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Li J, Luo C, Sun T, Zhou Y, Huang X, Wu D, Luo X, Zeng C, Li H. Hypoxia-Specific Metal-Organic Frameworks Augment Cancer Immunotherapy of High-Intensity Focused Ultrasound. ACS NANO 2024; 18:18412-18424. [PMID: 38949962 DOI: 10.1021/acsnano.4c02921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
As a noninvasive treatment modality, high-intensity focused ultrasound (HIFU)-induced antitumor immune responses play a vital role in surgery prognosis. However, limited response intensity largely hinders postoperative immunotherapy. Herein, a hypoxia-specific metal-organic framework (MOF) nanosystem, coordinated by Fe3+, hypoxic-activated prodrug AQ4N, and IDO-1 signaling pathway inhibitor NLG919, is developed for the potentiating immunotherapy of HIFU surgery. The loaded AQ4N enhances the photoacoustic imaging effects to achieve accurate intraoperative navigation. Within the HIFU-established severe hypoxic environment, AQ4N is activated sequentially, following which it cooperates with Fe3+ to effectively provoke immunogenic cell death. In addition, potent NLG919 suppresses IDO-1 activity and degrades the immunosuppressive tumor microenvironment aggravated by postoperative hypoxia. In vivo studies demonstrate that the MOF-mediated immunotherapy greatly inhibits the growth of primary/distant tumors and eliminates lung metastasis. This work establishes a robust delivery platform to improve immunotherapy and the overall prognosis of HIFU surgery with high specificity and potency.
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Affiliation(s)
- Jingnan Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, P. R. China
| | - Chengyan Luo
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, P. R. China
| | - Tingyu Sun
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, P. R. China
| | - Yinglin Zhou
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, P. R. China
| | - Xinchang Huang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, P. R. China
| | - Dezhou Wu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, P. R. China
| | - Xirui Luo
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, P. R. China
| | - Chao Zeng
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, P. R. China
| | - Huanan Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, P. R. China
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Kolanukuduru KP, Busby D, Grauer R, Choudhary MK, Mandel A, Maheshwari A, Tewari AK, Menon M. Outcomes after precision prostatectomy: safety, efficacy and transference of skills. World J Urol 2024; 42:394. [PMID: 38985306 DOI: 10.1007/s00345-024-05074-2] [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: 03/15/2024] [Accepted: 05/20/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE Precision Prostatectomy (PP) is a viable treatment option for men with unilateral dominant cancer who are interested in preserving functional outcomes. To date, the data published about the outcomes of this technique has come from a single center only (Henry Ford - HF). We present the surgical, functional, and oncological outcomes of the first series of patients to undergo PP outside of HF, to demonstrate the safety and reproducibility of the technique. METHODS Between 2022 and 2023, PP was offered to select patients who were interested in preserving their functional status. Men who underwent PP were followed at 3 monthly intervals; information regarding their functional status was simultaneously obtained. Men who had biochemical recurrence were advised to undergo remnant biopsy. If residual cancer was detected, then remnant removal was performed. RESULTS The median age and median PSA of the study group was 63 years and 6.89 ng/ml respectively. The median operative and console times were 196.5 and 154 minutes. No intra-operative complications were noted. Three patients had a total of three post-operative complications. Three patients had biochemical recurrence; cancer was not detected in any of these patients on postoperative biopsies of the prostatic remnant. At 12 months, 91% of patients reported using 0 pads/day and 90.9% of pre-operatively potent patients were potent at 12 months. CONCLUSION PP is a safe and reproducible technique that can ensure cancer control and preservation of functional status in select patients. Further studies with large sample sizes and longer follow-up are required to ascertain the long-term outcomes of this surgical technique.
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Affiliation(s)
| | - Dallin Busby
- Department of Urology, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manish K Choudhary
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Asher Mandel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Maheshwari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ash K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Windisch O, Valerio M. Re: Evaluation of Outcomes Following Focal Ablative Therapy for Treatment of Localised Clinically Significant Prostate Cancer in Patients >70 Years: A Multi-institute, Multi-energy 15-year Experience. Eur Urol 2024; 86:75. [PMID: 38538420 DOI: 10.1016/j.eururo.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/05/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Olivier Windisch
- Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland.
| | - Massimo Valerio
- Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
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Tsukuda F, Shimizu T, Hagiwara K, Kawano Y, Sakamoto N, Itagaki S, Horiguchi Y, Koga S, Ukimura O. Robotic-assisted laparoscopic radical prostatectomy for treatment of a newly identified lesion revealed no viable cells in the previously treated area with microwave focal therapy. IJU Case Rep 2024; 7:313-315. [PMID: 38966774 PMCID: PMC11221935 DOI: 10.1002/iju5.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/24/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction Histological outcome of the targeted focal therapy is in principle confirmed by targeted needle biopsy from the treated area in clinical trial. Herein, we report a rare case in which the MFT was followed by RARP. Case presentation A 68-year-old man with PSA 9.6 ng/mL and PI-RADS 4 lesion in the right transition zone on multi-parametric MRI underwent MR/ultrasound fusion-guided targeted biopsy, which revealed grade-group 1 cancer. Targeted focal therapy with microwave ablation was performed, resulting in disappearance of the PI-RADS 4 lesion at post-operative 4 months. However, PSA rose to 11.5 ng/mL, and a new PI-RADS 4 lesion, was identified in the left peripheral zone. RARP was performed to reveal new grade-group 3 cancer, and no viable cells in the previously treated area with MFT. Conclusion RARP was safely performed even after MFT and proved the pathological complete response of microwave ablation.
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Affiliation(s)
| | | | | | | | | | | | | | - Shoji Koga
- Department of UrologyEdogawa HospitalTokyoJapan
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
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5
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Rokan N, Reddy D, Dudderidge T. Focal therapy for prostate cancer - when to refer? BJU Int 2024; 133:665-666. [PMID: 38481100 DOI: 10.1111/bju.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Nadia Rokan
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
| | - Deepika Reddy
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
- Imperial College London, London, UK
| | - Tim Dudderidge
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Ladjevardi S, Ebner A, Femic A, Huebner NA, Shariat SF, Kraler S, Kubik-Huch RA, Ahlman RC, Häggman M, Hefermehl LJ. Focal high-intensity focused ultrasound therapy for localized prostate cancer: An interim analysis of the multinational FASST study. Eur J Clin Invest 2024; 54:e14192. [PMID: 38445798 DOI: 10.1111/eci.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) emerged as a novel approach for the treatment of localized prostate cancer (PCa). However, prospective studies on HIFU-related outcomes and predictors of treatment failure (TF) remain scarce. MATERIALS AND METHODS We conducted a multinational prospective cohort study among patients undergoing HIFU therapy for localized, low- to intermediate-risk PCa. Follow-up data on serial prostate specific antigen (PSA), multi-parametric magnetic resonance imaging (mpMRI), targeted/systematic biopsies, adverse events and functional outcomes were collected. The primary endpoint was TF, defined as histologically confirmed PCa requiring whole-gland salvage treatment. Uni- and multi-variable adjusted hazard ratios (HRs) were calculated using Cox proportional hazard regression models. RESULTS At baseline, mean (standard deviation) age was 64.14 (7.19) years, with the majority of patients showing T-stage 1 (73.9%) and International Society of Urological Pathology grading system Grade 2 (58.8%). PSA nadir (median, 1.70 ng/mL) was reached after 6 months. Of all patients recruited, 16% had clinically significant PCa, as confirmed by biopsy, of which 13.4% had TF. Notably, T-stage and number of positive cores at initial biopsy were independent predictors of TF during follow-up (HR [95% CI] 1.27 [1.02-1.59] and 5.02 [1.80-14.03], respectively). Adverse events were minimal (17% and 8% early and late adverse events, respectively), with stable or improved functional outcomes in the majority of patients. CONCLUSIONS This interim analysis of a multinational study on HIFU therapy for the management of low-to-intermediate-risk PCa reveals good functional outcomes, minimal adverse events and low incidence of TF over the short-term. Data on long-term outcomes, specifically as it relates to oncological outcomes, are awaited eagerly.
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Affiliation(s)
- Sam Ladjevardi
- Department of Urology, University of Uppsala, Uppsala, Sweden
| | - Anna Ebner
- Department of Urology, Cantonal Hospital Baden, Baden, Switzerland
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | | | - Nicolai A Huebner
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Working Group for Diagnostic imaging in Urology (ABDU), Austrian association of Urology (ÖGU), Vienna, Austria
- Department of urology, University of California Davis, Sacramento, California, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | | | | | - Michael Häggman
- Department of Urology, University of Uppsala, Uppsala, Sweden
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7
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Liu C, Chang Z, Chen K, Xue Q, Shu B, Wei Z, Zhou X, Guo L, Zhang Y, Pan Y, Cao Q, Liang H, Sun Q, Zhang X. A mitochondrion-targeted cyanine agent for NIR-II fluorescence-guided surgery combined with intraoperative photothermal therapy to reduce prostate cancer recurrence. J Nanobiotechnology 2024; 22:224. [PMID: 38702709 PMCID: PMC11069140 DOI: 10.1186/s12951-024-02477-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024] Open
Abstract
Poorly identified tumor boundaries and nontargeted therapies lead to the high recurrence rates and poor quality of life of prostate cancer patients. Near-infrared-II (NIR-II) fluorescence imaging provides certain advantages, including high resolution and the sensitive detection of tumor boundaries. Herein, a cyanine agent (CY7-4) with significantly greater tumor affinity and blood circulation time than indocyanine green was screened. By binding albumin, the absorbance of CY7-4 in an aqueous solution showed no effects from aggregation, with a peak absorbance at 830 nm and a strong fluorescence emission tail beyond 1000 nm. Due to its extended circulation time (half-life of 2.5 h) and high affinity for tumor cells, this fluorophore was used for primary and metastatic tumor diagnosis and continuous monitoring. Moreover, a high tumor signal-to-noise ratio (up to ~ 10) and excellent preferential mitochondrial accumulation ensured the efficacy of this molecule for photothermal therapy. Therefore, we integrated NIR-II fluorescence-guided surgery and intraoperative photothermal therapy to overcome the shortcomings of a single treatment modality. A significant reduction in recurrence and an improved survival rate were observed, indicating that the concept of intraoperative combination therapy has potential for the precise clinical treatment of prostate cancer.
