporting and Data System (PI-RADS) guidelines aimed at standardising the acquisition, interpretation and reporting of prostate MRI. Subsequent experience and technical developments have highlighted some limitations, and a joint steering committee formed by the American College of Radiology, ESUR, and the AdMeTech Foundation have recently announced an updated version of the proposals. We summarise the main proposals of PI-RADS version 2, explore the evidence behind the recommendations, and highlight key differences for the benefit of those already familiar with the original.
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Affiliation(s)
- T Barrett
- Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Cambridge, CB2 0QQ, UK.
| | - B Turkbey
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - P L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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39
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Shah TT, Kasivisvanathan V, Jameson C, Freeman A, Emberton M, Ahmed HU. Histological outcomes after focal high-intensity focused ultrasound and cryotherapy. World J Urol 2015; 33:955-64. [PMID: 25944676 PMCID: PMC4480821 DOI: 10.1007/s00345-015-1561-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/13/2015] [Indexed: 01/28/2023] Open
Abstract
Introduction Focal therapy has increasingly become an accepted treatment option for patients with localised prostate cancer. Most follow-up protocols use a mixture of protocol biopsies or “for cause” biopsies triggered by a rising PSA. In this paper, we discuss the histological outcomes from these biopsies and their use in guiding subsequent management and trial development. Methods We conducted a literature search and reviewed the post-treatment biopsy results from studies on focal HIFU and focal cryotherapy. We subsequently reviewed the results of three recently published consensus statements released discussing many of the issues concerning focal therapy. Results Research suggests that 1 in 5 of all post-treatment biopsies after focal therapy are positive. However, the majority of these seemed to be from the untreated portion of the gland or met criteria for clinically insignificant disease. The histological outcomes from focal therapy are promising and confirm its effectiveness in the short to medium term. Furthermore re-treatment is possible whilst maintaining a low-side-effect profile. Conclusion Debate is ongoing about the clinical significance of various levels of residual disease after focal therapy and the exact threshold at which to call failure within a patient who has had focal therapy.
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Affiliation(s)
- Taimur T Shah
- Division of Surgery and Interventional Science, Urology Research Group, UCL, Room 4.23, 4th Floor, 132 Hampstead Road, London, NW1 2PS, UK,
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40
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Maruvada S, Liu Y, Soneson JE, Herman BA, Harris GR. Comparison between experimental and computational methods for the acoustic and thermal characterization of therapeutic ultrasound fields. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2015; 137:1704-1713. [PMID: 25920823 DOI: 10.1121/1.4916280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
For high intensity therapeutic ultrasound (HITU) devices, pre-clinical testing can include measurement of power, pressure/intensity and temperature distribution, acoustic and thermal simulations, and assessment of targeting accuracy and treatment monitoring. Relevant International Electrotechnical Commission documents recently have been published. However, technical challenges remain because of the often focused, large amplitude pressure fields encountered. Measurement and modeling issues include using hydrophones and radiation force balances at HITU power levels, validation of simulation models, and tissue-mimicking material (TMM) development for temperature measurements. To better understand these issues, a comparison study was undertaken between simulations and measurements of the HITU acoustic field distribution in water and TMM and temperature rise in TMM. For the specific conditions of this study, the following results were obtained. In water, the simulated values for p+ and p- were 3% lower and 10% higher, respectively, than those measured by hydrophone. In TMM, the simulated values for p+ and p- were 2% and 10% higher than those measured by hydrophone, respectively. The simulated spatial-peak temporal-average intensity values in water and TMM were greater than those obtained by hydrophone by 3%. Simulated and measured end-of-sonication temperatures agreed to within their respective uncertainties (coefficients of variation of approximately 20% and 10%, respectively).
