1
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Marra G, Marquis A, Suberville M, Woo H, Govorov A, Hernandez-Porras A, Bhatti K, Turkbey B, Katz AE, Polascik TJ. Surveillance after Focal Therapy - a Comprehensive Review. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00905-0. [PMID: 39367182 DOI: 10.1038/s41391-024-00905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/02/2024] [Accepted: 09/27/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND to date, no standardized, evidence-based follow-up schemes exist for the monitoring of patients who underwent focal therapy (FT) and expert centers rely mainly on their own experience and/or institutional protocols. We aimed to perform a comprehensive review of the most advantageous follow-up strategies and their rationale after FT for prostate cancer (PCa). METHODS a narrative review of the literature was conducted to investigate different follow-up protocols of FT for PCa. Outcomes of interest were post-ablation oncological and functional outcomes and complications. RESULTS Oncological success after FT was generally defined as the biopsy-confirmed absence of clinically significant PCa in the treated zone. De novo PCa in the untreated area usually reflects an inaccurate patient selection and should be treated as primary PCa. During follow-up, oncological outcomes should be evaluated with periodic PSA, multiparametric MRI and prostate biopsy. The use of PSA derivatives and new biomarkers is still controversial and therefore not recommended. The first MRI after FT should be performed between 6-12 months to avoid ablation-related artifacts and diagnostic delay in case of FT failure. Other imaging modalities, such as PSMA PET/CT scan, are promising but still need to be validated in the post-FT setting. A 12-month "for-protocol" prostate biopsy, including targeted and systematic biopsy, was generally considered the preferred biopsy method to rule out tumor persistence/recurrence. Subsequent mpMRIs and biopsies should follow a risk-adapted approach depending on the clinical scenario. Functional outcomes should be periodically assessed using validated questionnaires within the first year, when typically recover to a new baseline. Complications, despite uncommon, should be strictly monitored mainly in the first month. CONCLUSIONS FT follow-up is a multifaceted process involving clinical, radiological, and histological assessment. Studies evaluating the impact of different follow-up strategies and ideal timings are needed to produce standardized protocols following FT.
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Affiliation(s)
- Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, City of Health and Science, Molinette Hospital and University of Turin, Turin, Italy
| | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, City of Health and Science, Molinette Hospital and University of Turin, Turin, Italy.
- Smith Institute for Urology, Zucker School of Medicine at Hofstra/Northwell University, New York, NY, USA.
| | - Michel Suberville
- Department of Urology, Pôle Saint Germain Centre Hospitalier de Brive, Brive la Gaillarde, France
| | - Henry Woo
- Department of Urology, Blacktown Mount Druitt Hospitals, Blacktown, NSW, Australia
- Department of Uro-Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | | | | | - Kamran Bhatti
- Urology Department, Hamad Medical Corporation, Alkhor, Qatar
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Aaron E Katz
- Department of Urology, NYU Winthrop Hospital, Garden City, NY, USA
| | - Thomas J Polascik
- Department of Urology and Duke Cancer Institute, Duke Medical Center, Durham, NC, USA
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2
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Meng X, Costa DN. A case of recto-urethral fistula following MRI-guided transurethral ablation (TULSA) of the prostate. Urol Case Rep 2024; 56:102827. [PMID: 39263217 PMCID: PMC11388761 DOI: 10.1016/j.eucr.2024.102827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024] Open
Abstract
We describe the first case of a recto-urethral fistula following an MRI-guided transurethral prostate ablation procedure (TULSA). The patient experienced urine per rectum six weeks after the procedure. A voiding cystourethrogram confirmed the presence of a recto-urethral fistula, which was managed with a urethral catheter and a suprapubic tube. Patient was then asymptomatic, with spontaneous healing of the fistula and catheters removed after six weeks. Not previously reported following TULSA, rectourethral fistula is a rare but known complication with other focal therapy modalities. Awareness of this potential complication will help improve patient counseling, early detection and adequate management of this rare complication.
