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Calio B, Kasson M, Sugano D, Ortman M, Gaitonde K, Verma S, Sidana A. Multiparametric MRI: An Opportunity for Focal Therapy of Prostate Cancer. Semin Roentgenol 2018; 53:227-233. [DOI: 10.1053/j.ro.2018.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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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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Marshall S, Taneja S. Focal therapy for prostate cancer: The current status. Prostate Int 2015; 3:35-41. [PMID: 26157765 PMCID: PMC4494637 DOI: 10.1016/j.prnil.2015.03.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 12/29/2022] Open
Abstract
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.
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Miano R, De Nunzio C, Kim FJ, Rocco B, Gontero P, Vicentini C, Micali S, Oderda M, Masciovecchio S, Asimakopoulos AD. Transperineal versus transrectal prostate biopsy for predicting the final laterality of prostate cancer: are they reliable enough to select patients for focal therapy? Results from a multicenter international study. Int Braz J Urol 2014; 40:16-22. [PMID: 24642146 DOI: 10.1590/s1677-5538.ibju.2014.01.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 11/12/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the concordance of prostate cancer (PCa) laterality between the extended transperineal (TP) or transrectal (TR) prostate biopsy (BP) and radical prostatectomy (RP) specimens. To identify predictors of laterality agreement between BP and RP. MATERIALS AND METHODS Data from 533 consecutive patients with PCa (278 TP and 255 TR-diagnosed) treated with RP were analyzed. A 12-core technique was used for both TP and TR biopsies. Additional cores were obtained when necessary. RESULTS Overall, the percentage of agreement of PCa laterality between BP and RP was 60% (K = 0.27, p < 0.001). However, the RP confirmation of unilaterality at BP was obtained in just 33% of the cases. Considering the concordance on bilaterality as the ″target″ of our analysis, the sensitivity and specificity were 54.3% and 98.2% , respectively, with TP and 47.5% and 92.5%, respectively with TR. Focusing on patients with unilaterality at biopsy, none of the evaluated preoperative variables (biopsy technique, age, total positive biopsy cores, PSA, prostate volume, Gleason score on biopsy) were able to predict RP bilaterality in the multivariate analyses. CONCLUSIONS Most of the patients with unilateral involvement at BP harbored bilateral PCa after RP. TR and TP biopsy showed no difference in their capacity to predict the concordance of tumor laterality at RP. None of the preoperative evaluated variables can predict the tumor laterality at RP. Using BP unilaterality to include patients in focal therapy (FT) protocols may hinder the oncologic efficacy of FT.
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Affiliation(s)
- R Miano
- Division of Urology, Department of Experimental Medicine and Surgery, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
| | - C De Nunzio
- Department of Urology, Sant'Andrea Hospital, University of La Sapienza, Rome, Italy
| | - F J Kim
- Division of Urology, Department of Surgery, Denver Health Medical Centre, Denver, CO, USA
| | - B Rocco
- Clinica Urologica I, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - P Gontero
- Department of Urology-1, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy
| | - C Vicentini
- Division of Urology, Ospedale Civile G.Mazzini, University of L'Aquila, L'Aquila, Italy
| | - S Micali
- Department of Urology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - M Oderda
- DDivision of Urology, Ospedale Civile G.Mazzini, University of L'Aquila, L'Aquila, Italy
| | - S Masciovecchio
- Division of Urology, Ospedale Civile G.Mazzini, University of L'Aquila, L'Aquila, Italy
| | - A D Asimakopoulos
- Division of Urology, Department of Experimental Medicine and Surgery, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
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Habchi H, Bratan F, Paye A, Pagnoux G, Sanzalone T, Mège-Lechevallier F, Crouzet S, Colombel M, Rabilloud M, Rouvière O. Value of prostate multiparametric magnetic resonance imaging for predicting biopsy results in first or repeat biopsy. Clin Radiol 2014; 69:e120-8. [DOI: 10.1016/j.crad.2013.10.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/13/2013] [Accepted: 10/30/2013] [Indexed: 12/31/2022]
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Van Velthoven R, Aoun F, Limani K, Narahari K, Lemort M, Peltier A. Primary Zonal High Intensity Focused Ultrasound for Prostate Cancer: Results of a Prospective Phase IIa Feasibility Study. Prostate Cancer 2014; 2014:756189. [PMID: 24587908 PMCID: PMC3920856 DOI: 10.1155/2014/756189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To present the results of a prospective phase IIa study assessing the role of primary zonal High Intensity Focused Ultrasound (HIFU) for prostate cancer treatment. METHODS 31 consecutive patients with unilateral organ confined prostate cancer primarily treated by zonal HIFU (from February 2007 to June 2011) were recruited into a single centre prospective phase IIa feasibility study. Complications were prospectively recorded and graded according to the Clavien-Dindo score. Postoperatively, patients were followed with serial serum PSA determinations and digital rectal examinations. An individual PSA nadir was identified in each patient. Followup also included whole gland biopsies performed in the event of a PSA rising>2.0 ng/mL above nadir value (Phoenix criteria). RESULTS At a median followup of 38 months, biochemical recurrence free survival was 100%, 89%, and 82.7% at 1, 2, and 3 years, respectively, with overall and cancer specific survival of 100%. The procedure was safe and well tolerated with no major adverse events. All patients were continent at their last followup and 55.2% (16/29) had erectile function sufficient for penetration. CONCLUSION Primary zonal HIFU is a valid focal therapy strategy, safe and feasible in day to day practice with good promising results [corrected].
