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Kim J, Lim B, Jeong IG, Ro JY, Go H, Cho YM, Park KJ. Biopsy-Integrated 3D Magnetic Resonance Imaging Modeling of Prostate Cancer and Its Application for Gleason Grade and Tumor Laterality Assessment. Arch Pathol Lab Med 2023; 147:159-166. [PMID: 35512234 DOI: 10.5858/arpa.2021-0256-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Grade Group assessed using Gleason combined score and tumor extent is a main determinant for risk stratification and therapeutic planning of prostate cancer. OBJECTIVE.— To develop a 3-dimensional magnetic resonance imaging (MRI) model regarding Grade Group and tumor extent in collaboration with uroradiologists and uropathologists for optimal treatment planning for prostate cancer. DESIGN.— We studied the data from 83 patients with prostate cancer who underwent multiparametric MRI and subsequent MRI-transrectal ultrasound fusion biopsy and radical prostatectomy. A 3-dimensional MRI model was constructed by integrating topographic information of MRI-based segmented lesions, biopsy paths, and histopathologic information of biopsy specimens. The multiparametric MRI-integrated Grade Group and laterality were assessed by using the 3-dimensional MRI model and compared with the radical prostatectomy specimen. RESULTS.— The MRI-defined index tumor was concordant with radical prostatectomy in 94.7% (72 of 76) of cases. The multiparametric MRI-integrated Grade Group revealed the highest agreement (weighted κ, 0.545) and a significantly higher concordance rate (57.9%) than the targeted (47.8%, P = .008) and systematic (39.4%, P = .01) biopsies. The multiparametric MRI-integrated Grade Group showed significantly less downgrading rates than the combined biopsy (P = .001), without significant differences in upgrading rate (P = .06). The 3-dimensional multiparametric MRI model estimated tumor laterality in 66.2% (55 of 83) of cases, and contralateral clinically significant cancer was missed in 9.6% (8 of 83) of cases. The tumor length measured by multiparametric MRI best correlated with radical prostatectomy as compared with the biopsy-defined length. CONCLUSIONS.— The 3-dimensional model incorporating MRI and MRI-transrectal ultrasound fusion biopsy information easily recognized the spatial distribution of MRI-visible and MRI-nonvisible cancer and provided better Grade Group correlation with radical prostatectomy specimens but still requires validation.
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Affiliation(s)
- Jisup Kim
- From the Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea (Kim)
| | - Bumjin Lim
- From the Department of Urology (Lim, Jeong), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- From the Department of Urology (Lim, Jeong), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Y Ro
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Medical College of Cornell University, Houston, Texas (Ro)
| | - Heounjeong Go
- From the Department of Pathology (Go, Cho), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Mee Cho
- From the Department of Pathology (Go, Cho), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kye Jin Park
- From the Department of Radiology (Park), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Nassiri N, Richardson S, Kuppermann D, Brisbane WG, Gonzalez S, Kwan L, Felker E, Wallner C, Marks LS. Partial Gland Ablation of Prostate Cancer: Effects of Repeat Treatment. Urology 2022; 170:161-167. [PMID: 35907484 DOI: 10.1016/j.urology.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/24/2022] [Accepted: 07/17/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the near-term clinical and pathological effects of repeat partial gland ablation (PGA) in men with intermediate-risk prostate cancer (PCa). MATERIALS AND METHODS One hundred seventy men with focal lesions of PCa (all GG2 or GG3) underwent PGA with high-intensity focused ultrasound (HIFU) or cryotherapy (CRYO) in prospective trials. Residual PCa in or near the ablation zone was found in 37 men after a first PGA; 30 went on to receive a second PGA and were the subjects of study. At 3 timepoints, baseline and 6 months after first and second ablations, quality-of-life (QOL) questionnaires (IIEF, IPSS) and MRI-guided biopsies (MRGB) were performed. Biopsies were targeted and systematic at baseline and in follow-up, comprehensively about the ablation zone. RESULTS All 30 patients completed QOL questionnaires and 26 had MRGB at the 3 timepoints. Mean QOL scores were not significantly different from the baseline after the first or second PGA. No operative complications were encountered; and "decisional regret" was reported in only 2/29 men after the repeat ablation. A decrease in semen volume was reported by 25% of patients. Repeat ablation was successful (absence of csPCa on MRGB) in 14/26 (53%) of men. PSA levels decreased and MRI lesions resolved after ablations, but neither was a reliable predictor of biopsy outcomes. CONCLUSION When initial PGA fails, repeat PGA is a reasonable consideration, because in near-term follow-up, secondary procedures appear to be safe, causing only minimal detriment to urinary and sexual function, with csPCa becoming undetectable by MRGB in approximately half the patients.
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Affiliation(s)
- Nima Nassiri
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shannon Richardson
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - David Kuppermann
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Wayne G Brisbane
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Samantha Gonzalez
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ely Felker
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Caroline Wallner
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Choi YH, Lee CU, Song W, Chang Jeong B, Seo SI, Jeon SS, Lee HM, Jeon HG, Lee SJ. Combination of multiparametric magnetic resonance imaging and transperineal template-guided mapping prostate biopsy to determine potential candidates for focal therapy. Prostate Int 2022. [DOI: 10.1016/j.prnil.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Avital Y, Fütterer JJ, Cherniavsky A, Bomers JGR. Minimally Invasive Procedures in the Diagnosis and Treatment of Localized Prostate Cancer: an Interventional Radiologist's Perspective. Curr Oncol Rep 2022; 24:1433-1441. [PMID: 35670993 PMCID: PMC9606051 DOI: 10.1007/s11912-022-01291-3] [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: 04/30/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Minimal invasive procedures, including targeted biopsy (TB) and focal therapy (FT), are increasingly used in diagnosis and treatment of localized prostate cancer. Here, we review the current role of these procedures, from a perspective of an interventional radiologist. RECENT FINDINGS TB is an established part of current guidelines for diagnosis of PCa. Several modalities of FT are gaining prevalence in recent years, as a tissue-preserving alternative for definitive treatment of localized PCa. FT is currently at early research stages, offered to selected patients in clinical trials settings. TB and FT are minimally invasive procedures used by multidisciplinary teams for diagnosis and treatment of localized PCa.
