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Payen T, Crouzet S, Guillen N, Chen Y, Chapelon JY, Lafon C, Catheline S. Passive Elastography for Clinical HIFU Lesion Detection. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:1594-1604. [PMID: 38109239 DOI: 10.1109/tmi.2023.3344182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
High-intensity Focused Ultrasound (HIFU) is a promising treatment modality for a wide range of pathologies including prostate cancer. However, the lack of a reliable ultrasound-based monitoring technique limits its clinical use. Ultrasound currently provides real-time HIFU planning, but its use for monitoring is usually limited to detecting the backscatter increase resulting from chaotic bubble appearance. HIFU has been shown to generate stiffening in various tissues, so elastography is an interesting lead for ablation monitoring. However, the standard techniques usually require the generation of a controlled push which can be problematic in deeper organs. Passive elastography offers a potential alternative as it uses the physiological wave field to estimate the elasticity in tissues and not an external perturbation. This technique was adapted to process B-mode images acquired with a clinical system. It was first shown to faithfully assess elasticity in calibrated phantoms. The technique was then implemented on the Focal One® clinical system to evaluate its capacity to detect HIFU lesions in vitro (CNR = 9.2 dB) showing its independence regarding the bubbles resulting from HIFU and in vivo where the physiological wave field was successfully used to detect and delineate lesions of different sizes in porcine liver. Finally, the technique was performed for the very first time in four prostate cancer patients showing strong variation in elasticity before and after HIFU treatment (average variation of 33.0 ± 16.0 % ). Passive elastography has shown evidence of its potential to monitor HIFU treatment and thus help spread its use.
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De Cillis S, Osman N, Guillot-Tantay C, Hervé F, Przydacz M, Tutolo M, Culha G, Geretto P, Cancrini F, Checcucci E, Phé V. Urinary outcomes of new ultra-minimally invasive treatments for prostate cancers. Curr Opin Urol 2023; 33:497-501. [PMID: 37609708 DOI: 10.1097/mou.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW The aim of this narrative review is to evaluate the current available literature on urinary outcomes following cryotherapy and high-intensity focused ultrasound (HIFU) for localized prostate cancer (PCa). RECENT FINDINGS The available literature is heterogeneous in terms of intervention modalities and assessment of urinary outcome measures. Nevertheless, ultra-minimally invasive treatments seem to provide good urinary outcomes. Technological advancement and the adoption of more conservative ablation templates allow for a further reduction of toxicity and better preservation of urinary function. Urinary incontinence occurs in 0-10% of the patients and, is mostly transient. Voiding and storage lower urinary tract symptoms (LUTS) mostly occur in the early postoperative period and rarely require surgical treatment. Focal therapies performed with a salvage intent after external beam radiotherapy have a significantly higher impact on patient's urinary function. SUMMARY Ultra-minimally invasive treatment for PCa show a good safety profile concerning urinary function, but consensus on when and how best to assess this is still lacking. Efforts should be made to standardize the report of preoperative and postoperative urinary function to provide higher level of evidence.
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Affiliation(s)
- Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Nadir Osman
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Francois Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gokhan Culha
- Department of Urology, University of Health Sciences, Prof. Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Paolo Geretto
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabiana Cancrini
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Veronique Phé
- Department of Urology, Tenon Academic Hospital, AP-HP, Sorbonne University, Paris, France
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Maestroni U, Tafuri A, Dinale F, Campobasso D, Antonelli A, Ziglioli F. Oncologic outcome of salvage high-intensity focused ultrasound (HIFU) in radiorecurrent prostate cancer. A systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021191. [PMID: 34487074 DOI: 10.23750/abm.v92i3.11475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION External Beam Radiation Therapy (EBRT) is one of the option available for the treatment of clinically localized prostate cancer. In patients with radiorecurrent localized prostate cancer, Androgen Deprivation Therapy (ADT) is one of the most common therapeutic strategies. However, in the last decades, other salvage treatment options have been investigated, such as brachytherapy, cryoablation and High Intensity Focused Ultrasound (Hifu). MATERIAL AND METHODS The oncologic outcome of Hifu in a salvage setting after EBRT failure was investigated. We reviewed the literature from 2005 to 2020 in order to report the oncologic outcome of the technique. RESULTS A total of 1241 patients were analyzed, with a mean age of 68.6 years and a PSA value of 5.87 ng/mL before treatment. Mean follow-up was 24.3 months after treatment, ranging from 3 to 168 months. CONCLUSION Our review of the literature revealed that salvage Hifu is effective in the treatment of radiorecurrent clinically localized prostate cancer, with an overall survival of 85.2% at 5 years.
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Büchser D, Medina R, Mayrata E, González A, Marban M, Achard V, Alongi F, Gomez-Iturriaga A, Couñago F. Salvage local treatment for localized radio-recurrent prostate cancer: a narrative review and future perspectives. Future Oncol 2021; 17:4207-4219. [PMID: 34448402 DOI: 10.2217/fon-2021-0320] [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: 11/21/2022] Open
Abstract
Although dose escalation protocols have improved biochemical control in prostate cancer radiotherapy, 10-45% of patients will experience disease recurrence. The prostate and seminal vesicles are the most frequent site of the first relapse. Traditionally, these patients have been managed with hormonal therapy, which is not curative. Recent improvements in diagnostic tests (e.g., multiparametric magnetic resonance and molecular imaging, including PET/CT scan with choline or Ga-PSMA) and new treatment techniques (e.g., stereotactic body radiation therapy or other minimally invasive alternatives like high-intensity focus ultrasound, cryoablation or high-dose-rate brachytherapy) offer new therapeutic strategies with the potential to cure some patients with limited adverse effects. In this narrative review, the authors present the most recent evidence to help identify the most suitable candidates for salvage treatment.
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Affiliation(s)
- David Büchser
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Rafael Medina
- Urology, Virgen del Rocio University Hospital, Sevilla 41013, Spain
| | - Esther Mayrata
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Alba González
- Radiation Oncology, Basurto University Hospital, Bilbao 48013, Spain.,Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, 48903 Barakaldo, Spain
| | - Marina Marban
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Vérane Achard
- Radiation Oncology, Geneva University Hospital, Geneva 1205, Switzerland
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Negrar 37024, Italy
| | - Alfonso Gomez-Iturriaga
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Felipe Couñago
- Radiation Oncology, Quirón Salud University Hospital, Madrid 28223, Spain.,Radiation Oncology, La Luz Hospital, Madrid 28003, Spain.,Clinical Department, Universidad Europea de Madrid, Madrid 28670, Spain
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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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Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment. Int J Impot Res 2021; 33:457-463. [PMID: 33854206 DOI: 10.1038/s41443-021-00437-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/08/2022]
Abstract
Male sexual dysfunction, a common sequela following primary prostate cancer (PC) treatment, is likely to be more significant following salvage PC therapy. In general, these impairments in sexual domains can be divided into three groups, namely (1) sexual desire, sexuality and masculinity; (2) erectile function (EF); and (3) ejaculation and orgasm. However, there is considerable overlap between these sexual domains and male sexual response cycle, and various factors such as cancer status, mental well-being, medical conditions and social circumstances can adversely impact on the male sexual function. While several preventive and treatment strategies for the preservation and recovery of sexual function are available, there is limited consensus guidelines exist regarding the optimal rehabilitation or treatment protocol for men with sexual dysfunction following salvage therapy. While penile rehabilitation may be effective to restore erectile function and the ability to have coital sex, there is lack of effective treatments in other domains of male sexual function, thereby underscoring the importance of psychological and sexual counselling in sexual rehabilitation. Indeed, a comprehensive multidisciplinary approach is necessary to better understand and optimally assist and manage the men and their respective partners for better sexual health and activity.
