Ablation of bull prostate using novel bipolar radiofrequency ablation probe

Focal bipolar radiofrequency ablation for localized prostate cancer: Safety and feasibility

OBJECTIVES

To evaluate the safety and feasibility of focal bipolar radiofrequency ablation in men with localized prostate cancer.

METHODS

A review of 10 patients treated with a novel bipolar radiofrequency ablation probe integrated in a coil design (Encage; Trod Medical, Bradenton, FL, USA) between 2011 and 2017 in two prospective pilot trials. All men had clinical stage T1c prostate cancer, prostate-specific antigen <10 ng/mL and Gleason score ≤7. Ablation was carried out under general anesthesia, and bipolar probes were inserted transperineally under transrectal ultrasound guidance. Treatment-related adverse events, quality of life and negative biopsy rate were evaluated at 6 months after ablation. The Wilcoxon signed-rank test was used to compare baseline and post-treatment symptom scores.

RESULTS

The median age was 58 years (range 50-64 years) and the median prostate volume was 49.65 cc (range 21-68 cc). Prostate cancer with a Gleason score of 6 (3 + 3) and 7 (3 + 4) was noted in seven and three patients, respectively. The median number of radiofrequency ablation cycles was 2.5 (range 2-5). All patients were catheter-free and able to void the day of surgery. Within 6 months after ablation, all adverse events were low grade, with the exception of one grade 3 hematuria that required cystoscopy without coagulation. Six months after ablation bowel, urinary and hormonal functions, and overall satisfaction remained stable. Erectile dysfunction occurred in two out of four patients who had normal sexual function before the procedure. Neither urinary incontinence nor urinary infection was noted.

CONCLUSIONS

This first report on focal bipolar radiofrequency ablation documents a safe and feasible treatment option for selected patients with localized prostate cancer.

CEUS examination of the outcome of radiofrequency ablation of canine prostate lesions

Purpose: To determine the feasibility of using contrast-enhanced ultrasonography (CEUS) to dynamically examine the scope and development of radiofrequency ablation (RFA) lesions in the canine prostate.Material and methods: Ten male canines were divided into two groups of five canines each: the 1 week after the RFA group and the 1 month after the RFA group. RFA was performed on one side of the prostate in each canine. For the 1 month after the RFA group, the other side of the prostate underwent RFA prior to euthanasia, and the RFA lesion on this side was included as the immediate RFA group. The RFA lesion volume was measured by CEUS. The evaluation efficacy of CEUS for prostate RFA lesions was determined and compared with the pathological measurements.Results: In the immediately after RFA group, 1 week after RFA group, and 1 month after RFA group, the RFA lesion volumes were 0.77 ± 0.34, 1.11 ± 0.61, and 0.19 ± 0.09 cm³, as measured by CEUS; the volumes measured by pathology at the corresponding time points were 0.85 ± 0.28, 0.96 ± 0.31, and 0.20 ± 0.06 cm³, respectively. CEUS accurately assessed the RFA lesions at all the time points, and the measurement results were not significantly different from those of the pathological results (p > .05).Conclusions: CEUS reflects the extent of prostate RFA lesions and dynamically shows their changes in blood flow perfusion.

Focal therapy for localized prostate cancer: is there a "middle ground" between active surveillance and definitive treatment?

In recent years, it has come a long way in the diagnosis, treatment, and follow-up of prostate cancer. Beside this, it was argued that definitive treatments could cause overtreatment, particularly in the very low, low, and favorable risk group. When alternative treatment and follow-up methods are being considered for this group of patients, active surveillance is seen as a good alternative for patients with very low and low-risk groups in this era. However, it has become necessary to find other alternatives for patients in the favorable risk group or patients who cannot adopt active follow-up. In the light of technological developments, the concept of focal therapy was introduced with the intensification of research to treat only the lesioned area instead of treating the entire organ for prostate lesions though there are not many publications about many of them yet. According to the initial results, it was understood that the results could be good if the appropriate focal therapy technique was applied to the appropriate patient. Thus, focal therapies have begun to find their "middle ground" place between definitive therapies and active follow-up.