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Affiliation(s)
- Subha Maruvada
- Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993
| | - Yunbo Liu
- Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993
| | - Joshua E Soneson
- Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993
| | - Bruce A Herman
- Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993
| | - Gerald R Harris
- Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Silver Spring, Maryland 20993
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41
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Imagerie post-thérapeutique du cancer de la prostate. Prog Urol 2015; 25:128-37. [DOI: 10.1016/j.purol.2014.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/19/2014] [Accepted: 12/06/2014] [Indexed: 12/20/2022]
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42
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Hectors SJCG, Jacobs I, Strijkers GJ, Nicolay K. Multiparametric MRI analysis for the identification of high intensity focused ultrasound-treated tumor tissue. PLoS One 2014; 9:e99936. [PMID: 24927280 PMCID: PMC4057317 DOI: 10.1371/journal.pone.0099936] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 05/20/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose In this study endogenous magnetic resonance imaging (MRI) biomarkers for accurate segmentation of High Intensity Focused Ultrasound (HIFU)-treated tumor tissue and residual or recurring non-treated tumor tissue were identified. Methods Multiparametric MRI, consisting of quantitative T1, T2, Apparent Diffusion Coefficient (ADC) and Magnetization Transfer Ratio (MTR) mapping, was performed in tumor-bearing mice before (n = 14), 1 h after (n = 14) and 72 h (n = 7) after HIFU treatment. A non-treated control group was included (n = 7). Cluster analysis using the Iterative Self Organizing Data Analysis (ISODATA) technique was performed on subsets of MRI parameters (feature vectors). The clusters resulting from the ISODATA segmentation were divided into a viable and non-viable class based on the fraction of pixels assigned to the clusters at the different experimental time points. ISODATA-derived non-viable tumor fractions were quantitatively compared to histology-derived non-viable tumor volume fractions. Results The highest agreement between the ISODATA-derived and histology-derived non-viable tumor fractions was observed for feature vector {T1, T2, ADC}. R1 (1/T1), R2 (1/T2), ADC and MTR each were significantly increased in the ISODATA-defined non-viable tumor tissue at 1 h after HIFU treatment compared to viable, non-treated tumor tissue. R1, ADC and MTR were also significantly increased at 72 h after HIFU. Conclusions This study demonstrates that non-viable, HIFU-treated tumor tissue can be distinguished from viable, non-treated tumor tissue using multiparametric MRI analysis. Clinical application of the presented methodology may allow for automated, accurate and objective evaluation of HIFU treatment.
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Affiliation(s)
- Stefanie J. C. G. Hectors
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Center for Imaging Research and Education (CIRE), Eindhoven, The Netherlands
- * E-mail:
| | - Igor Jacobs
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Center for Imaging Research and Education (CIRE), Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Center for Imaging Research and Education (CIRE), Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Center for Imaging Research and Education (CIRE), Eindhoven, The Netherlands
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43
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Crouzet S, Chapelon JY, Rouvière O, Mege-Lechevallier F, Colombel M, Tonoli-Catez H, Martin X, Gelet A. Whole-gland Ablation of Localized Prostate Cancer with High-intensity Focused Ultrasound: Oncologic Outcomes and Morbidity in 1002 Patients. Eur Urol 2014; 65:907-14. [DOI: 10.1016/j.eururo.2013.04.039] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 04/20/2013] [Indexed: 12/20/2022]
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44
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T1
ρ
mapping for the evaluation of high intensity focused ultrasound tumor treatment. Magn Reson Med 2014; 73:1593-601. [DOI: 10.1002/mrm.25269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/18/2014] [Accepted: 04/07/2014] [Indexed: 12/22/2022]
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45
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Wang X, Chen H, Zhang K, Ma M, Li F, Zeng D, Zheng S, Chen Y, Jiang L, Xu H, Shi J. An intelligent nanotheranostic agent for targeting, redox-responsive ultrasound imaging, and imaging-guided high-intensity focused ultrasound synergistic therapy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2014; 10:1403-1411. [PMID: 24288148 DOI: 10.1002/smll.201302846] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 10/21/2013] [Indexed: 06/02/2023]
Abstract
A novel multifunctional nanotheranostic agent with targeting, redox-responsive ultrasound imaging and ultrasound imaging-guided high-intensity focused ultrasound (HIFU) therapy (MSNC-PEG-HA(SS)-PFH, abbreviated as MPH(SS)-PFH) capabilities is developed. The redox-responsive guest molecule release and ultrasound imaging functions can be both integrated in such a "smart" theranostic agent, which is accomplished by the redox-triggered transition from the crosslinking state to retrocrosslinking state of the grafted polyethylene glycol-disulfide hyaluronic acid molecules on the particle surface when reaching a reducing environment in vitro. More importantly, under the tailored ultrasound imaging guiding, in vivo Hela tumor-bearing nude mice can be thoroughly and spatial-accurately ablated during HIFU therapy, due to the targeted accumulation, responsive ultrasound imaging guidance and the synergistic ablation functions of nanotheranostic agent MPH(SS)-PFH in the tumors. This novel multifunctional nano-platform can serve as a promising candidate for further studies on oncology therapy, due to its high stability, responsive and indicative ultrasound imaging of tumors, and enhanced HIFU therapeutic efficiency and spatial accuracy under ultrasound-guidance.