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Affiliation(s)
- Xiaosong Meng
- Departments of Urology (X.M. and D.N.C) and Radiology (D.N.C), University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel N Costa
- Departments of Urology (X.M. and D.N.C) and Radiology (D.N.C), University of Texas Southwestern Medical Center, Dallas, TX, USA
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3
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Katsimperis S, Pinitas A, Zerva M, Bellos T, Manolitsis I, Feretzakis G, Verykios VS, Kyriazis I, Neofytou P, Kapsalos S, Deligiannis P, Triantafyllou P, Juliebø-Jones P, Somani B, Mitsogiannis I, Tzelves L. The Contemporary Role of Salvage Radical Prostatectomy in the Management of Recurrent Prostate Cancer: An Up-to-Date Review. Life (Basel) 2024; 14:868. [PMID: 39063621 PMCID: PMC11277914 DOI: 10.3390/life14070868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Prostate cancer is the second most common cancer among men, with many treatment modalities available for patients, such as radical prostatectomy, external beam radiotherapy, brachytherapy, high-intensity focused ultrasound, cryotherapy, electroporation and other whole-gland or focal ablative novel techniques. Unfortunately, up to 60% of men with prostate cancer experience recurrence at 5 to 10 years. Salvage radical prostatectomy can be offered as an option in the setting of recurrence after a primary non-surgical treatment. However, the complexity of salvage radical prostatectomy is considered to be greater than that of primary surgery, making it the least popular treatment of choice. With the wide use of robotic platforms in urologic oncologic surgery, salvage radical prostatectomy has attracted attention again because, compared to past data, modern series involving salvage Robot-Assisted Radical Prostatectomy have shown promising results. In this narrative literature review, we comprehensively examined data on salvage radical prostatectomy. We investigated the correlation between the different types of primary prostate cancer therapy and the following salvage radical prostatectomy. Furthermore, we explored the concept of a robotic approach and its beneficial effect in salvage surgery. Lastly, we emphasized several promising avenues for future research in this field.
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Affiliation(s)
- Stamatios Katsimperis
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
| | - Alexandros Pinitas
- Department of Urology, General Hospital of Athens “G. Gennimatas”, 11527 Athens, Greece;
| | - Maria Zerva
- Department of Urology, Red Cross General Hospital of Athens, 11526 Athens, Greece;
| | - Themistoklis Bellos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
| | - Ioannis Manolitsis
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
| | - Georgios Feretzakis
- School of Science and Technology, Hellenic Open University, 26335 Patras, Greece; (G.F.); (V.S.V.)
| | - Vassilios S. Verykios
- School of Science and Technology, Hellenic Open University, 26335 Patras, Greece; (G.F.); (V.S.V.)
| | - Ioannis Kyriazis
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
| | - Panagiotis Neofytou
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
| | - Sotirios Kapsalos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
| | - Panagiotis Deligiannis
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
| | - Panagiotis Triantafyllou
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
| | | | - Bhaskar Somani
- Department of Urology, University Hospital, Southampton SO16 6YD, UK;
| | - Iraklis Mitsogiannis
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
| | - Lazaros Tzelves
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, 15126 Athens, Greece; (T.B.); (I.M.); (I.K.); (P.N.); (S.K.); (P.D.); (P.T.); (I.M.); (L.T.)
