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Séguier D, Adams ES, Kotamarti S, D'Anniballe V, Michael ZD, Deivasigamani S, Olivier J, Villers A, Hoimes C, Polascik TJ. Intratumoural immunotherapy plus focal thermal ablation for localized prostate cancer. Nat Rev Urol 2024; 21:290-302. [PMID: 38114768 DOI: 10.1038/s41585-023-00834-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/21/2023]
Abstract
Major advances have been made in the use of immunotherapy for the treatment of solid tumours, including the use of intratumourally injected immunotherapy instead of systemically delivered immunotherapy. The success of immunotherapy in prostate cancer treatment has been limited to specific populations with advanced disease, which is thought to be a result of prostate cancer being an immunologically 'cold' cancer. Accordingly, combining intratumoural immunotherapy with other treatments that would increase the immunological heat of prostate cancer is of interest. Thermal ablation therapy is currently one of the main strategies used for the treatment of localized prostate cancer and it causes immunological activation against prostate tissue. The use of intratumoural immunotherapy as an adjunct to thermal ablation offers the potential to elicit a systemic and lasting adaptive immune response to cancer-specific antigens, leading to a synergistic effect of combination therapy. The combination of thermal ablation and immunotherapy is currently in the early stages of investigation for the treatment of multiple solid tumour types, and the potential for this combination therapy to also offer benefit to prostate cancer patients is exciting.
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Affiliation(s)
- Denis Séguier
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA.
- Department of Urology, Lille University, Lille, France.
- Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER; UMR9020-U1277), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France.
| | - Eric S Adams
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Srinath Kotamarti
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Vincent D'Anniballe
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Zoe D Michael
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Sriram Deivasigamani
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Jonathan Olivier
- Department of Urology, Lille University, Lille, France
- Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER; UMR9020-U1277), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Arnauld Villers
- Department of Urology, Lille University, Lille, France
- Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER; UMR9020-U1277), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Christopher Hoimes
- Department of Medicine, Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, 27708, USA
| | - Thomas J Polascik
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
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French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease. Prog Urol 2022; 32:1275-1372. [DOI: 10.1016/j.purol.2022.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
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3
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Khandwala YS, Morisetty S, Ghanouni P, Fan RE, Soerensen SJC, Rusu M, Sonn GA. Evaluation of post-ablation mpMRI as a predictor of residual prostate cancer after focal high intensity focused ultrasound (HIFU) ablation. Urol Oncol 2022; 40:489.e9-489.e17. [PMID: 36058811 PMCID: PMC10058305 DOI: 10.1016/j.urolonc.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the performance of multiparametric magnetic resonance imaging (mpMRI) and PSA testing in follow-up after high intensity focused ultrasound (HIFU) focal therapy for localized prostate cancer. METHODS A total of 73 men with localized prostate cancer were prospectively enrolled and underwent focal HIFU followed by per-protocol PSA and mpMRI with systematic plus targeted biopsies at 12 months after treatment. We evaluated the association between post-treatment mpMRI and PSA with disease persistence on the post-ablation biopsy. We also assessed post-treatment functional and oncological outcomes. RESULTS Median age was 69 years (Interquartile Range (IQR): 66-74) and median PSA was 6.9 ng/dL (IQR: 5.3-9.9). Of 19 men with persistent GG ≥ 2 disease, 58% (11 men) had no visible lesions on MRI. In the 14 men with PIRADS 4 or 5 lesions, 7 (50%) had either no cancer or GG 1 cancer at biopsy. Men with false negative mpMRI findings had higher PSA density (0.16 vs. 0.07 ng/mL2, P = 0.01). No change occurred in the mean Sexual Health Inventory for Men (SHIM) survey scores (17.0 at baseline vs. 17.7 post-treatment, P = 0.75) or International Prostate Symptom Score (IPSS) (8.1 at baseline vs. 7.7 at 24 months, P = 0.81) after treatment. CONCLUSIONS Persistent GG ≥ 2 cancer may occur after focal HIFU. mpMRI alone without confirmatory biopsy may be insufficient to rule out residual cancer, especially in patients with higher PSA density. Our study also validates previously published studies demonstrating preservation of urinary and sexual function after HIFU treatment.