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Affiliation(s)
- Chenchen Liu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology & Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, China
| | - Zong Chang
- Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology & Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, China
| | - Kailei Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qiang Xue
- Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology & Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, China
| | - Bingxin Shu
- Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology & Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, China
| | - Zhihao Wei
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xuan Zhou
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Like Guo
- Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology & Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, China
| | - Yuling Zhang
- Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology & Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, China
| | - Yingying Pan
- Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology & Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, China
| | - Qi Cao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huageng Liang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qinchao Sun
- Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology & Center for Biomedical Optics and Molecular Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, China.
| | - Xiaoping Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Institute of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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8
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Light A, Mayor N, Cullen E, Kirkham A, Padhani AR, Arya M, Bomers JGR, Dudderidge T, Ehdaie B, Freeman A, Guillaumier S, Hindley R, Lakhani A, Pendse D, Punwani S, Rastinehad AR, Rouvière O, Sanchez-Salas R, Schoots IG, Sokhi HK, Tam H, Tempany CM, Valerio M, Verma S, Villeirs G, van der Meulen J, Ahmed HU, Shah TT. The Transatlantic Recommendations for Prostate Gland Evaluation with Magnetic Resonance Imaging After Focal Therapy (TARGET): A Systematic Review and International Consensus Recommendations. Eur Urol 2024; 85:466-482. [PMID: 38519280 DOI: 10.1016/j.eururo.2024.02.001] [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: 05/03/2023] [Revised: 11/29/2023] [Accepted: 02/04/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Magnetic resonance imaging (MRI) can detect recurrences after focal therapy for prostate cancer but there is no robust guidance regarding its use. Our objective was to produce consensus recommendations on MRI acquisition, interpretation, and reporting after focal therapy. METHODS A systematic review was performed in July 2022 to develop consensus statements. A two-round consensus exercise was then performed, with a consensus meeting in January 2023, during which 329 statements were scored by 23 panellists from Europe and North America spanning urology, radiology, and pathology with experience across eight focal therapy modalities. Using RAND Corporation/University of California-Los Angeles methodology, the Transatlantic Recommendations for Prostate Gland Evaluation with MRI after Focal Therapy (TARGET) were based on consensus for statements scored with agreement or disagreement. KEY FINDINGS AND LIMITATIONS In total, 73 studies were included in the review. All 20 studies (100%) reporting suspicious imaging features cited focal contrast enhancement as suspicious for cancer recurrence. Of 31 studies reporting MRI assessment criteria, the Prostate Imaging-Reporting and Data System (PI-RADS) score was the scheme used most often (20 studies; 65%), followed by a 5-point Likert score (six studies; 19%). For the consensus exercise, consensus for statements scored with agreement or disagreement increased from 227 of 295 statements (76.9%) in round one to 270 of 329 statements (82.1%) in round two. Key recommendations include performing routine MRI at 12 mo using a multiparametric protocol compliant with PI-RADS version 2.1 standards. PI-RADS category scores for assessing recurrence within the ablation zone should be avoided. An alternative 5-point scoring system is presented that includes a major dynamic contrast enhancement (DCE) sequence and joint minor diffusion-weighted imaging and T2-weighted sequences. For the DCE sequence, focal nodular strong early enhancement was the most suspicious imaging finding. A structured minimum reporting data set and minimum reporting standards for studies detailing MRI data after focal therapy are presented. CONCLUSIONS AND CLINICAL IMPLICATIONS The TARGET consensus recommendations may improve MRI acquisition, interpretation, and reporting after focal therapy for prostate cancer and provide minimum standards for study reporting. PATIENT SUMMARY Magnetic resonance imaging (MRI) scans can detect recurrent of prostate cancer after focal treatments, but there is a lack of guidance on MRI use for this purpose. We report new expert recommendations that may improve practice.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nikhil Mayor
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Cullen
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alex Kirkham
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Manit Arya
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joyce G R Bomers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Behfar Ehdaie
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Richard Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Amish Lakhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Douglas Pendse
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | | | - Olivier Rouvière
- Department of Vascular and Urinary Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine, Université de Lyon, Lyon, France
| | | | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Heminder K Sokhi
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK; Department of Radiology, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Henry Tam
- Department of Imaging, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Massimo Valerio
- Department of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Geert Villeirs
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
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9
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Enikeeva K, Rafikova G, Sharifyanova Y, Mulyukova D, Vanzin A, Pavlov V. Epigenetics as a Key Factor in Prostate Cancer. Adv Biol (Weinh) 2024; 8:e2300520. [PMID: 38379272 DOI: 10.1002/adbi.202300520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/01/2024] [Indexed: 02/22/2024]
Abstract
Nowadays, prostate cancer is one of the most common forms of malignant neoplasms in men all over the world. Against the background of increasing incidence, there is a high mortality rate from prostate cancer, which is associated with an inadequate treatment strategy. Such a high prevalence of prostate cancer requires the development of methods that can ensure early detection of the disease, improve the effectiveness of treatment, and predict the therapeutic effect. Under these circumstances, it becomes crucial to focus on the development of effective diagnostic and therapeutic approaches. Due to the development of molecular genetic methods, a large number of studies have been accumulated on the role of epigenetic regulation of gene activity in cancer development, since it is epigenetic changes that can be detected at the earliest stages of cancer development. The presence of epigenetic aberrations in tumor tissue and correlations with drug resistance suggest new therapeutic approaches. Detection of epigenetic alterations such as CpG island methylation, histone modification, and microRNAs as biomarkers will improve the diagnosis of the disease, and the use of these strategies as targets for therapy will allow for greater personalization of prostate cancer treatment.
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Affiliation(s)
- Kadriia Enikeeva
- Institute of Urology and Clinical Oncology, Bashkir State Medical University, Ufa, 450008, Russia
| | - Guzel Rafikova
- Institute of Urology and Clinical Oncology, Bashkir State Medical University, Ufa, 450008, Russia
| | - Yuliya Sharifyanova
- Institute of Urology and Clinical Oncology, Bashkir State Medical University, Ufa, 450008, Russia
| | - Diana Mulyukova
- Institute of Urology and Clinical Oncology, Bashkir State Medical University, Ufa, 450008, Russia
| | - Alexandr Vanzin
- Institute of Urology and Clinical Oncology, Bashkir State Medical University, Ufa, 450008, Russia
| | - Valentin Pavlov
- Institute of Urology and Clinical Oncology, Bashkir State Medical University, Ufa, 450008, Russia
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10
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Rodríguez-Sánchez L, Emberton M, de Reijke T, Stricker P, Miñana B, Bianco F, Escrig JLD, Lantz A, Sanchez-Salas R. Revisiting Delphi to Create a Basis for the Future of Focal Therapy for Prostate Cancer. World J Mens Health 2024; 42:245-255. [PMID: 37853538 PMCID: PMC10949031 DOI: 10.5534/wjmh.230160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Theo de Reijke
- Department of Urology, UMC Amsterdam University Hospital, Amsterdam, the Netherlands
| | - Phillip Stricker
- Department of Urology, St. Vincent's Private Hospital and Clinic, Melbourne, Australia
| | - Bernardino Miñana
- Department of Urology, Clinica Universidad de Navarra, Madrid, Spain
| | - Fernando Bianco
- Urological Research Network, Nova Southeastern University, Hollywood, FL, USA
| | | | - Anna Lantz
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Rafael Sanchez-Salas
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada
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Gelikman DG, Kenigsberg AP, Mee Law Y, Yilmaz EC, Harmon SA, Parikh SH, Hyman JA, Huth H, Koller CR, Nethala D, Hesswani C, Merino MJ, Gurram S, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Evaluating Diagnostic Accuracy and Inter-reader Agreement of the Prostate Imaging After Focal Ablation Scoring System. EUR UROL SUPPL 2024; 62:74-80. [PMID: 38468864 PMCID: PMC10925932 DOI: 10.1016/j.euros.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
Background and objective Focal therapy (FT) is increasingly recognized as a promising approach for managing localized prostate cancer (PCa), notably reducing treatment-related morbidities. However, post-treatment anatomical changes present significant challenges for surveillance using current imaging techniques. This study aimed to evaluate the inter-reader agreement and efficacy of the Prostate Imaging after Focal Ablation (PI-FAB) scoring system in detecting clinically significant prostate cancer (csPCa) on post-FT multiparametric magnetic resonance imaging (mpMRI). Methods A retrospective cohort study was conducted involving patients who underwent primary FT for localized csPCa between 2013 and 2023, followed by post-FT mpMRI and a prostate biopsy. Two expert genitourinary radiologists retrospectively evaluated post-FT mpMRI using PI-FAB. The key measures included inter-reader agreement of PI-FAB scores, assessed by quadratic weighted Cohen's kappa (κ), and the system's efficacy in predicting in-field recurrence of csPCa, with a PI-FAB score cutoff of 3. Additional diagnostic metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were also evaluated. Key findings and limitations Scans from 38 patients were analyzed, revealing a moderate level of agreement in PI-FAB scoring (κ = 0.56). Both radiologists achieved sensitivity of 93% in detecting csPCa, although specificity, PPVs, NPVs, and accuracy varied. Conclusions and clinical implications The PI-FAB scoring system exhibited high sensitivity with moderate inter-reader agreement in detecting in-field recurrence of csPCa. Despite promising results, its low specificity and PPV necessitate further refinement. These findings underscore the need for larger studies to validate the clinical utility of PI-FAB, potentially aiding in standardizing post-treatment surveillance. Patient summary Focal therapy has emerged as a promising approach for managing localized prostate cancer, but limitations in current imaging techniques present significant challenges for post-treatment surveillance. The Prostate Imaging after Focal Ablation (PI-FAB) scoring system showed high sensitivity for detecting in-field recurrence of clinically significant prostate cancer. However, its low specificity and positive predictive value necessitate further refinement. Larger, more comprehensive studies are needed to fully validate its clinical utility.