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Affiliation(s)
- Yaniv Avital
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, Gelderland The Netherlands ,Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), 70300 Zerifin, Israel
| | - Jurgen J. Fütterer
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, Gelderland The Netherlands
| | - Alexei Cherniavsky
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), 70300 Zerifin, Israel
| | - Joyce G. R. Bomers
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, Gelderland The Netherlands
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Chesnut GT, Tin AL, Sivaraman A, Takeda T, Lee T, Fainberg J, Benfante N, Sjoberg DD, Vargas HA, Fine SW, Scardino PT, Eastham JA, Coleman JA, Touijer KA, Zelefsky MJ, Ehdaie B. Defining the index lesion for potential salvage partial or hemi-gland ablation after radiation therapy for localized prostate cancer. Urol Oncol 2021; 39:495.e17-495.e24. [PMID: 33583697 DOI: 10.1016/j.urolonc.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/17/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Salvage partial gland ablation (sPGA) has been proposed to treat some localized radiorecurrent prostate cancer. The role of prostate biopsy and magnetic resonance imaging (MRI) characteristics to identify patients eligible for sPGA is unknown. OBJECTIVE To evaluate the ability of MRI and prostate biopsy characteristics to identify an index lesion suitable for sPGA and validate this selection using detailed tumor maps created from whole-mount slides from salvage radical prostatectomy (sRP) specimens. DESIGN, SETTING, AND PARTICIPANTS Men who underwent sRP for recurrent prostate cancer following primary radiotherapy with external beam radiotherapy (EBRT) and/or brachytherapy between 2000 and 2014 at a single high-volume cancer center were eligible. Those with tumor maps, MRI and biopsy data were included in analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome was the ability of clinicopathologic and imaging criteria to identify patients who may be eligible for sPGA based on detailed tumor map from whole-mount sRP slides. RESULTS AND LIMITATIONS Of 216 men who underwent sRP following whole gland radiotherapy, tumor maps, MRI, and biopsy data were available for 77. Of these, 15 (19%) were determined to be eligible for sPGA based on biopsy-proven unilateral disease in contiguous sextant segments, a dominant lesion on MRI concordant with biopsy location or no focal region of interest, and no imaging evidence of extraprostatic disease. Review of tumor maps identified 6 additional men who would have met criteria for sPGA, resulting in sensitivity of 71% (95% C.I. 48%-89%) and specificity of 100% (lower bound of 95% C.I. 94%). None of the 15 men who met the criteria for sPGA on clinical data were identified incorrectly on tumor maps to require full gland surgery (upper bound of 95% C.I. 22%). Median tumor volume of the index lesion was 0.4 cc and recurrent cancer was noted in the apex, mid-gland, and base in 81%, 100%, and 29% of men. CONCLUSIONS In men with recurrent prostate cancer after radiotherapy, biopsy findings and MRI can be used to select index lesions potentially amenable for sPGA and can guide patient evaluation for inclusion in clinical trials of sPGA following radiation failure. Larger, prospective studies are required to evaluate both the role of MRI and clinical criteria in guiding focal salvage therapy and the effectiveness of this modality for radiorecurrent prostate cancer.
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Affiliation(s)
- Gregory T Chesnut
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Arjun Sivaraman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Toshikazu Takeda
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Taehyoung Lee
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan Fainberg
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Nicole Benfante
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter T Scardino
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James A Eastham
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan A Coleman
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karim A Touijer
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Behfar Ehdaie
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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von Hardenberg J, Borkowetz A, Siegel F, Kornienko K, Westhoff N, Jordan TB, Hoffmann M, Drerup M, Lieb V, Taymoorian K, Schostak M, Ganzer R, Höfner T, Cash H, Bruendl J. Potential Candidates for Focal Therapy in Prostate Cancer in the Era of Magnetic Resonance Imaging-targeted Biopsy: A Large Multicenter Cohort Study. Eur Urol Focus 2020; 7:1002-1010. [PMID: 33877047 DOI: 10.1016/j.euf.2020.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/23/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Focal therapy (FT) with its favorable side-effect profile represents an option between active surveillance and traditional whole-gland treatment in localized prostate cancer (PCa). Consensus statements recommend eligibility criteria based on magnetic resonance imaging (MRI)-targeted and systematic combination biopsy. OBJECTIVE To estimate the future potential of FT by analyzing the number of men eligible for FT among all men with biopsy-proven PCa and to judge the potential of different energy sources. DESIGN, SETTING, AND PARTICIPANTS Consensus criteria on FT were analyzed. Patients with biopsy-proven PCa from six tertiary referral hospitals and one outpatient practice in Germany had received a software-based combination biopsy. Men with Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesions based on PI-RADS v2 were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were analyzed for potential treatment by FT and hemiablation. MRI lesions were mapped according to prostatic zones. RESULTS AND LIMITATIONS In total, 2371 patients were analyzed. According to consensus criteria (biopsy-proven unifocal lesion of International Society of Urological Pathology [ISUP] grade group ≤2, prostate-specific antigen [PSA] ≤15ng/mL, and life expectancy >10yr), 303 patients (12.8%; ISUP 1: n=148 [6.2%]; ISUP 2: n=155 [6.5%]) were potential candidates for FT. A maximum PSA level of <10ng/mL would exclude further 60 (2.5%) of these men. The eligibility for hemiablation is slightly higher (16.2%). Unifocal lesions (n=288) were equally distributed within the prostate (anteriorly [31%], apically [29%], and dorsally [36%]). CONCLUSIONS With adherence to consensus statements, only a minority of PCa patients present as potential candidates for FT. Distribution of tumor localization suggests the need for different energy modalities to warrant an optimal FT treatment. PATIENT SUMMARY We analyzed how many men who receive a magnetic resonance imaging-targeted and systematic prostate biopsy are candidates for the experimental focal therapy of the prostate. When following expert recommendations, only a small number of men are potential candidates for this alternative treatment.