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Affiliation(s)
- Yash S Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Shravan Morisetty
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University Medical Center, Stanford, CA
| | - Richard E Fan
- Department of Urology, Stanford University Medical Center, Stanford, CA; Department of Radiology, Stanford University Medical Center, Stanford, CA
| | | | - Mirabela Rusu
- Department of Radiology, Stanford University Medical Center, Stanford, CA
| | - Geoffrey A Sonn
- Department of Urology, Stanford University Medical Center, Stanford, CA; Department of Radiology, Stanford University Medical Center, Stanford, CA.
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Magnetic resonance imaging of the prostate after focal therapy with high-intensity focused ultrasound. Abdom Radiol (NY) 2020; 45:3882-3895. [PMID: 32447414 DOI: 10.1007/s00261-020-02577-5] [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] [Indexed: 12/31/2022]
Abstract
For clinically significant, locally confined prostate cancer, whole-gland radical prostatectomy and radiotherapy are established effective treatment strategies that, however, come at a cost of significant morbidity related to urinary and sexual side effects. The concept of risk stratification paired with a better understanding of prognostic factors has led to the development of alternative management options including active surveillance and focal therapy for appropriately selected patients with localized disease. High-intensity focused ultrasound (HIFU) is one such minimally invasive, image-guided treatment option for prostate cancer. Due to the relative novelty of HIFU and the increased use of magnetic resonance imaging in prostate cancer, many radiologists are not yet familiar with imaging findings related to HIFU, their temporal evolution as well as imaging appearance of recurrent disease after this type of focal therapy. HIFU induces sharply demarcated, localized coagulative necrosis of a tumor through thermal energy delivered via an endorectal or transurethral ultrasound transducer. In this pictorial review, we aim at providing relevant background information that will guide the reader through the general principles of HIFU in the prostate, as well as demonstrate the imaging appearance of expected post-HIFU changes versus recurrent tumor.
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Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : cancer de la prostate. Prog Urol 2020; 30:S136-S251. [DOI: 10.1016/s1166-7087(20)30752-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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6
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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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Hyperpolarized MRI of Human Prostate Cancer Reveals Increased Lactate with Tumor Grade Driven by Monocarboxylate Transporter 1. Cell Metab 2020; 31:105-114.e3. [PMID: 31564440 PMCID: PMC6949382 DOI: 10.1016/j.cmet.2019.08.024] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/11/2019] [Accepted: 08/30/2019] [Indexed: 01/17/2023]
Abstract
Metabolic imaging using hyperpolarized magnetic resonance can increase the sensitivity of MRI, though its ability to inform on relevant changes to biochemistry in humans remains unclear. In this work, we image pyruvate metabolism in patients, assessing the reproducibility of delivery and conversion in the setting of primary prostate cancer. We show that the time to max of pyruvate does not vary significantly within patients undergoing two separate injections or across patients. Furthermore, we show that lactate increases with Gleason grade. RNA sequencing data demonstrate a significant increase in the predominant pyruvate uptake transporter, monocarboxylate transporter 1. Increased protein expression was also observed in regions of high lactate signal, implicating it as the driver of lactate signal in vivo. Targeted DNA sequencing for actionable mutations revealed the highest lactate occurred in patients with PTEN loss. This work identifies a potential link between actionable genomic alterations and metabolic information derived from hyperpolarized pyruvate MRI.
