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Diagnostic value of multiparametric MRI in detecting residual or recurrent prostate cancer after high-intensity focused ultrasound. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00531-8. [DOI: 10.1038/s41391-022-00531-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/04/2022] [Accepted: 03/23/2022] [Indexed: 11/08/2022]
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Shah TT, Peters M, Kanthabalan A, McCartan N, Fatola Y, van der Voort van Zyp J, van Vulpen M, Freeman A, Moore CM, Arya M, Emberton M, Ahmed HU. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. Prostate Cancer Prostatic Dis 2016; 19:311-6. [PMID: 27431499 PMCID: PMC4983180 DOI: 10.1038/pcan.2016.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 12/03/2022]
Abstract
Background: Treatment options for radio-recurrent prostate cancer are either androgen-deprivation therapy or salvage prostatectomy. Whole-gland high-intensity focussed ultrasound (HIFU) might have a role in this setting. Methods: An independent HIFU registry collated consecutive cases of HIFU. Between 2005 and 2012, we identified 50 men who underwent whole-gland HIFU following histological confirmation of localised disease following prior external beam radiotherapy (2005–2012). No upper threshold was applied for risk category, PSA or Gleason grade either at presentation or at the time of failure. Progression was defined as a composite with biochemical failure (Phoenix criteria (PSA>nadir+2 ng ml−1)), start of systemic therapies or metastases. Results: Median age (interquartile range (IQR)), pretreatment PSA (IQR) and Gleason score (range) were 68 years (64–72), 5.9 ng ml−1 (2.2–11.3) and 7 (6–9), respectively. Median follow-up was 64 months (49–84). In all, 24/50 (48%) avoided androgen-deprivation therapies. Also, a total of 28/50 (56%) achieved a PSA nadir <0.5 ng ml−1, 15/50 (30%) had a nadir ⩾0.5 ng ml−1 and 7/50 (14%) did not nadir (PSA non-responders). Actuarial 1, 3 and 5-year progression-free survival (PFS) was 72, 40 and 31%, respectively. Actuarial 1, 3 and 5-year overall survival (OS) was 100, 94 and 87%, respectively. When comparing patients with PSA nadir <0.5 ng ml−1, nadir ⩾0.5 and non-responders, a statistically significant difference in PFS was seen (P<0.0001). Three-year PFS in each group was 57, 20 and 0%, respectively. Five-year OS was 96, 100 and 38%, respectively. Early in the learning curve, between 2005 and 2007, 3/50 (6%) developed a fistula. Intervention for bladder outlet obstruction was needed in 27/50 (54%). Patient-reported outcome measure questionnaires showed incontinence (any pad-use) as 8/26 (31%). Conclusions: In our series of high-risk patients, in whom 30–50% may have micro-metastases, disease control rates were promising in PSA responders, however, with significant morbidity. Additionally, post-HIFU PSA nadir appears to be an important predictor for both progression and survival. Further research on focal salvage ablation in order to reduce toxicity while retaining disease control rates is required.
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Affiliation(s)
- T T Shah
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, Whittington Hospital NHS Trust, London, UK
| | - M Peters
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Kanthabalan
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - N McCartan
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Y Fatola
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - J van der Voort van Zyp
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M van Vulpen
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Freeman
- Department of Histopathology, UCLH NHS Foundation Trust, London, UK
| | - C M Moore
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK.,NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
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Prostate Focused Ultrasound Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:21-41. [PMID: 26486330 DOI: 10.1007/978-3-319-22536-4_2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Hedgire SS, Eberhardt SC, Borczuk R, McDermott S, Harisinghani MG. Interpretation and reporting multiparametric prostate MRI: a primer for residents and novices. ACTA ACUST UNITED AC 2015; 39:1036-51. [PMID: 24566965 DOI: 10.1007/s00261-014-0097-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multiparametric MRI has developed as a tool for prostate cancer lesion detection, characterization, staging, surveillance, and imaging of local recurrence. Given the disease frequency and the growing importance of imaging, as reliance on PSA declines, radiologists involved in prostate MRI imaging must become proficient with the fundamentals of multiparametric prostate MRI (T2WI, DWI, DCE-MRI, and MR spectroscopy). Interpretation and reporting must yield accuracy, consistency, and add value to clinical care. This review provides a primer to novices and trainees learning about multiparametric prostate MRI. MRI technique is presented along with the use of particular MRI sequences. Relevant prostate anatomy is outlined and imaging features of prostate cancer with staging are discussed. Finally structured reporting is introduced, and some limitations of prostate MRI are discussed.
