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Mehralivand S, George AK, Hoang AN, Rais-Bahrami S, Rastinehad AR, Lebastchi AH, Ahdoot M, Siddiqui MM, Bloom J, Sidana A, Merino MJ, Choyke PL, Shih JH, Turkbey B, Wood BJ, Pinto PA. MRI-guided focal laser ablation of prostate cancer: a prospective single-arm, single-center trial with 3 years of follow-up. Diagn Interv Radiol 2021; 27:394-400. [PMID: 34003127 PMCID: PMC8136525 DOI: 10.5152/dir.2021.20095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE We aimed to assess post-interventional and 36-month follow-up results of a single-center, single-arm, in-bore phase I trial of focal laser ablation (FLA) guided by multiparametric magnetic resonance imaging (mpMRI). METHODS FLA procedures were done in-bore MRI using a transperineal approach. Primary endpoints were feasibility and safety expressed as lack of grade 3 complications. Secondary endpoints were changes in international prostate symptom score (IPSS), sexual health inventory for men (SHIM), quality of life (QoL) scores, and serum prostate specific antigen (PSA) levels. Treatment outcomes were assessed by combined mpMRI-ultrasound fusion-guided and extended sextant systematic biopsy after 12, 24, and optionally after 36 months. RESULTS Fifteen participants were included. Seven patients (46.67%) had Gleason 3+3 and 8 patients (53.33%) had Gleason 3+4 cancer. All patients tolerated the procedure well, and no grade 3/4 complications occurred. All grade 1 and 2 complications were transient and resolved completely. There was no significant change in mean IPSS from baseline (-1, p = 0.460) and QoL (0, p = 0.441) scores following FLA but there was a significant drop in mean SHIM scores (-2, p = 0.010) compared to pretreatment baselines. Mean PSA significantly decreased after FLA (-2.5, p < 0.001). Seven out of 15 patients (46.67%) had residual cancer in, adjacent, or in close proximity to the treatment area (1 × 4+3=7, 1 × 3+4=7, and 5 × 3+3=6). Four out of 15 patients (26.67%) underwent salvage therapy (2 repeat FLA, 2 radical prostatectomy). CONCLUSION After 3 years of follow-up we conclude focal laser ablation is safe and feasible without significant complications.
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Affiliation(s)
- Sherif Mehralivand
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Arvin K. George
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Anthony N. Hoang
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Soroush Rais-Bahrami
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Ardeshir R. Rastinehad
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Amir H. Lebastchi
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Ahdoot
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Mohummad Minhaj Siddiqui
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonathan Bloom
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Abhinav Sidana
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria J. Merino
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter L. Choyke
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Joanna H. Shih
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Baris Turkbey
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Bradford J. Wood
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter A. Pinto
- From the Department of Urology and Pediatric Urology (S.M.), University Medical Center, Mainz, Germany; Urologic Oncology Branch (S.M., A.H.L., M.A., J.B., A.S., P.A.P.) and Molecular Imaging Branch (S.M., P.L.C., B.T. ), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Department of Urology (A.K.G.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA; Houston Metro Urology (A.N.H.), Houston, Texas, USA; Departments of Urology and Radiology (S.R.B.), University of Alabama, Birmingham, Alabama, USA; Mount Sinai Urology Associates (A.R.R.), Mount Sinai Hospital, New York, USA; University of Maryland Medical Center (M.M.S.), Baltimore, Marland; Laboratory of Pathology (M.J.M.), National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; Division of Cancer Treatment and Diagnosis (J.H.S.), Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA; Center for Interventional Oncology (B.J.W.), National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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