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Development of a model to predict prostate cancer at the apex (PCAP model) in patients undergoing robot-assisted radical prostatectomy. World J Urol 2019; 38:813-819. [DOI: 10.1007/s00345-019-02905-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/09/2019] [Indexed: 11/27/2022] Open
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Murad HY, Yu H, Luo D, Bortz EP, Halliburton GM, Sholl AB, Khismatullin DB. Mechanochemical Disruption Suppresses Metastatic Phenotype and Pushes Prostate Cancer Cells toward Apoptosis. Mol Cancer Res 2019; 17:1087-1101. [PMID: 30617107 DOI: 10.1158/1541-7786.mcr-18-0782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/22/2018] [Accepted: 01/03/2019] [Indexed: 12/30/2022]
Abstract
Chemical-based medicine that targets specific oncogenes or proteins often leads to cancer recurrence due to tumor heterogeneity and development of chemoresistance. This challenge can be overcome by mechanochemical disruption of cancer cells via focused ultrasound (FUS) and sensitizing chemical agents such as ethanol. We demonstrate that this disruptive therapy decreases the viability, proliferation rate, tumorigenicity, endothelial adhesion, and migratory ability of prostate cancer cells in vitro. It sensitized the cells to TNFR1-- and Fas--mediated apoptosis and reduced the expression of metastatic markers CD44 and CD29. Using a prostate cancer xenograft model, we observed that the mechanochemical disruption led to complete tumor regression in vivo. This switch to a nonaggressive cell phenotype was caused by ROS and Hsp70 overproduction and subsequent impairment of NFκB signaling. FUS induces mechanical perturbations of diverse cancer cell populations, and its combination with agents that amplify and guide remedial cellular responses can stop lethal cancer progression. IMPLICATIONS: Mechanochemical disruption therapy in which FUS is combined with ethanol can be curative for locally aggressive and castration-resistant prostate cancer.
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Affiliation(s)
- Hakm Y Murad
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana.,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, New Orleans, Louisiana
| | - Heng Yu
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana.,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, New Orleans, Louisiana
| | - Daishen Luo
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana.,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, New Orleans, Louisiana
| | - Emma P Bortz
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana.,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, New Orleans, Louisiana
| | - Gray M Halliburton
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana.,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, New Orleans, Louisiana
| | - Andrew B Sholl
- Department of Pathology and Laboratory Medicine, Tulane University, New Orleans, Louisiana
| | - Damir B Khismatullin
- Department of Biomedical Engineering, Tulane University, New Orleans, Louisiana. .,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University, New Orleans, Louisiana.,Tulane Cancer Center, Tulane University, New Orleans, Louisiana
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Capogrosso P, Barret E, Sanchez-Salas R, Nunes-Silva I, Rozet F, Galiano M, Ventimiglia E, Briganti A, Salonia A, Montorsi F, Cathelineau X. Oncological and functional outcomes of elderly men treated with HIFU vs. minimally invasive radical prostatectomy: A propensity score analysis. Eur J Surg Oncol 2017; 44:185-191. [PMID: 29223469 DOI: 10.1016/j.ejso.2017.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/24/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022] Open
Abstract
AIM To assess outcomes of whole gland high-intensity focused ultrasound (HIFU) as compared with minimally-invasive radical prostatectomy (MIRP) in elderly patients. MATERIALS & METHODS Patients aged ≥70 years with, cT1-cT2 disease, biopsy Gleason score (GS) 3 + 3 or 3 + 4 and preoperative PSA ≤10 ng/mL were submitted to either whole-gland HIFU or MIRP. Propensity-score matching analysis was performed to ensure the baseline equivalence of groups. Follow-up visits were routinely performed assessing PSA and urinary function according to the International Continence Score (ICS) and the International Prostatic Symptoms Score (IPSS) questionnaires. Estimated rates of salvage-treatment free survival (SFS) overall-survival (OS), cancer-specific survival (CSS) and metastasis-free survival (MTS) were assessed and compared. RESULTS Overall, 84 (33.3%) and 168 (66.7%) patients were treated with HIFU and MIRP, respectively. MIRP was associated with a 5-yrs SFS of 93.4% compared to 74.8% for HIFU (p < 0.01). The two groups did not differ in terms of OS and MTS. No cancer-related deaths were registered. Patients treated with HIFU showed better short-term (6-mos) continence outcomes [mean-ICS: 1.7 vs. 4.8; p = 0.005] but higher IPSS mean scores at 12-mos assessment. A comparable rate of patients experiencing post-treatment Clavien-Dindo grade ≥III complications was observed within the two groups. CONCLUSIONS Whole-gland HIFU is a feasible treatment in elderly men with low-to intermediate-risk PCa and could be considered for patients either unfit for surgery, or willing a non-invasive treatment with a low morbidity burden, although a non-negligible risk of requiring subsequent treatment for recurrence should be expected.