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Affiliation(s)
- Jost von Hardenberg
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Heinrich-Lanz Center, Department of Biomedical Informatics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kira Kornienko
- Department of Urology, Charité University Medicine Berlin, Berlin, Germany
| | - Niklas Westhoff
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tobias B Jordan
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Manuela Hoffmann
- Department of Occupational Health and Safety, Federal Ministry of Defense, Bonn, Germany
| | - Martin Drerup
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Verena Lieb
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | | | - Martin Schostak
- Clinic of Urology, Urooncology, Robotic-assisted and Focal Therapy, Medical Faculty and University Clinics of Magdeburg, Magdeburg, Germany
| | - Roman Ganzer
- Department of Urology, Asklepios Hospital Bad Tölz, Bad Tölz, Germany
| | - Thomas Höfner
- Department of Urology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hannes Cash
- Department of Urology, Charité University Medicine Berlin, Berlin, Germany
| | - Johannes Bruendl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
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Mithal P, Truong M, Quarrier S, Lu D, Hollenberg G, Weinberg E, Miyamoto H, Frye T. Cribriform pattern and perineural invasion on MR/US fusion biopsy predict failure of selection criteria for prostatic hemigland ablation. Urol Oncol 2019; 38:38.e1-38.e8. [PMID: 31753604 DOI: 10.1016/j.urolonc.2019.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/20/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess clinicopathologic factors on MR/US fusion biopsy that might predict failure of theoretical selection criteria for prostatic hemigland ablation (HA). SUBJECTS AND METHODS A retrospectively maintained single institution multiparametric MRI database (n = 1667) was queried to identify 355 patients who underwent MR/US fusion biopsy, including both targeted biopsy and concurrent systematic biopsy from December 1, 2014 to June 1, 2018. Clinical, pathological, and imaging variables were assessed on fusion biopsy (Table 1) to determine who met theoretical selection criteria for HA, defined as unilateral intermediate-risk prostate cancer per NCCN criteria (Grade Group [GG] 2 or 3 with prostate-specific antigen <20) and no evidence of extraprostatic extension (EPE) on multiparametric MRI. Predictors of selection criteria failure were then assessed in patients who also underwent radical prostatectomy (RP). Failure of the theoretical HA selection criteria was defined as presence of GG ≧ 2 on the contralateral (untreated) side, or the presence of high-risk disease (any GG ≧ 4 or EPE) in the RP specimen. RESULTS Of the 355 patients who underwent fusion biopsy, 84 patients met the theoretical selection criteria for HA. Of those patients eligible, 54 underwent RP, 37 (68.5%) of which represented unsuccessful HA selection criteria. Patients no longer met HA selection criteria on the basis of upgrading alone in 6/54 (11.1%), EPE alone in 9/54 (16.7%), bilateral GG 2 or 3 in 16/54 (29.6%) or combined EPE and bilateral GG 2 or 3 in 6/54 (11.1%) cases. In the HA selection failures due to upgrading, three also had EPE, one of whom also had missed contralateral GG ≧ 2 disease. The only factor independently associated with HA failure was any presence of cribriform pattern (HR 7.01, P = 0.021). Perineural invasion on systematic biopsyalso appeared to improve the performance of our multivariable model (HR 5.33, P = 0.052), though it was not statistically significant when using a cutoff of <0.05. Accuracy for predicting successful HA was 0.32 and improved to 0.74 if PNI or cribriform were excluded and 0.84 if both were excluded. CONCLUSIONS In a retrospective analysis of RP patients who underwent preoperative MRI/US fusion biopsy, current selection criteria for prostatic HA based on NCCN intermediate-risk stratification failed to accurately identify appropriate candidates in 68.5% of patients. Cribriform pattern and PNI detected on biopsy reduced the failure of hemigland selection criteria to 43%. These criteria should be routinely reported on biopsy pathology and taken into consideration when selecting patients for HA in prospective clinical trials.
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Affiliation(s)
- Prabhakar Mithal
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Matthew Truong
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Scott Quarrier
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Diane Lu
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Gary Hollenberg
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Eric Weinberg
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Hiroshi Miyamoto
- University of Rochester Medical Center, Department of Urology, Rochester, NY
| | - Thomas Frye
- University of Rochester Medical Center, Department of Urology, Rochester, NY.
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Zhou SR, Priester AM, Jayadevan R, Johnson DC, Yang JJ, Ballon J, Natarajan S, Marks LS. Using spatial tracking with magnetic resonance imaging/ultrasound-guided biopsy to identify unilateral prostate cancer. BJU Int 2019; 125:399-406. [PMID: 31680423 DOI: 10.1111/bju.14943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To create reliable predictive metrics of unilateral disease using spatial tracking from a fusion device, thereby improving patient selection for hemi-gland ablation of prostate cancer. PATIENTS AND METHODS We identified patients who received magnetic resonance imaging (MRI)/ultrasound-guided biopsy and radical prostatectomy at a single institution between 2011 and 2018. In addition to standard clinical features, we extracted quantitative features related to biopsy core and MRI target locations predictive of tumour unilaterality. Classification and Regression Tree (CART) analysis was used to create a decision tree (DT) for identifying cancer laterality. We evaluated concordance of model-determined laterality with final surgical pathology. RESULTS A total of 173 patients were identified with biopsy coordinates and surgical pathology available. Based on CART analysis, in addition to biopsy- and MRI-confirmed disease unilaterality, patients should be further screened for cancer detected within 7 mm of midline in a 40 mL prostate, which equates to the central third of any-sized prostate by radius. The area under the curve for this DT was 0.82. Standard diagnostics and the DT correctly identified disease laterality in 73% and 80% of patients, respectively (P = 0.13). Of the patients identified as unilateral by standard diagnostics, 47% had undetected contralateral disease or were otherwise incorrectly identified. This error rate was reduced to 17% (P = 0.01) with the DT. CONCLUSION Using spatial tracking from fusion devices, a DT was more reliable for identifying laterality of prostate cancer compared to standard diagnostics. Patients with cancer detected within the central third of the prostate by radius are poor hemi-gland ablation candidates due to the risk of midline extension of tumour.