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Affiliation(s)
- David G. Gelikman
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexander P. Kenigsberg
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yan Mee Law
- Department of Radiology, Singapore General Hospital, Singapore
| | - Enis C. Yilmaz
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie A. Harmon
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sahil H. Parikh
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason A. Hyman
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hannah Huth
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Christopher R. Koller
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daniel Nethala
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charles Hesswani
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maria J. Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter L. Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J. Wood
- Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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12
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Sanchez-Salas R. Candid choices: optimising patient selection in prostate cancer focal therapy. BJU Int 2024; 133:355-356. [PMID: 38243865 DOI: 10.1111/bju.16270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Affiliation(s)
- Rafael Sanchez-Salas
- Division of Urology, Department of Surgery, McGill University, Montréal, Québec, Canada
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13
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Peretsman SJ, Emberton M, Fleshner N, Shoji S, Bahler CD, Miller LE. High-intensity focused ultrasound with visually directed power adjustment for focal treatment of localized prostate cancer: systematic review and meta-analysis. World J Urol 2024; 42:175. [PMID: 38507093 PMCID: PMC10954869 DOI: 10.1007/s00345-024-04840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE To characterize patient outcomes following visually directed high-intensity focused ultrasound (HIFU) for focal treatment of localized prostate cancer. METHODS We performed a systematic review of cancer-control outcomes and complication rates among men with localized prostate cancer treated with visually directed focal HIFU. Study outcomes were calculated using a random-effects meta-analysis model. RESULTS A total of 8 observational studies with 1,819 patients (median age 67 years; prostate-specific antigen 7.1 mg/ml; prostate volume 36 ml) followed over a median of 24 months were included. The mean prostate-specific antigen nadir following visually directed focal HIFU was 2.2 ng/ml (95% CI 0.9-3.5 ng/ml), achieved after a median of 6 months post-treatment. A clinically significant positive biopsy was identified in 19.8% (95% CI 12.4-28.3%) of cases. Salvage treatment rates were 16.2% (95% CI 9.7-23.8%) for focal- or whole-gland treatment, and 8.6% (95% CI 6.1-11.5%) for whole-gland treatment. Complication rates were 16.7% (95% CI 9.9-24.6%) for de novo erectile dysfunction, 6.2% (95% CI 0.0-19.0%) for urinary retention, 3.0% (95% CI 2.1-3.9%) for urinary tract infection, 1.9% (95% CI 0.1-5.3%) for urinary incontinence, and 0.1% (95% CI 0.0-1.4%) for bowel injury. CONCLUSION Limited evidence from eight observational studies demonstrated that visually directed HIFU for focal treatment of localized prostate cancer was associated with a relatively low risk of complications and acceptable cancer control over medium-term follow-up. Comparative, long-term safety and effectiveness results with visually directed focal HIFU are lacking.
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Affiliation(s)
| | - Mark Emberton
- Interventional Oncology, Division of Surgery and Interventional Science, University College London, London, UK
| | - Neil Fleshner
- Department of Surgical Oncology Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, Isehara, Japan
| | - Clinton D Bahler
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Larry E Miller
- Miller Scientific, 3101 Browns Mill Road, Ste 6, #311, Johnson City, TN, 37604, USA.
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14
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Ghai S, Finelli A, Corr K, Lajkosz K, McCluskey S, Chan R, Gertner M, van der Kwast TH, Incze PF, Zlotta AR, Kucharczyk W, Perlis N. MRI-guided Focused Ultrasound Focal Therapy for Intermediate-Risk Prostate Cancer: Final Results from a 2-year Phase II Clinical Trial. Radiology 2024; 310:e231473. [PMID: 38441092 DOI: 10.1148/radiol.231473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Background MRI-guided focal therapy (FT) allows for accurate targeting of localized clinically significant prostate cancer (csPCa) while preserving healthy prostate tissue, but the long-term outcomes of this approach require more study. Purpose To assess the 2-year oncological and functional outcomes of men with intermediate-risk prostate cancer (PCa) treated with targeted FT. Materials and Methods In this single-center prospective phase II trial, men with localized unifocal intermediate-risk PCa underwent transrectal MRI-guided focused ultrasound between July 2016 and July 2019. Planned ablation volumes included 10-mm margins when possible. Data regarding adverse events were collected and quality-of-life questionnaires were completed by participants at 6 weeks and at 5, 12, 18, and 24 months after treatment. Multiparametric MRI and targeted and systematic biopsies were performed at 24 months. Ablation volumes were determined by manual contouring of nonperfused volumes on immediate contrast-enhanced images. Generalized estimating equations were used to model trends in quality-of-life measures. Results Treatment was successfully completed in the 44 participants (median age, 67 years; IQR, 62-70 years; 36 patients with grade group [GG] 2; eight patients with GG 3). No major adverse events from treatment were recorded. One participant refused biopsy at 24 months. After 2 years, 39 of 43 participants (91%) had no csPCa at the treatment site and 36 of 43 (84%) had no cancer in the entire gland. No changes in International Index of Erectile Function-15 score or International Prostate Symptom Score were observed during 2-year follow-up (P = .73 and .39, respectively). Conclusion The majority of men treated with MRI-guided focused ultrasound for intermediate risk PCa had negative results for csPCa at biopsy 2 years after treatment. Additionally, there was no significant decline in quality of life per the validated questionnaires. Clinical trial registration no. NCT02968784 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Woodrum in this issue.
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Affiliation(s)
- Sangeet Ghai
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Antonio Finelli
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Kateri Corr
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Katherine Lajkosz
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Stuart McCluskey
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Rosanna Chan
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Mark Gertner
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Theodorus H van der Kwast
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Peter F Incze
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Alexandre R Zlotta
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Walter Kucharczyk
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
| | - Nathan Perlis
- From the Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, 1PMB-292, Toronto, ON, Canada M5G 2N2 (S.G., K.C., R.C., M.G., W.K.); Division of Urology, Department of Surgical Oncology (A.F., A.R.Z., N.P.), Department of Anesthesia (S.M.), and Department of Pathology, Laboratory Medicine Program (T.H.v.d.K.), University Health Network, University of Toronto, Toronto, Canada; Biostatistics Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada (K.L.); and Department of Urology, Oakville Trafalgar Memorial Hospital, Toronto, Canada (P.F.I.)
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15
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Shoji S. Focal therapy with high-intensity focused ultrasound for localized prostate cancer: approval as advanced medical care and future outlook. J Med Ultrason (2001) 2024; 51:1-3. [PMID: 38252181 DOI: 10.1007/s10396-023-01401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Sunao Shoji
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
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16
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Peyrottes A, Rouprêt M, Fiard G, Fromont G, Barret E, Brureau L, Créhange G, Gauthé M, Baboudjian M, Renard-Penna R, Roubaud G, Rozet F, Sargos P, Ruffion A, Mathieu R, Beauval JB, De La Taille A, Ploussard G, Dariane C. [Early detection of prostate cancer: Towards a new paradigm?]. Prog Urol 2023; 33:956-965. [PMID: 37805291 DOI: 10.1016/j.purol.2023.09.016] [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: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 10/09/2023]
Abstract
Prostate cancer (PCa) is a public health issue. The diagnostic strategy for PCa is well codified and assessed by digital rectal examination, PSA testing and multiparametric MRI, which may or may not lead to prostate biopsies. The formal benefit of organized PCa screening, studied more than 10 years ago at an international scale and for all incomers, is not demonstrated. However, diagnostic and therapeutic modalities have evolved since the pivotal studies. The contribution of MRI and targeted biopsies, the widespread use of active surveillance for unsignificant PCa, the improvement of surgical techniques and radiotherapy… have allowed a better selection of patients and strengthened the interest for an individualized approach, reducing the risk of overtreatment. Aiming to enhance coverage and access to screening for the population, the European Commission recently promoted the evaluation of an organized PCa screening strategy, including MRI. The lack of screening programs has become detrimental to the population and must shift towards an early detection policy adapted to the risk of each individual.
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Affiliation(s)
- A Peyrottes
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, membre junior, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, 20 rue Leblanc, 75015 Paris, France.