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George AK, Miocinovic R, Patel AR, Lomas DJ, Correa AF, Chen DYT, Rastinehad AR, Schwartz MJ, Uchio EM, Sidana A, Helfand BT, Gahan JC, Yu A, Vourganti S, Barqawi AB, Brisbane WG, Wysock JS, Polascik TJ, McClure TD, Coleman JA. A Description and Safety Overview of Irreversible Electroporation for Prostate Tissue Ablation in Intermediate-Risk Prostate Cancer Patients: Preliminary Results from the PRESERVE Trial. Cancers (Basel) 2024; 16:2178. [PMID: 38927884 PMCID: PMC11201469 DOI: 10.3390/cancers16122178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/31/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
The PRESERVE study (NCT04972097) aims to evaluate the safety and effectiveness of the NanoKnife System to ablate prostate tissue in patients with intermediate-risk prostate cancer (PCa). The NanoKnife uses irreversible electroporation (IRE) to deliver high-voltage electrical pulses to change the permeability of cell membranes, leading to cell death. A total of 121 subjects with organ-confined PCa ≤ T2c, prostate-specific antigens (PSAs) ≤ 15 ng/mL, and a Gleason score of 3 + 4 or 4 + 3 underwent focal ablation of the index lesion. The primary endpoints included negative in-field biopsy and adverse event incidence, type, and severity through 12 months. At the time of analysis, the trial had completed accrual with preliminary follow-up available. Demographics, disease characteristics, procedural details, PSA responses, and adverse events (AEs) are presented. The median (IQR) age at screening was 67.0 (61.0-72.0) years and Gleason distribution 3 + 4 (80.2%) and 4 + 3 (19.8%). At 6 months, all patients with available data (n = 74) experienced a median (IQR) percent reduction in PSA of 67.6% (52.3-82.2%). Only ten subjects (8.3%) experienced a Grade 3 adverse event; five were procedure-related. No Grade ≥ 4 AEs were reported. This study supports prior findings that IRE prostate ablation with the NanoKnife System can be performed safely. Final results are required to fully assess oncological, functional, and safety outcomes.
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Affiliation(s)
- Arvin K. George
- VA Ann Arbor Health System, Ann Arbor, MI 48105, USA
- Michigan Medicine, Ann Arbor, MI 48109, USA
- Johns Hopkins University, Brady Urological Institute, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | | - Abhinav Sidana
- University of Cincinnati, College of Medicine, Cincinnati, OH 45221, USA
- University of Chicago, Section of Urology, Chicago, IL 60637, USA
| | - Brian T. Helfand
- Northshore University HealthSystem, Northshore University HealthSystem Research Institute, Evanston, IL 60201, USA
| | - Jeffrey C. Gahan
- University of Texas, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Alice Yu
- Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Al Baha Barqawi
- University of Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - James S. Wysock
- NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Thomas J. Polascik
- Duke University, Duke University School of Medicine, Durham, NC 27705, USA
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5
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Rokan N, Reddy D, Dudderidge T. Focal therapy for prostate cancer - when to refer? BJU Int 2024; 133:665-666. [PMID: 38481100 DOI: 10.1111/bju.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Nadia Rokan
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
| | - Deepika Reddy
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
- Imperial College London, London, UK
| | - Tim Dudderidge
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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6
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Zattoni F, Matrone F, Bortolus R, Giannarini G. Navigating the evolving diagnostic and therapeutic landscape of low- and intermediate-risk prostate cancer. Asian J Androl 2024:00129336-990000000-00183. [PMID: 38738954 DOI: 10.4103/aja20249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/08/2024] [Indexed: 05/14/2024] Open
Abstract
ABSTRACT In this nonsystematic review of the literature, we explored the changing landscape of detection and treatment of low- and intermediate-risk prostate cancer (PCa). Through emphasizing improved cancer assessment with histology classification and genomics, we investigated key developments in PCa detection and risk stratification. The pivotal role of prostate magnetic resonance imaging (MRI) in the novel diagnostic pathway is examined, alongside the benefits and drawbacks of MRI-targeted biopsies for detection and tumor characterization. We also delved into treatment options, particularly active surveillance for intermediate-risk PCa. Outcomes are compared between intermediate- and low-risk patients, offering insights into tailored management. Surgical techniques, including Retzius-sparing surgery, precision prostatectomy, and partial prostatectomy for anterior cancer, are appraised. Each technique has the potential to enhance outcomes and minimize complications. Advancements in technology and radiobiology, including computed tomography (CT)/MRI imaging and positron emission tomography (PET) fusion, allow for precise dose adjustment and daily target monitoring with imaging-guided radiotherapy, opening new ways of tailoring patients' treatments. Finally, experimental therapeutic approaches such as focal therapy open new treatment frontiers, although they create new needs in tumor identification and tracking during and after the procedure.