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Affiliation(s)
- Steve R Zhou
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alan M Priester
- Department of Urology, University of California, Los Angeles, CA, USA.,Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Rajiv Jayadevan
- Department of Urology, University of California, Los Angeles, CA, USA
| | - David C Johnson
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Jason J Yang
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jorge Ballon
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Shyam Natarajan
- Department of Urology, University of California, Los Angeles, CA, USA.,Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Leonard S Marks
- Department of Urology, University of California, Los Angeles, CA, USA
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Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer. Urology 2019; 126:158-164. [PMID: 30659903 DOI: 10.1016/j.urology.2018.11.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate safety, efficacy, and quality of life impact of hemi-gland cryotherapy for clinically-significant prostate cancer (CaP), when patient selection and follow-up includes MRI-guided biopsy. METHODS Twenty-nine men with unilateral CaP (all clinically significant with prostate volume <60 cc) were enrolled in a prospective observational trial of hemi-gland cryotherapy. Mean patient age was 68.7 years. Median prostate-specific antigen (PSA) was 6.6 ng/mL. MRI-guided biopsy (3T-MRI, Artemis US fusion) was used for diagnosis and repeated at 6-month follow-up in all men. Treatment was under general anesthesia using the BTG/Galil system. Validated questionnaires were used to determine effects of treatment on urinary and sexual function and quality of life. RESULTS Cryotherapy was completed satisfactorily in all 29 cases in <60 minutes with no intraoperative complications. Significant decreases in PSA (median decrease 5.6 ng/mL) and PSA density (median decrease 0.14 ng/mL/cc) were observed (P < .01). At 6 months, 23 patients (79%) demonstrated no residual cancer on follow-up MRI-guided biopsy of the treated side. Three patients (10%) revealed micro-residual disease. Three patients (10%) had residual cancer and underwent further treatment. Ipsilateral MRI lesions were present before treatment in 26 patients and after treatment in only 2, reflecting the gross ablative effect; however, MRI showed disappearance of lesions in 4 patients with residual tumor on biopsy. The single complication was 1 case of transient urinary retention; 85% of men who were sexually active continued without change after treatment. Voiding function was unchanged. CONCLUSION Hemi-gland cryoablation for clinically-significant CaP is well-tolerated, and when patients are selected and followed by MRI/US fusion biopsy, cancer control appears promising at 6 months.
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Song Y, Ren M, Wu Y, Li S, Song C, Wang F, Huang Y. The effect of different surface treatment methods on the physical, chemical and biological performances of a PGA scaffold. RSC Adv 2019; 9:20174-20184. [PMID: 35514696 PMCID: PMC9065566 DOI: 10.1039/c9ra02100k] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/06/2019] [Indexed: 12/22/2022] Open
Abstract
In order to improve the adhesion between a PGA scaffold and islet cells, it is necessary to find a suitable method to modify the scaffold. In this study, the PGA scaffold surface was modified by plasma, polylysine coating and plasma combined with polylysine coating (P–P-PGA). The surface adhesion of the modified PGA scaffold was examined, and the stretchability and infiltration of the PGA scaffold were also tested. Then, the PGA scaffold treated under the optimal treatment conditions was selected to co-culture with rat islet cells, and the survival activity of the rat islet cells on the untreated PGA scaffold and the P–P-PGA scaffold was examined via the MTT method. Rhodamine staining and DAPI staining were used to detect the number of islet cells adhered to four groups of scaffolds at different culture time points. The PGA-islet graft in the leg muscle of rats was stained with HE to perform the PGA-islet graft pathological examination. The experimental results showed that when the plasma treatment power was 240 W, the processing time was 4 min; the concentration of the polylysine coating solution was 2 mg ml−1, the tensile strength of the PGA scaffold was 320.45 MPa and the amount of infiltration of the PGA scaffold by the serum medium presented the maximum value: 3.17 g g−1. The MTT survival activity test results showed that after 3 d of culture, the survival activity of the islet cells of the treated PGA scaffold culture group (2.02 ± 0.13) was significantly different from the survival activity of the islet cells of the untreated PGA scaffold culture group (1.93 ± 0.10). The survival activities of the islet cells in the experimental groups (1.60 ± 0.13, 1.40 ± 0.12) were still higher than those of the control groups (0.96 ± 013, 0.69 ± 0.09) at 15 and 21 d. The results of the rhodamine and DAPI staining showed that with the increase in culture time, the number of the adherent cells in each group increased, and the number of the adherent islet cells in the experimental group was higher than that in the untreated group. The HE staining results showed that the islet cells on the P–P-PGA scaffold were more than those on the untreated PGA scaffold. After modification of the PGA scaffold, the adhesion of the islet cells improved, which was conducive to the growth of islet cells. These results confirmed that the plasma combined with polylysine coating treatment could enhance the adhesion of the PGA scaffold surface, so that the scaffold and the islet cells exhibited better adhesion and biocompatibility, and the modified PGA scaffold (P–P-PGA) could be used as a promising islet cell scaffold. In order to improve the adhesion between a PGA scaffold and islet cells, it is necessary to find a suitable method to modify the scaffold.![]()
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Affiliation(s)
- Yimin Song
- Department of Health Medicine
- Peking Union Medical College Hospital
- Beijing 100730
- China
| | - Minghua Ren
- Surgery Department
- the Key Laboratory of Cell Transplantation of Ministry of Health of the First Affiliated Hospital of Harbin Medical University
- Harbin
- 150001 China
| | - Yadong Wu
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage
- School of Chemistry and Chemical Engineering
- Harbin Institute of Technology
- Harbin
- China
| | - Siyu Li
- Surgery Department