| | - M Rouprêt
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne university, GRC 5 Predictive Onco-Uro, AP-HP, urology, Pitié-Salpétrière hospital, 75013 Paris, France
| | - G Fiard
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, Grenoble Alpes university hospital, université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - G Fromont
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of pathology, CHRU, 37000 Tours, France
| | - E Barret
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, institut mutualiste Montsouris, Paris, France
| | - L Brureau
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, CHU de Pointe-à-Pitre, university of Antilles, university of Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR S 1085, 97110 Pointe-à-Pitre, Guadeloupe
| | - G Créhange
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of radiotherapy, institut Curie, Paris, France
| | - M Gauthé
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sintep nuclear medicine, 38100 Grenoble, France
| | - M Baboudjian
- Department of urology, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - R Renard-Penna
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne university, AP-HP, radiology, Pitie-Salpétrière hospital, 75013 Paris, France
| | - G Roubaud
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of medical oncology, institut Bergonié, 33000 Bordeaux, France
| | - F Rozet
- Sorbonne university, GRC 5 Predictive Onco-Uro, AP-HP, urology, Pitié-Salpétrière hospital, 75013 Paris, France; Department of urology, institut mutualiste Montsouris, Paris, France
| | - P Sargos
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of radiotherapy, institut Bergonié, 33000 Bordeaux, France
| | - A Ruffion
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, Lyon, France
| | - R Mathieu
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, CHU de Rennes, Rennes, France
| | - J-B Beauval
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France
| | - A De La Taille
- Department of urology, university hospital Henri-Mondor, AP-HP, Créteil, France
| | - G Ploussard
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Department of urology, La Croix du Sud Hôpital, Quint-Fonsegrives, France
| | - C Dariane
- Comité de Cancérologie de l'Association Française d'Urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, 20 rue Leblanc, 75015 Paris, France
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17
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Tang F, Zhong Q, Ni T, Xue Y, Wu J, Deng R, Zhang Q, Li Y, He X, Yang Z, Zhang Y. High-intensity focused ultrasound ablation combined with systemic therapy for unresectable colorectal cancer liver metastasis: A propensity score-matched analysis. Cancer Med 2023; 12:21985-21995. [PMID: 38032013 PMCID: PMC10757091 DOI: 10.1002/cam4.6774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/27/2023] [Accepted: 10/07/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE Unresectable colorectal cancer liver metastasis (CRLM) remains a challenging obstacle that often prevents curative treatment. In this study, we retrospectively analyzed the efficacy and safety of high-intensity focused ultrasound (HIFU) as a local adjuvant therapy for systemic chemotherapy for patients with unresectable CRLM. HIFU is a noninvasive method previously demonstrated as efficacious for various solid malignancies. METHODS Propensity score matching was used for the combination therapy group (HIFU group, n = 59) and the observation group receiving systemic therapy only (No-HIFU group, n = 59). In addition, the survival benefit, adverse effects, and factors affecting prognosis following HIFU were evaluated. RESULTS The disease control rate was 77.9% and 62.7%, and the objective remission rate was 18.9% and 6.8% in the HIFU and non-HIFU groups, respectively. The survival analysis showed that median progression-free survival (mPFS) was 12.0 months and 11.0 months for the HIFU and non-HIFU groups, respectively (p = 0.002). The univariate and multivariate analysis showed that pre-treatment colorectal cancer liver metastasis lesion size was significantly associated with mPFS. In addition, patients that received a combination treatment for CRLM lesions <5.0 cm had a longer mPFS when compared to those receiving systemic therapy alone (13.0 months vs. 11.0 months, p = 0.001). In the HIFU group, patients with lesions <5.0 cm had a longer mPFS than patients with lesions ≥5.0 cm (13.0 months vs. 10.0 months, p = 0.04) (Figure 3B,C). Most treatment-related adverse events observed in both groups were grade 1-2. Only four cases (6.8%) of grade 1-2 skin burns were observed in patients in the HIFU group; no other statistically significant adverse events were observed. CONCLUSIONS Our study showed that HIFU ablation targeting unresectable CRLM alongside systemic therapy safely and significantly improved local control rates and prolonged mPFS, especially for lesions smaller than 5.0 cm.
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Affiliation(s)
- Fei Tang
- Department of Cancer Center, Second Affiliated HospitalChongqing Medical UniversityChongqingChina
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
| | - Qin Zhong
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
| | - Tingting Ni
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
| | - Yingbo Xue
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
| | - Jing Wu
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
| | - Rong Deng
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
| | - Qi Zhang
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
| | - Yan Li
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
| | - Xuanlu He
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
| | - Zhenzhou Yang
- Department of Cancer Center, Second Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Yu Zhang
- Department of Medical OncologyGuizhou Province People's HospitalGuiyangChina
- National Health Commission Key Laboratory of Pulmonary Immune‐Related DiseasesGuizhou Province People's HospitalGuiyangChina
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18
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Busby D, Rich JM, Grauer R, Kaufmann B, Pandav K, Sood A, Tewari AK, Menon M, Patel HD, Gorin MA. Biopsy and Erectile Functional Outcomes of Partial Prostate Ablation: A Systematic Review and Meta-analysis of Prospective Studies. Urology 2023; 182:14-26. [PMID: 37774854 DOI: 10.1016/j.urology.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/24/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To provide a systematic summary of prospectively performed studies evaluating ablative therapies for the treatment of prostate cancer (PCa) that included protocol-mandated assessment of (1) residual disease by post-treatment biopsy and/or (2) erectile functional outcomes. MATERIALS AND METHODS We performed a comprehensive literature search in September 2022. Studies were evaluated according to a predefined and registered plan in PROSPERO (CRD42022302777). Only prospective trials with protocol-mandated post-treatment prostate biopsies or functional assessments were included. Targeted focal therapy was the only ablation pattern with sufficient data to perform meta-analyses (29 studies, 1079 patients). RESULTS At baseline, 65.0% of patients treated with targeted focal therapy harbored grade group (GG) ≥2 PCa. One year after treatment, in-field treatment failure with ≥GG1 and ≥GG2 PCa occurred in 25.7% (range 11.1%-66.7%) and 8.8% (range 0%-27.8%) of men, respectively. In patients that received whole-gland biopsies 1year after ablation, residual ≥GG1 and ≥GG2 PCa was detected anywhere in the prostate in 43.7% (range 19.4%-71.7%) and 13.0% (range 0%-35.9%) of men. Erectile function was negatively affected by treatment, but 78.7% were potent 1year after targeted focal therapy (7 studies, 197 patients), and the average decrease in erectile function scores was 8.8% at 1year (21 studies, 760 patients). CONCLUSION Though long-term data after targeted focal therapy are limited, oncologic and treatment failure occurred in 13% and 9% (≥GG2 at 6-12months after treatment). Most men were able to maintain potency. This work can help benchmark new techniques and power future trials.
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Affiliation(s)
- Dallin Busby
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY; Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Jordan M Rich
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Ralph Grauer
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Basil Kaufmann
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY; Department of Urology, University Hospital of Zurich, Zurich, Switzerland
| | - Krunal Pandav
- Department of Biomedical Engineering, Emory University, Atlanta, GA
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ashutosh K Tewari
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Mani Menon
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Hiten D Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
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19
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Debard C, Margue G, Klein C, Rompré-Brodeur A, Marcq G, Bensadoun H, Robert G, Anidjar M, Bladou F. [Oncological and functional results of focal treatment of localized prostate cancer with HIFU]. Prog Urol 2023; 33:966-973. [PMID: 37770359 DOI: 10.1016/j.purol.2023.09.012] [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: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION In recent years, improved diagnosis of prostate cancer has allowed the development of focal therapy, in order to reduce the morbidity of treatments. Our study assesses the medium-term oncological and functional results of FocalOne® HIFU treatment in localized prostate cancer. METHODS This is a retrospective, multicentre study including patients with low- or intermediate-risk localized prostate cancer treated with Focal one HIFU between November 2014 and December 2019. The primary endpoint was the retreatment rate and subgroup analyses were performed to identify predictive factors of retreatment. RESULTS One hundred and thirty-seven patients were included with a median follow-up of 25.5 months. Seventy percent of patients had clinical stage T2, 64% had an ISUP score of 2 or 3 on initial biopsies and 38% were treated with hemi-ablation. Follow-up biopsies were performed in 76.6% of patients during follow-up with 21.8% having clinically significant cancers. The retreatment rate at 24 months was 37.2%, with positive biopsies being the primary criterion for retreatment. Patients with a PSA>8ng/mL had a significantly higher retreatment rate. Finally, morbidity remained acceptable with 5.8% of patients requiring reoperation for complications and 21% for de novo erectile dysfunction. CONCLUSION Our results are in agreement with those of the literature, seeming to indicate a lower morbidity of the focal treatment by HIFU compared to the radical treatments while offering an acceptable oncological control. Prospective randomized trials are ongoing. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- C Debard
- Service d'urologie, CHU de Pellegrin, Bordeaux, France.
| | - G Margue
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - C Klein
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - A Rompré-Brodeur
- Department of Surgery (Division of Urology), Mc Gill University Health Center, Montreal, Canada
| | - G Marcq
- Service d'urologie, hôpital Claude-Huriez, CHU de Lille, Lille, France
| | - H Bensadoun
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - G Robert
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - M Anidjar
- Department of Surgery (Division of Urology), Mc Gill University Health Center, Montreal, Canada
| | - F Bladou
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
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20
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Mala KS, Plage H, Mödl L, Hofbauer S, Friedersdorff F, Schostak M, Miller K, Schlomm T, Cash H. Follow-Up of Men Who Have Undergone Focal Therapy for Prostate Cancer with HIFU-A Real-World Experience. J Clin Med 2023; 12:7089. [PMID: 38002699 PMCID: PMC10672492 DOI: 10.3390/jcm12227089] [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: 09/24/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE To determine oncological and functional outcomes and side effects after focal therapy of prostate cancer (PCa) with high-intensity focused ultrasound (HIFU). METHODS This retrospective single-center study included 57 consecutive patients with localised PCa. Aged 18-80 with ≤2 suspicious lesions on mpMRI (PIRADS ≥ 3), PSA of ≤15 ng/mL, and an ISUP GG of ≤2. HIFU was performed between November 2014 and September 2018. All men had an MRI/US fusion-guided targeted biopsy (TB) combined with a TRUS-guided 10-core systematic biopsy (SB) prior to focal therapy. HIFU treatment was performed as focal, partial, or hemiablative, depending on the prior histopathology. Follow-up included Questionnaires (IIEF-5, ICIQ, and IPSS), prostate-specific antigen (PSA) measurement, follow-up mpMRI, and follow-up biopsies. RESULTS The median age of the cohort was 72 years (IQR 64-76), and the median PSA value before HIFU was 7.3 ng/mL (IQR 5.75-10.39 ng/mL). The median follow-up was 27.5 (IQR 23-41) months. At the time of the follow-up, the median PSA value was 2.5 ng/mL (IQR 0.94-4.96 ng/mL), which shows a significant decrease (p < 0.001). In 17 (29.8%) men, mpMRI revealed a suspicious lesion, and 19 (33.3%) men had a positive biopsy result. Only IIEF values significantly decreased from 16 (IQR 10.75-20.25) to 11.5 (IQR 4.5-17) (p < 0.001). The rate of post-HIFU complications was low, at 19.3% (11 patients). The limitation of this study is the lack of long-term follow-up. CONCLUSIONS HIFU as a therapy option for nonmetastatic, significant prostate cancer is effective in the short term for carefully selected patients and shows a low risk of adverse events and side effects.
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Affiliation(s)
- Katharina Sophie Mala
- Department of Urology, Charité University Medicine Berlin, 10117 Berlin, Germany; (H.P.); (H.C.)
| | - Henning Plage
- Department of Urology, Charité University Medicine Berlin, 10117 Berlin, Germany; (H.P.); (H.C.)
| | - Lukas Mödl
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Sebastian Hofbauer
- Department of Urology, Charité University Medicine Berlin, 10117 Berlin, Germany; (H.P.); (H.C.)
| | - Frank Friedersdorff
- Department of Urology, Charité University Medicine Berlin, 10117 Berlin, Germany; (H.P.); (H.C.)
