Technical Aspects of Focal Therapy in Localized Prostate Cancer: Follow-Up After Focal Therapy

Objective. The study aimed at investigating the outcome of prostate HIFU focal therapy using the MRI-US fusion platform for treatment localization and delivery. Methods. It is a prospectively designed case series of HIFU focal therapy for localized prostate cancer. The inclusion criteria include clinical tumor stage ≤T2, visible index lesion on multiparametric MRI less than 20 mm in diameter, absence of Gleason 5 pattern on prostate biopsy, and PSA ≤ 20 ng/ml. HIFU focal therapy was performed in the conventional manner in the beginning 50% of the series, whereas the subsequent cases were performed with MRI-US fusion platform. The primary outcome was treatment failure rate which is defined by the need of salvage therapy. Secondary outcomes included tumor recurrence in follow-up biopsy, PSA change, perioperative complications, and postoperative functional outcomes. Results. Twenty patients underwent HIFU focal ablation. HIFU on an MRI-US fusion platform had a trend of a longer total operative time than the conventional counterpart (124.2 min vs. 107.1 min, p = 0.066 ). There was no difference in the mean ablation volume to lesion volume ratio between the two. The mean PSA percentage change from baseline to 6-month is more significant in the conventional group (63.3% vs. 44.6%, p = 0.035 ). No suspicious lesion was seen at 6-month mpMRI in all 20 patients. Two patients, one from each group, eventually underwent radical treatment because of the presence of clinically significant prostate cancer in the form of out-of-field recurrences during follow-up biopsy. No significant difference was observed before and after HIFU concerning uroflowmetry, SF-12 score, and EPIC-26 score. It was observed that energy used per volume was positively correlated with PSA density of the patient (r = 0.6364, p = 0.014 ). Conclusion. In conclusion, HIFU with conventional or MRI-US fusion platform provided similar oncological and functional outcomes.

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MP42-20 CLINICAL PREDICTORS FOR DETECTION OF SIGNIFICANT CANCER IN FOLLOW-UP BIOPSY AFTER FOCAL THERAPY WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR LOCALIZED PROSTATE CANCER

The Journal of Urology ◽

10.1097/ju.0000000000000891.020 ◽

2020 ◽

Vol 203 ◽

pp. e611

Author(s):

Sunao Shoji* ◽

Koichiro Yamada ◽

Jun Naruse ◽

Hanada Izumi ◽

Tatsuya Otaki ◽

...

Keyword(s):

Prostate Cancer ◽

High Intensity ◽

Focused Ultrasound ◽

Focal Therapy ◽

High Intensity Focused Ultrasound ◽

Localized Prostate Cancer ◽

Clinical Predictors

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Management of Localized Prostate Cancer by Focal Transurethral Resection of Prostate Cancer: An Application of Radical TUR-PCa to Focal Therapy

Advances in Urology ◽

10.1155/2012/564372 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Masaru Morita ◽

Takeshi Matsuura

Keyword(s):

Prostate Cancer ◽

Bladder Neck ◽

Peripheral Zone ◽

Focal Therapy ◽

Localized Prostate Cancer ◽

Transurethral Resection Of Prostate ◽

Bladder Neck Contracture ◽

Psa Failure ◽

The Mean

Background. We analyzed radical TUR-PCa against localized prostate cancer.Patients and Methods. Seventy-nine out of 209 patients with prostate cancer in one lobe were studied. Patients’ age ranged from 58 to 91 years and preoperative PSA, 0.70 to 17.30 ng/mL. In other 16 additional patients we performed focal TUR-PCa. Patients’ age ranged from 51 to 87 years and preoperative PSA, 1.51 to 25.74 ng/mL.Results. PSA failure in radical TUR-PCa was 5.1% during the mean follow-up period of 58.9 months. The actuarial biochemical non-recurrence rate was 98.2% for pT2a and 90.5% for pT2b. Bladder neck contracture occurred in 28 patients (35.4%). In 209 patients, pathological study revealed prostate cancer of the peripheral zone near the neurovascular bundle bilaterally in 25%, unilaterally in 39% and no cancer bilaterally in 35%, suggesting the possibility of focal TUR-PCa. Postoperative PSA of 16 patients treated by focal TUR-PCa was stable between 0.007 and 0.406 ng/mL at 24.2 months’ follow-up. No patients suffered from urinary incontinence. Bladder neck contracture developed in only 1 patient and all 5 patients underwent nerve-preserving TUR-PCa did not show erectile dysfunction.Conclusion. Focal TUR-PCa was considered to be a promising option among focal therapies against localized prostate cancer.

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