- the Key Laboratory of Cell Transplantation of Ministry of Health of the First Affiliated Hospital of Harbin Medical University
- Harbin
- 150001 China
| | - Chun Song
- Surgery Department
- the Key Laboratory of Cell Transplantation of Ministry of Health of the First Affiliated Hospital of Harbin Medical University
- Harbin
- 150001 China
| | - Fang Wang
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage
- School of Chemistry and Chemical Engineering
- Harbin Institute of Technology
- Harbin
- China
| | - Yudong Huang
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage
- School of Chemistry and Chemical Engineering
- Harbin Institute of Technology
- Harbin
- China
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11
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Wysock JS, Lepor H. Optimizing patient selection for focal therapy-mapping and ablating the index lesion. Transl Androl Urol 2018; 7:S519-S525. [PMID: 30363486 PMCID: PMC6178318 DOI: 10.21037/tau.2018.03.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- James S Wysock
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, NY, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, NY, USA
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12
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Taneja SS. Editorial Comment. J Urol 2018; 200:792. [DOI: 10.1016/j.juro.2018.05.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Samir S. Taneja
- Department of Urology, New York University, New York, New York
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13
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Marks LS. Editorial Comment. J Urol 2018; 200:563. [PMID: 29913157 DOI: 10.1016/j.juro.2018.03.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Pompe RS, Kühn-Thomä B, Nagaraj Y, Veleva V, Preisser F, Leyh-Bannurah SR, Graefen M, Huland H, Tilki D, Salomon G. Validation of the current eligibility criteria for focal therapy in men with localized prostate cancer and the role of MRI. World J Urol 2018; 36:705-712. [PMID: 29492583 DOI: 10.1007/s00345-018-2238-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/16/2018] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To validate current eligibility criteria for focal therapy (FT) in prostate cancer men undergoing radical prostatectomy (RP) and to assess the role of magnetic resonance imaging (MRI). METHODS Retrospective analysis of 217 RP patients (2009-2016) with preoperative MRI (almost all in external institutions) and fulfillment of different FT eligibility criteria: unilateral tumor, clinical tumor stage ≤ cT2a, prostate volume ≤ 60 mL and either biopsy Gleason 3 + 3 or ≤ 3 + 4 and PSA ≤ 10 or ≤ 15 ng/mL. Multivariable logistic regression analyses (MVA) assessed the role of MRI to predict the presence of significant contralateral tumor or extracapsular extension (ECE), including seminal vesicle invasion. To quantify model accuracy, Receiver Operating Characteristics-derived area under the curve (AUC) was used. RESULTS Of 217 patients fulfilling widest biopsy criteria and 113 fulfilling additional MRI criteria, 64 (29.7%) and 37 (32.7%) remained eligible for FT according to histopathological results. In MVA, fulfillment of MRI criteria reached independent predictor status for prediction of contralateral tumor but not for ECE. Addition of MRI resulted in AUC gain (57.5-64.6%). Sensitivity, specificity, PPV and NPV for MRI to predict contralateral tumor were: 41.8, 71.6, 70.9 and 42.6%, respectively. Virtually the same results were recorded for Gleason 3 + 3 and/or PSA ≤ 10 ng/mL. CONCLUSIONS Patient eligibility criteria for FT using biopsy criteria remained insufficient with respect to contralateral tumor disease. Although, MRI improves accuracy, it cannot safely exclude or minimize chance of significant cancer on contralateral prostate side. To date, stricter eligibility criteria are needed to provide more diagnostic reliability.
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Affiliation(s)
- Raisa S Pompe
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Bieke Kühn-Thomä
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Yamini Nagaraj
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Valia Veleva
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Sami-Ramzi Leyh-Bannurah
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Salomon
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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15
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Nassiri N, Chang E, Lieu P, Priester AM, Margolis DJA, Huang J, Reiter RE, Dorey FJ, Marks LS, Natarajan S. Focal Therapy Eligibility Determined by Magnetic Resonance Imaging/Ultrasound Fusion Biopsy. J Urol 2018; 199:453-458. [PMID: 28830754 PMCID: PMC5780241 DOI: 10.1016/j.juro.2017.08.085] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE We assessed focal therapy eligibility in men who underwent multiparametric magnetic resonance imaging and targeted biopsy with correlation to whole mount histology after radical prostatectomy. MATERIALS AND METHODS Subjects were selected from among the 454 men in whom targeted biopsy proven prostate cancer was derived from regions of interest on multiparametric magnetic resonance imaging from 2010 to 2016. Focal therapy eligibility was limited to a maximum Gleason score of 4 + 3 in regions of interest with or without other foci of low risk prostate cancer (Gleason score 3 + 3 and less than 4 mm). Men who did not meet NCCN® intermediate risk criteria were classified as ineligible for focal therapy. Of the 454 men 64 underwent radical prostatectomy and biopsy findings were compared to final pathology findings. RESULTS Of the 454 men with a biopsy proven region of interest 175 (38.5%) were eligible for focal therapy. Fusion biopsy, which combined targeted and template biopsy, had 80.0% sensitivity (12 of 15 cases), 73.5% specificity (36 of 49) and 75.0% accuracy (48 of 64) for focal therapy eligibility. Targeted cores alone yielded 73.3% sensitivity (11 of 15 cases), 47.9% specificity (23 of 48) and 54.7% accuracy (35 of 64). Gleason score and extension across the midline differed in 4 and 9, respectively, of the 13 cases that showed discordant biopsy and whole mount histology. CONCLUSIONS Using intermediate risk eligibility criteria more than a third of men with a targeted biopsy proven lesion identified on multiparametric magnetic resonance imaging would have been eligible for focal therapy. Eligibility determined by fusion biopsy was concordant with whole mount histology in 75% of cases. Improved selection criteria are needed to reliably determine focal therapy eligibility.