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Affiliation(s)
- Paolo Capogrosso
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy; Institut Mutualiste Montsouris, Paris, France
| | - Eric Barret
- Institut Mutualiste Montsouris, Paris, France.
| | | | | | | | | | - Eugenio Ventimiglia
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS, Ospedale San Raffaele, Milan, Italy
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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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12
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Arora JS, Murad HY, Ashe S, Halliburton G, Yu H, He J, John VT, Khismatullin DB. Ablative Focused Ultrasound Synergistically Enhances Thermally Triggered Chemotherapy for Prostate Cancer in Vitro. Mol Pharm 2016; 13:3080-90. [PMID: 27383214 DOI: 10.1021/acs.molpharmaceut.6b00216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
High-intensity focused ultrasound (HIFU) can locally ablate biological tissues such as tumors, i.e., induce their rapid heating and coagulative necrosis without causing damage to surrounding healthy structures. It is widely used in clinical practice for minimally invasive treatment of prostate cancer. Nonablative, low-power HIFU was established as a promising tool for triggering the release of chemotherapeutic drugs from temperature-sensitive liposomes (TSLs). In this study, we combine ablative HIFU and thermally triggered chemotherapy to address the lack of safe and effective treatment options for elderly patients with high-risk localized prostate cancer. DU145 prostate cancer cells were exposed to chemotherapy (free and liposomal Sorafenib) and ablative HIFU, alone or in combination. Prior to cell viability assessment by trypan blue exclusion and flow cytometry, the uptake of TSLs by DU145 cells was verified by confocal microscopy and cryogenic scanning electron microscopy (cryo-SEM). The combination of TSLs encapsulating 10 μM Sorafenib and 8.7W HIFU resulted in a viability of less than 10% at 72 h post-treatment, which was significant less than the viability of the cells treated with free Sorafenib (76%), Sorafenib-loaded TSLs (63%), or HIFU alone (44%). This synergy was not observed on cells treated with Sorafenib-loaded nontemperature sensitive liposomes and HIFU. According to cryo-SEM analysis, cells exposed to ablative HIFU exhibited significant mechanical disruption. Water bath immersion experiments also showed an important role of mechanical effects in the synergistic enhancement of TSL-mediated chemotherapy by ablative HIFU. This combination therapy can be an effective strategy for treatment of geriatric prostate cancer patients.
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Affiliation(s)
- Jaspreet S Arora
- Department of Chemical and Biomolecular Engineering, Tulane University , New Orleans, Louisiana 70118, United States.,Vector-Borne Infectious Disease Research Center, Tulane University , New Orleans, Louisiana 70118, United States
| | - Hakm Y Murad
- Department of Biomedical Engineering, Tulane University , New Orleans, Louisiana 70118, United States.,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University , New Orleans, Louisiana 70118, United States
| | - Stephen Ashe
- Department of Chemical and Biomolecular Engineering, Tulane University , New Orleans, Louisiana 70118, United States
| | - Gray Halliburton
- Department of Biomedical Engineering, Tulane University , New Orleans, Louisiana 70118, United States.,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University , New Orleans, Louisiana 70118, United States
| | - Heng Yu
- Department of Biomedical Engineering, Tulane University , New Orleans, Louisiana 70118, United States.,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University , New Orleans, Louisiana 70118, United States
| | - Jibao He
- Department of Chemical and Biomolecular Engineering, Tulane University , New Orleans, Louisiana 70118, United States
| | - Vijay T John
- Department of Chemical and Biomolecular Engineering, Tulane University , New Orleans, Louisiana 70118, United States.,Vector-Borne Infectious Disease Research Center, Tulane University , New Orleans, Louisiana 70118, United States
| | - Damir B Khismatullin
- Department of Biomedical Engineering, Tulane University , New Orleans, Louisiana 70118, United States.,Tulane Institute for Integrative Engineering for Health and Medicine, Tulane University , New Orleans, Louisiana 70118, United States.,Tulane Cancer Center, Tulane University School of Medicine , New Orleans, Louisiana 70118, United States
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Yao Y, Yang K, Cao Y, Zhou X, Xu J, Liu J, Wang Q, Wang Z, Wang D. Comparison of the synergistic effect of lipid nanobubbles and SonoVue microbubbles for high intensity focused ultrasound thermal ablation of tumors. PeerJ 2016; 4:e1716. [PMID: 26925336 PMCID: PMC4768712 DOI: 10.7717/peerj.1716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/30/2016] [Indexed: 01/20/2023] Open