- Department of Urology, Koenigin Elisabeth Herzberge, 10365 Berlin, Germany
| | - Martin Schostak
- Department of Urology, Otto-von-Guericke-University Magdeburg, 39106 Magdeburg, Germany
| | - Kurt Miller
- Department of Urology, Charité University Medicine Berlin, 10117 Berlin, Germany; (H.P.); (H.C.)
| | - Thorsten Schlomm
- Department of Urology, Charité University Medicine Berlin, 10117 Berlin, Germany; (H.P.); (H.C.)
| | - Hannes Cash
- Department of Urology, Charité University Medicine Berlin, 10117 Berlin, Germany; (H.P.); (H.C.)
- Department of Urology, Otto-von-Guericke-University Magdeburg, 39106 Magdeburg, Germany
- PROURO, 10117 Berlin, Germany
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21
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Suarez-Castellanos IM, de Sallmard G, Vanstaevel G, Ganeau A, Bawiec C, Chapelon JY, Guillen N, Senegond N, N'Djin WA. Dynamic Ultrasound Focusing and Centimeter-Scale Ex Vivo Tissue Ablations With a CMUT Probe Developed for Endocavitary HIFU Therapies. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1470-1481. [PMID: 37540608 DOI: 10.1109/tuffc.2023.3301977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Thermal ablation of localized prostate tumors via endocavitary ultrasound-guided high-intensity focused ultrasound (USgHIFU) faces challenges that could be alleviated by better integration of dual modalities (imaging/therapy). Capacitive micromachined ultrasound transducers (CMUTs) may provide an alternative to existing piezoelectric technologies by exhibiting advanced integration capability through miniaturization, broad frequency bandwidth, and potential for high electroacoustic efficiency. An endocavitary dual-mode USgHIFU probe was built to investigate the potential of using CMUT technologies for transrectal prostate cancer ablative therapy. The USgHIFU probe included a planar 64-element annular high-intensity focused ultrasound (HIFU) CMUT array ( [Formula: see text] = 3 MHz) surrounding a 256-element linear imaging CMUT array. Acoustic characterization of the HIFU array included 3-D pressure field mapping and radiation force balance measurements. Ex vivo proof-of-concept experiments consisted in generating HIFU thermal ablations with the CMUT probe on porcine liver tissues. The planar CMUT probe enabled HIFU dynamic focusing (distance range: 32-72 mm) while providing acoustic surface intensities of 1 W/cm2 that allowed producing elementary ex vivo ablations in depth of liver tissue ( L ×W ≈ 10×5 mm). Combinations of dynamic focusing, along with probe rotation and translation produced larger thermal ablations ( L ×W ≈ 20×20 mm) by juxtaposing multiple elementary ablations, consistent with expected results obtained through numerical modeling. The technical feasibility of using a USgHIFU probe, fully developed using CMUTs for tissue ablation purposes, was demonstrated. The HIFU-CMUT array showed tissue ablation capabilities with volumes compatible with localized cancer targeting, thus providing assets for further development of focal therapies.
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22
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Mjaess G, Peltier A, Roche JB, Lievore E, Lacetera V, Chiacchio G, Beatrici V, Mastroianni R, Simone G, Windisch O, Benamran D, Fourcade A, Nguyen TA, Fournier G, Fiard G, Ploussard G, Roumeguère T, Albisinni S, Diamand R. A Novel Nomogram to Identify Candidates for Focal Therapy Among Patients with Localized Prostate Cancer Diagnosed via Magnetic Resonance Imaging-Targeted and Systematic Biopsies: A European Multicenter Study. Eur Urol Focus 2023; 9:992-999. [PMID: 37147167 DOI: 10.1016/j.euf.2023.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/12/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Suitable selection criteria for focal therapy (FT) are crucial to achieve success in localized prostate cancer (PCa). OBJECTIVE To develop a multivariable model that better delineates eligibility for FT and reduces undertreatment by predicting unfavorable disease at radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS Data were retrospectively collected from a prospective European multicenter cohort of 767 patients who underwent magnetic resonance imaging (MRI)-targeted and systematic biopsies followed by RP in eight referral centers between 2016 and 2021. The Imperial College of London eligibility criteria for FT were applied: (1) unifocal MRI lesion with Prostate Imaging-Reporting and Data System score of 3-5; (2) prostate-specific antigen (PSA) ≤20 ng/ml; (3) cT2-3a stage on MRI; and (4) International Society of Urological Pathology grade group (GG) 1 and ≥6 mm or GG 2-3. A total of 334 patients were included in the final analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was unfavorable disease at RP, defined as GG ≥4, and/or lymph node invasion, and/or seminal vesicle invasion, and/or contralateral clinically significant PCa. Logistic regression was used to assess predictors of unfavorable disease. The performance of the models including clinical, MRI, and biopsy information was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. A coefficient-based nomogram was developed and internally validated. RESULTS AND LIMITATIONS Overall, 43 patients (13%) had unfavorable disease on RP pathology. The model including PSA, clinical stage on digital rectal examination, and maximum lesion diameter on MRI had an AUC of 73% on internal validation and formed the basis of the nomogram. Addition of other MRI or biopsy information did not significantly improve the model performance. Using a cutoff of 25%, the proportion of patients eligible for FT was 89% at the cost of missing 30 patients (10%) with unfavorable disease. External validation is required before the nomogram can be used in clinical practice. CONCLUSIONS We report the first nomogram that improves selection criteria for FT and limits the risk of undertreatment. PATIENT SUMMARY We conducted a study to develop a better way of selecting patients for focal therapy for localized prostate cancer. A novel predictive tool was developed using the prostate-specific antigen (PSA) level measured before biopsy, tumor stage assessed via digital rectal examination, and lesion size on magnetic resonance imaging (MRI) scans. This tool improves the prediction of unfavorable disease and may reduce the risk of undertreatment of localized prostate cancer when using focal therapy.
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Affiliation(s)
- Georges Mjaess
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Elena Lievore
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France; Department of Urology, IRCCS Istituto Europeo di Oncologia, Milan, Italy
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giuseppe Chiacchio
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olivier Windisch
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Truong An Nguyen
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, Grenoble, France
| | | | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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23
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Parry MG, Sujenthiran A, Nossiter J, Morris M, Berry B, Nathan A, Aggarwal A, Payne H, van der Meulen J, Clarke NW. Prostate cancer outcomes following whole-gland and focal high-intensity focused ultrasound. BJU Int 2023; 132:568-574. [PMID: 37422679 DOI: 10.1111/bju.16122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To report the 5-year failure-free survival (FFS) following high-intensity focused ultrasound (HIFU). PATIENTS AND METHODS This observational cohort study used linked National Cancer Registry data, radiotherapy data, administrative hospital data and mortality records of 1381 men treated with HIFU for clinically localised prostate cancer in England. The primary outcome, FFS, was defined as freedom from local salvage treatment and cancer-specific mortality. Secondary outcomes were freedom from repeat HIFU, prostate cancer-specific survival (CSS) and overall survival (OS). Cox regression was used to determine whether baseline characteristics, including age, treatment year, T stage and International Society of Urological Pathology (ISUP) Grade Group were associated with FFS. RESULTS The median (interquartile range [IQR]) follow-up was 37 (20-62) months. The median (IQR) age was 65 (59-70) years and 81% had an ISUP Grade Group of 1-2. The FFS was 96.5% (95% confidence interval [CI] 95.4%-97.4%) at 1 year, 86.0% (95% CI 83.7%-87.9%) at 3 years and 77.5% (95% CI 74.4%-80.3%) at 5 years. The 5-year FFS for ISUP Grade Groups 1-5 was 82.9%, 76.6%, 72.2%, 52.3% and 30.8%, respectively (P < 0.001). Freedom from repeat HIFU was 79.1% (95% CI 75.7%-82.1%), CSS was 98.8% (95% CI 97.7%-99.4%) and OS was 95.9% (95% CI 94.2%-97.1%) at 5 years. CONCLUSION Four in five men were free from local salvage treatment at 5 years but treatment failure varied significantly according to ISUP Grade Group. Patients should be appropriately informed with respect to salvage radical treatment following HIFU.
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Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
| | - Arunan Sujenthiran
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
- Flatiron, London, UK
| | - Julie Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
| | - Brendan Berry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
| | - Arjun Nathan
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
- University College London, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Noel W Clarke
- Departments of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
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24
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Light A, Peters M, Reddy D, Kanthabalan A, Otieno M, Pavlou M, Omar R, Adeleke S, Giganti F, Brew-Graves C, Williams NR, Emara A, Haroon A, Latifoltojar A, Sidhu H, Freeman A, Orczyk C, Nikapota A, Dudderidge T, Hindley RG, Virdi J, Arya M, Payne H, Mitra AV, Bomanji J, Winkler M, Horan G, Moore C, Emberton M, Punwani S, Ahmed HU, Shah TT. External validation of a risk model predicting failure of salvage focal ablation for prostate cancer. BJU Int 2023; 132:520-530. [PMID: 37385981 PMCID: PMC10615865 DOI: 10.1111/bju.16102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVES To externally validate a published model predicting failure within 2 years after salvage focal ablation in men with localised radiorecurrent prostate cancer using a prospective, UK multicentre dataset. PATIENTS AND METHODS Patients with biopsy-confirmed ≤T3bN0M0 cancer after previous external beam radiotherapy or brachytherapy were included from the FOcal RECurrent Assessment and Salvage Treatment (FORECAST) trial (NCT01883128; 2014-2018; six centres), and from the high-intensity focussed ultrasound (HIFU) Evaluation and Assessment of Treatment (HEAT) and International Cryotherapy Evaluation (ICE) UK-based registries (2006-2022; nine centres). Eligible patients underwent either salvage focal HIFU or cryotherapy, with the choice based predominantly on anatomical factors. Per the original multivariable Cox regression model, the predicted outcome was a composite failure outcome. Model performance was assessed at 2 years post-salvage with discrimination (concordance index [C-index]), calibration (calibration curve and slope), and decision curve analysis. For the latter, two clinically-reasonable risk threshold ranges of 0.14-0.52 and 0.26-0.36 were considered, corresponding to previously published pooled 2-year recurrence-free survival rates for salvage local treatments. RESULTS A total of 168 patients were included, of whom 84/168 (50%) experienced the primary outcome in all follow-ups, and 72/168 (43%) within 2 years. The C-index was 0.65 (95% confidence interval 0.58-0.71). On graphical inspection, there was close agreement between predicted and observed failure. The calibration slope was 1.01. In decision curve analysis, there was incremental net benefit vs a 'treat all' strategy at risk thresholds of ≥0.23. The net benefit was therefore higher across the majority of the 0.14-0.52 risk threshold range, and all of the 0.26-0.36 range. CONCLUSION In external validation using prospective, multicentre data, this model demonstrated modest discrimination but good calibration and clinical utility for predicting failure of salvage focal ablation within 2 years. This model could be reasonably used to improve selection of appropriate treatment candidates for salvage focal ablation, and its use should be considered when discussing salvage options with patients. Further validation in larger, international cohorts with longer follow-up is recommended.