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Affiliation(s)
- Nima Nassiri
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Edward Chang
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California
| | - Daniel J A Margolis
- Department of Radiology, Weill Cornell at New York Presbyterian, New York, New York
| | - Jiaoti Huang
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Frederick J Dorey
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, Los Angeles, California
| | - Shyam Natarajan
- Department of Urology, David Geffen School of Medicine, Los Angeles, California; Department of Bioengineering, University of California-Los Angeles, Los Angeles, California.
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16
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High-Intensity Focused Ultrasound (HIFU) Options for High-Risk Prostate Cancer. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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Wysock JS, Lepor H. Multi-parametric MRI imaging of the prostate-implications for focal therapy. Transl Androl Urol 2017; 6:453-463. [PMID: 28725587 PMCID: PMC5503978 DOI: 10.21037/tau.2017.04.29] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The primary goal of a focal therapy treatment paradigm is to achieve cancer control through targeted tissue destruction while simultaneously limiting deleterious effects on peri-prostatic structures. Focal therapy approaches are employed in several oncologic treatment protocols, and have been shown to provide equivalent cancer control for malignancies such as breast cancer and renal cell carcinoma. Efforts to develop a focal therapy approach for prostate cancer have been challenged by several concepts including the multifocal nature of the disease and limited capability of prostate ultrasound and systematic biopsy to reliably localize the site(s) and aggressiveness of disease. Multi-parametric MRI (mpMRI) of the prostate has significantly improved disease localization, spatial demarcation and risk stratification of cancer detected within the prostate. The accuracy of this imaging modality has further enabled the urologist to improve biopsy approaches using targeted biopsy via MRI-ultrasound fusion. From this foundation, an improved delineation of the location of disease has become possible, providing a critical foundation to the development of a focal therapy strategy. This chapter reviews the accuracy of mpMRI for detection of “aggressive“ disease, the accuracy of mpMRI in determining the tumor volume, and the ability of mpMRI to accurately identify the index lesion. While mpMRI provides a critical, first step in developing a strategy for focal therapy, considerable questions remain regarding the relationship between MR identified tumor volume and pathologic tumor volume, the accuracy and utility of mpMRI for treatment surveillance and the optimal role and timing of follow-up mpMRI.
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Affiliation(s)
- James S Wysock
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Herbert Lepor
- Department of Urology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
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18
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Sundaram KM, Chang SS, Penson DF, Arora S. Therapeutic Ultrasound and Prostate Cancer. Semin Intervent Radiol 2017; 34:187-200. [PMID: 28579687 PMCID: PMC5453783 DOI: 10.1055/s-0037-1602710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Therapeutic ultrasound approaches including high-intensity focused ultrasound (HIFU) are emerging as popular minimally invasive alternative treatments for localized, low-to-intermediate risk prostate cancer. FDA approval was recently granted for two ultrasound-guided HIFU devices. Clinical trials for devices using MRI guidance are ongoing. The current level of evidence for whole-gland ultrasound ablation suggests that its clinical efficacy and adverse event rates including erectile dysfunction and urinary incontinence are similar to current definitive therapies such as radical prostatectomy and external-beam radiotherapy. Short-term data suggest that more focal therapy could reduce the rates of adverse events.
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Affiliation(s)
- Karthik M. Sundaram
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sam S. Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandeep Arora
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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19
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Golan R, Bernstein AN, McClure TD, Sedrakyan A, Patel NA, Parekh DJ, Marks LS, Hu JC. Partial Gland Treatment of Prostate Cancer Using High-Intensity Focused Ultrasound in the Primary and Salvage Settings: A Systematic Review. J Urol 2017; 198:1000-1009. [PMID: 28433640 DOI: 10.1016/j.juro.2017.03.137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Advances in prostate imaging, biopsy and ablative technologies have been accompanied by growing enthusiasm for partial gland ablation, particularly using high-intensity focused ultrasound, to treat prostate cancer. Preserving noncancerous prostate tissue and minimizing damage to the neurovascular bundles and external urethral sphincter may improve functional outcomes. MATERIALS AND METHODS A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using a combination of MeSH® terms, free text search and examination of relevant bibliographies using MEDLINE® and Embase® from the inception of each database through October 10, 2016. We excluded studies describing exclusively whole gland ablation, case reports and series where treatment was followed by immediate resection. RESULTS A total of 13 studies that enrolled 543 patients were included. Of the studies 11 were performed in the primary setting and 2 in the salvage setting. Median followup ranged from 6 months to 10.6 years. Rates of posttreatment erectile dysfunction and urinary incontinence ranged from 0% to 48% and 0% to 50%, respectively, with definitions varying by study. Overall there were 254 reported complications. Marked heterogeneity between studies limited the ability to pool results regarding functional and oncologic outcomes. A total of 76 patients (14%) subsequently received further oncologic treatment. CONCLUSIONS Early evidence suggests that partial gland ablation is a safe treatment option for men with localized disease. Longer term data are needed to evaluate oncologic efficacy and functional outcomes, and will aid in identifying the optimal candidates for therapy. Standardization of outcomes definitions will allow for better comparison between studies and among treatment modalities.