Abstract
Microbubbles (MBs) are considered as an important enhancer for high intensity focused ultrasound (HIFU) treatment of benign or malignant tumors. Recently, different sizes of gas-filled bubbles have been investigated to improve the therapeutic efficiency of HIFU thermal ablation and reduce side effects associated with ultrasound power and irradiation time. However, nanobubbles (NBs) as an ultrasound contrast agent for synergistic therapy of HIFU thermal ablation remain controversial due to their small nano-size in diameter. In this study, phospholipid-shell and gas-core NBs with a narrow size range of 500–600 nm were developed. The synergistic effect of NBs for HIFU thermal ablation was carefully studied both in excised bovine livers and in breast tumor models of rabbits, and made a critical comparison with that of commercial SonoVue microbubbles (SonoVue MBs). In addition, the pathological changes of the targeted area in tumor tissue after HIFU ablation were further investigated. Phosphate buffer saline (PBS) was used as the control. Under the same HIFU parameters, the quantitative echo intensity of B-mode ultrasound image and the volume of coagulative necrosis in lipid NBs groups were significantly higher and larger than that in PBS groups, but could not be demonstrated a difference to that in SonoVue MBs groups both ex vivo and in vivo. These results showed that the synergistic effect of lipid NBs for HIFU thermal ablation were similar with that of SonoVue MBs, and further indicate that lipid NBs could potentially become an enhancer for HIFU thermal ablation of tumors.
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Affiliation(s)
- Yuanzhi Yao
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Ke Yang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Yang Cao
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Xuan Zhou
- Department of Emergency, Chinese PLA General Hospital , Beijing , China
| | - Jinshun Xu
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Jianxin Liu
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Qi Wang
- Institute of Ultrasound Engineering in Medical of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Zhigang Wang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Dong Wang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China; Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
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14
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Sadimin ET, Ye H, Epstein JI. Should the involvement of skeletal muscle by prostatic adenocarcinoma be reported on biopsies? Hum Pathol 2016; 49:10-4. [PMID: 26826403 DOI: 10.1016/j.humpath.2015.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/09/2015] [Accepted: 10/16/2015] [Indexed: 11/26/2022]
Abstract
Skeletal muscle is seen at the distal part of the prostate apex, where benign glands may reside as part of normal anatomy and histology, and extends more proximally anteriorly. At times, prostatic adenocarcinoma can be seen admixed with skeletal muscle, raising the question of extraprostatic extension. Although there has been increased attention regarding biopsy sampling of the distal apex to guide the performing of the apical dissection on radical prostatectomy, the finding of skeletal muscle involvement by prostatic adenocarcinoma has not been consistently reported by pathologists on biopsies. We searched our database spanning 12 years from 2000 to 2012 for all patients who had prostatic adenocarcinoma Gleason score 3 + 3 = 6 involving skeletal muscle on biopsy. We identified 220 patients who met the criteria. Of the 220 patients, 101 underwent prostatectomy, which comprised the "study group." Prostatectomy reports from these patients were compared with those of a "control group," which consisted of 201 contemporaneous patients with Gleason score 3 + 3 = 6 prostatic adenocarcinoma on biopsy without skeletal muscle involvement. The results showed a significantly higher percentage of positive margins in the study group compared with the control group (P = .006). The study group also had a higher percentage of positive margins at the apex admixed with skeletal muscle (P = .008). In summary, the findings in this study support that pathologists should report the involvement of skeletal muscle by tumor, and recommend that urologists performing radical prostatectomies on these patients try to ensure adequate excision in the apical area to avoid positive apical margin.
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Affiliation(s)
- Evita T Sadimin
- Department of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231
| | - Huihui Ye
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02120
| | - Jonathan I Epstein
- Department of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231.
