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Correia ETDO, Baydoun A, Li Q, Costa DN, Bittencourt LK. Emerging and anticipated innovations in prostate cancer MRI and their impact on patient care. Abdom Radiol (NY) 2024:10.1007/s00261-024-04423-4. [PMID: 38877356 DOI: 10.1007/s00261-024-04423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Abstract
Prostate cancer (PCa) remains the leading malignancy affecting men, with over 3 million men living with the disease in the US, and an estimated 288,000 new cases and almost 35,000 deaths in 2023 in the United States alone. Over the last few decades, imaging has been a cornerstone in PCa care, with a crucial role in the detection, staging, and assessment of PCa recurrence or by guiding diagnostic or therapeutic interventions. To improve diagnostic accuracy and outcomes in PCa care, remarkable advancements have been made to different imaging modalities in recent years. This paper focuses on reviewing the main innovations in the field of PCa magnetic resonance imaging, including MRI protocols, MRI-guided procedural interventions, artificial intelligence algorithms and positron emission tomography, which may impact PCa care in the future.
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Affiliation(s)
| | - Atallah Baydoun
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Qiubai Li
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daniel N Costa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Leonardo Kayat Bittencourt
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Department of Radiology, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
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2
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Nicoletti R, Alberti A, Castellani D, Yee CH, Zhang K, Poon DMC, Chiu PKF, Campi R, Resta GR, Dibilio E, Pirola GM, Chiacchio G, Fuligni D, Brocca C, Giulioni C, De Stefano V, Serni S, Gauhar V, Ng CF, Gacci M, Teoh JYC. Functional outcomes and safety of focal therapy for prostate cancer: a systematic review on results and patient-reported outcome measures (PROMs). Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00698-8. [PMID: 37491432 DOI: 10.1038/s41391-023-00698-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Focal therapy (FT) is a promising alternative with curative intent for Low- to Intermediate-risk localized Prostate Cancer (PCa), claiming better functional outcomes and safety profile than standard whole-gland treatments. Ten different FT modalities have been described in the literature. The objective of our narrative review is to evaluate the safety profile and functional outcomes of these different modalities and the current most used tools of assessment for those outcomes. MATERIAL AND METHODS Literature search was performed on 21st February 2023 using PubMed, EMBASE, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Articles reporting whole-gland treatments were excluded. All articles reporting functional outcomes were included. RESULTS One-hundred-seven studies, reporting data on 6933 patients, were included (26 on High Intensity Focal Ultrasound, 22 on Focal Cryotherapy, 14 on Irreversible Electroporation, 11 on Focal brachytherapy, 10 on Focal Laser Ablation, 8 on Photodynamic Therapy, 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation, 1 on Prostatic Artery Embolization, and 7 studies comparing different FTs). Post-operative pad-free rate ranged between 92.3-100%. Greater heterogeneity exists considering the Change in Erectile Function, with Changing in Erectile function- rates ranging between 0-94.4% (Cryotherapy). The most used Patient-Reported Outcome Measures (PROMs) were the International Prostate Symptom Score and the International Index of Erectile Function for incontinence/urinary function and potency, respectively. The most common reported complications were hematuria, infections, and urethral strictures, with rates widely ranging among different treatments. The Clavien-Dindo Classification was the most used (40/88 papers) to describe adverse events. CONCLUSION FT is a promising treatment for localized PCa, achieving excellent results in terms of safety and functional outcomes. There is a wide heterogeneity in the definition of PROMS and time of collection between studies. High quality comparative studies with standard treatments are needed to reinforce these findings.
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Affiliation(s)
- Rossella Nicoletti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Andrea Alberti
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Chi Hang Yee
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Zhang
- Department of Urology, Beijing United Family Hospital and Clinics, 100015, Beijing, China
| | - Darren M C Poon
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Giulio Raffaele Resta
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Edoardo Dibilio
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | | | - Giuseppe Chiacchio
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Demetra Fuligni
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Brocca
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Giulioni
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Virgilio De Stefano
- Faculty of Medicine and Surgery, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Vineet Gauhar
- Ng Teng Fong General Hospital (NUHS), Singapore, Singapore
| | - Chi Fai Ng
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Jeremy Yuen Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
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3
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Focal Therapy for Prostate Cancer: The Impact on Sexual Function. URO 2022. [DOI: 10.3390/uro2040025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Focal therapy (FT) has emerged as a potential treatment for localized prostate cancer (PCa) with encouraging functional outcomes. According to the compelling evidence based on meta-analyses and recent trials, erectile function (EF) is mostly retained at 6 and 12 months after FT when compared to baseline. These findings are consistent across different energy sources reported to date. However, overall, quality of life, including impotence, was not the endpoint for most studies. Additionally, impotency has not been consistently reported in most of the recent literature. Furthermore, confounding factors such as baseline potency and usage of phosphodiesterase 5 inhibitors (PDE5-I) were also frequently undisclosed. Long-term functional outcomes are awaited. To fully comprehend how FT affects EF, more extensive long-term randomized clinical trials using EF as a primary outcome are needed.