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Affiliation(s)
- Fabio Zattoni
- Urologic Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Fabio Matrone
- Department of Radiotherapy, National Cancer Institute (CRO), Aviano 33081, Italy
| | - Roberto Bortolus
- Department of Radiotherapy, National Cancer Institute (CRO), Aviano 33081, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria Della Misericordia University Hospital, Udine 33100, Italy
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7
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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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Prabhakar P, Avudaiappan AP, Sandman M, Eldefrawy A, Caso J, Narayanan G, Manoharan M. Irreversible electroporation as a focal therapy for localized prostate cancer: A systematic review. Indian J Urol 2024; 40:6-16. [PMID: 38314081 PMCID: PMC10836445 DOI: 10.4103/iju.iju_370_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/10/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Irreversible electroporation (IRE) is a new and promising focal therapy for the treatment of localized prostate cancer. In this systematic review, we summarize the literature on IRE for prostate cancer published over the last decade. Methods PubMed and EMBASE were searched with the end date of May 2023 to find relevant publications on prostate cancer ablation using IRE. Original studies with focal IRE as the primary curative treatment which reported on functional or oncological outcomes were included. The bibliography of relevant studies was also scanned to identify suitable articles. Results A total of 14 studies reporting on 899 patients treated with IRE for localized prostate cancer were included. Of all the studies reviewed, 77% reported on recurrence within the zone of ablation, and it ranged from 0% to 38.9% for in-field and 3.6% to 28% for out-of-field recurrence. Although, a standardised follow-up protocol was not followed, all the studies employed serial prostate-specific antigen monitoring, a multiparametric magnetic resonance imaging, and a biopsy (6-12 months post-treatment). Across all the studies, 58% reported that the urinary continence returned to the pretreatment levels and 25% reported a minor decrease in the continence from the baseline at 12-months of follow-up. Erections sufficient for intercourse varied from 44% to 75% at the baseline to 55% to 100% at 12-months of follow-up across all the studies. Conclusion IRE, as a focal therapy, shows promising results with minimal complications and reasonably effective oncological control, but the data comparing it to the standard of care is still lacking. Future research should focus on randomized definitive comparisons between IRE, radical prostatectomy, and radiation therapy.
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Affiliation(s)
- Pushan Prabhakar
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
| | | | - Mayer Sandman
- Department of Urology, Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Ahmed Eldefrawy
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
- Department of Urology, Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Jorge Caso
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
- Department of Urology, Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Govindarajan Narayanan
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida, USA
| | - Murugesan Manoharan
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
- Department of Urology, Herbert Wertheim College of Medicine, Miami, Florida, USA
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Chiu PKF, Chan CH, Yee CH, Lau SY, Teoh JYC, Wong HF, Lo KL, Yuen TY, Hung HY, Cho CCM, Ng CF. Transperineal Targeted Microwave Ablation (TMA) of localized prostate cancer guided by MRI-Ultrasound fusion and organ-based tracking: a pilot study. Prostate Cancer Prostatic Dis 2023; 26:736-742. [PMID: 35835844 DOI: 10.1038/s41391-022-00577-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND To investigate the efficacy of transperineal targeted microwave ablation (TMA) in treating localized prostate cancer (PCa). METHODS This is a single-centre prospective phase 2 trial recruiting men with low to intermediate-risk localized PCa to undergo transperineal TMA. TMA was performed with MRI-Ultrasound fusion guidance and organ-based tracking. A per-protocol 6-month MRI and biopsy were performed for all patients. The primary outcome was any cancer detected on biopsy of each ablated area. Secondary outcomes included per-patient analysis of positive biopsy, complications, urinary symptom score, erectile function and quality of life (QOL) scores. RESULTS In the first 15 men, 23 areas were being treated. The median age was 70 years, number of TMA ablations were 5 (range 2-8), and the total ablation time and operating time was 22 (IQR 14-28) and 75 (IQR 65-85) minutes, respectively. PSA level dropped from a median of 7.7 to 2.4 ng/mL. For the primary outcome, 91.3% (21/23) ablated area had no cancer in 6-month biopsy. In per-patient analysis, 33.3% (5/15) had in or out-of-field positive biopsy at 6 months. Among these five cases, four of them were amenable to active surveillance and 1 (6.7%) case with out-of-field ISUP grade group 2 cancer received radiotherapy. The urinary symptoms, uroflowmetry, erectile function, and QOL scores had no significant difference at 6 months. One patient (out of five patients with normal erection) in the cohort complained of significant worsening of erectile function after TMA. Grade 1 complications including hematuria (33.3%), dysuria (6.7%), and perineal discomfort (13.4%) were observed. CONCLUSIONS In this first pilot study, transperineal TMA guided by MRI-Ultrasound fusion guidance and organ-based tracking was shown to be effective, safe, and easily applicable in men with localized PCa.