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Sankineni S, Wood BJ, Rais-Bahrami S, Walton Diaz A, Hoang AN, Pinto PA, Choyke PL, Türkbey B. Image-guided focal therapy for prostate cancer. Diagn Interv Radiol 2015; 20:492-7. [PMID: 25205025 DOI: 10.5152/dir.2014.14134] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The adoption of routine prostate specific antigen screening has led to the discovery of many small and low-grade prostate cancers which have a low probability of causing mortality. These cancers, however, are often treated with radical therapies resulting in long-term side effects. There has been increasing interest in minimally invasive focal therapies to treat these tumors. While imaging modalities have improved rapidly over the past decade, similar advances in image-guided therapy are now starting to emerge--potentially achieving equivalent oncologic efficacy while avoiding the side effects of conventional radical surgery. The purpose of this article is to review the existing literature regarding the basis of various focal therapy techniques such as cryotherapy, microwave, laser, and high intensity focused ultrasound, and to discuss the results of recent clinical trials that demonstrate early outcomes in patients with prostate cancer.
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Kuru TH, van Essen J, Pfister D, Porres D. Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer. Oncol Res Treat 2015; 38:634-8. [DOI: 10.1159/000441600] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/09/2015] [Indexed: 11/19/2022]
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High Intensity Focused Ultrasound versus Brachytherapy for the Treatment of Localized Prostate Cancer: A Matched-Pair Analysis. Adv Urol 2015; 2015:350324. [PMID: 26357511 PMCID: PMC4556829 DOI: 10.1155/2015/350324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/09/2015] [Indexed: 12/15/2022] Open
Abstract
Purpose. To evaluate postoperative morbidity and long term oncologic and functional outcomes of high intensity focused ultrasound (HIFU) compared to brachytherapy for the treatment of localized prostate cancer. Material and Methods. Patients treated by brachytherapy were matched 1 : 1 with patients who underwent HIFU. Differences in postoperative complications across the two groups were assessed using Wilcoxon's rank-sum or χ (2) test. Kaplan-Meier curves, log-rank tests, and Cox regression models were constructed to assess differences in survival rates between the two groups. Results. Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p < 0.05). Median oncologic follow-up was 83 months (13-123 months) in the HIFU cohort and 44 months (13-89 months) in the brachytherapy cohort. Median time to achieve PSA nadir was statistically shorter in the HIFU. Biochemical recurrence-free survival rate was significantly higher in the brachytherapy cohort compared to HIFU cohort (68.5% versus 53%, p < 0.05). No statistically significant difference in metastasis-free, cancer specific, and overall survivals was observed between the two groups. Conclusion. HIFU and brachytherapy are safe with no significant difference in cancer specific survival on long term oncologic follow-up. Nonetheless, a randomized controlled trial is needed to confirm these results.
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Veereman G, Jonckheer P, Desomer A, Van Brabandt H, D'Hont C, Van Velthoven R, Tombal B. Systematic Review of the Efficacy and Safety of High-intensity Focussed Ultrasound for Localised Prostate Cancer. Eur Urol Focus 2015; 1:158-170. [PMID: 28723429 DOI: 10.1016/j.euf.2015.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/01/2015] [Accepted: 04/25/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT High-intensity focussed ultrasound (HIFU) has been used for 10 yr to treat localised prostate cancer (PCa). OBJECTIVE To evaluate systematically the evidence on the efficacy and side effects of HIFU in the primary treatment of localised PCa. EVIDENCE ACQUISITION We performed a critical review and appraisal of Medline (Ovid), PreMedline, Embase, and Cochrane Database of Systematic Reviews publications on HIFU up to May 2013. One systematic review and 18 primary studies, all case series, were eligible. EVIDENCE SYNTHESIS Outcomes were summarised and evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation methodology. Low-quality evidence suggests an overall survival rate after Ablatherm HIFU ranging from 80% to 89% for >5 yr. The PCa survival rate ranges from 97% to 99% for >5 yr. Effect of HIFU on quality of life remains undetermined. Erectile dysfunction was the most frequent adverse event reported from zero but up to 74% of patients. Adverse events affecting the urinary tract occurred in 0.7-31% of patients, bladder outlet obstruction in 4-51.5%, and they were more frequent in patients who had transurethral resection of the prostate the same day or within 2 d of HIFU. Outcomes vary for low- and high-risk categories. CONCLUSIONS Good quality evidence on the efficacy of HIFU treatment for localised PCa is lacking. PATIENT SUMMARY We reviewed all the data on treatment with high-intensity focussed ultrasound (HIFU) for localised prostate cancer (PCa). The quality of the evidence is very low because the information is based on a series of patients who received HIFU treatment with no comparison with active surveillance or radical treatment. Case series suggest an overall survival rate up to 89% and a PCa survival rate up to 99% after 5 yr, but these numbers vary according to the patient's risk category. Longer term and effects on quality of life are unknown.