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Estimation of porcine pancreas optical properties in the 600-1100 nm wavelength range for light-based therapies. Sci Rep 2022; 12:14300. [PMID: 35995952 PMCID: PMC9395366 DOI: 10.1038/s41598-022-18277-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
This work reports the optical properties of porcine pancreatic tissue in the broad wavelength range of 600–1100 nm. Absorption and reduced scattering coefficients (µa and µs′) of the ex vivo pancreas were obtained by means of Time-domain Diffuse Optical Spectroscopy. We have investigated different experimental conditions—including compression, repositioning, spatial sampling, temporal stability—the effect of the freezing procedure (fresh vs frozen-thawed pancreas), and finally inter-sample variability. Good repeatability under different experimental conditions was obtained (median coefficient of variation less than 8% and ~ 16% for µa and µs′, respectively). Freezing–thawing the samples caused an irreversible threefold reduction of µs′ and no effect on µa. The absorption and reduced scattering spectra averaged over different samples were in the range of 0.12–0.74 cm−1 and 12–21 cm−1 with an inter-sample variation of ~ 10% and ~ 40% for µa and µs′, respectively. The calculated effective transport coefficient (µeff) for fresh pancreatic tissue shows that regions between 800–900 nm and 1050–1100 nm are similar and offer the lowest tissue attenuation in the considered range (i.e., µeff ranging from 2.4 to 2.7 cm−1). These data, describing specific light-pancreas interactions in the therapeutic optical window for the first time, provide pivotal information for planning of light-based thermotherapies (e.g., laser ablation) and instruction of light transport models for biophotonic applications involving this organ.
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Ragonese M, Dibitetto F, Bassi P, Pinto F. Laser technology in urologic oncology. Urologia 2022; 89:338-346. [PMID: 35422152 DOI: 10.1177/03915603221088721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laser technology has been used in Urology since the 80s with a lot of different applications in endoscopic and open surgery. With the developments of the technology and the introduction of new active medium and source of laser energy, this technology have become the gold standard not only in stone surgery but even in benign prostate enlargement (BPE) surgical treatment. Regarding urologic oncology, laser energy has now reached an important role in focal therapy and in conservative treatment. The possibility of having better functional outcomes without any relevant impact on oncological results led to an increased use of laser in penile surgery, with a significant mention in urological guidelines for this option. In urothelial cancers as well, both in conservative management of upper tract tumors that in the treatment of non muscle invasive bladder cancer, a clear role of these relatively new source of energy have been demonstrated. Finally, both in prostate that in renal cancer the strategy of focal therapy may take advantage from this precise and fine technology. In this review we analyzed and described the applications of laser energy in urological cancers with a specific focus on penile, urothelial and prostate cancer.