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Affiliation(s)
- Sandeep S Hedgire
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA,
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Lee DJ, Ahmed HU, Moore CM, Emberton M, Ehdaie B. Multiparametric magnetic resonance imaging in the management and diagnosis of prostate cancer: current applications and strategies. Curr Urol Rep 2014; 15:390. [PMID: 24430171 DOI: 10.1007/s11934-013-0390-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Magnetic resonance imaging (MRI) has become increasingly used worldwide in the diagnosis and management of prostate cancer. With advances in multiparametric MRI (mpMRI) technology, such as the use of dynamic contrast-enhanced and diffusion-weighted imaging sequences, observational studies have evaluated the utility for mpMRI in the continuum of prostate cancer management, from improving the detection of clinically significant prostate cancer, to planning radical prostatectomy and radiation therapy and the early detection of local recurrence. Furthermore, the potential for advanced imaging to reduce the burden of routine serial prostate needle biopsies for men on active surveillance is a promising area of research. MRI technology continues to evolve, and the potential applications in the management of prostate cancer care will require well-designed multi-institutional prospective clinical trials and rigorous efforts to standardize reporting and improve dissemination of expertise across institutions.
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Affiliation(s)
- Daniel J Lee
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
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Lai CY, Fite BZ, Ferrara KW. Ultrasonic enhancement of drug penetration in solid tumors. Front Oncol 2013; 3:204. [PMID: 23967400 PMCID: PMC3746679 DOI: 10.3389/fonc.2013.00204] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/25/2013] [Indexed: 12/22/2022] Open
Abstract
Increasing the penetration of drugs within solid tumors can be accomplished through multiple ultrasound-mediated mechanisms. The application of ultrasound can directly change the structure or physiology of tissues or can induce changes in a drug or vehicle in order to enhance delivery and efficacy. With each ultrasonic pulse, a fraction of the energy in the propagating wave is absorbed by tissue and results in local heating. When ultrasound is applied to achieve mild hyperthermia, the thermal effects are associated with an increase in perfusion or the release of a drug from a temperature-sensitive vehicle. Higher ultrasound intensities locally ablate tissue and result in increased drug accumulation surrounding the ablated region of interest. Further, the mechanical displacement induced by the ultrasound pulse can result in the nucleation, growth and collapse of gas bubbles. As a result of such cavitation, the permeability of a vessel wall or cell membrane can be increased. Finally, the radiation pressure of the propagating pulse can translate particles or tissues. In this perspective, we will review recent progress in ultrasound-mediated tumor delivery and the opportunities for clinical translation.
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Affiliation(s)
- Chun-Yen Lai
- Department of Biomedical Engineering, University of California Davis , Davis, CA , USA
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Autran-Gomez AM, Scarpa RM, Chin J. High-Intensity Focused Ultrasound and Cryotherapy as Salvage Treatment in Local Radio-Recurrent Prostate Cancer. Urol Int 2012; 89:373-9. [DOI: 10.1159/000339616] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rouvière O. Imaging techniques for local recurrence of prostate cancer: for whom, why and how? Diagn Interv Imaging 2012; 93:279-90. [PMID: 22464995 DOI: 10.1016/j.diii.2012.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Since there are salvage solutions, it is important to detect local recurrence of prostate cancer as early as possible. The first sign is "biochemical failure" in that the prostate specific antigen (PSA) concentration rises again. The definition of biochemical failure varies depending on the initial treatment: PSA greater than 0.2ng/mL after prostatectomy, nadir+2ng/mL after radiotherapy. There is no standardised definition of biochemical failure after cryotherapy, focused ultrasound, or brachytherapy. Magnetic resonance imaging (MRI) (particularly dynamic MRI) can detect local recurrence with good sensitivity. The role of spectroscopy is still under discussion. For the moment, ultrasound techniques are less effective than MRI.
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Affiliation(s)
- O Rouvière
- Department of Urinary and Vascular Imaging, hospices civils de Lyon, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon, France.
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Boutier R, Girouin N, Cheikh AB, Belot A, Rabilloud M, Gelet A, Chapelon JY, Rouvière O. Location of residual cancer after transrectal high-intensity focused ultrasound ablation for clinically localized prostate cancer. BJU Int 2011; 108:1776-81. [PMID: 21711432 DOI: 10.1111/j.1464-410x.2011.10251.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED What's known on the subject ? and What does the study add? Transrectal High-Intensity Focused Ultrasound (HIFU) ablation has been used as a minimally invasive treatment for localized prostate cancer for 15 years. Five-year disease-free survival rates of 66-78% have been reported, challenging the results of external-beam radiation therapy. Usually, a 6-mm safety margin is used in the apex to preserve the urinary sphincter and potency. The influence of this 6-mm margin on the results of the treatment has never been assessed. This retrospective study of a cohort of 99 patients who underwent systematic biopsy 3-6 months after HIFU ablation for prostate cancer (with a 6-mm safety margin in the apex) shows that post-HIFU residual cancer is found more frequently in the apex. Therefore, new strategies improving the prostate destruction at the apex while preserving the urinary continence need to be found. OBJECTIVE • To evaluate whether the location (apex/midgland/base) of prostate cancer influences the risk of incomplete transrectal high-intensity focused ultrasonography (HIFU) ablation. PATIENTS AND METHODS • We retrospectively studied 99 patients who underwent prostate cancer HIFU ablation (Ablatherm; EDAP, Vaulx-en-Velin, France) with a 6-mm safety margin at the apex, and had systematic biopsies 3-6 months after treatment. • Locations of positive pre- and post-HIFU sextants were compared. • The present study included two analyses. First, sextants negative before and positive after treatment were recoded as positive/positive, hypothesizing that cancer had been missed at pretreatment biopsy. Second, patients with such sextants were excluded. RESULTS • Pre-HIFU biopsies found cancer in all patients and in 215/594 sextants (36.2%); 55 (25.6%) positive sextants were in the apex, 86 (40%) in the midgland and 74 (34.4%) in the base. • After treatment, residual cancer was found in 36 patients (36.4%) and 50 sextants (8.4%); 30 (60%) positive sextants were in the apex, 12 (24%) in the midgland and eight (16%) in the base. • Both statistical analyses found that the locations of the positive sextants before and after HIFU ablation were significantly different (P < 0.001), with a higher proportion of positive apical sextants after treatment. • At the first analysis, the mean (95% confidence interval) probability for a sextant to remain positive after HIFU ablation was 8.8% (3.5-20.3%) in the base, 12.7% (5.8-25.9%) in the midgland and 41.7% (27.2-57.89%) in the apex. • At the second analysis, these same probabilities were 5.9% (1.9-17%), 9.9% (3.9-23.2%) and 27.3% (13.7-47%), respectively. CONCLUSION • When a 6-mm apical safety margin is used, residual cancer after HIFU ablation is found significantly more frequently in the apex.