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Affiliation(s)
- Peter Ka-Fung Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
| | - Chun-Hong Chan
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Hang Yee
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Sui-Yan Lau
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho-Fai Wong
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Lun Lo
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz-Yau Yuen
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Hiu-Yee Hung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Carmen Chi-Min Cho
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
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10
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Alabousi M, Ghai S, Haider MA. MRI-guided Minimally Invasive Focal Therapies for Prostate Cancer. Radiology 2023; 309:e230431. [PMID: 38051187 DOI: 10.1148/radiol.230431] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Two cases involving patients diagnosed with localized prostate cancer and treated with MRI-guided focal therapies are presented. Patient selection procedures, techniques, outcomes, challenges, and future directions of MRI-guided focal therapies, as well as their role in the treatment of low- to intermediate-risk localized prostate cancer, are summarized.
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Affiliation(s)
- Mostafa Alabousi
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto, 263 McCaul St, 4th Floor, Toronto, ON, Canada M5T 1W7 (M.A., S.G., M.A.H.); and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.)
| | - Sangeet Ghai
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto, 263 McCaul St, 4th Floor, Toronto, ON, Canada M5T 1W7 (M.A., S.G., M.A.H.); and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.)
| | - Masoom A Haider
- From the Joint Department of Medical Imaging, University Health Network, University of Toronto, 263 McCaul St, 4th Floor, Toronto, ON, Canada M5T 1W7 (M.A., S.G., M.A.H.); and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada (M.A.H.)
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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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12
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Costantini E, Di Nicola M, Marchioni M, Aielli L, Reale M, Schips L. Effects of Curcumin and Lactoferrin to Inhibit the Growth and Migration of Prostatic Cancer Cells. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16193. [PMID: 36498267 PMCID: PMC9737629 DOI: 10.3390/ijerph192316193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 05/14/2023]
Abstract
Prostate cancer remains one of the main causes of death for men worldwide. Despite recent advances in cancer treatment, patients develop resistance after an initial period of optimal efficacy. Nowadays, it is accepted that natural compounds can result in health benefits with a preventive or adjuvant effect. The purpose of this study was to evaluate the effects of curcumin (CU), a bioactive compound in the spice turmeric, and lactoferrin (LF), a natural glycoprotein with immunomodulatory properties, on DU145 and PC3. Prostate cancer cells were cultured with and without LF (175 μM) and CU (2.5 μg/mL and 5 μg/mL), alone and in combination. Cell viability, migration ability, death receptors (DRs), and integrins (α3, β1) gene expression were evaluated, as well as human annexin V quantification and Akt phosphorylation. Differences among cells group, defined according to the treatment used, were assessed with ANOVA. The results showed that the effects of CU and LF are different between the two prostatic cell lines analyzed. In DU145, a reduction in cell proliferation and migration is reported both in the presence of single and combined treatments. In PC3 cells, there is a significant reduction in proliferation in the presence of CU alone, while the inhibition of migration is mainly related to the LF treatment and its combination with CU, compared to untreated cells. Moreover, the reduction in gene expression of integrins and Akt pathway activation were observed mostly in the presence of the CU and LF combination, including the upregulation of DR and annexin V levels, with greater significance for the DU145 cells. In conclusion, our results suggest that CU and LF may have a potentially beneficial effect, mainly when administered in combination, leading to a reduction in cancer cells' aggressiveness.