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Affiliation(s)
- Mauro Ragonese
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
| | - Francesco Dibitetto
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
| | - PierFrancesco Bassi
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
| | - Francesco Pinto
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
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Focal prostate cancer therapy in the era of multiparametric MRI: a review of options and outcomes. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00501-0. [PMID: 35246609 DOI: 10.1038/s41391-022-00501-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/19/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The goal of prostate cancer focal therapy is to achieve oncologic control while reducing the rate of adverse events associated with whole-gland treatments. Numerous focal therapy modalities are currently available with early data demonstrating highly variable rates of cancer control and preservation of sexual/urinary function. METHODS All English language clinical trial publications evaluating various focal therapies for localized prostate cancer were reviewed. The literature search was limited to studies from the modern era of MRI-guided treatment, as MRI is hypothesized to improve tumor localization and targeting. Primary outcomes were post-treatment cancer-free rates, in-field/out-of-field recurrence rates, and rates of conversion to radical therapy. Secondary outcomes were related to functional status and adverse events. RESULTS Numerous focal therapies were identified with clinical data including high-intensity focused ultrasound, transurethral ultrasound ablation, focal laser ablation, focal cryotherapy, irreversible electroporation, and photodynamic therapy. Recurrence rates among all technologies were low to moderate (0-51%) and rates of freedom from radical treatment were highly variable (46-98%). Rates of erectile dysfunction and incontinence generally ranged from 0 to 44% and 0 to 12%, respectively, with variability between focal therapy modalities. Caution should be exercised when comparing studies as outcomes are strongly associated with patient selection. No individual focal therapy is currently recommended by society guidelines. Randomized controlled trials are ongoing in search of a standard of care. CONCLUSION For localized MRI-visible prostate cancer, early clinical trial data demonstrate that focal therapy can provide good to moderate cancer control while having preferable side effect profiles compared to whole-gland treatments. While current studies do not make head-to-head comparisons between technologies, early data suggest a potential for these technologies to provide adequate cancer control in a well-selected patient population. The oncologic outcomes of some focal therapies appear promising; however, longer-term follow-up data are needed to assess the durability of early outcomes.
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Candela L, Kasraeian A, Barret E. Current evidence for focal laser ablation and vascular-targeted photodynamic therapy for localized prostate cancer: review of literature published in the last 2 years. Curr Opin Urol 2022; 32:192-198. [PMID: 35013079 DOI: 10.1097/mou.0000000000000964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Currently, a significant number of patients are diagnosed with unilateral and apparently unifocal low or intermediate-risk prostate cancer (PCa). These patients are suitable for focal therapy, thus preventing radical treatment side effects without affecting cancer control. Among focal therapy energy sources, laser-based technologies have shown promising outcomes. We aimed to summarize recent data on focal laser ablation (FLA) and vascular-targeted photodynamic therapy (VTP) for PCa. RECENT FINDINGS We selected eight studies reporting data on 1155 patients with PCa who underwent laser-based focal therapy. Five studies were on FLA and three on VTP (six prospective and two retrospective series); four reported both oncologic and functional outcomes whereas in three only oncologic and one only functional outcomes were discussed. Follow-up protocols and durations varied widely among the studies. PCa recurrence rates ranged between 20 and 56%. Urinary and erectile function were preserved after treatment, and complications were mild and transient. A lack of high-quality data on long-term oncological outcomes still remains, thus further highlighting the need for prospective controlled studies. SUMMARY FLA and VTP are well tolerated procedures with excellent functional outcomes. However, both procedures showed a significant rate of PCa recurrence, thus demonstrating a certain grade of oncologic control failure of the procedure and/or nonoptimal patients' selection.
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Affiliation(s)
- Luigi Candela
- Urology Department, Institut Mutualiste Montsouris, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Eric Barret
- Urology Department, Institut Mutualiste Montsouris, Paris, France
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MR Imaging in Real Time Guiding of Therapies in Prostate Cancer. Life (Basel) 2022; 12:life12020302. [PMID: 35207589 PMCID: PMC8878909 DOI: 10.3390/life12020302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
Magnetic resonance imaging (MRI)-guided therapy for prostate cancer (PCa) aims to reduce the treatment-associated comorbidity of existing radical treatment, including radical prostatectomy and radiotherapy. Although active surveillance has been used as a conservative method to reduce overtreatment, there is a growing demand for less morbidity and personalized (focal) treatment. The development of multiparametric MRI was of real importance in improving the detection, localization and staging of PCa. Moreover, MRI has been useful for lesion targeting within the prostate, as it is used in the guidance of prostate biopsies, by means of cognitive registration, MRI-ultrasound fusion guidance or direct in-bore MRI-guidance. With regard to PCa therapies, MRI is used for precise probe placement into the lesion and to accurately monitor the treatment in real-time. Moreover, advances in MR-compatible thermal ablation allow for noninvasive real-time temperature mapping during treatment. In this review, we present an overview of the current status of MRI-guided therapies in PCa, focusing on cryoablation, focal laser ablation, high intensity focused ultrasound and transurethral ultrasound ablation. We explain the important role of MRI in the evaluation of the completeness of the ablation and during follow-up. Finally, we will discuss the challenges and future development inherent to these new technologies.