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Affiliation(s)
- Ron Golan
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Adrien N Bernstein
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Timothy D McClure
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Neal A Patel
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Dipen J Parekh
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical College, New York, New York.
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20
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Natarajan S, Jones TA, Priester AM, Geoghegan R, Lieu P, Delfin M, Felker E, Margolis DJA, Sisk A, Pantuck A, Grundfest W, Marks LS. Focal Laser Ablation of Prostate Cancer: Feasibility of Magnetic Resonance Imaging-Ultrasound Fusion for Guidance. J Urol 2017; 198:839-847. [PMID: 28396184 DOI: 10.1016/j.juro.2017.04.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Focal laser ablation is a potential treatment in some men with prostate cancer. Currently focal laser ablation is performed by radiologists in a magnetic resonance imaging unit (in bore). We evaluated the safety and feasibility of performing focal laser ablation in a urology clinic (out of bore) using magnetic resonance imaging-ultrasound fusion for guidance. MATERIALS AND METHODS A total of 11 men with intermediate risk prostate cancer were enrolled in this prospective, institutional review board approved pilot study. Magnetic resonance imaging-ultrasound fusion was used to guide laser fibers transrectally into regions of interest harboring intermediate risk prostate cancer. Thermal probes were inserted for real-time monitoring of intraprostatic temperatures during laser activation. Multiparametric magnetic resonance imaging (3 Tesla) was done immediately after treatment and at 6 months along with comprehensive fusion biopsy. RESULTS Ten of 11 patients were successfully treated while under local anesthesia. Mean procedure time was 95 minutes (range 71 to 105). Posttreatment magnetic resonance imaging revealed a confined zone of nonperfusion in all 10 men. Mean zone volume was 4.3 cc (range 2.1 to 6.0). No CTCAE grade 3 or greater adverse events developed and no changes were observed in urinary or sexual function. At 6 months magnetic resonance imaging-ultrasound fusion biopsy of the treatment site showed no cancer in 3 patients, microfocal Gleason 3 + 3 in another 3 and persistent intermediate risk prostate cancer in 4. CONCLUSIONS Focal laser ablation of prostate cancer appears safe and feasible with the patient under local anesthesia in a urology clinic using magnetic resonance imaging-ultrasound fusion for guidance and thermal probes for monitoring. Further development is necessary to refine out of bore focal laser ablation and additional studies are needed to determine appropriate treatment margins and oncologic efficacy.
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Affiliation(s)
- Shyam Natarajan
- Department of Urology, University of California-Los Angeles, Los Angeles, California; Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Tonye A Jones
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Rory Geoghegan
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Merdie Delfin
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Ely Felker
- Department of Radiology, University of California-Los Angeles, Los Angeles, California
| | | | - Anthony Sisk
- Department of Pathology, University of California-Los Angeles, Los Angeles, California
| | - Allan Pantuck
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Warren Grundfest
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California.
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21
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Padeliporfin vascular-targeted photodynamic therapy versus active surveillance in men with low-risk prostate cancer (CLIN1001 PCM301): an open-label, phase 3, randomised controlled trial. Lancet Oncol 2017; 18:181-191. [DOI: 10.1016/s1470-2045(16)30661-1] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/05/2016] [Accepted: 10/18/2016] [Indexed: 12/20/2022]
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22
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Ouzzane A, Betrouni N, Valerio M, Rastinehad A, Colin P, Ploussard G. Focal therapy as primary treatment for localized prostate cancer: definition, needs and future. Future Oncol 2016; 13:727-741. [PMID: 27882770 DOI: 10.2217/fon-2016-0229] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Focal therapy (FT) may offer a promising treatment option in the field of low to intermediate risk localized prostate cancer. The aim of this concept is to combine minimal morbidity with cancer control as well as maintain the possibility of retreatment. Recent advances in MRI and targeted biopsy has improved the diagnostic pathway of prostate cancer and increased the interest in FT. However, before implementation of FT in routine clinical practice, several challenges are still to overcome including patient selection, treatment planning, post-therapy monitoring and definition of oncologic outcome surrogates. In this article, relevant questions regarding the key steps of FT are critically discussed and the main available energy modalities are analyzed taking into account their advantages and unmet needs.
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Affiliation(s)
- Adil Ouzzane
- Department of Urology, CHRU de Lille, Hôpital Claude Huriez, F-59037 Lille, France.,NSERM, U1189, ONCO-THAI, F-59037 Lille, France
| | | | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Pierre Colin
- Department of Urology, Hôpital Privé de la Louvière, Ramsay Générale de Santé, 59000 Lille, France
| | - Guillaume Ploussard
- Institut universitaire du Cancer de Toulouse - Oncopole, Toulouse, France.,Department of Urology, Saint-Jean Languedoc Hospital, Toulouse, France
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23
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Mendhiratta N, Taneja SS, Rosenkrantz AB. The role of MRI in prostate cancer diagnosis and management. Future Oncol 2016; 12:2431-2443. [PMID: 27641839 DOI: 10.2217/fon-2016-0169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Multiparametric MRI of the prostate demonstrates strong potential to address many limitations of traditional prostate cancer diagnosis and management strategies. Recent evidence supports roles for prostate MRI in prebiopsy risk stratification, guidance of targeted biopsy and preoperative disease staging. Prostate MRI may also assist the planning and follow-up of investigational partial gland ablative therapies. This article reviews the impact of prostate MRI on such diagnostic and therapeutic paradigms in contemporary prostate cancer management.