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Affiliation(s)
- Erica Costantini
- Department of Medicine and Aging Sciences, University “G. d’Annunzio”, Via dei Vestini, 66100 Chieti, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio”, Via dei Vestini, 66100 Chieti, Italy; (M.D.N.); (L.S.)
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio”, Via dei Vestini, 66100 Chieti, Italy; (M.D.N.); (L.S.)
| | - Lisa Aielli
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio”, Via dei Vestini, 66100 Chieti, Italy; (L.A.); (M.R.)
| | - Marcella Reale
- Department of Innovative Technologies in Medicine and Dentistry, University “G. d’Annunzio”, Via dei Vestini, 66100 Chieti, Italy; (L.A.); (M.R.)
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio”, Via dei Vestini, 66100 Chieti, Italy; (M.D.N.); (L.S.)
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13
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Oderda M, Marquis A, Calleris G, D'Agate D, Faletti R, Gatti M, Marra G, Gontero P. Safety and Feasibility of Transperineal Targeted Microwave Ablation for Low- to Intermediate-risk Prostate Cancer. EUR UROL SUPPL 2022; 46:3-7. [PMID: 36304751 PMCID: PMC9594111 DOI: 10.1016/j.euros.2022.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Background Focal therapy has emerged as an interesting option for localized low- to intermediate-risk prostate cancer (PCa). Targeted microwave ablation (TMA) is a novel FT modality involving targeted delivery of microwave energy under multiparametric magnetic resonance imaging (MRI)/ultrasound guidance. Objective To describe the step-by-step procedure for TMA and report early functional outcomes. Design, setting, and participants This was an experimental phase 1–2 trial in 11 patients diagnosed with a single, MRI-visible PCa lesion of up to 12 mm, scored as International Society of Urological Pathology grade group (GG) 1 or 2. Surgical procedure Transperineal TMA under MRI/ultrasound image fusion guidance. Measurements We recorded patient and PCa features; intraoperative and postoperative parameters; pain (Visual Analog Scale [VAS]) and adverse events (Common Terminology Criteria for Adverse Events v5.0); and prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) scores at 1 wk and 1, 3, and 6 mo. Results and limitations The median patient age was 67 yr (interquartile range [IQR] 18). Median PSA was 5.4 ng/ml (IQR 1.8), median prostate volume was 51 cm3 (IQR 35), and median lesion size on MRI was 10 mm (IQR 4). Ten patients had GG 2 PCa and one had GG 1 disease. The median procedure time was 40 min (IQR 30). No intraoperative complications were reported. All treatments were performed on a day-case basis and no patients were discharged with a urinary catheter. Postoperatively, no grade ≥2 complications were reported. No significant changes in PSA (p = 0.46), IPSS (p = 0.39), or IIEF-5 scores (p = 0.18) scores were reported. The postoperative VAS score at 24 h was 0 for all patients. Conclusions TMA is safe, feasible, and well tolerated in patients with low- to intermediate-risk PCa. Oncological outcomes are still awaited. Patient summary Targeted microwave therapy is safe and feasible for selected patients with low- to intermediate-risk prostate cancer. The procedure is well tolerated and does not require a urinary catheter after the procedure. Cancer control outcomes are still awaited.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy,Corresponding author. Department of Surgical Sciences-Urology, University of Turin, Turin, Italy. Tel. +39 34 7938 3465.
| | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Daniele D'Agate
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Division of Radiology, Molinette Hospital, University of Turin, Turin, Italy
| | - Marco Gatti
- Division of Radiology, Molinette Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
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14
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Hashemi M, Mirzaei S, Barati M, Hejazi ES, Kakavand A, Entezari M, Salimimoghadam S, Kalbasi A, Rashidi M, Taheriazam A, Sethi G. Curcumin in the treatment of urological cancers: Therapeutic targets, challenges and prospects. Life Sci 2022; 309:120984. [PMID: 36150461 DOI: 10.1016/j.lfs.2022.120984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/09/2022] [Accepted: 09/17/2022] [Indexed: 11/26/2022]
Abstract
Urological cancers include bladder, prostate and renal cancers that can cause death in males and females. Patients with urological cancers are mainly diagnosed at an advanced disease stage when they also develop resistance to therapy or poor response. The use of natural products in the treatment of urological cancers has shown a significant increase. Curcumin has been widely used in cancer treatment due to its ability to trigger cell death and suppress metastasis. The beneficial effects of curcumin in the treatment of urological cancers is the focus of current review. Curcumin can induce apoptosis in the three types of urological cancers limiting their proliferative potential. Furthermore, curcumin can suppress invasion of urological cancers through EMT inhibition. Notably, curcumin decreases the expression of MMPs, therefore interfering with urological cancer metastasis. When used in combination with chemotherapy agents, curcumin displays synergistic effects in suppressing cancer progression. It can also be used as a chemosensitizer. Based on pre-clinical studies, curcumin administration is beneficial in the treatment of urological cancers and future clinical applications might be considered upon solving problems related to the poor bioavailability of the compound. To improve the bioavailability of curcumin and increase its therapeutic index in urological cancer suppression, nanostructures have been developed to favor targeted delivery.
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Affiliation(s)
- Mehrdad Hashemi
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Sepideh Mirzaei
- Department of Biology, Faculty of Science, Islamic Azad University, Science and Research Branch, Tehran, Iran
| | - Maryamsadat Barati
- Department of Biology, Faculty of Basic (Fundamental) Science, Shahr Qods Branch, Islamic Azad University, Tehran, Iran
| | - Elahe Sadat Hejazi
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Amirabbas Kakavand
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Maliheh Entezari
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Shokooh Salimimoghadam
- Department of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Alireza Kalbasi
- Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - Mohsen Rashidi
- Department Pharmacology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; The Health of Plant and Livestock Products Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Afshin Taheriazam
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Department of Orthopedics, Faculty of medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore; NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore.
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15
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Mansur A, Garg T, Shrigiriwar A, Etezadi V, Georgiades C, Habibollahi P, Huber TC, Camacho JC, Nour SG, Sag AA, Prologo JD, Nezami N. Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors. Diagnostics (Basel) 2022; 12:diagnostics12061300. [PMID: 35741109 PMCID: PMC9221861 DOI: 10.3390/diagnostics12061300] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Timothy C. Huber
- Vascular and Interventional Radiology, Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Sherif G. Nour
- Department of Radiology and Medical Imaging, Florida State University College of Medicine, Gainesville, FL 32610, USA;
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA;
| | - John David Prologo
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence: or
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16
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Jaipuria J, Ahmed HU. Clinical and pathologic characteristics to select patients for focal therapy or partial gland ablation of nonmetastatic prostate cancer. Curr Opin Urol 2022; 32:224-230. [PMID: 35184067 DOI: 10.1097/mou.0000000000000976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Focal therapy or partial gland ablation for nonmetastatic prostate cancer is gaining popularity not just as an alternative to active surveillance, but as an acceptable alternative to whole gland therapy in appropriate cases. This review summarizes recent evidence to help select patients for optimal outcomes. RECENT FINDINGS Recommendations by expert panels have become less conservative with each meeting. As experience with older modalities for focal therapy grows, newer modalities continue to be introduced. We are now in a position to offer personalized treatment pathway considering nuances of each focal therapy modality. SUMMARY The ideal case for focal therapy should be an MRI visible significant lesion (PIRADS score ≥ 3), with a positive biopsy for significant cancer (Gleason grade group 2-3) in the corresponding targeted biopsy area, and insignificant or absent disease in the nontarget random biopsy areas. Multifocal disease can also be selectively treated. Salvage focal ablation is an attractive treatment option for radio-recurrent or index focal therapy failure cases.