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Li CL, Fisher CJ, Wilson BC, Weersink RA. Preclinical evaluation of a clinical prototype transrectal diffuse optical tomography system for monitoring photothermal therapy of focal prostate cancer. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-210262RR. [PMID: 35106981 PMCID: PMC8806493 DOI: 10.1117/1.jbo.27.2.026001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/05/2022] [Indexed: 05/20/2023]
Abstract
SIGNIFICANCE Our work demonstrates in preclinical models that continuous-wave transrectal diffuse optical tomography (TRDOT) can be used to accurately monitor photothermal therapy (PTT) and, in particular, the progression of the photocoagulation boundary toward the rectum. When used in patients, this should prevent rectal damage during PTT, thereby achieving maximum treatment efficacy while ensuring safety, using a technology platform suitable for wide dissemination. AIM We aim to validate that TRDOT measurements analyzed using a shape-based image-reconstruction algorithm (SBDOT) allow localization of the photocoagulation boundary during PTT within ±1 mm toward the rectum in the transverse plane. APPROACH TRDOT measurements were performed in tissue-simulating phantoms, ex vivo tissues, and an in vivo canine prostate model. The accuracy and sensitivity of reconstructing the size and location of the coagulation zone were determined, based on changes in the tissue absorption and reduced scattering coefficients upon photocoagulation. The reconstruction also yields the native and coagulated tissue optical properties. RESULTS The TRDOT measurements and SBDOT reconstruction algorithm were confirmed to perform sufficiently well for clinical translation in PTT monitoring, recovering the location of the coagulation boundary within ±1 mm compared to the true value as determined by direct visualization postexcision and/or MRI. CONCLUSIONS Implementing previously described TRDOT instrumentation and SBDOT image reconstruction in different tissue models confirms the potential for clinincal translation, including required refinements of the system and reconstruction algorithm.
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Affiliation(s)
- Celina L. Li
- University of Toronto, Department of Medical Biophysics, Toronto, Canada
| | - Carl J. Fisher
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Brian C. Wilson
- University of Toronto, Department of Medical Biophysics, Toronto, Canada
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert A. Weersink
- University of Toronto, Department of Medical Biophysics, Toronto, Canada
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Department of Radiation Oncology, Toronto, Canada
- University of Toronto, Institute of Biomedical Engineering, Toronto, Canada
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Fiard G, Chowdhury A, Potter AR, Pook CJ, Kelly D, Emberton M, Yap T. Detailing Sexual Outcomes After Focal Therapy for Localised Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2021; 8:926-941. [PMID: 34580049 DOI: 10.1016/j.euf.2021.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/04/2021] [Accepted: 09/10/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Focal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures, such as the urethral sphincter and neurovascular bundles. However, how this tissue preservation may translate into improved outcomes, particularly into improved sexual outcomes, is still an active research field. OBJECTIVE We conducted a systematic review and meta-analysis of the literature to summarise the existing evidence, in order to provide patients with updated data on what to expect after treatment and help identify gaps in current knowledge that may warrant future research. EVIDENCE ACQUISITION A systematic literature search was conducted on Medline, EMBASE, Scopus, and Web of Science. The search strategy was defined using the "litsearchr" function in R based on a preliminary "naïve" search using the following terms on Medline: (("focal therapy" OR "focal treatment") AND ("prostate cancer") AND ("sexual function" OR "erectile function")). A total of 42 studies, comprising 3117 patients treated and 2352 with available sexual outcomes, were included in the qualitative data synthesis and 26 in a random-effect meta-analysis. EVIDENCE SYNTHESIS The five-item International Index of Erectile Function (IIEF-5) was the most frequently used questionnaire (30/42 studies), with completion rates ranging from 24% to 100% at 18-24 mo. A decrease was noted at 3 mo (IIEF-5 decrease estimate -3.70 [95% confidence interval -4.43, -2.96]), with improvements at 6 mo (-2.18 [-2.91, -1.46]) and 12 mo (-2.14 [-2.96, -1.32]). Studies in which patients had an altered baseline sexual function were more likely to report a significant and durable postoperative decrease in erectile function scores. The patient-reported outcome questionnaires used were not designed for a diverse population. Functional outcomes were not the primary endpoint and have not been reported consistently in most studies considered. CONCLUSIONS Focal therapy led to changes in erectile function in most cases under the significance threshold of the patient-reported outcome questionnaires used. However, patients should be counselled according to their baseline erectile function. More research is warranted to detail aspects other than erectile function, such as ejaculation or orgasm. The early postoperative period appears key to study sexual changes after focal therapy, while only a moderate decrease is expected at 12 mo. PATIENT SUMMARY We reviewed the published literature detailing the sexual consequences of focal therapy for localised prostate cancer using patient-reported outcome questionnaires. Patients were likely to describe a significant decrease in their erectile function at 3 mo, with improvements noted at 6 and 12 mo. The results obtained may not be reproducible in a more diverse population, and further research is warranted to better study aspects other than erectile function, such as ejaculation or orgasm.