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Abufaraj M, Siyam A, Ali MR, Suarez-Ibarrola R, Yang L, Foerster B, Shariat SF. Functional Outcomes after Local Salvage Therapies for Radiation-Recurrent Prostate Cancer Patients: A Systematic Review. Cancers (Basel) 2021; 13:cancers13020244. [PMID: 33440752 PMCID: PMC7826752 DOI: 10.3390/cancers13020244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess the rate and severity of functional outcomes after salvage therapy for radiation recurrent prostate cancer. METHODS This systematic review of the MEDLINE/PubMed database yielded 35 studies, evaluating salvage radical prostatectomy (RP), brachytherapy (BT), high-intensity focal ultrasound (HIFU) and cryotherapy (CT) after failure of primary radiation therapy. Data on pre- and post-salvage rates and severity of functional outcomes (urinary incontinence, erectile dysfunction, and lower urinary tract symptoms) were collected from each study. RESULTS The rates of severe urinary incontinence ranged from 28-88%, 4.5-42%, 0-6.5%, 2.4-8% post salvage RP, HIFU, CT and BT, respectively. The rates of erectile dysfunction were relatively high reaching as much as 90%, 94.6%, 100%, 62% following RP, HIFU, CT and BT, respectively. Nonetheless, the high pre-salvage rates of ED preclude accurate estimation of the effect of salvage therapy. There was an increase in the median IPSS following salvage HIFU, BT and CT ranging from 2.5-3.4, 3.5-12, and 2, respectively. Extended follow-up showed a return-to-baseline IPSS in a salvage BT study. The reported data suffer from selection, reporting, publication and period of study biases, making inter-study comparisons inappropriate. CONCLUSIONS local salvage therapies for radiation recurrent PCa affect continence, lower urinary tract symptoms and sexual functions. The use of local salvage therapies may be warranted in the setting of local disease control, but each individual decision must be made with the informed patient in a shared decision working process.
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Affiliation(s)
- Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, A-1080 Vienna, Austria;
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
| | - Abdelmuez Siyam
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
| | - Mustafa Rami Ali
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg—Medical Centre, 79098 Freiburg, Germany;
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
- Departments of Oncology and Community Health Sciences, Cumming school of medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Beat Foerster
- Department of Urology, Kantonsspital Winterthur, 8401 Winterthur, Switzerland;
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, A-1080 Vienna, Austria;
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, 11942 Amman, Jordan; (A.S.); (M.R.A.)
- Institute for Urology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, 119992 Moscow, Russia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10075, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
- Correspondence: ; Tel.: +43-140-4002-6150; Fax: +43-140-4002-3320
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Mantica G, Chierigo F, Suardi N, Gomez Rivas J, Kasivisvanathan V, Papalia R, Fiori C, Porpiglia F, Terrone C, Esperto F. Minimally invasive strategies for the treatment of prostate cancer recurrence after radiation therapy: a systematic review. MINERVA UROL NEFROL 2020; 72:563-578. [PMID: 32748617 DOI: 10.23736/s0393-2249.20.03783-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The aim of this review was to conduct a comprehensive analysis of the role of minimally invasive salvage modalities in radio-recurrent prostate cancer and the associated clinical outcomes and toxicity profiles. EVIDENCE ACQUISITION A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Scopus databases in January 2020. All papers published after 2000, concerning studies conducted on humans for radio-recurrent prostate cancer were considered for the review. EVIDENCE SYNTHESIS Overall, 545 studies were identified. After duplicate exclusion, initial screening, and eligibility evaluation, a total of 80 studies were included in the qualitative analysis, corresponding to a cohort of 6681 patients. The median age at initial diagnosis ranged from 59 to 75.5. Pre-treatment PSA ranged from 6.2 to 27.4 ng/mL. All patients underwent primary radiotherapy for localized prostate cancer. Cryotherapy, Brachytherapy, EBRT, HIFU were the minimally invasive options mostly used as salvage therapy. They showed to be promising approaches for recurrent prostate cancer (PCa) control, with acceptable toxicities. CONCLUSIONS Minimally invasive therapeutic options offer promising results in terms of biochemical control in the local recurrence setting. Unfortunately, the absence of high quality and comparative studies makes it difficult to establish which method is the best in terms of oncological and safety outcomes.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Francesco Chierigo
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy -
| | - Nazareno Suardi
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain.,Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid, Spain
| | - Veeru Kasivisvanathan
- UCL Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Hospital, School of Medicine, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Hospital, School of Medicine, University of Turin, Orbassano, Turin, Italy
| | - Carlo Terrone
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
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Napoli A, Alfieri G, Scipione R, Leonardi A, Fierro D, Panebianco V, De Nunzio C, Leonardo C, Catalano C. High-intensity focused ultrasound for prostate cancer. Expert Rev Med Devices 2020; 17:427-433. [PMID: 32275187 DOI: 10.1080/17434440.2020.1755258] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
High-intensity focused ultrasound (HIFU) is a noninvasive procedure that has shown promising results in a wide range of malignant and nonmalignant conditions, including localized prostate cancer (PCa). This review aims to describe the application of HIFU in the management of patients with PCa, explaining its basic therapeutic principles, going through the main phases during aHIFU session, and providing an overview of the main available pieces of evidence from literature. HIFU treatment for prostate cancer is increasingly performed with high success and safety. MR guidance (MR-guided HIFU) has the advantage of real-time intraprocedural thermometric feedback that ensures that the whole region of interest has been covered by critical thermal damage (and that all surrounding healthy tissues have been spared). The absence of comparative long-term trials prevents HIFU from being considered as afirst choice for the treatment of patients with PCa.