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Affiliation(s)
- Neil Mendhiratta
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Samir S Taneja
- Department of Urology, NYU Langone Medical Center, New York, NY, USA.,Department of Radiology, NYU Langone Medical Center, New York, NY, USA
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24
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Abstract
Strategies that seek to enhance musculoskeletal tissue regeneration and repair by modulating the biologic microenvironment at the site of injury have considerable therapeutic potential. Current and emerging biologic approaches include the use of growth factors, platelet-rich plasma, stem cell therapy, and scaffolds. The American Academy of Orthopaedic Surgeons hosted a research symposium in November 2015 to review the current state-of-the-art biologic treatments of articular cartilage, muscle, tendon, and bone injuries and identify knowledge gaps related to these emerging treatments. This review outlines the findings of the symposium and summarizes the consensus reached on how best to advance research on biologic treatment of orthopaedic injuries.
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25
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Final Results of a Phase I/II Multicenter Trial of WST11 Vascular Targeted Photodynamic Therapy for Hemi-Ablation of the Prostate in Men with Unilateral Low Risk Prostate Cancer Performed in the United States. J Urol 2016; 196:1096-104. [PMID: 27291652 DOI: 10.1016/j.juro.2016.05.113] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Vascular targeted photodynamic therapy with WST11 (TOOKAD® Soluble) is a form of tissue ablation that may be used therapeutically for localized prostate cancer. To study dosing parameters and associated treatment effects we performed a prospective, multicenter, phase I/II trial of WST11 vascular targeted photodynamic therapy of prostate cancer. MATERIALS AND METHODS A total of 30 men with unilateral, low volume, Gleason 3 + 3 prostate cancer were enrolled at 5 centers after local institutional review board approval. Light energy, fiber number and WST11 dose were escalated to identify optimal dosing parameters for vascular targeted photodynamic therapy hemi-ablation. Men were treated with photodynamic therapy and evaluated by posttreatment magnetic resonance imaging and biopsy. Prostate specific antigen, light dose index (defined as fiber length/desired treatment volume), toxicity and quality of life parameters were recorded. RESULTS After dose escalation 21 men received optimized dosing of 4 mg/kg WST11 at 200 J energy. On posttreatment biopsy residual prostate cancer was found in the treated lobe in 10 men, the untreated lobe in 4 and both lobes in 1. At a light dose index of 1 or greater with optimal dosing in 15 men 73.3% had a negative biopsy in the treated lobe. Six men undergoing retreatment with the optimal dose and a light dose index of 1 or greater had a negative posttreatment biopsy. Minimal effects were observed on urinary and sexual function, and overall quality of life. CONCLUSIONS Hemi-ablation of the prostate with WST11 vascular targeted photodynamic therapy was well tolerated and resulted in a negative biopsy in the treated lobe in the majority of men. Dosing parameters and the light dose index appear related to tissue response as determined by magnetic resonance imaging and biopsy. These parameters may serve as the basis for further prospective studies.
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Abstract
Prostate cancer is unique in that unlike other solid organ malignancies, only recently has imaging been employed to routinely detect and localize disease. The introduction of transrectal ultrasound was a significant development, transitioning digitally guided prostate biopsies to ultrasound guidance. The arrival of multiparametric MRI has become the next major step, transforming the way Urologist's diagnose, stage, and treat prostate cancer. Recent recommendations against PSA screening have changed the landscape of urologic oncology with the changing needs being reflected in the initiation of additional robust imaging techniques at different time points in prostate cancer care. The current review aims to provide a clinical perspective in the history, current standard of care, and novel imaging modalities in the evaluation of prostate cancer.
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Natarajan S, Raman S, Priester AM, Garritano J, Margolis DJA, Lieu P, Macairan ML, Huang J, Grundfest W, Marks LS. Focal Laser Ablation of Prostate Cancer: Phase I Clinical Trial. J Urol 2015; 196:68-75. [PMID: 26748164 DOI: 10.1016/j.juro.2015.12.083] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Focal laser ablation is an investigational technique to treat prostate cancer in a region confined manner via coagulative necrosis. This phase I trial primarily examines the safety of transrectal magnetic resonance imaging guided (in-bore) focal laser ablation in men with intermediate risk prostate cancer. An exploratory end point is cancer control after 6 months. MATERIALS AND METHODS In an institutional review board approved trial we studied focal laser ablation in 8 men with intermediate risk prostate cancer diagnosed using magnetic resonance-ultrasound fusion. Focal laser ablation was performed by inserting a cylindrically diffusing, water cooled laser fiber into magnetic resonance visible regions of interest, followed by interstitial heating at 10 to 15 W for up to 3 minutes. Secondary safety monitors (thermal probes) were inserted to assess the accuracy of magnetic resonance thermometry. Comprehensive magnetic resonance-ultrasound fusion biopsy was performed after 6 months. Adverse events and health related quality of life questionnaires were recorded. RESULTS Focal laser ablation was successfully performed in all 8 subjects. No grade 3 or greater adverse events occurred and no changes in International Prostate Symptom Score or International Index of Erectile Function 5 were observed. Ablation zones, as measured by posttreatment magnetic resonance imaging, had a median volume of 3 cc or 7.7% of prostate volume. Prostate specific antigen decreased in 7 men (p <0.01). At followup magnetic resonance-ultrasound fusion biopsy cancer was not detected in the ablation zone in 5 men but was present outside the treatment margin in 6 men. CONCLUSIONS Focal laser ablation of the prostate is feasible and safe in men with intermediate risk prostate cancer without serious adverse events or changes in urinary or sexual function at 6 months. Comprehensive biopsy followup indicates that larger treatment margins than previously thought necessary may be required for complete tumor ablation.
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Affiliation(s)
- Shyam Natarajan
- Department of Urology, University of California, Los Angeles, Los Angeles, California; Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California
| | - Steven Raman
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California
| | - James Garritano
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J A Margolis
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, University of California, Los Angeles, Los Angeles, California
| | - Maria L Macairan
- Department of Urology, University of California, Los Angeles, Los Angeles, California
| | - Jiaoti Huang
- Department of Pathology, University of California, Los Angeles, Los Angeles, California
| | - Warren Grundfest
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, University of California, Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California, Los Angeles, Los Angeles, California.
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