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Affiliation(s)
- Gaelle Fiard
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Department of Urology, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France.
| | - Aminah Chowdhury
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK; GKT School of Medical Education, King's College London, London, UK
| | - Aneirin R Potter
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK; GKT School of Medical Education, King's College London, London, UK
| | - Celina J Pook
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK; GKT School of Medical Education, King's College London, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Tet Yap
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Hopstaken JS, Bomers JGR, Sedelaar MJP, Valerio M, Fütterer JJ, Rovers MM. An Updated Systematic Review on Focal Therapy in Localized Prostate Cancer: What Has Changed over the Past 5 Years? Eur Urol 2021; 81:5-33. [PMID: 34489140 DOI: 10.1016/j.eururo.2021.08.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 08/12/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Focal therapy is a promising, minimally invasive strategy to selectively treat localized prostate cancer. A previous systematic review indicated that there is growing evidence for favorable functional outcomes, but that oncological effectiveness was yet to be defined. OBJECTIVE To assess the effectiveness of focal therapy in patients with localized prostate cancer in terms of functional and oncological outcomes. EVIDENCE ACQUISITION PubMed, Embase, and The Cochrane Library were searched for studies between October 2015 and December 31, 2020. In addition, the research stages were acquired according to the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) recommendations. Ongoing studies were identified through clinical trial registries. EVIDENCE SYNTHESIS Seventy-two studies were identified exploring eight different sources of energy to deliver focal therapy in 5827 patients. Twenty-seven studies reported on high-intensity focused ultrasound (HIFU), nine studies on irreversible electroporation, 11 on cryoablation, eight on focal laser ablation and focal brachytherapy, seven on photodynamic therapy (PDT), two on radiofrequency ablation, and one on prostatic artery embolization. The majority of studies were prospective development stage 2a studies (n = 35). PDT and HIFU, both in stage 3, showed promising results. Overall, HIFU studies reported a median of 95% pad-free patients and a median of 85% patients with no clinically significant cancer (CSC) in the treated area. For PDT, no changes in continence were reported and a median of 90% of patients were without CSC. Both treatments were well tolerated. CONCLUSIONS Over the past 5 yr, focal therapy has been studied for eight different energy sources, mostly in single-arm stage 2 studies. Although a first randomized controlled trial in focal therapy has been performed, more high-quality evaluations are needed, preferably via multicenter randomized controlled trials with long-term follow-up and predefined assessment of oncological and functional outcomes and health-related quality-of-life measures. PATIENT SUMMARY Focal treatment (FT) of prostate cancer has potential, considering that it has less impact on continence and potency than radical treatment. Our systematic review indicates that despite the method being studied extensively over the past half decade, the majority of studies remain in an early research stage. The techniques high-intensity focused ultrasound and photodynamic therapy have shown most progression toward advanced research stages and show favorable results. However, more high-quality evidence is required before FT can become available as a standard treatment.