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Affiliation(s)
- Xia Wang
- State Key Laboratory of High Performance Ceramic and Superfine Microstructures, Shanghai Institute of Ceramics, Chinese Academy of Science, Shanghai, 200050, P.R. China
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46
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Abstract
BACKGROUND Imaging of prostate carcinoma is an important adjunct to clinical evaluation and prostate specific antigen measurement for detecting metastases and tumor recurrence. In the past, the ability to assess intraprostatic tumor was limited. METHODS Pertinent literature was reviewed to describe the capabilities and limitations of the currently available imaging techniques for assessing prostate carcinoma. Evaluation of primary tumor and metastatic disease by ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine techniques is discussed. RESULTS Ultrasonography and MRI have limited usefulness for local staging of prostate cancer because of suboptimal sensitivity and specificity for identifying tumor extent and capsular penetration. Additional MRI techniques such as magnetic resonance-based perfusion imaging, diffusion imaging, and spectroscopy may provide incremental benefit. CT and bone scanning provide an assessment of metastatic disease but are also limited by the poor sensitivity of lymph node size as a criterion for detecting metastases. Novel imaging techniques such as hybrid imaging devices in the form of single-photon emission CT/CT gamma cameras, positron emission tomography/CT cameras, and, in the near future, positron emission tomography/MRI combined with tumor specific imaging radiotracers may have a significant impact on tumor staging and treatment response. CONCLUSIONS Cross-sectional imaging and scintigraphy have an important role in assessing prostate carcinoma metastases and treatment response. Increasingly, the incremental value of primary tumor imaging through MRI is being realized.
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Affiliation(s)
- Eric K Outwater
- Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Muller BG, Fütterer JJ, Gupta RT, Katz A, Kirkham A, Kurhanewicz J, Moul JW, Pinto PA, Rastinehad AR, Robertson C, de la Rosette J, Sanchez-Salas R, Jones JS, Ukimura O, Verma S, Wijkstra H, Marberger M. The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel. BJU Int 2013; 113:218-27. [PMID: 24215670 DOI: 10.1111/bju.12243] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy. METHODS Urological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors. Topics specifically did not include staging of prostate cancer, but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to (i) determine focality of prostate cancer (e.g. localising small target lesions of ≥0.5 mL), (ii) to monitor and assess the outcome of focal ablation therapies, and (iii) to identify the diagnostic advantages of new MRI methods. In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy? RESULTS Consensus was reached on most key aspects of the meeting; however, on definition of the optimal requirements for mpMRI, there was one dissenting voice. mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) and judged by an experienced radiologist. Structured and standardised reporting of prostate MRI is paramount. State of the art mpMRI is capable of localising small tumours for focal therapy. State of the art mpMRI is the technique of choice for follow-up of focal ablation. CONCLUSIONS The present evidence for MRI in focal therapy is limited. mpMRI is not accurate enough to consistently grade tumour aggressiveness. Template-guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available; however, suspicious lesions should always be confirmed by (targeted) biopsy.