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Affiliation(s)
- Romain Boutier
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
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Sciarra A, Barentsz J, Bjartell A, Eastham J, Hricak H, Panebianco V, Witjes JA. Advances in Magnetic Resonance Imaging: How They Are Changing the Management of Prostate Cancer. Eur Urol 2011; 59:962-77. [PMID: 21367519 DOI: 10.1016/j.eururo.2011.02.034] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 02/15/2011] [Indexed: 12/25/2022]
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Abstract
OBJECTIVE In patients with clinically suspected local recurrence of prostate cancer, a lobulated hyperintense mass in the radical prostatectomy fossa can be readily visualized with T2-weighted MRI, but this imaging technique is less successful after treatments such as radiation therapy, high-intensity focused ultrasound, and cryosurgery. We describe the additional value of functional techniques in the assessment of local recurrence. CONCLUSION The use of functional MRI techniques such as MR spectroscopy, diffusion-weighted imaging, and dynamic contrast-enhanced MRI has shown promise in increasing overall imaging performance in the detection of local recurrence.
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Management of prostate cancer recurrence after definitive radiation therapy. Cancer Treat Rev 2010; 36:91-100. [DOI: 10.1016/j.ctrv.2009.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 06/08/2009] [Accepted: 06/21/2009] [Indexed: 11/18/2022]
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Rouvière O, Vitry T, Lyonnet D. Imaging of prostate cancer local recurrences: why and how? Eur Radiol 2009; 20:1254-66. [DOI: 10.1007/s00330-009-1647-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 09/07/2009] [Accepted: 10/09/2009] [Indexed: 10/20/2022]
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Rouvière O, Girouin N, Glas L, Ben Cheikh A, Gelet A, Mège-Lechevallier F, Rabilloud M, Chapelon JY, Lyonnet D. Prostate cancer transrectal HIFU ablation: detection of local recurrences using T2-weighted and dynamic contrast-enhanced MRI. Eur Radiol 2009; 20:48-55. [PMID: 19690866 DOI: 10.1007/s00330-009-1520-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 06/07/2009] [Indexed: 12/14/2022]
Abstract
The objective was to evaluate T2-weighted (T2w) and dynamic contrast-enhanced (DCE) MRI in detecting local cancer recurrences after prostate high-intensity focused ultrasound (HIFU) ablation. Fifty-nine patients with biochemical recurrence after prostate HIFU ablation underwent T2-weighted and DCE MRI before transrectal biopsy. For each patient, biopsies were performed by two operators: operator 1 (blinded to MR results) performed random and colour Doppler-guided biopsies ("routine biopsies"); operator 2 obtained up to three cores per suspicious lesion on MRI ("targeted biopsies"). Seventy-seven suspicious lesions were detected on DCE images (n = 52), T2w images (n = 2) or both (n = 23). Forty patients and 41 MR lesions were positive at biopsy. Of the 36 remaining MR lesions, 20 contained viable benign glands. Targeted biopsy detected more cancers than routine biopsy (36 versus 27 patients, p = 0.0523). The mean percentages of positive cores per patient and of tumour invasion of the cores were significantly higher for targeted biopsies (p < 0.0001). The odds ratios of the probability of finding viable cancer and viable prostate tissue (benign or malignant) at targeted versus routine biopsy were respectively 3.35 (95% CI 3.05-3.64) and 1.38 (95% CI 1.13-1.63). MRI combining T2-weighted and DCE images is a promising method for guiding post-HIFU biopsy towards areas containing recurrent cancer and viable prostate tissue.
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Affiliation(s)
- Olivier Rouvière
- Department of Urinary and Vascular Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon 69437, France.
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Lemaitre L, Rouvière O, Penna-Renard R, Villers A, Puech P. L’IRM du cancer de la prostate : un changement de paradigme. ACTA ACUST UNITED AC 2008; 89:1053-64. [DOI: 10.1016/s0221-0363(08)73909-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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