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Affiliation(s)
- Roland Van Velthoven
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
| | - Fouad Aoun
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
| | - Ksenija Limani
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
| | - Krishna Narahari
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
| | - Marc Lemort
- Department of Radiology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute, 1 Héger-Bordet Street, 1000 Brussels, Belgium
- Université Libre de Bruxelles, 50 Franklin Roosevelt Avenue, 1050 Brussels, Belgium
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Durand M, Barret E, Galiano M, Rozet F, Sanchez-Salas R, Ahallal Y, Macek P, Gaya JM, Cerruti J, Devilliers H, Loeffler J, Amiel J, Vallancien G, Cathelineau X. Focal cryoablation: a treatment option for unilateral low-risk prostate cancer. BJU Int 2013; 113:56-64. [DOI: 10.1111/bju.12370] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Matthieu Durand
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
- Department of Urology; Hôpital Archet 2; Centre Hospitalier Universitaire de Nice; University of Nice Sophia-Antipolis; Nice France
| | - Eric Barret
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
| | - Marc Galiano
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
| | - François Rozet
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
| | - Rafael Sanchez-Salas
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
| | - Youness Ahallal
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
| | - Petr Macek
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
| | - Jose-Maria Gaya
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
| | - Jennifer Cerruti
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Disease; University Hospital of Dijon; Dijon France
| | - Joyce Loeffler
- Department of Urology; Centre Hospitalier de Grasse; Grasse France
| | - Jean Amiel
- Department of Urology; Hôpital Archet 2; Centre Hospitalier Universitaire de Nice; University of Nice Sophia-Antipolis; Nice France
| | - Guy Vallancien
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
| | - Xavier Cathelineau
- Department of Urology; Institut Montsouris; Université Paris-Descartes; Paris France
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Bozzini G, Colin P, Betrouni N, Maurage CA, Leroy X, Simonin S, Martin-Schmitt C, Villers A, Mordon S. Efficiency of 5-ALA mediated photodynamic therapy on hypoxic prostate cancer: a preclinical study on the Dunning R3327-AT2 rat tumor model. Photodiagnosis Photodyn Ther 2013; 10:296-303. [PMID: 23993856 DOI: 10.1016/j.pdpdt.2013.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 01/10/2013] [Accepted: 01/13/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate photodynamic therapy (PDT) using 5-ALA-induced protoporphyrin IX (PPIX) in an in vivo hypoxic tumor model and its monitoring using MRI. MATERIAL AND METHODS Dunning R3327-AT2 tumors were grafted in the neck of Copenhagen rats. PDT using 150 mg 5-ALA/kg i.v. was performed by focal interstitial illumination of the photosensitized tumor (λ=633 nm; fluence=100 J/cm(2)). MRI at baseline and 2 days after treatment (T1, T2 and dynamic gadolinium enhanced sequences) were performed. Necrosis volumes were determined on post-procedure MRI. Tumors were resected 2 days post-PDT and obtained necrosis was determined histopathologically. Intra-tumoral PPIX distribution was evaluated using confocal microscopy and tissue porphyrin quantification. RESULTS Twenty rats were treated divided into three groups: continuous (n=7), fractionated illumination (n=7), and a control group receiving only light or only ALA or neither (n=6). Baseline MRI confirmed the hypoxic character of tumors. Necrosis volumes determined on posttreatment MRI were not reproducible and presented with important geometric and volumetric variability. Average necrosis volumes of 0.39 cc (0-0.874 cc) in the continuous group, 0.24 cc (0.107-0.436 cc) in the fractionated group and 0.012 cc (0-0.071 cc) in the control group were observed. Intra-tumoral PPIX distribution was heterogeneous and PPIX quantification revealed low intra-tumoral concentration. CONCLUSION Necrosis volumes induced by 5-ALA-mediated PDT were highly variable and non reproducible, probably because of lack of intra-tissular oxygen. Photosensitizer was poorly represented inside the tumor and its distribution was heterogeneous. Our study suggests that 5-ALA-mediated PDT might not be the best management option for hypoxic prostatic adenocarcinoma.
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Affiliation(s)
- G Bozzini
- Lille University Hospital, Department of Urology, France.