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Affiliation(s)
- Berrend G Muller
- Department of Urology, AMC University Hospital, Amsterdam, the Netherlands
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48
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Hectors SJCG, Jacobs I, Strijkers GJ, Nicolay K. Amide proton transfer imaging of high intensity focused ultrasound-treated tumor tissue. Magn Reson Med 2013; 72:1113-22. [PMID: 24154945 DOI: 10.1002/mrm.25000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/11/2013] [Accepted: 09/24/2013] [Indexed: 11/08/2022]
Abstract
PURPOSE In this study, the suitability of amide proton transfer (APT) imaging as a biomarker for the characterization of high intensity focused ultrasound (HIFU)-treated tumor tissue was assessed. METHODS APT imaging was performed on tumor-bearing mice before (n = 15), directly after (n = 15) and at 3 days (n = 8) after HIFU treatment. A control group (n = 7) of nontreated animals was scanned at the same time points. Histogram analysis of the tumor APT-weighted signal distributions was performed to assess HIFU-induced changes in the tumor APT contrast. RESULTS Distinct regions of decreased APT-weighted signal were observed at both time points after HIFU treatment. Analysis of the tumor APT-weighted signal distribution showed a pronounced shift toward lower APT-weighted signal values after HIFU treatment. A significantly increased fraction of pixels with an APT-weighted signal value between -10 and -2% was observed both directly (0.37 ± 0.16) and at 3 days (0.49 ± 0.16) after HIFU treatment as compared to baseline (0.22 ± 0.16). CONCLUSION The presented results show that APT imaging is sensitive to HIFU-induced changes in tumor tissue and may thus serve as a new biomarker for monitoring the response of tumor tissue to HIFU treatment.
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Affiliation(s)
- Stefanie J C G Hectors
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Center for Imaging Research and Education (CIRE), Eindhoven, The Netherlands
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49
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Tong WY, Cohen G, Yamada Y. Focal low-dose rate brachytherapy for the treatment of prostate cancer. Cancer Manag Res 2013; 5:315-25. [PMID: 24049459 PMCID: PMC3775638 DOI: 10.2147/cmar.s33056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Whole-gland low-dose rate (LDR) brachytherapy has been a well-established modality of treating low-risk prostate cancer. Treatment in a focal manner has the advantages of reduced toxicity to surrounding organs. Focal treatment using LDR brachytherapy has been relatively unexplored, but it may offer advantages over other modalities that have established experiences with a focal approach. This is particularly true as prostate cancer is being detected at an earlier and more localized stage with the advent of better detection methods and newer imaging modalities.
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Affiliation(s)
- William Y Tong
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Kasivisvanathan V, Emberton M, Ahmed HU. Focal therapy for prostate cancer: rationale and treatment opportunities. Clin Oncol (R Coll Radiol) 2013; 25:461-73. [PMID: 23759249 PMCID: PMC4042323 DOI: 10.1016/j.clon.2013.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 03/21/2013] [Accepted: 05/08/2013] [Indexed: 01/20/2023]
Abstract
Focal therapy is an emerging treatment modality for localised prostate cancer that aims to reduce the morbidity seen with radical therapy, while maintaining cancer control. Focal therapy treatment strategies minimise damage to non-cancerous tissue, with priority given to the sparing of key structures such as the neurovascular bundles, external sphincter, bladder neck and rectum. There are a number of ablative technologies that can deliver energy to destroy cancer cells as part of a focal therapy strategy. The most widely investigated are cryotherapy and high-intensity focussed ultrasound. Existing radical therapies, such as brachytherapy and external beam radiotherapy, also have the potential to be applied in a focal manner. The functional outcomes of focal therapy from several phase I and II trials have been encouraging, with low rates of urinary incontinence and erectile dysfunction. Robust medium- and long-term cancer control outcomes are currently lacking. Controversies in focal therapy remain, notably treatment paradigms based on the index lesion hypothesis, appropriate patient selection for focal therapy and how the efficacy of focal therapy should be assessed. This review articles discusses the current status of focal therapy, highlighting controversies and emerging strategies that can influence treatment outcomes for the future.
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Affiliation(s)
- V Kasivisvanathan
- Division of Surgery and Interventional Sciences, University College London, UK.
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