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Affiliation(s)
- Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Giulia Alfieri
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Roberto Scipione
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Andrea Leonardi
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Davide Fierro
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Valeria Panebianco
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Cosimo De Nunzio
- UOC Urologia, Ospedale Sant'Andrea, Sapienza, University of Rome, Italy
| | - Costantino Leonardo
- Department of Gynecology-Obstetrics and Urology, Sapienza University of Rome; Rome (RM), Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
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Maoui M, Gonindard-Melodelima C, Chapet O, Colombel M, Ruffion A, Crouzet S, Rouvière O. Candidates to salvage therapy after external-beam radiotherapy of prostate cancer: Predictors of local recurrence volume and metastasis-free survival. Diagn Interv Imaging 2020; 102:93-100. [PMID: 32534903 DOI: 10.1016/j.diii.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this study was to assess the predictors of metastasis-free survival (MFS) and of the volume of the local recurrence in patients with rising prostate-specific antigen (PSA) serum level after radiotherapy for prostate cancer and referred for prostate magnetic resonance imaging (MRI) and biopsy in view of salvage treatment. MATERIALS AND METHODS A total of 132 consecutive men (median age, 70 years; IQR, 66-77 years) with rising PSA after prostate radiotherapy who underwent prostate MRI and biopsy in view of salvage treatment between January 2010 and July 2017 were retrospectively evaluated at a single center. MFS predictors were assessed with Cox models. Predictors of the volume of the local recurrence (number of invaded prostate sectors at biopsy) were assessed using Poisson regression among variables available at PSA relapse. RESULTS At multivariate analysis, an initial Gleason score≥8 (OR=7 [95% confidence interval (CI): 1.2-40]; P=0.03), a recent radiotherapy (OR=17 [95% CI: 3.9-72]; P<0.0001), the use of androgen deprivation therapy at PSA relapse (OR=12.5 [95% CI: 2.8-57]; P=0.001) and the number of invaded prostate sectors (OR=1.5 [95% CI: 1.1-2]; P=0.007) and maximum cancer core length (OR=0.7 [95%CI: 0.6-0.9]; P=0.002) at biopsy performed at PSA relapse were significant MFS predictors. The PSA level at relapse was significant independent predictor of the volume of local recurrence only when used as a continuous variable (P=0.0002) but not when dichotomized using the nadir+2 threshold (P=0.41). CONCLUSION Pathological and clinical factors can help predict MFS in patients with rising PSA after prostate radiotherapy and candidates to salvage treatment. The PSA level at relapse has strong influence on the local recurrence volume when used as a continuous variable.
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Affiliation(s)
- M Maoui
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Édouard-Herriot, 69437 Lyon, France
| | - C Gonindard-Melodelima
- Université Joseph Fourier, Laboratoire d'Écologie Alpine, BP 53, 38041 Grenoble, France; CNRS, UMR 5553, BP 53, 38041 Grenoble, France
| | - O Chapet
- Hospices Civils de Lyon, Department of Radiation Oncology, Centre Hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - M Colombel
- Hospices Civils de Lyon, Department of Urology, Hôpital Édouard-Herriot, 69437 Lyon, France; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, 69003 Lyon, France
| | - A Ruffion
- Hospices Civils de Lyon, Department of Urology, Centre Hospitalier Lyon Sud, 69310 Pierre-Bénite, France
| | - S Crouzet
- Hospices Civils de Lyon, Department of Urology, Hôpital Édouard-Herriot, 69437 Lyon, France; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, 69003 Lyon, France; Inserm, U1032, LabTau, 69003 Lyon, France
| | - O Rouvière
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Édouard-Herriot, 69437 Lyon, France; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, 69003 Lyon, France; Inserm, U1032, LabTau, 69003 Lyon, France.
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Khoo CC, Miah S, Connor MJ, Tam J, Winkler M, Ahmed HU, Shah TT. A systematic review of salvage focal therapies for localised non-metastatic radiorecurrent prostate cancer. Transl Androl Urol 2020; 9:1535-1545. [PMID: 32676441 PMCID: PMC7354313 DOI: 10.21037/tau.2019.08.21] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although radiotherapy to the prostate for cancer is effective, recurrence occurs in 10–15% within 5 years. Traditional salvage treatments for men with radiorecurrent prostate cancer comprise of watchful waiting (WW) with or without androgen deprivation therapy (ADT) or radical prostatectomy (RP). Neither strategy provides ideal therapeutic ratios. Salvage focal ablation is an emerging option. We performed a systematic review of the Medline and Embase databases for studies reporting outcomes of focal salvage brachytherapy (sBT), cryotherapy (sCT) or high-intensity focused ultrasound (sHIFU) for radiorecurrent prostate cancer (conception to April 2019). Results were screened for inclusion against predetermined eligibility criteria. Certain data were extracted, including rates of biochemical disease-free survival (BDFS), metastasis, conversion to second-line therapies and adverse events. Of a total 134 articles returned from the search, 15 studies (14 case series and 1 comparative study) reported outcomes after focal sBT [5], sCT [7] and sHIFU [3]. Cohort size varied depending on intervention, with eligible studies of sBT being small case series. Median follow-up ranged from 10 to 56 months. Although pre-salvage demographics were similar [median age range, 61–75 years; prostate-specific antigen (PSA) range, 2.8–5.5 ng/mL], there was heterogeneity in patient selection, individual treatment protocols and outcome reporting. At 3 years, BDFS ranged from 61% to 71.4% after sBT, 48.1–72.4% after sCT and 48% after sHIFU. Only studies of sCT reported 5-year BDFS, which ranged from 46.5% to 54.4%. Rates of metastasis were low after all salvage modalities, as were conversion to second-line therapies (although this was poorly reported). Grade 3 adverse events were rare. This systematic review indicates that salvage focal ablation of radiorecurrent prostate cancer provides acceptable oncological outcomes and is well tolerated. Unfortunately, there is heterogeneity in the study design of existing evidence. Level 1 research comparing salvage focal therapies to existing whole-gland strategies is needed to further establish the role of these promising treatments.
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Affiliation(s)
- Christopher C Khoo
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Saiful Miah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Joseph Tam
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Taimur T Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery and Interventional Sciences, University College London, London, UK
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12
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Bomers JGR, Overduin CG, Jenniskens SFM, Cornel EB, van Lin ENJT, Sedelaar JPM, Fütterer JJ. Focal Salvage MR Imaging-Guided Cryoablation for Localized Prostate Cancer Recurrence after Radiotherapy: 12-Month Follow-up. J Vasc Interv Radiol 2019; 31:35-41. [PMID: 31735483 DOI: 10.1016/j.jvir.2019.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate safety, quality of life (QoL), and local cancer control after focal salvage MR imaging-guided cryoablation in patients with local recurrence of prostate cancer (PCa) after radiotherapy. MATERIALS AND METHODS A retrospective, single-center study was performed in 62 patients with radiorecurrent PCa who underwent MR imaging-guided cryoablation since May 2011 with a follow-up ≥12 months in December 2017. Rates and descriptions of adverse events were reported. Ablation complications were classified according to the Clavien and SIR systems. Validated questionnaires were used to observe functional outcomes and QoL before therapy and 6 and 12 months after therapy. Cancer control was defined as no biochemical failure according to Phoenix criteria and no other clinical evidence for local or metastatic disease. RESULTS All procedures were technically feasible. The number of complications requiring major therapy (Clavien grade 3b/4 or SIR grade D/E/F) was low (2 [3.2%] and 1 [1.6%], respectively). After 12 months, the International Consultation of Incontinence Questionnaire-Short Form (P < .001) and 5-item International Index of Erectile Function (P = .001) scores became significantly worse, indicating increased symptoms of incontinence and diminished erectile function, without compromising QoL. Six patients developed metastases within 6 months. After 12 months, 36 patients (63%) were disease-free. CONCLUSIONS Focal salvage MR imaging-guided cryoablation is safe and is associated with a high technical success rate, preservation of QoL, and local PCa control. This treatment can be a reasonable alternative to salvage radical prostatectomy in properly selected patients with low morbidity and preservation of QoL; however, longer follow-up is needed.