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Affiliation(s)
- Alexander Light
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | - Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Deepika Reddy
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | - Abi Kanthabalan
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Marjorie Otieno
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Sola Adeleke
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Cancer & Pharmaceutical Sciences, King’s College London, London, UK
| | - Francesco Giganti
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Chris Brew-Graves
- Division of Medicine, Faculty of Medicine, University College London, UK
| | - Norman R. Williams
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Athar Haroon
- Department of Nuclear Medicine, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arash Latifoltojar
- Division of Medicine, Faculty of Medicine, University College London, UK
- Department of Radiology, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Harbir Sidhu
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, Faculty of Medicine, University College London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Clement Orczyk
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ashok Nikapota
- Sussex Cancer Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard G. Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | - Heather Payne
- Department of Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Anita V. Mitra
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
| | - Gail Horan
- Department of Oncology, Queen Elizabeth Hospital, The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, King's Lynn, UK
| | - Caroline Moore
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
- Division of Medicine, Faculty of Medicine, University College London, UK
| | - Hashim U. Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Taimur T. Shah
- Imperial Prostate, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
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Shoji S, Naruse J, Oda K, Kuroda S, Umemoto T, Nakajima N, Hasegawa M, Mukasa A, Koizumi N, Miyajima A. Current status and future outlook of ultrasound treatment for prostate cancer. J Med Ultrason (2001) 2023:10.1007/s10396-023-01368-x. [PMID: 37787881 DOI: 10.1007/s10396-023-01368-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 10/04/2023]
Abstract
Radical prostatectomy and radiation therapy are the standard treatment options for localized prostate cancer (PC). However, radical prostatectomy may cause the deterioration of urinary and sexual function, and radiation-induced hemorrhagic cystitis and severe rectal bleeding are risk factors for fatal conditions in patients after radiation therapy. With the recent development of magnetic resonance imaging (MRI) for the localization of clinically significant PC (csPC) and treatment modalities, "focal therapy", which cures csPC while preserving anatomical structures related to urinary and sexual functions, has become a minimally invasive treatment for localized PC. Based on the clinical results of transrectal high-intensity focused ultrasound (HIFU) for localized PC in the whole gland and focal therapy, HIFU is considered an attractive treatment option for focal therapy. Recently, the short-term clinical results of transurethral high-intensity directional ultrasound (HIDU) have been reported. With the resolution of some issues, HIDU may be commonly used for PC treatment similar to HIFU. Because HIFU and HIDU have limitations regarding the treatment of patients with large prostate calcifications and large prostate volumes, the proper use of these modalities will enable the treatment of any target area in the prostate. To establish a standard treatment strategy for localized PC, pair-matched and historically controlled studies are required to verify the oncological and functional outcomes of ultrasound treatment for patients with localized PC.
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Affiliation(s)
- Sunao Shoji
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Jun Naruse
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kazuya Oda
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Satoshi Kuroda
- Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Tatsuya Umemoto
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Nobuyuki Nakajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masanori Hasegawa
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Anju Mukasa
- Department of Mechanical and Intelligent Systems Engineering, Graduate School of Informatics and Engineering, The University of Electro-Communications, Chofu, Tokyo, Japan
| | - Norihiro Koizumi
- Department of Mechanical and Intelligent Systems Engineering, Graduate School of Informatics and Engineering, The University of Electro-Communications, Chofu, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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26
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Sonn G, Khandwala Y. Reply to Carmen Gravina, Riccardo Lombardo, and Cosimo De Nunzio's Letter to the Editor re: Yash S. Khandwala, Simon John Christoph Soerensen, Shravan Morisetty, et al. The Association of Tissue Change and Treatment Success During High-intensity Focused Ultrasound Focal Therapy for Prostate Cancer. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2022.10.010. Eur Urol Focus 2023; 9:822-823. [PMID: 37012086 DOI: 10.1016/j.euf.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Geoffrey Sonn
- Department of Urology, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | - Yash Khandwala
- Department of Urology, Stanford Hospital and Clinics, Palo Alto, CA, USA.
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27
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Nicoletti R, Alberti A, Castellani D, Yee CH, Zhang K, Poon DMC, Chiu PKF, Campi R, Resta GR, Dibilio E, Pirola GM, Chiacchio G, Fuligni D, Brocca C, Giulioni C, De Stefano V, Serni S, Gauhar V, Ng CF, Gacci M, Teoh JYC. Oncological results and cancer control definition in focal therapy for Prostate Cancer: a systematic review. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00699-7. [PMID: 37507479 DOI: 10.1038/s41391-023-00699-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Focal therapy (FT) is a promising alternative to whole-gland treatments for Localized Prostate Cancer. Ten different FT modalities have been described in literature. However, FT is not yet recommended by the International Guidelines, due to the lack of robust data on Oncological Outcomes. The objective of our Narrative Review is to evaluate the oncological profile of the available FT modalities and to offer a comprehensive overview of the definitions of Cancer Control for FT. MATERIAL AND METHODS Literature search was performed on 21st February 2023 using PubMed, EMBASE, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Articles reporting whole gland-treatments were excluded. All articles reporting oncological outcomes were included. RESULTS One-hundred-twenty-four studies, reporting data on more than 8000 patients treated with FT, were included. Overall, 40 papers were on High Intensity Focal Ultrasound (HIFU), 24 on Focal Cryotherapy, 13 on Irreversible Electroporation (IRE), 11 on Focal brachytherapy, 10 on Focal Laser Ablation (FLA), 8 on Photo-Dynamic Therapy (PDT), 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation (bRFA), 1 on Prostatic Artery Embolization (PAE) and 9 comparative papers. Overall, the Biochemical Recurrence (BCR) rate ranged from 0% (Focal Brachytherapy) to 67.5% (HIFU); the Salvage treatment rate ranged from 1% (IRE) to 54% (HIFU) considering re-treatment with FT and from 0% (Focal Brachytherapy) to 66.7% considering standard Radical Treatments. There is no univocal definition of Cancer Control, however the "Phoenix criteria" for BCR were the most commonly used. CONCLUSIONS FT is a promising alternative treatment for localized prostate cancer in terms of Oncological Outcomes, however there is a wide heterogeneity in the definition of cancer control, the reporting of oncological outcomes and a lack of high-quality clinical trials. Solid comparative studies with standard treatments and an unambiguous consensus on how to describe Cancer Control in the field of Focal Therapy are needed.
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Affiliation(s)
- Rossella Nicoletti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Alberti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Daniele Castellani
- Urology Division, Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Chi Hang Yee
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Zhang
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, 100015, China
| | - Darren M C Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Giulio Raffaele Resta
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Edoardo Dibilio
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | | | - Giuseppe Chiacchio
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Demetra Fuligni
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Brocca
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Giulioni
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Virgilio De Stefano
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Vineet Gauhar
- Ng Teng Fong General Hospital (NUHS), Singapore, Singapore
| | - Chi Fai Ng
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Jeremy Yuen Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
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28
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Cai Y, Sun Y, Xu F, Wu Y, Ren C, Hao X, Gao B, Cao Q. Effects of high-intensity focused ultrasound combined with levonorgestrel-releasing intrauterine system on patients with adenomyosis. Sci Rep 2023; 13:9903. [PMID: 37336924 DOI: 10.1038/s41598-023-37096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Abstract
It is very important to treat adenomyosis which may cause infertility, menorrhagia, and dysmenorrhea for women at the reproductive age. High-intensity focused ultrasound (HIFU) is effective in destroying target tumor tissues without damaging the path of the ultrasound beam and surrounding normal tissues. The levonorgestrel-releasing intrauterine system (LN-IUS) is a medical system which is inserted into the uterine to provide medicinal treatment for temporary control of the symptoms caused by adenomyosis. This study was to investigate the effect of HIFU combined with the LN-IUS on adenomyosis. In the HIFU treatment, the parameters of the ultrasound were transmission frequency 0.8 MHz and input power 50-400 W (350 ± 30), and the temperature in the target tissue under these conditions would reach 60-100 °C (85 °C ± 6.3 °C). Size reduction and blood flow signal decrease were used to assess the effect of combined treatment. In this study, 131 patients with adenomyosis treated with HIFU combined with LN-IUS were retrospectively enrolled. The clinical and follow-up data were analyzed. After treatment, the volume of the uterine lesion was significantly decreased with an effective rate of 72.1%, and the adenomyosis blood flow signals were significantly reduced, with an effective rate of 71.3%. At six months, the menstrual cycle was significantly (P < 0.05) decreased from 31.4 ± 3.5 days before treatment to 28.6 ± 1.9 days, the menstrual period was significantly shortened from 7.9 ± 1.2 days before HIFU to 6.5 ± 1.3 days, and the menstrual volume was significantly (P < 0.05) decreased from 100 to 49% ± 13%. The serum hemoglobin significantly (P < 0.05) increased from 90.8 ± 6.2 g/L before treatment to 121.6 ± 10.8 g/L at six months for patients with anemia. Among seventy-two (92.3%) patients who finished the six-month follow-up, sixty-five (90.3%) patients had the dysmenorrhea completely relieved, and the other seven (9.7%) patients had only slight dysmenorrhea which did not affect their daily life. Adverse events occurred in 24 (18.3%) patients without causing severe consequences, including skin burns in two (1.5%) patients, skin swelling in four (3.1%), mild lower abdominal pain and low fever in 15 (11.5%), and subcutaneous induration in three (2.3%). Six months after treatment, no other serious side effects occurred in any patients with follow-up. In conclusions, the use of high-intensity focused ultrasound combined with the levonorgestrel-releasing intrauterine system for the treatment of adenomyosis is safe and effective even though the long-term effect remains to be confirmed.