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Affiliation(s)
| | | | - Anja Desomer
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Chris D'Hont
- Department of Urology, AZ Middelheim, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
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Abstract
OBJECTIVE Prostate tumors occasionally have unusual manifestations on multiparametric MR images that can present a diagnostic dilemma and result in a false-negative interpretation. This article presents examples of such "hiding places" of prostate tumors, four in the peripheral zone and four in the central gland. CONCLUSION The provided pointers in multiparametric MRI assessment can aid the radiologist in achieving an accurate diagnosis of tumor in the eight scenarios described.
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Abstract
Surgery remains a mainstay in the management of localized prostate cancer. This article addresses surgical aspects germane to the management of men with prostate cancer, including patient selection for surgery, nerve-sparing approaches, minimization of positive surgical margins, and indications for pelvic lymph node dissection. Outcomes for men with high-risk prostate cancer following surgery are reviewed, and the present role of neoadjuvant therapy before radical prostatectomy is discussed. In addition, there is a review of the published literature on surgical ablative therapies for prostate cancer.
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Baco E, Gelet A, Crouzet S, Rud E, Rouvière O, Tonoli-Catez H, Berge V, Chapelon JY, Eggesbø HB. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. BJU Int 2014; 114:532-40. [DOI: 10.1111/bju.12545] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eduard Baco
- Division of Surgery and Cancer Medicine; Department of Urology Oslo University Hospital; Aker Norway
| | - Albert Gelet
- Hospices Civils de Lyon; Department of Urology and Transplantation Surgery; Edouard Herriot Hospital; Lyon France
- Inserm; U1032; LabTau
| | - Sébastien Crouzet
- Hospices Civils de Lyon; Department of Urology and Transplantation Surgery; Edouard Herriot Hospital; Lyon France
- Inserm; U1032; LabTau
| | - Erik Rud
- Division of Diagnostic and Intervention; Department of Radiology and Nuclear Medicine; Oslo University Hospital; Aker Norway
| | - Olivier Rouvière
- Inserm; U1032; LabTau
- Department of Urinary and Vascular Imaging; Hospices Civils de Lyon; Edouard Herriot Hospital; Lyon France
- Faculté de Médecine; Hospices Civils de Lyon; Edouard Herriot Hospital; Lyon France
| | - Hélène Tonoli-Catez
- Hospices Civils de Lyon; Department of Urology and Transplantation Surgery; Edouard Herriot Hospital; Lyon France
| | - Viktor Berge
- Division of Surgery and Cancer Medicine; Department of Urology Oslo University Hospital; Aker Norway
| | | | - Heidi B. Eggesbø
- Division of Diagnostic and Intervention; Department of Radiology and Nuclear Medicine; Oslo University Hospital; Rikshospitalet Norway
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Salvage high-intensity focused ultrasound ablation for prostate cancer local recurrence after external-beam radiation therapy: Prognostic value of prostate MRI. Clin Radiol 2013; 68:661-7. [DOI: 10.1016/j.crad.2012.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/17/2012] [Accepted: 12/19/2012] [Indexed: 11/21/2022]
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Nix JW, Turkbey B, Hoang A, Volkin D, Yerram N, Chua C, Linehan WM, Wood B, Choyke P, Pinto PA. Very distal apical prostate tumours: identification on multiparametric MRI at 3 Tesla. BJU Int 2012; 110:E694-700. [PMID: 23035719 DOI: 10.1111/j.1464-410x.2012.11503.