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Affiliation(s)
- Joyce G R Bomers
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Christiaan G Overduin
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd F M Jenniskens
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik B Cornel
- Department of Urology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | | | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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13
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Liu W, Zukotynski K, Emmett L, Chung HT, Chung P, Wolfson R, Rachinsky I, Kapoor A, Metser U, Loblaw A, Morton G, Sexton T, Lock M, Helou J, Berlin A, Boylan C, Archer S, Pond GR, Bauman G. A Prospective Study of 18F-DCFPyL PSMA PET/CT Restaging in Recurrent Prostate Cancer following Primary External Beam Radiotherapy or Brachytherapy. Int J Radiat Oncol Biol Phys 2019; 106:546-555. [PMID: 31730876 DOI: 10.1016/j.ijrobp.2019.11.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Radio-recurrent prostate cancer is typically detected by a rising prostate-specific antigen and may reflect local or distant disease. Positron emission tomography (PET) radiotracers targeting prostate-specific membrane antigen, such as 18F-DCFPyL have shown promise in restaging men with recurrent disease postprostatectomy but are less well characterized in the setting of radio-recurrent disease. METHODS AND MATERIALS A prospective, multi-institutional study was conducted to evaluate the effect of 18F-DCFPyL PET/computed tomography (CT) when added to diagnostic imaging (DI; CT abdomen and pelvis, bone scan, multiparametric magnetic resonance imaging pelvis) for men with radio-recurrent prostate cancer. All men were imaged with DI and subsequently underwent 18F-DCFPyL PET/CT with local and central reads. Tie break reads were performed as required. Management questionnaires were completed after DI and again after 18F-DCFPyL PET/CT. Discordance in patterns of disease detected with 18F-DCFPyL PET/CT versus DI and changes in management were characterized. RESULTS Seventy-nine men completed the study. Most men had T1 disease (62%) and Gleason score <7 (95%). Median prostate-specific antigen at diagnosis was 7.4 ng/mL and at relapse was 4.8 ng/mL. DI detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 9 out of 79 (11%), distant disease in 12 out of 79 (15%), and no disease in 26 out of 79 (33%). 18F-DCFPyL PET/CT detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 21 out of 79 (27%), distant disease in 24 out of 79 (30%), and no disease in 10 out of 79 (13%). DI identified 8 out of 79 (10%) patients to have oligometastatic disease, compared with 21 out of 79 (27%) with 18F-DCFPyL PET/CT. 18F-DCFPyL PET/CT changed proposed management in 34 out of 79 (43%) patients. CONCLUSIONS 18F-DCFPyL PET/CT identified extraprostatic disease in twice as many men with radio-recurrent prostate cancer compared with DI and detected a site of recurrence in 87% of men compared with 67% with DI. Furthermore, 18F-DCFPyL PET/CT identified potentially actionable disease (prostate only recurrence or oligometastatic disease) in 75% of men and changed proposed management in 43% of men.
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Affiliation(s)
- Wei Liu
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Katherine Zukotynski
- Department of Radiology, Hamilton Health Sciences Centre and McMaster University, Hamilton, Canada
| | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital and University of New South Wales, Sydney, Australia
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert Wolfson
- Department of Medical Imaging, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Irina Rachinsky
- Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada
| | - Anil Kapoor
- Urologic Cancer Centre for Research & Innovation and McMaster University, Hamilton, Ontario
| | - Ur Metser
- Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; University of Toronto, Institute of Health Care Policy and Evaluation, Toronto, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Tracy Sexton
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Michael Lock
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Colm Boylan
- Department of Diagnostic Imaging, St. Joseph's Healthcare and McMaster University, Hamilton, Canada
| | - Susan Archer
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, Canada
| | - Glenn Bauman
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada.
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14
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Salvage Hemiablation High Intensity Focused Ultrasound for unilateral radio-recurrent prostate cancer. Prog Urol 2019; 29:627-633. [DOI: 10.1016/j.purol.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/16/2019] [Accepted: 06/11/2019] [Indexed: 12/19/2022]
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15
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Hostiou T, Gelet A, Chapelon JY, Rouvière O, Mège-Lechevalier F, Lafon C, Tonoli-Catez H, Badet L, Crouzet S. Salvage high-intensity focused ultrasound for locally recurrent prostate cancer after low-dose-rate brachytherapy: oncological and functional outcomes. BJU Int 2019; 124:746-757. [PMID: 31148367 DOI: 10.1111/bju.14838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To evaluate the oncological and functional outcomes of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after low-dose-rate (LDR) brachytherapy. PATIENTS AND METHODS Clinical phase II studies (2003-2015) included 50 consecutive patients with post-brachytherapy local recurrence treated by S-HIFU. S-HIFU was performed with post-external beam radiotherapy (EBRT) parameters and, since 2008, with specific post-brachytherapy parameters. Treatments were whole-gland ablation and, since 2009, hemi-ablation in cases of unilateral prostate cancer. The primary objective was to assess oncological outcomes: treatment failure-free survival, progression-free survival (PFS), overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) rates. The secondary objective was to evaluate adverse events, continence, and erectile function. Kaplan-Meier analysis estimated oncological outcomes. RESULTS In all, 13 patients were treated with post-EBRT parameters, 37 with post-brachytherapy parameters, 35 with whole-gland treatment, and 15 with hemi-ablation. The median follow-up was 4.6 years. After S-HIFU, the median prostate-specific antigen level was 0.3 ng/mL. At 6 years, treatment failure-free survival, PFS, OS, CSS, and MFS rates were 41%, 45%, 93%, 98%, and 80%, respectively. Post-brachytherapy compared with post-EBRT parameters reduced Grade 2-3 incontinence (34% vs 62%, P = 0.015). Incontinence, bladder outlet obstruction and Grade ≥III complications were significantly reduced with hemi-ablation compared with whole-gland treatment (14% vs 54%, P < 0.001; 13% vs 46%, P = 0.03; 13% vs 63%, P = 0.001; respectively). Before S-HIFU, 25 patients had a five-item version of the International Index of Erectile Function score of ≥17, which was maintained in 48% at 12 months. CONCLUSION S-HIFU for locally recurrent prostate cancer after LDR brachytherapy is associated with favourable survival rates at a price of significant morbidity. Dedicated post-brachytherapy parameters and hemi-ablation improve the safety of the treatment.