The prostate cancer focal therapy

Despite prostate cancer (PCa) is the leading form of non-cutaneous cancer in men, most patients with PCa die with disease rather than of the disease. Therefore, the risk of overtreatment should be considered by clinicians who have to distinguish between patients with high risk PCa (who would benefit from radical treatment) and patients who may be managed more conservatively, such as through active surveillance or emerging focal therapy (FT). The aim of FT is to eradicate clinically significant disease while protecting key genito-urinary structures and function from injury. While effectiveness studies comparing FT with conventional care options are still lacking, the rationale supporting FT relies on evidence-based advances such as the understanding of the index lesion's central role in the natural history of the PCa and the improvement of multiparametric magnetic resonance imaging (mpMRI) in the detection and risk stratification of PCa. In this literature review, we want to highlight the rationale for FT in PCa management and the current evidence on patient eligibility. Furthermore, we summarize the best imaging modalities to localize the target lesion, describe the current FT techniques in PCa, provide an update on their oncological outcomes and highlight trends for future research.

Focal therapy for prostate cancer: The current status

Purpose

In an era of increasing prostate cancer incidence and earlier detection, the assessment of clinical significance of prostate cancer is critical. Minimally invasive therapies are increasingly being investigated in localized prostate cancer.

Methods and results

In this review, we discuss the current status of magnetic resonance imaging targeted fusion prostate biopsy and focal therapy for prostate cancer, its rationale, and techniques.

Conclusion

Focal therapy offers a promising outlook for prostate cancer treatment, with the goal of effectively achieving cancer control while minimizing morbidity. Long term studies are needed.

Electrosurgery in urology: recent advances

Inadequate hemostasis is one of the most important causes of morbidity and mortality following urological surgery. Despite the long-term usage of coagulation, there is an ongoing development of new devices, including bipolar transurethral resection of the prostate or new vessel-sealing devices. A thorough understanding of the advantages and disadvantages of these new instruments can improve the operative experience for both the urologist and patient. The optimal coagulation system should be small, efficient, easy to handle and with low heat spread. In this article, we analyze different electrothermal coagulation systems and modern tissue-sealing devices in urological applications with the aim to substantiate the advantages and disadvantages of each technique in terms of efficacy and safety.

Long-term results of bipolar radiofrequency needle ablation of the prostate for lower urinary tract symptoms

PURPOSE

To report the first long-term experience on the efficacy of bipolar transurethral radiofrequency needle ablation (RFA) in patients with lower urinary tract symptoms that are secondary to benign prostatic hyperplasia.

PATIENTS AND METHODS

A nonrandomized prospective cohort of 12 candidates for transurethral resection of the prostate underwent bipolar transurethral RFA in 2004 (mean age 63; prostate volume 34 cc). Patients were evaluated preoperatively and at 3, 12, 36, and 60 months postprocedure. International Prostate Symptom Score (IPSS), quality-of-life (QoL) index, peak urinary flow rate (Qmax), postvoid residual volume (PVR), and need for a second procedure were evaluated at each follow-up interval.

RESULTS

Significant improvement in urinary symptoms and voiding parameters occurred at 1 year after the procedure. Mean improvements for IPSS, QoL, and Q(max) were 12 points, 3.5 points, and 8 mL/s, respectively. Improvement, however, was not sustained in the long term. Nine patients ultimately had treatment failure necessitating a secondary procedure, one at 2 months, five after 3 years, and three by 5 years. Two patients were lost to follow-up. Only one patient had long-term benefit from the procedure.

CONCLUSION

In the short term, bipolar RFA produced clinically meaningful improvement in symptom scores and voiding parameters. The majority of patients, however, eventually experienced treatment failure and needed additional surgical procedures. Only 8% of patients had long-term (>5 years) benefit.