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Affiliation(s)
- Yuru Cai
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Yanan Sun
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Feng Xu
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Yunzhe Wu
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Chunfeng Ren
- Department of Laboratory Analysis, The First Affiliated Hospital of Zhengzhou University, 1 Longhu Middle Ring Road, Zhengzhou, 450018, Henan Province, China
| | - Xiaohong Hao
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Bulang Gao
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Qinying Cao
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China.
- Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China.
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29
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Koelker M, Labban M, Frego N, Meyer CP, Salomon G, Lipsitz SR, Withington J, Moore CM, Tempany CM, Tuncali K, George A, Kibel AS, Trinh QD, Cole AP. Contemporary patterns of local ablative therapies for prostate cancer at United States cancer centers: results from a national registry. World J Urol 2023; 41:1309-1315. [PMID: 36930254 PMCID: PMC10506077 DOI: 10.1007/s00345-023-04354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/26/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To describe the national-level patterns of care for local ablative therapy among men with PCa and identify patient- and hospital-level factors associated with the receipt of these techniques. METHODS We retrospectively interrogated the National Cancer Database (NCDB) for men with clinically localized PCa between 2010 and 2017. The main outcome was receipt of local tumor ablation with either cryo- or laser-ablation, and "other method of local tumor destruction including high-intensity focused ultrasound (HIFU)". Patient level, hospital level, and demographic variables were collected. Mixed effect logistic regression models were fitted to identify separately patient- and hospital-level predictors of receipt of local ablative therapy. RESULTS Overall, 11,278 patients received ablative therapy, of whom 78.8% had cryotherapy, 15.6% had laser, and 5.7% had another method including HIFU. At the patient level, men with intermediate-risk PCa were more likely to be treated with local ablative therapy (OR 1.05; 95% CI 1.00-1.11; p = 0.05), as were men with Charlson Comorbidity Index > 1 (OR 1.36; 95% CI 1.29-1.43; p < 0.01), men between 71 and 80 years (OR 3.70; 95% CI 3.43-3.99; p < 0.01), men with Medicare insurance (OR 1.38; 95% 1.31-1.46; p < 0.01), and an income < $47,999 (OR 1.16; 95% CI 1.06-1.21; p < 0.01). At the hospital-level, local ablative therapy was less likely to be performed in academic/research facilities (OR 0.45; 95% CI 0.32-0.64; p < 0.01). CONCLUSIONS Local ablative therapy for PCa treatment is more commonly offered among older and comorbid patients. Future studies should investigate the uptake of these technologies in non-hospital-based settings and in light of recent changes in insurance coverage.
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Affiliation(s)
- Mara Koelker
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Muhieddine Labban
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Nicola Frego
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
- Department of Urology, Humanitas Research Hospital-IRCCS, Rozzano, Milan, Italy
| | - Christian P Meyer
- Department of Urology, Ruhr University Bochum, Klinikum Herford, Herford, Germany
| | - Georg Salomon
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stuart R Lipsitz
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - John Withington
- Division of Surgical and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals Trust, London, UK
| | - Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospitals Trust, London, UK
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Arvin George
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Adam S Kibel
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA
| | - Alexander P Cole
- Division of Urological Surgery and Center of Surgery and Public Health, Brigham and Women's Hospital, 45 Francis St, ASB II-3, Boston, MA, 02115, USA.
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30
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Duwe G, Boehm K, Haack M, Sparwasser P, Brandt MP, Mager R, Tsaur I, Haferkamp A, Höfner T. Single-center, prospective phase 2 trial of high-intensity focused ultrasound (HIFU) in patients with unilateral localized prostate cancer: good functional results but oncologically not as safe as expected. World J Urol 2023; 41:1293-1299. [PMID: 36920492 PMCID: PMC10188406 DOI: 10.1007/s00345-023-04352-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/26/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Focal therapy (FT) for localized prostate cancer (PCa) is only recommended within the context of clinical trials by international guidelines. We aimed to investigate oncological follow-up and safety data of focal high-intensity focused ultrasound (HIFU) treatment. METHODS We conducted a single-center prospective study of 29 patients with PCa treated with (focal) HIFU between 2016 and 2021. Inclusion criteria were unilateral PCa detected by mpMRI-US-fusion prostate biopsy and maximum prostate specific antigen (PSA) of 15 ng/ml. Follow-up included mpMRI-US fusion-re-biopsies 12 and 24 months after HIFU. No re-treatment of HIFU was allowed. The primary endpoint was failure-free survival (FFS), defined as freedom from intervention due to cancer progression. RESULTS Median follow-up of all patients was 23 months, median age was 67 years and median preoperative PSA was 6.8 ng/ml. One year after HIFU treatment PCa was still detected in 13/ 29 patients histologically (44.8%). Two years after HIFU another 7/29 patients (24.1%) were diagnosed with PCa. Until now, PCa recurrence was detected in 11/29 patients (37.93%) which represents an FFS rate of 62%.One patient developed local metastatic disease 2 years after focal HIFU. Adverse events (AE) were low with 70% of patients remaining with sufficient erectile function for intercourse and 97% reporting full maintenance of urinary continence. CONCLUSION HIFU treatment in carefully selected patients is feasible. However, HIFU was oncologically not as safe as expected because of progression rates of 37.93% and risk of progression towards metastatic disease. Thus, we stopped usage of HIFU in our department.
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Affiliation(s)
- Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Katharina Boehm
- Department of Urology, Carl-Gustav-Carus University Medical Center, Dresden, Germany
| | - Maximilian Haack
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Maximilian Peter Brandt
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medical Center Johannes-Gutenberg University, Langenbeckstraße 1, 55131 Mainz, Germany
- Department of Urology, Ordensklinikum Linz Elisabethinen, Linz, Austria
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31
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Tang J, Tang J, Li H, Zhou J, Tang N, Zhu Q, Wang X, Zhu B, Li N, Liu Z. Mechanical destruction using a minimally invasive Ultrasound Needle induces anti-tumor immune responses and synergizes with the anti-PD-L1 blockade. Cancer Lett 2023; 554:216009. [PMID: 36400312 DOI: 10.1016/j.canlet.2022.216009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have been widely used in treating various tumors; however, the objective response rate of ICIs is less than 40%. In this study, we attempted to induce anti-tumor immune responses using an improved ultrasonic horn device, Ultrasound Needle (UN). We tested its synergistic anti-tumor efficacy with an anti-PD-L1 antibody in a mouse tumor model. Under different parameters, UN treatment selectively induced mechanical destruction and thermal ablation effects on tumor tissues. The mechanical destruction effect of UN treatment increased the infiltration of CD8+ T cells in tumors and relieved the immunosuppressive tumor microenvironment. It also induced systemic anti-tumor immune responses and enhanced the therapeutic efficacy of the anti-PD-L1 antibody in both local and abscopal tumors. The mechanical destruction effect of UN treatment resulted in the release of damage-associated molecular patterns and promoted dendritic cells (DCs)-based antigen presentation. Depletion of DCs or CD8+ T cells eliminated the anti-tumor immune responses induced by UN treatment and weakened the synergistic anti-tumor efficacy with anti-PD-L1 antibody. Therefore, minimally invasive UN may provide a new therapeutic modality for ultrasound-assisted immunotherapy.
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Affiliation(s)
- Jiawei Tang
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Junhui Tang
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hui Li
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jing Zhou
- Institute of Immunology, PLA, Third Military Medical University, Chongqing, China
| | - Najiao Tang
- Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Qiong Zhu
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xinxin Wang
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory of Immunotherapy, Chongqing, China
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, China; Chongqing Key Laboratory of Immunotherapy, Chongqing, China
| | - Ningshan Li
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
| | - Zheng Liu
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
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Alabousi M, Ghai S. Magnetic resonance imaging-guided ultrasound ablation for prostate cancer - A contemporary review of performance. Front Oncol 2023; 12:1069518. [PMID: 36686753 PMCID: PMC9846805 DOI: 10.3389/fonc.2022.1069518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
Prostate cancer (PCa) is one of the most common malignancies in men, but patient outcomes are varied depending on extent of disease. Radical, whole-gland therapies, such as prostatectomy or radiotherapy, are definitive treatments for PCa, but they are associated with significant morbidity, including erectile dysfunction and urinary incontinence. Focal therapies for PCa, whereby the part of gland harboring disease is selectively treated, spares the normal surrounding structures, and minimizes the morbidity associated with whole gland treatment. The use of magnetic resonance imaging (MRI) guidance provides advantages over ultrasound guidance, such as better localization and targeting of clinically significant PCa (csPCa), as well as MRI thermometry which optimizes tissue ablation temperatures. This review will discuss two MRI-guided high-intensity focused ultrasound (HIFU) techniques - transrectal MR-guided focused ultrasound (MRgFUS) and TULSA (transurethral ultrasound ablation) ablation for localized PCa. Overall, recent major trials for MRgFUS and TULSA have shown promising oncological and functional results in the treatment of low- to intermediate-risk PCa. Recent Phase II MRgFUS trials have shown better oncologic outcomes than the published results for focal ultrasound guided HIFU and may justify the additional costs associated with MRI guidance. While initial studies on TULSA have focused on subtotal gland ablation, recent trials assessing oncological outcomes for focal treatment of angular sectors have shown promise.