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Affiliation(s)
- Thomas Hostiou
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.,Department of Urology, Université de Lyon, Lyon, France.,INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France
| | - Albert Gelet
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.,Department of Urology, Université de Lyon, Lyon, France.,INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France
| | | | - Olivier Rouvière
- Department of Urology, Université de Lyon, Lyon, France.,INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France.,Department of Radiology, Edouard Herriot Hospital, Lyon, France
| | | | - Cyril Lafon
- INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France
| | - Hélène Tonoli-Catez
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France
| | - Lionel Badet
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.,Department of Urology, Université de Lyon, Lyon, France
| | - Sébastien Crouzet
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.,Department of Urology, Université de Lyon, Lyon, France.,INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France
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16
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Glybochko PV, Amosov AV, Krupinov GE, Petrovskii NV, Lumpov IS. Hemiablation of Localized Prostate Cancer by High-Intensity Focused Ultrasound: A Series of 35 Cases. Oncology 2019; 97:44-48. [PMID: 31071712 DOI: 10.1159/000499739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/07/2019] [Indexed: 01/04/2023]
Abstract
Prostate cancer (PrC) is one of the most common tumors diagnosed in men. The detection rate of localized PrC has been dramatically enhanced by screening and the development of visualization methods. There are currently several techniques for focal treatment available, among which the most interesting in our opinion is high-intensity focused ultrasound (HIFU). Currently, HIFU hemiablation of PrC is not an established treatment, although evidence of its effectiveness and safety is growing. We have been performing HIFU hemiablation since 2013 and here report our results to add to the evidence on the effectiveness of the technique. Between October 2013 and December 2016, we performed HIFU hemiablation of the prostate for a total of 35 patients with confirmed PrC stage <cT2a at our urology clinic and retrospectively examined duration of ablation, pre- and postoperative prostate-specific antigen (PSA) levels, prostate volume, erectile function, and dysuria. The mean duration of ablation was 22 min (10-35). The mean postoperative hospital stay was 4 days. None of the patients experienced serious complications. Postoperative PSA tests showed the greatest decrease after 3 months to 2.4 ng/mL on average (p < 0.001). The pathological focus seen on MRI before the procedure in each case was absent after 3 months. Control biopsy after 12 months revealed residual cancer in the contralateral lobe in 4 patients. The findings obtained during follow-up and from control biopsies indicate that the treatment was highly efficacious with a low rate of nonserious postoperative complications. HIFU hemiablation proved to be a reliable therapeutic modality for localized PrC and was associated with a low rate of complications and comparable risk of recurrence. Despite the fact that this method of treatment is currently experimental, the results of this case series and other studies indicate its feasibility and safety.
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Affiliation(s)
- Peter V Glybochko
- Institute for Urology and Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Alexander V Amosov
- Institute for Urology and Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - German E Krupinov
- Institute for Urology and Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Nikolay V Petrovskii
- Institute for Urology and Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation,
| | - Ilya S Lumpov
- Institute for Urology and Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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17
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Dinis Fernandes C, Ghobadi G, van der Poel HG, de Jong J, Heijmink SWTPJ, Schoots I, Walraven I, van Houdt PJ, Smolic M, Pos FJ, van der Heide UA. Quantitative 3-T multi-parametric MRI and step-section pathology of recurrent prostate cancer patients after radiation therapy. Eur Radiol 2018; 29:4160-4168. [PMID: 30421016 PMCID: PMC6610274 DOI: 10.1007/s00330-018-5819-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/30/2018] [Accepted: 10/02/2018] [Indexed: 12/21/2022]
Abstract
Objectives Diagnosis of radio-recurrent prostate cancer using multi-parametric MRI (mp-MRI) can be challenging due to the presence of radiation effects. We aim to characterize imaging of prostate tissue after radiation therapy (RT), using histopathology as ground truth, and to investigate the visibility of tumor lesions on mp-MRI. Methods Tumor delineated histopathology slides from salvage radical prostatectomy patients, primarily treated with RT, were registered to MRI. Median T2-weighted, ADC, Ktrans, and kep values in tumor and other regions were calculated. Two radiologists independently performed mp-MRI-based tumor delineations which were compared with the true pathological extent. General linear mixed-effect modeling was used to establish the contribution of each imaging modality and combinations thereof in distinguishing tumor and benign voxels. Results Nineteen of the 21 included patients had tumor in the available histopathology slides. Recurrence was predominantly multifocal with large tumor foci seen after external beam radiotherapy, whereas these were small and sparse after low-dose-rate brachytherapy. MRI-based delineations missed small foci and slightly underestimated tumor extent. The combination of T2-weighted, ADC, Ktrans, and kep had the best performance in distinguishing tumor and benign voxels. Conclusions Using high-resolution histopathology delineations, the real tumor extent and size were found to be underestimated on MRI. mp-MRI obtained the best performance in identifying tumor voxels. Appropriate margins around the visible tumor-suspected region should be included when designing focal salvage strategies. Recurrent tumor delineation guidelines are warranted. Key Points • Compared to the use of individual sequences, multi-parametric MRI obtained the best performance in distinguishing recurrent tumor from benign voxels. • Delineations based on mp-MRI miss smaller foci and slightly underestimate tumor volume of local recurrent prostate cancer. • Focal salvage strategies should include appropriate margins around the visible tumor. Electronic supplementary material The online version of this article (10.1007/s00330-018-5819-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catarina Dinis Fernandes
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ghazaleh Ghobadi
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen de Jong
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Ivo Schoots
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Iris Walraven
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Milena Smolic
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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18
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Lee CS, Lee JY, Ro S, Choi S, Moon JY. Comparison of effectiveness of epidural analgesia and monitored anesthesia care for high-intensity focused ultrasound treatment of adenomyosis. Int J Hyperthermia 2018; 35:617-625. [DOI: 10.1080/02656736.2018.1516300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Chang-Soon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Integrated Cancer Care Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soohan Ro
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seungeun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Integrated Cancer Care Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea
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19
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Babalola O, Lee TH(J, Viviano CJ. Prostate Ablation Using High Intensity Focused Ultrasound: A Literature Review of the Potential Role for Patient Preference Information. J Urol 2018; 200:512-519. [DOI: 10.1016/j.juro.2018.04.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Olufemi Babalola
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Ting-Hsuan (Joyce) Lee
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Charles J. Viviano
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
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20
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Zequi SDC, Mourão TC, Guimarães GC. Prostate Cancer - Local Treatment after Radiorecurrence: HIFU - High-Intensity Focused Ultrasound. Int Braz J Urol 2018; 44:429-432. [PMID: 29792650 PMCID: PMC5996802 DOI: 10.1590/s1677-5538.ibju.2018.03.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Stenio de Cassio Zequi
- Divisão de Urologia, AC Camargo Cancer Center, Fundação A. Prudente, São Paulo, SP, Brasil
| | - Thiago Camelo Mourão
- Departamento de Urooncologia, Laparoscopia e Robótica, AC Camargo Cancer Center, Fundação A. Prudente, São Paulo, SP, Brasil
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21
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Dason S, Wong NC, Allard CB, Hoogenes J, Orovan W, Shayegan B. High-intensity Focused Ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: predictors of disease response. Int Braz J Urol 2018; 44:248-257. [PMID: 29211405 PMCID: PMC6050568 DOI: 10.1590/s1677-5538.ibju.2017.0025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022] Open
Abstract
Background Some men with localized radio-recurrent prostate cancer may benefit from salvage high-intensity focused ultrasound (HIFU). Herein, we describe oncologic outcomes and predictors of disease response after salvage whole gland HIFU from our prospective cohort. Materials and Methods Patients with localized radio-recurrent prostate cancer were prospectively enrolled from January 2005 to December 2014. Participants had to meet both biochemical and histological definitions of recurrence. Exclusion criteria included the receipt of prior salvage therapy, presence of metastatic disease, and administration of ADT in the 6-months prior to enrollment. Participants were treated with a single session of whole-gland HIFU ablation with the AblathermTM device (EDAP, France). The primary endpoint was recurrence-free survival (RFS), defined as a composite endpoint of PSA progression (Phoenix criteria), receipt of any further salvage therapy, receipt of ADT, clinical progression, or death. Kaplan-Meier survival analysis was used to determine the primary end-point and stratifications were used to determine the significance of 6 pre-specified predictors of improved RFS (TRUS biopsy grade, number of study entry TRUS biopsy cores positive, palpable disease at study enrollment, pre-HIFU PSA, an undetectable post-HIFU PSA nadir, and receipt of prior hormone therapy). Survival analysis was performed on participants with a minimum of 1-year follow-up. Results Twenty-four participants were eligible for study inclusion with a median follow-up of 31.0 months. Median PSA at study entry was 4.02ng/ml. Median time to PSA nadir was 3 months after treatment and median post-HIFU PSA nadir was 0.04ng/ml. Median 2-year and 5-year RFS was 66.3% and 51.6% respectively. Of our 6 prespecified predictors, an undetectable PSA nadir was the only significant predictor of improved RFS (HR 0.07, 95% CI 0.02-0.29, log-rank P<0.001). One participant underwent an intervention for a urethral stricture. No participants developed osteitis pubis or rectourethral fistulae. Conclusions Salvage HIFU allows for disease control in selected patients with localized radio-recurrent prostate cancer. An undetectable PSA nadir serves as an early predictor of disease response.