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Affiliation(s)
- Jana S Hopstaken
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Joyce G R Bomers
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel J P Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jurgen J Fütterer
- Department of Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Tracey AT, Nogueira LM, Alvim RG, Coleman JA, Murray KS. Focal therapy for primary and salvage prostate cancer treatment: a narrative review. Transl Androl Urol 2021; 10:3144-3154. [PMID: 34430417 PMCID: PMC8350247 DOI: 10.21037/tau-20-1212] [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] [Received: 08/30/2020] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Despite innovations in surgical technology and advancements in radiation therapy, radical treatments for clinically localized prostate cancer are associated with significant patient morbidity, including both urinary and sexual dysfunction. This has created a vital need for therapies and management strategies that provide an acceptable degree of oncologic efficacy while mitigating these undesirable side effects. Successful developments in screening approaches and advances in prostate imaging have allowed clinicians to identify, localize, and more precisely target early cancers. This has afforded urologists with an important opportunity to develop and employ focal ablation techniques that selectively destroy tumors while preserving the remainder of the gland, thus avoiding detrimental treatment effects to surrounding sensitive structures. A lack of high-level evidence supporting such an approach had previously hindered widespread adoption of focal treatments, but there are now numerous published clinical trials which have sought to establish benchmarks for safety and efficacy. As the clinical evidence supporting a potential role in prostate cancer treatment begins to accumulate, there has been a growing acceptance of focal therapy in the urologic oncology community. In this narrative review article, we describe the techniques, advantages, and side effect profiles of the most commonly utilized focal ablative techniques and analyze published clinical trial data supporting their evolving role in the prostate cancer treatment paradigm.
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Affiliation(s)
- Andrew T Tracey
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lucas M Nogueira
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricardo G Alvim
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katie S Murray
- Division of Urology, Department of Surgery, University of Missouri, Columbia, MO, USA
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13
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Current evidence for focal therapy and partial gland ablation for organ-confined prostate cancer: systematic review of literature published in the last 2 years. Curr Opin Urol 2021; 31:49-57. [PMID: 33196540 DOI: 10.1097/mou.0000000000000838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The shift in the diagnostic algorithm for prostate cancer to early imaging with mpMRI has resulted in many patients being diagnosed with small volume, apparently unilateral, clinically significant cancers. In these patients, a minimally invasive, nonmorbid intervention is appealing. The aim of this study was to review data reported within the last 2 years on focal therapy and partial gland ablation for organ-confined prostate cancer. RECENT FINDINGS High-intensity focal ultrasound, focal cryotherapy, photodynamic therapy, irreversible electroporation and focal laser ablation, have been used as treatment modalities for localized prostate cancer treatment. The reported oncologic outcomes vary widely and makes comparisons challenging. All the focal therapies report low rates of complications, and high rates of continence and erectile function preservation. The most common adverse events are hematuria, urinary retention and urinary tract infections. During this period, the initial results of several new technologies including MRI-guided transurethral ultrasound ablation were published. SUMMARY Focal therapy and partial gland ablation for organ-confined prostate cancer is an option for patients with intermediate-risk disease because of its low complication profile and preservation of QOL. Trials comparing the outcome of different focal therapy technologies have not been carried out, and the existing evidence does not point to one approach being clearly superior to others. Long-term oncologic outcome is lacking. Despite this, for men with unilateral intermediate-risk prostate cancer whose disease is often relatively indolent, focal therapy is an appealing option.
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Abstract
The prostate imaging reporting and data system (PI-RADS) has revolutionized the use of magnetic resonance imaging (MRI) for the management of prostate cancer (PCa). The most recent version 2.1, PI-RADS v2.1, provides specific refinements in the performance, relaxing some recommendations which were not found to be helpful, while reinforcing and clarifying others. The interpretation of T2-weighted imaging (T2WI) in the transition zone (TZ), and the overall assessment of TZ nodules, now allows for a clearer distinction between those which are clearly benign and those which might warrant tissue sampling. Additional changes also resolve discrepancies in T2WI and diffusion-weighted imaging (DWI) of the peripheral zone (PZ). PI-RADS v2.1 is a simpler, more straightforward, and more reproducible method to better communicate between physicians regarding findings on prostate MRI.
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Affiliation(s)
- Silvina P Dutruel
- Department of Radiology, Weill Cornell Medicine/New York-Presbyterian, 525 E 68th St, Box 141, New York, NY, 10065, USA
| | - Sunil Jeph
- Department of Radiology, Weill Cornell Medicine/New York-Presbyterian, 525 E 68th St, Box 141, New York, NY, 10065, USA
| | - Daniel J A Margolis
- Department of Radiology, Weill Cornell Medicine/New York-Presbyterian, 525 E 68th St, Box 141, New York, NY, 10065, USA.
| | - Natasha Wehrli
- Department of Radiology, Weill Cornell Medicine/New York-Presbyterian, 525 E 68th St, Box 141, New York, NY, 10065, USA
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