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? MRI has been shown to improve prostate cancer detection rates. Pinto et al. (J Urol 2011; 86: 1281-5) reported their outcomes on 101 patients with low, moderate or high suspicion lesions on multiparametric MRI that were subsequently targeted via an MRI/ultrasound fusion biopsy platform. The prostate cancer detection rates were 27%, 66% and 89% respectively. Sciarra et al. (Clin Cancer Res 2010; 16: 1875-83) performed a prospective trial in 180 patients with prior negative biopsy and persistent PSA elevation. Patients were randomized to either MRI targeted biopsy followed by random 12-core TRUS biopsy vs random TRUS guided biopsy alone. Prostate cancer detection in the MRI targeted group was 45.5% vs 24.4% in the random group. Although MRI has been shown to improve prostate cancer detection rates, there has not previously been any work looking at the ability of MRI to detect prostate cancer localized to the very distal apex of the prostate. This is an important topic in that it might lead clinicians to counsel their patients in treatment decisions if it is felt that a treatment might not treat this section of the prostate well, e.g. high intensity focused ultrasound therapy that might spare the distal apex. OBJECTIVE • To describe an undescribed 'very distal' apical prostate cancer on multiparametric MRI (mpMRI) since apical prostate cancer can be difficult to detect in transrectal ultrasound guided biopsy and might therefore be missed in treatment decisions such as high intensity focused ultrasound or surgical therapy. PATIENTS AND METHODS • From January 2011 to December 2012 a total of 210 consecutive patients underwent 3 T mpMRI with endorectal coil followed by our previously described MRI/ultrasound image fused and directed TRUS biopsies. • Patients also underwent 12-core TRUS sextant biopsies. • The inclusion criteria required at least one distal apical prostate lesion visualized on mpMRI and targeted for biopsy. RESULTS • A total of 38 men (median age 62 years, median PSA 7.68 ng/dL) were identified as having distal apical prostate cancer on mpMRI. • Thirteen patients (34%) had a prior diagnosis of cancer and were on active surveillance protocols while 25 (66%) did not. Of those patients, 21 (55%) had undergone a median of two prior negative biopsies. • Twenty-two patients (58%) were positive on biopsy for prostate cancer. On breakdown of patients who were positive, 17 (77%) were positive on TRUS random biopsies and 21 (95%) were positive on MRI targeted biopsies with the majority of patients having multifocal disease. • At the distal apical lesions of interest, 80% were positive on MRI targeted biopsy. In addition 33% of these patients were upgraded based on MRI targeted biopsy at the distal lesion. CONCLUSIONS • Very distal apical prostate cancer can be accurately detected and sampled with mpMRI and subsequent MRI/ultrasound fusion biopsy. • This may aid clinicians and patients in decision making for therapeutic modalities.
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Affiliation(s)
- Jeffrey W Nix
- National Institute of Health, National Cancer Institute, Urologic Oncology Branch, Bethesda, MD 20892, USA.
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Guillonneau B. Prostate cancer: new treatments for localized tumours-what matters first? Nat Rev Urol 2012; 9:414-5. [PMID: 22732857 DOI: 10.1038/nrurol.2012.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
High-intensity focused ultrasound (HIFU) represents a fairly new treatment option for focal therapy of prostate cancer. However, studies evaluating its efficacy have not provided strong data to support the use of HIFU in the majority of patients. Thus, high-profile studies investigating feasibility of the modality in terms of adverse effects seem premature.
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Affiliation(s)
- Bertrand Guillonneau
- Department of Urology, Deaconesses-Croix St Simon Medical Center, 12-18 rue du Sergent Bauchat, 75102 Paris, France.
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Current world literature. Curr Opin Urol 2012; 22:336-45. [PMID: 22677776 DOI: 10.1097/mou.0b013e3283551cbf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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So AI. HIFU ablation is not a proven standard treatment for localized prostate cancer. Can Urol Assoc J 2011; 5:424-6. [PMID: 22154640 PMCID: PMC3235211 DOI: 10.5489/cuaj.11232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Alan I. So
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC
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