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Affiliation(s)
- Shawn Dason
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Nathan C Wong
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | | | - Jen Hoogenes
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - William Orovan
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- Division of Urology, McMaster University, Hamilton, ON, Canada
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22
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Ganzer R. [High intensity focused ultrasound (HIFU) : Importance in the treatment of prostate cancer]. Radiologe 2018; 57:659-664. [PMID: 28439616 DOI: 10.1007/s00117-017-0245-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND High intensity focused ultrasound (HIFU) has been used since the beginning of the 1990s as an alternative treatment for prostate cancer. OBJECTIVE Overview of the current status and critical review of the different indications for HIFU in the treatment of prostate cancer. MATERIAL AND METHODS Review of the current literature on the indications, side effects, oncologic results and current guideline recommendations. RESULTS The principle of HIFU is based on high energy sound waves, which lead to coagulation necrosis at the focal point. It can be applied for different indications: complete ablation of prostatic tissue is attempted in whole gland HIFU in the primary treatment of localized prostate cancer. There are several case series in the current literature with a maximum median follow-up of 8.1 years. The main side effect is the formation of bladder neck sclerosis. A further indication is for salvage HIFU in patients with localized recurrent prostate cancer after radiotherapy. This is a high-risk procedure due to increased risk of incontinence and formation of rectourethral fistula. Focal therapy is an innovative field aiming at partial prostate gland ablation with HIFU thereby reducing side effects. Technical improvements in HIFU enable treatment planning with fusion of multiparametric magnetic resonance imaging (mpMRI). Due to the experimental character, this should only be carried out within clinical trials. DISCUSSION Due to a lack of prospective randomized trials and limited long-term results, whole gland HIFU is considered differently in the guidelines of European countries. Focal therapy is still experimental and should only be carried out within clinical trials.
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Affiliation(s)
- R Ganzer
- Klinik und Poliklinik für Urologie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland.
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23
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Bloom JB, Gold SA, Hale GR, Rayn KN, Sabarwal VK, Bakhutashvili I, Valera V, Turkbey B, Pinto PA, Wood BJ. "Super-active surveillance": MRI ultrasound fusion biopsy and ablation for less invasive management of prostate cancer. Gland Surg 2018; 7:166-187. [PMID: 29770311 DOI: 10.21037/gs.2018.03.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) of the prostate has allowed clinicians to better visualize and target suspicious lesions during biopsy. Targeted prostate biopsies give a more accurate representation of the true cancer volume and stage so that appropriate treatment or active surveillance can be selected. Advances in technology have led to the development of MRI and ultrasound fusion platforms used for targeted biopsies, monitoring cancer progression, and more recently for the application of focal therapy. Lesions visualized on mpMRI can be targeted for ablation with a variety of energy sources employed under both local and general anesthesia. Focal ablation may offer an alternative option for treating prostate cancer as compared to the well-established interventions of whole-gland radiation or prostatectomy. Focal ablation may also be an option for patients on active surveillance who wish to be even more "active" in their surveillance. In this review, we describe the advancements and development of fusion biopsies, the rationale behind focal therapy, and introduce focal ablative techniques for indolent prostate cancers ("super-active surveillance"), including cryoablation and focal laser ablation (FLA) and the subsequent MRI/biopsy surveillance.
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Affiliation(s)
- Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Vikram K Sabarwal
- Department of Urology, George Washington University, Washington, DC, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
| | - Vladimir Valera
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
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Golbari NM, Katz AE. Salvage Therapy Options for Local Prostate Cancer Recurrence After Primary Radiotherapy: a Literature Review. Curr Urol Rep 2018; 18:63. [PMID: 28688020 DOI: 10.1007/s11934-017-0709-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW While recurrence after primary treatment of prostate cancer (PCa) is not uncommon, there is currently no consensus on the most appropriate management after radiation treatment failure. This article seeks to explore the currently utilized modalities for salvage treatment for radiorecurrent PCa. We focused our review on the oncologic outcomes and reported toxicity rates in the latest studies examining salvage radical prostatectomy (SRP), salvage cryotherapy (SCT), salvage high-intensity focused ultrasound (HIFU) and re-irradiation. RECENT FINDINGS There does not appear to be any significant difference in overall survival for more invasive salvage radical prostatectomy compared to the minimally invasive salvage approaches. Additionally, there seems to be a trend towards lower morbidity rates associated with minimally invasive and focal salvage treatment. We are encouraged by the results presented in this review and find that there is clearly a role for emerging minimally invasive and focal therapies as durable options for salvage treatment in patients with radiorecurrent PCa.
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Editorial Comment. J Urol 2018; 199:138. [DOI: 10.1016/j.juro.2017.06.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Scheltema MJ, van den Bos W, Siriwardana AR, Kalsbeek AM, Thompson JE, Ting F, Böhm M, Haynes AM, Shnier R, Delprado W, Stricker PD. Feasibility and safety of focal irreversible electroporation as salvage treatment for localized radio-recurrent prostate cancer. BJU Int 2017; 120 Suppl 3:51-58. [DOI: 10.1111/bju.13991] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Matthijs J. Scheltema
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Willemien van den Bos
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Amila R. Siriwardana
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Anton M.F. Kalsbeek
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | | | - Francis Ting
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Maret Böhm
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Ron Shnier
- Southern Radiology; Randwick NSW Australia
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Golan R, Bernstein AN, McClure TD, Sedrakyan A, Patel NA, Parekh DJ, Marks LS, Hu JC. Partial Gland Treatment of Prostate Cancer Using High-Intensity Focused Ultrasound in the Primary and Salvage Settings: A Systematic Review. J Urol 2017; 198:1000-1009. [PMID: 28433640 DOI: 10.1016/j.juro.2017.03.137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Advances in prostate imaging, biopsy and ablative technologies have been accompanied by growing enthusiasm for partial gland ablation, particularly using high-intensity focused ultrasound, to treat prostate cancer. Preserving noncancerous prostate tissue and minimizing damage to the neurovascular bundles and external urethral sphincter may improve functional outcomes. MATERIALS AND METHODS A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using a combination of MeSH® terms, free text search and examination of relevant bibliographies using MEDLINE® and Embase® from the inception of each database through October 10, 2016. We excluded studies describing exclusively whole gland ablation, case reports and series where treatment was followed by immediate resection. RESULTS A total of 13 studies that enrolled 543 patients were included. Of the studies 11 were performed in the primary setting and 2 in the salvage setting. Median followup ranged from 6 months to 10.6 years. Rates of posttreatment erectile dysfunction and urinary incontinence ranged from 0% to 48% and 0% to 50%, respectively, with definitions varying by study. Overall there were 254 reported complications. Marked heterogeneity between studies limited the ability to pool results regarding functional and oncologic outcomes. A total of 76 patients (14%) subsequently received further oncologic treatment. CONCLUSIONS Early evidence suggests that partial gland ablation is a safe treatment option for men with localized disease. Longer term data are needed to evaluate oncologic efficacy and functional outcomes, and will aid in identifying the optimal candidates for therapy. Standardization of outcomes definitions will allow for better comparison between studies and among treatment modalities.