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Affiliation(s)
- Jiten Jaipuria
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust
| | - Hashim U Ahmed
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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17
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Applications of Focused Ultrasound in the Treatment of Genitourinary Cancers. Cancers (Basel) 2022; 14:cancers14061536. [PMID: 35326687 PMCID: PMC8945954 DOI: 10.3390/cancers14061536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Cancer is a prevalent disease globally, and conventional treatment options have been associated with substantial morbidity for patients. The unique acoustic properties and biological effects of focused ultrasound have been investigated for use as an alternative treatment option for various forms of cancer with lower associated morbidity than standard treatments. The objective of our review was to assess the current state and various applications of focused ultrasound for the treatment of genitourinary cancers, including prostate, kidney, bladder, penile, and testicular malignancies. Current research demonstrates that focused ultrasound-based focal therapy shows promise for the treatment of localized prostate and kidney cancer, and the effect of ultrasound on cell membranes may increase the efficacy of chemotherapeutics and radiotherapy. Focused ultrasound-based treatment modalities should continue to be investigated as an alternative or complementary treatment option for cancer patients. Abstract Traditional cancer treatments have been associated with substantial morbidity for patients. Focused ultrasound offers a novel modality for the treatment of various forms of cancer which may offer effective oncological control and low morbidity. We performed a review of PubMed articles assessing the current applications of focused ultrasound in the treatment of genitourinary cancers, including prostate, kidney, bladder, penile, and testicular cancer. Current research indicates that high-intensity focused ultrasound (HIFU) focal therapy offers effective short-term oncologic control of localized prostate and kidney cancer with lower associated morbidity than radical surgery. In addition, studies in mice have demonstrated that focused ultrasound treatment increases the accuracy of chemotherapeutic drug delivery, the efficacy of drug uptake, and cytotoxic effects within targeted cancer cells. Ultrasound-based therapy shows promise for the treatment of genitourinary cancers. Further research should continue to investigate focused ultrasound as an alternative cancer treatment option or as a complement to increase the efficacy of conventional treatments such as chemotherapy and radiotherapy.
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18
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Avital Y, Fütterer JJ, Cherniavsky A, Bomers JGR. Minimally Invasive Procedures in the Diagnosis and Treatment of Localized Prostate Cancer: an Interventional Radiologist's Perspective. Curr Oncol Rep 2022; 24:1433-1441. [PMID: 35670993 PMCID: PMC9606051 DOI: 10.1007/s11912-022-01291-3] [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] [Accepted: 04/30/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Minimal invasive procedures, including targeted biopsy (TB) and focal therapy (FT), are increasingly used in diagnosis and treatment of localized prostate cancer. Here, we review the current role of these procedures, from a perspective of an interventional radiologist. RECENT FINDINGS TB is an established part of current guidelines for diagnosis of PCa. Several modalities of FT are gaining prevalence in recent years, as a tissue-preserving alternative for definitive treatment of localized PCa. FT is currently at early research stages, offered to selected patients in clinical trials settings. TB and FT are minimally invasive procedures used by multidisciplinary teams for diagnosis and treatment of localized PCa.
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Affiliation(s)
- Yaniv Avital
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, Gelderland The Netherlands ,Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), 70300 Zerifin, Israel
| | - Jurgen J. Fütterer
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, Gelderland The Netherlands
| | - Alexei Cherniavsky
- Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), 70300 Zerifin, Israel
| | - Joyce G. R. Bomers
- Department of Medical Imaging, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, Gelderland The Netherlands
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