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Bozzini G, Colin P, Nevoux P, Villers A, Mordon S, Betrouni N. Focal therapy of prostate cancer: energies and procedures. Urol Oncol 2013; 31:155-67. [DOI: 10.1016/j.urolonc.2012.05.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/29/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW The advent of prostate-specific antigen screening has led to a seven-fold increase in the incidence of prostate cancer without a resultant decrease in mortality rate. This has led to the belief that urologists are overdetecting and overtreating clinically insignificant disease. To maintain the delicate balance between high cancer cure rate and overtreatment, which could potentially lead to unnecessary morbidities, focal therapy has emerged as the reasonable middle ground. In this article, we present the conceptual basis and the challenges of focal therapy, while emphasizing the critical role of imaging in focal treatment of prostate cancer. RECENT FINDINGS Multiple phase I trials have demonstrated the feasibility, short-term efficacy, and safety of focal therapy. Fundamental to the success of these trials and the ultimate acceptance of focal therapy is the integral role of imaging in optimal patient selection. Among the different imaging modalities, only ultrasound and multiparametric MRI are intimately involved in the detection, diagnosis, staging, and treatment of prostate cancer. Each modality has its own unique advantages and shortcomings. Recent advances in enhanced ultrasound modalities, functional MRIs, and biopsy platforms have taken focal therapy one step closer to becoming the standard of care. SUMMARY Although early results of phase I focal therapy trials are encouraging, long-term oncological outcomes remain to be elucidated. Incorporation of these technological advances into large prospective trials is needed to establish focal therapy as an important asset in the urologist's armamentarium against prostate cancer.
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Orczyk C, Mikheev A, Rosenkrantz AB, Melamed J, Taneja SS, Rusinek H. Imaging of prostate cancer: a platform for 3D co-registration of in-vivo MRI ex-vivo MRI and pathology. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2012; 8316:83162M. [PMID: 24563727 DOI: 10.1117/12.911369] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Multi-parametric MRI is emerging as a promising method for prostate cancer diagnosis. prognosis and treatment planning. However, the localization of in-vivo detected lesions and pathologic sites of cancer remains a significant challenge. To overcome this limitation we have developed and tested a system for co-registration of in-vivo MRI, ex-vivo MRI and histology. MATERIALS AND METHODS Three men diagnosed with localized prostate cancer (ages 54-72, PSA levels 5.1-7.7 ng/ml) were prospectively enrolled in this study. All patients underwent 3T multi-parametric MRI that included T2W, DCE-MRI, and DWI prior to robotic-assisted prostatectomy. Ex-vivo multi-parametric MRI was performed on fresh prostate specimen. Excised prostates were then sliced at regular intervals and photographed both before and after fixation. Slices were perpendicular to the main axis of the posterior capsule, i.e., along the direction of the rectal wall. Guided by the location of the urethra, 2D digital images were assembled into 3D models. Cancer foci, extra-capsular extensions and zonal margins were delineated by the pathologist and included in 3D histology data. A locally-developed software was applied to register in-vivo, ex-vivo and histology using an over-determined set of anatomical landmarks placed in anterior fibro-muscular stroma, central. transition and peripheral zones. The mean root square distance across corresponding control points was used to assess co-registration error. RESULTS Two specimens were pT3a and one pT2b (negative margin) at pathology. The software successfully fused in-vivo MRI. ex-vivo MRI fresh specimen and histology using appropriate (rigid and affine) transformation models with mean square error of 1.59 mm. Coregistration accuracy was confirmed by multi-modality viewing using operator-guided variable transparency. CONCLUSION The method enables successful co-registration of pre-operative MRI, ex-vivo MRI and pathology and it provides initial evidence of feasibility of MRI-guided surgical planning.
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Affiliation(s)
- Clement Orczyk
- University Hospital of Caen, Avenue de la Côte de Nacre, Caen FRANCE 14033 ; New York University Medical Center. 550 1 Avenue, New York NY USA 10016
| | - Artem Mikheev
- New York University Medical Center. 550 1 Avenue, New York NY USA 10016
| | | | - Jonathan Melamed
- New York University Medical Center. 550 1 Avenue, New York NY USA 10016
| | - Samir S Taneja
- New York University Medical Center. 550 1 Avenue, New York NY USA 10016
| | - Henry Rusinek
- New York University Medical Center. 550 1 Avenue, New York NY USA 10016
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Borofsky MS, Ito T, Rosenkrantz AB, Taneja SS. Focal therapy for prostate cancer - where are we in 2011? Ther Adv Urol 2011; 3:183-92. [PMID: 21969848 DOI: 10.1177/1756287211418724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Prostate cancer treatment is a controversial topic amongst physicians and patients alike. Radical therapies such as prostatectomy and whole gland radiation offer the best outcomes in terms of oncologic efficacy, but the decision to undergo treatment must be weighed against its potential morbidity. Over the past decade, the concept of focal therapy for prostate cancer has been introduced as a potential method of achieving oncologic control with a lesser degree of morbidity. Focal therapy refers to isolated ablation of a tumor focus with sparing of uninvolved, surrounding tissue. While it remains in the early stages of development, considerable research is underway that will help determine the optimal method of achieving this goal. Current areas of investigation include appropriate candidate selection, lesion identification, modality of treatment, and follow-up strategies.
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Affiliation(s)
- Michael S Borofsky
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, NY, USA
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Abstract
Precise localization of prostate cancer is essential for the success of focal therapies. Despite suggestions that saturation biopsy might be useful in this regard, a new study implies it cannot accurately pinpoint prostate tumors. research efforts would perhaps be better focused on identifying which patients require treatment for clinically localized prostate cancer in the first place.
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