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Affiliation(s)
- Ron Golan
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Adrien N Bernstein
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Timothy D McClure
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Neal A Patel
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Dipen J Parekh
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical College, New York, New York.
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Crouzet S, Blana A, Murat FJ, Pasticier G, Brown SCW, Conti GN, Ganzer R, Chapet O, Gelet A, Chaussy CG, Robertson CN, Thuroff S, Ward JF. Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. BJU Int 2017; 119:896-904. [PMID: 28063191 DOI: 10.1111/bju.13766] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the oncological outcome of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre database. PATIENTS AND METHODS This retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S-HIFU from 1995 to 2009. The biochemical failure-free survival (bFFS) rate was based on the 'Phoenix' definition (PSA nadir + 2 ng/mL). Secondary endpoints included progression to metastasis and cancer-specific death. Kaplan-Meier analysis was performed examining overall (OS), cancer-specific (CSS) and metastasis-free survival (MFS). Adverse events and quality of life status are reported. RESULTS In all, 418 patients with a mean (SD) follow-up of 3.5 (2.5) years were included. The mean (SD) age was 68.6 (5.8) years and the PSA level before S-HIFU was 6.8 (7.8) ng/mL. The median PSA nadir after S-HIFU was 0.19 ng/mL. The OS, CSS and MFS rates at 7 years were 72%, 82% and 81%, respectively. At 5 years the bFFS rate was 58%, 51% and 36% for pre-EBRT low-, intermediate- and high-risk patients, respectively. The 5-year bFFS rate was 67%, 42% and 22% for pre-S-HIFU PSA level ≤4, 4-10 and ≥10 ng/mL, respectively. Complication rates decreased after the introduction of specific post-RT parameters: incontinence (grade II or III) from 32% to 19% (P = 0.002); bladder outlet obstruction or stenosis from 30% to 15% (P = 0.003); recto-urethral fistula decreased from 9% to 0.6% (P < 0.001). Study limitations include being a retrospective analysis from a registry with no control group. CONCLUSION S-HIFU for locally recurrent prostate cancer after failed EBRT is associated with 7-year CSS and MFS rates of >80% at a price of significant morbidity. S-HIFU should be initiated early following EBRT failure.
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Affiliation(s)
| | - Andreas Blana
- Department of Urology, Fuerth Hospital, Fürth, Germany
| | | | | | | | | | - Roman Ganzer
- Department of Urology, University of Regensburg, Regensburg, Germany
| | - Olivier Chapet
- Department of Radiation Oncology, Lyon Sud Hospital, Pierre Bénite, France
| | - Albert Gelet
- Department of Urology, Edouard Herriot Hospital, Lyon, France
| | | | | | - Stefan Thuroff
- Department of Urology, Harlaching Hospital, Munich, Germany
| | - John F Ward
- Department of Urology, M. D. Anderson Cancer Center, Houston, TX, USA
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Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids: a pilot study. J Ther Ultrasound 2017; 5:8. [PMID: 28194274 PMCID: PMC5299783 DOI: 10.1186/s40349-017-0088-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 01/06/2017] [Indexed: 02/07/2023] Open
Abstract
Background Magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids is rapidly gaining popularity as a treatment modality. This procedure is generally uncomfortable, painful, and requires minimal or absence of movement and an MR-HIFU synchronised breathing pattern of the patient. Procedural sedation and analgesia protocols have become the standard practice in interventional radiology departments worldwide. The aim of this study was to explore if a sedation regimen with low-dose propofol and ketamine performed by trained non-medical sedation practitioners could result in relief of discomfort for the patient and in adequate working conditions for MR-HIFU treatment for uterine fibroids. Methods In this study, conducted from August 2013 until November 2014, 20 patients were subjected to MR-HIFU treatment of uterine fibroids. Patients were deeply sedated using intravenous propofol and esketamine according to a standardised hospital protocol to allow synchronisation of the breathing pattern to the MR-HIFU. The quality of sedation for MR-HIFU and complications were recorded and analysed. The side effects of the sedation technique, the propofol and esketamine consumption rate, the duration of recovery, and patient satisfaction after 24 h were examined. Results A total of 20 female patients (mean age 42.4 [range 32–53] years) were enrolled. Mean propofol/esketamine dose was 1309 mg/39.5 mg (range 692–1970 mg/ 23.6–87.9 mg). Mean procedure time was 269 min (range 140–295 min). Application of the sedation protocol resulted in a regular breathing pattern, which could be synchronised with the MR-HIFU procedures without delay. The required treatment was completed in all cases. There were no major adverse events. Hypoxemia (oxygen desaturation <92%) and hallucinations were not observed. Conclusions The use of a specific combination of IV propofol and esketamine for procedural sedation and analgesia reduced the discomfort and pain during MR-guided HIFU treatments of uterine fibroids. The resulting regular breathing pattern allowed for easy synchronisation of the MR-HIFU procedure. Based on our results, esketamine and propofol sedation performed by trained non-medical sedation practitioners is feasible and safe, has a low risk of major adverse events, and has a short recovery time, avoiding a session of general anaesthesia. Electronic supplementary material The online version of this article (doi:10.1186/s40349-017-0088-9) contains supplementary material, which is available to authorized users.