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Gaffney CD, Ehdaie B. Thermal Partial Prostate Ablation for Intermediate- and High-risk Prostate Cancer: Con. Eur Urol Focus 2023:S2405-4569(22)00293-0. [PMID: 36604237 DOI: 10.1016/j.euf.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/25/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
Thermal partial-gland ablation (TPGA) is a promising treatment option for patients with prostate cancer (PCa) that has an excellent side-effect profile. However, the literature on TPGA in high-risk PCa is not robust enough to discount the risk of undertreatment and understaging in this population. Future studies, especially with incorporation of advanced imaging to better select patients, are necessary to understand the safety and efficacy of TPGA in high-risk disease.
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Affiliation(s)
| | - Behfar Ehdaie
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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34
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Reddy D, van Son M, Peters M, Bertoncelli Tanaka M, Dudderidge T, Cullen E, Ho CLT, Hindley RG, Emara A, McCracken S, Orczyk C, Shergill I, Mangar S, Nigam R, Virdi J, Moore CM, Arya M, Shah TT, Winkler M, Emberton M, Falconer A, Belsey J, Ahmed HU. Focal therapy versus radical prostatectomy and external beam radiotherapy as primary treatment options for non-metastatic prostate cancer: results of a cost-effectiveness analysis. J Med Econ 2023; 26:1099-1107. [PMID: 37656223 DOI: 10.1080/13696998.2023.2251849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
AIMS Focal therapy treats individual areas of tumour in non-metastatic prostate cancer in patients unsuitable for active surveillance. The aim of this work was to evaluate the cost-effectiveness of focal therapy versus prostatectomy and external beam radiotherapy (EBRT). MATERIALS AND METHODS A Markov cohort health state transition model with four health states (stable disease, local recurrence, metastatic disease and death) was created, evaluating costs and utilities over a 10-year time horizon for patients diagnosed with non-metastatic prostate cancer. National Health Service (NHS) for England perspective was used, based on direct healthcare costs. Clinical transition probabilities were derived from prostate cancer registries in patients undergoing radical prostatectomy, EBRT and focal therapy using cryotherapy (Boston Scientific) or high-intensity focused ultrasound (HIFU) (Sonablate). Propensity score matching was used to ensure that at-risk populations were comparable. Variables included age, prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group, maximum cancer core length (mm), T-stage and year of treatment. RESULTS Focal therapy was associated with a lower overall cost and higher quality-adjusted life year (QALY) gains than either prostatectomy or EBRT, dominating both treatment strategies. Positive incremental net monetary benefit (NMB) values confirm focal therapy as cost-effective versus the alternatives at a willingness to pay (WTP) threshold of £30,000/QALY. One-way deterministic sensitivity analyses revealed consistent results. LIMITATIONS Data used to calculate the transition probabilities were derived from a limited number of hospitals meaning that other potential treatment options were excluded. Limited data were available on later outcomes and none on quality of life data, therefore, literature-based estimates were used. CONCLUSIONS Cost-effectiveness modelling demonstrates use of focal therapy (cryotherapy or HIFU) is associated with greater QALY gains at a lower overall cost than either radical prostatectomy or EBRT, representing good value for money in the NHS.
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Affiliation(s)
| | | | - Max Peters
- Amsterdam University Medical Centers, The Netherlands
| | | | - Tim Dudderidge
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | | | - Richard G Hindley
- Hampshire Hospitals NHS Foundation Trust, UK
- BMI The Hampshire Clinic, Basingstoke, UK
| | - Amr Emara
- Hampshire Hospitals NHS Foundation Trust, UK
| | | | - Clement Orczyk
- University College London NHS Foundation Trust, London, UK
| | | | | | - Raj Nigam
- Royal Surrey NHS Foundation Trust, Guildford, UK
- BMI Mount Alvernia Hospital, Guildford, UK
| | - Jaspal Virdi
- Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Caroline M Moore
- University College London NHS Foundation Trust, London, UK
- Princess Grace Hospital, London, UK
- King Edward VII Hospital, London, UK
| | - Manit Arya
- Imperial College NHS Healthcare Trust, London, UK
- University College London NHS Foundation Trust, London, UK
| | - Taimur T Shah
- Imperial College, London, UK
- Imperial College NHS Healthcare Trust, London, UK
| | - Mathias Winkler
- Imperial College, London, UK
- Imperial College NHS Healthcare Trust, London, UK
| | - Mark Emberton
- University College London NHS Foundation Trust, London, UK
- Princess Grace Hospital, London, UK
- King Edward VII Hospital, London, UK
| | | | | | - Hashim U Ahmed
- Imperial College, London, UK
- Imperial College NHS Healthcare Trust, London, UK
- King Edward VII Hospital, London, UK
- Department of Urology, Cromwell Hospital, London, UK
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35
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Ong S, Chen K, Grummet J, Yaxley J, Scheltema MJ, Stricker P, Tay KJ, Lawrentschuk N. Guidelines of guidelines: focal therapy for prostate cancer, is it time for consensus? BJU Int 2023; 131:20-31. [PMID: 36083229 PMCID: PMC10087270 DOI: 10.1111/bju.15883] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To provide a summary and discussion of international guidelines, position statements and consensus statements in relation to focal therapy (FT) for prostate cancer (PCa). METHODS The European Association of Urology-European Association of Nuclear Medicine-European Society for Radiotherapy and Oncology-European Society of Urogential Radiology-International Society of Urological Pathology-International Society of Geriatric Oncology and American Urological Association-American Society for Radiation Oncology-Society of Urologic Oncology guidelines were interrogated for recommendations for FT. PubMed and Ovid Medline were searched for consensus statements. Only studies in English since 2015 were included. Reference lists of the included articles were also interrogated and a manual search for studies was also performed. RESULTS Our results showed a lack of long-term randomised data for FT. International Urological guidelines emphasised the need for more high-quality clinical trials with robust oncological and toxicity outcomes. Consensus and positions statements were heterogenous. CONCLUSION A globally accepted guideline for FT planning, technique and follow-up are still yet to be determined. Well-designed studies with long-term follow-up and robust clinical and toxicity endpoints are needed to improve our understanding of FT and create uniform guidelines to streamline management and follow-up.
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Affiliation(s)
- Sean Ong
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Vic., Australia.,Department of Surgery, University of Melbourne, Melbourne, Vic., Australia
| | - Kenneth Chen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Jeremy Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - John Yaxley
- The University of Queensland, School of Medicine, Brisbane, QLD, Australia.,Wesley Urology Clinic, Wesley Hospital, Brisbane, QLD, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Matthijs J Scheltema
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Department of Urology, St Vincents Hospital and Campus, Sydney, NSW, Australia
| | - Phillip Stricker
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Department of Urology, St Vincents Hospital and Campus, Sydney, NSW, Australia.,Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Nathan Lawrentschuk
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Vic., Australia.,Department of Surgery, University of Melbourne, Melbourne, Vic., Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia
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36
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Anttinen M, Blanco Sequeiros R, Boström PJ, Taimen P. Evolving imaging methods of prostate cancer and the emergence of magnetic resonance imaging guided ablation techniques. Front Oncol 2022; 12:1043688. [DOI: 10.3389/fonc.2022.1043688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
Established therapies for prostate cancer (PCa), surgery and radiotherapy, treat the entire gland regardless of the location of the cancerous lesion within the prostate. Although effective, these methods include a significant risk of worsening genitourinary outcomes. Targeted image-guided cancer therapy has gained acceptance through improved PCa detection, localization, and characterization by magnetic resonance imaging (MRI). Minimally-invasive ablative techniques aim to achieve comparable oncological outcomes to radical treatment while preserving genitourinary function. Transurethral ultrasound ablation (TULSA) and next-generation transrectal high-intensity focused ultrasound (HIFU) utilize MRI guidance to thermally ablate prostate tissue under real-time MRI monitoring and active temperature feedback control. Previous trials performed by our group and others, including a large multicenter study in men with localized favorable-risk disease, have demonstrated that TULSA provides effective prostate ablation with a favorable safety profile and low impact on quality of life. Recently, MRI-guided HIFU focal therapy was also shown as a safe and effective treatment of intermediate-risk PCa. Here we review the current literature on ablative techniques in the treatment of localized PCa with a focus on TULSA and HIFU methods.
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37
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The role of anti-tumor immunity of focused ultrasound for the malignancies: depended on the different ablation categories. Int J Clin Oncol 2022; 27:1543-1553. [PMID: 35943643 DOI: 10.1007/s10147-022-02219-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/07/2022] [Indexed: 11/05/2022]
Abstract
Improving anti-tumor immunity has promising outcomes in eradicating malignant tumors. Tumor cells can escape from immune surveillance and killing; therefore, various strategies are continuously developing to inhibit immune escape. Focused ultrasound (FUS) has recently emerged to play an important role in immune modulation. After FUS therapy, various tumor antigens and related signals are released. The non-thermal effect of FUS strengthens the blood and lymph circulation, increases cell permeability, and helps in crossing the physical barrier like the blood-brain barrier and blood-tumor barrier. However, the different ablation of FUS is proposed to have a different anti-tumor immune effect. Therefore, we categorized the FUS ablation into thermal and non-thermal ablation and summarized possible anti-tumor immunity mechanisms.
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38
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Reddy D, Ahmed HU. Reply to Francesco Montorsi, Armando Stabile, Elio Mazzone, Giorgio Gandaglia, and Alberto Briganti's Letter to the Editor re: Deepika Reddy, Max Peters, Taimur T. Shah, et al. Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience. Eur Urol 2022;81:407-13. Eur Urol 2022; 82:e74-e75. [PMID: 35690513 DOI: 10.1016/j.eururo.2022.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK.
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK; King Edward VII Hospital, London, UK; Cromwell Hospital, London, UK
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39
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Montorsi F, Stabile A, Mazzone E, Gandaglia G, Briganti A. Re: Deepika Reddy, Max Peters, Taimur T. Shah, et al. Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience. Eur Urol 2022;81:407-13. Eur Urol 2022; 82:e73. [PMID: 35661628 DOI: 10.1016/j.eururo.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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40
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Martini A, Ploussard G. Re: Cancer Control Outcomes Following Focal Therapy Using High-intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience. Eur Urol 2022; 82:241. [DOI: 10.1016/j.eururo.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
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