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Capogrosso P, Barret E. High-Intensity Focused Ultrasound. IMAGING AND FOCAL THERAPY OF EARLY PROSTATE CANCER 2017. [DOI: 10.1007/978-3-319-49911-6_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Detection of locally radio-recurrent prostate cancer at multiparametric MRI: Can dynamic contrast-enhanced imaging be omitted? Diagn Interv Imaging 2016; 97:433-41. [PMID: 26928245 DOI: 10.1016/j.diii.2016.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/17/2016] [Accepted: 01/26/2016] [Indexed: 11/21/2022]
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Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review. World J Urol 2016; 34:1521-1531. [PMID: 27012712 PMCID: PMC5063906 DOI: 10.1007/s00345-016-1811-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/11/2016] [Indexed: 11/16/2022] Open
Abstract
Background/Aim Patients with locally recurrent prostate cancer after primary radiotherapy can be eligible for salvage treatment. Whole-gland salvage techniques carry a high risk of toxicity. A focal salvage approach might reduce the risk of adverse events while maintaining cancer control in carefully selected patients. The aim of this review was to evaluate current literature to assess whether focal salvage leads to a comparable or favourable recurrence rate and less toxicity compared to whole-gland salvage. Methods A literature search was performed using PubMed, Embase and the Cochrane Library. A total of 3015 articles were screened and assessed for quality. Eight papers [on focal cryoablation (n = 3), brachytherapy (n = 3) and high-intensity focused ultrasound (n = 2)] were used to report outcomes. Results One-, 2-, 3- and 5-year biochemical disease-free survival (BDFS) ranges for focal salvage are, respectively, 69–100, 49–100, 50–91 and 46.5–54.5 %. Severe genitourinary, gastrointestinal and sexual function toxicity rates are 0–33.3 %. One study directly compares focal to whole-gland salvage cryotherapy, showing 5-year BDFS of, respectively, 54.4 and 86.5 % with lower toxicity rates for focal salvage patients. Conclusion Provisional data suggest that BDFS rates of focal salvage are in line with those of whole-gland approaches. There is evidence that focal salvage could decrease severe toxicity and preserve erectile function. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1811-9) contains supplementary material, which is available to authorized users.
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Srimathveeravalli G, Cornelis F, Mashni J, Takaki H, Durack JC, Solomon SB, Coleman JA. Comparison of ablation defect on MR imaging with computer simulation estimated treatment zone following irreversible electroporation of patient prostate. SPRINGERPLUS 2016; 5:219. [PMID: 27026913 PMCID: PMC4771651 DOI: 10.1186/s40064-016-1879-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/16/2016] [Indexed: 12/18/2022]
Abstract
To determine whether patient specific numerical simulations of irreversible electroporation (IRE) of the prostate correlates with the treatment effect seen on follow-up MR imaging. Computer models were created using intra-operative US images, post-treatment follow-up MR images and clinical data from six patients receiving IRE. Isoelectric contours drawn using simulation results were compared with MR imaging to estimate the energy threshold separating treated and untreated tissue. Simulation estimates of injury to the neurovascular bundle and rectum were compared with clinical follow-up and patient reported outcomes. At the electric field strength of 700 V/cm, simulation estimated electric field distribution was not different from the ablation defect seen on follow-up MR imaging (p = 0.43). Simulation predicted cross sectional area of treatment (mean 532.33 ± 142.32 mm(2)) corresponded well with the treatment zone seen on MR imaging (mean 540.16 ± 237.13 mm(2)). Simulation results did not suggest injury to the rectum or neurovascular bundle, matching clinical follow-up at 3 months. Computer simulation estimated zone of irreversible electroporation in the prostate at 700 V/cm was comparable to measurements made on follow-up MR imaging. Numerical simulation may aid treatment planning for irreversible electroporation of the prostate in patients.
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Affiliation(s)
- Govindarajan Srimathveeravalli
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Francois Cornelis
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA ; Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Joseph Mashni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Haruyuki Takaki
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Jeremy C Durack
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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Abstract
High intensity focused ultrasound (HIFU) is rapidly gaining clinical acceptance as a technique capable of providing non-invasive heating and ablation for a wide range of applications. Usually requiring only a single session, treatments are often conducted as day case procedures, with the patient either fully conscious, lightly sedated or under light general anesthesia. HIFU scores over other thermal ablation techniques because of the lack of necessity for the transcutaneous insertion of probes into the target tissue. Sources placed either outside the body (for treatment of tumors or abnormalities of the liver, kidney, breast, uterus, pancreas brain and bone), or in the rectum (for treatment of the prostate), provide rapid heating of a target tissue volume, the highly focused nature of the field leaving tissue in the ultrasound propagation path relatively unaffected. Numerous extra-corporeal, transrectal and interstitial devices have been designed to optimize application-specific treatment delivery for the wide-ranging areas of application that are now being explored with HIFU. Their principle of operation is described here, and an overview of their design principles is given.
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Affiliation(s)
- Gail Ter Haar
- Joint Department of Physics, The Institute of Cancer Research, Sutton, 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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Renard Penna R, Brenot-Rossi I, Salomon L, Soulié M. Imagerie du cancer de la prostate : IRM et imagerie nucléaire. Prog Urol 2015; 25:933-46. [DOI: 10.1016/j.purol.2015.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 10/25/2022]
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Faithfull S, Lemanska A, Aslet P, Bhatt N, Coe J, Drudge-Coates L, Feneley M, Glynn-Jones R, Kirby M, Langley S, McNicholas T, Newman J, Smith CC, Sahai A, Trueman E, Payne H. Integrative review on the non-invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies. Int J Clin Pract 2015; 69:1184-208. [PMID: 26292988 PMCID: PMC5042099 DOI: 10.1111/ijcp.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIM To develop a non-invasive management strategy for men with lower urinary tract symptoms (LUTS) after treatment for pelvic cancer, that is suitable for use in a primary healthcare context. METHODS PubMed literature searches of LUTS management in this patient group were carried out, together with obtaining a consensus of management strategies from a panel of authors for the management of LUTS from across the UK. RESULTS Data from 41 articles were investigated and collated. Clinical experience was sought from authors where there was no clinical evidence. The findings discussed in this paper confirm that LUTS after the cancer treatment can significantly impair men's quality of life. While many men recover from LUTS spontaneously over time, a significant proportion require long-term management. Despite the prevalence of LUTS, there is a lack of consensus on best management. This article offers a comprehensive treatment algorithm to manage patients with LUTS following pelvic cancer treatment. CONCLUSION Based on published research literature and clinical experience, recommendations are proposed for the standardisation of management strategies employed for men with LUTS after the pelvic cancer treatment. In addition to implementing the algorithm, understanding the rationale for the type and timing of LUTS management strategies is crucial for clinicians and patients.
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Affiliation(s)
- S Faithfull
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - A Lemanska
- School of Health Sciences, University of Surrey, Stag Hill, Guildford, UK
| | - P Aslet
- Department of Urology, Hampshire Hospitals Foundation Trust, Basingstoke, Hampshire, UK
| | - N Bhatt
- Sutton & Merton Community Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Coe
- University College Hospital, London, UK
| | | | - M Feneley
- University College Hospital, London, UK
| | | | - M Kirby
- Faculty of Health & Human Sciences, Centre for Research in Primary & Community Care (CRIPACC), University of Hertfordshire, Hertfordshire, UK
| | - S Langley
- The Royal Surrey County Hospital, Guildford, UK
| | | | - J Newman
- Oxford University Hospital, Oxford, UK
| | - C C Smith
- School of Health and Social Care, Bournemouth University, Dorset, UK
| | - A Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - E Trueman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Payne
- University College Hospital, London, UK
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Mendez MH, Joh DY, Gupta R, Polascik TJ. Current Trends and New Frontiers in Focal Therapy for Localized Prostate Cancer. Curr Urol Rep 2015; 16:35. [DOI: 10.1007/s11934-015-0513-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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