Abstract No. 75: Focal Therapy for Prostate Cancer-120 Patients with Up to 12 Year Follow-Up

Focal therapy is a promising option for localized prostate cancer treatment in low and intermediate risk patients. The combination of minimal invasiveness, disease control and the possibility of re-treatment in case of recurrence have significantly increased interest in focal therapy. However, before the final introduction of focal therapy into clinical practice, a number of significant limitations have yet to be overcome, such as patient selection, visualization of target, the choice of the treatment modality and the surgery planning, as well as the development of a follow-up protocol. Studies have shown that focal therapy has minimal impact on the quality of life, but its oncological effectiveness has yet to be evaluated in comparison with radical methods of treatment.

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High-Intensity Focused Ultrasound (HIFU) Focal Therapy for Localized Prostate Cancer with MRI-US Fusion Platform

Advances in Urology ◽

10.1155/2021/7157973 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Chi-Hang Yee ◽

Peter Ka-Fung Chiu ◽

Jeremy Yuen-Chun Teoh ◽

Chi-Fai Ng ◽

Chi-Kwok Chan ◽

...

Keyword(s):

Prostate Cancer ◽

Functional Outcomes ◽

Case Series ◽

Focal Therapy ◽

High Intensity Focused Ultrasound ◽

Localized Prostate Cancer ◽

Lesion Volume ◽

Significant Difference ◽

The Mean

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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MP30-06 INTERIM FOLLOW UP OF A PHASE II TRIAL OF MRI-ULTRASOUND FUSION BIOPSY GUIDED PROSTATE CANCER (PCA) FOCAL THERAPY BY BIPOLAR RADIOFREQUENCY ABLATION

The Journal of Urology ◽

10.1016/j.juro.2018.02.947 ◽

2018 ◽

Vol 199 (4S) ◽

Author(s):

Samir S Taneja ◽

Benjamin Press ◽

Richard Huang ◽

Fang-Ming Deng ◽

Andrew Rosenkrantz

Keyword(s):

Prostate Cancer ◽

Radiofrequency Ablation ◽

Phase Ii ◽

Phase Ii Trial ◽

Focal Therapy ◽

Fusion Biopsy ◽

Bipolar Radiofrequency

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Target focal therapy in early prostate cancer: Initial single institution results

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15574 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15574-15574 ◽

Cited By ~ 2

Author(s):

A. Barqawi ◽

J. Lugg ◽

E. D. Crawford

Keyword(s):

Prostate Cancer ◽

Early Stage ◽

Focal Therapy ◽

Urinary Continence ◽

Minimal Impact ◽

Alternative Option ◽

Early Results ◽

The Mean ◽

Mapping Biopsy

15574 Background: Currently the potential for over- and under-treatment using radical and watchful waiting options respectively constitutes a challenge in the management of patients with early organ-confined prostate cancer. Target focal therapy (TFT) is emerging as an intermediary alternative option for such men. The goal is to provide ablative treatment with minimal impact on morbidity. Methods: As part of an IRB approved study protocol a total of 24 patients initially underwent a 3 dimensional transperineal mapping biopsy under TRUS guidance to confirm the extent of tumor burden and localize the cancer foci within the prostate. Only 12 men qualified to undergo target focal cryotherapy. The remaining patients did not qualify due to upgrading or downgrading of their stage and opted for other treatment options. Follow- up consisted of serial PSA measurements at 3 months interval, disease specific QOL questionnaires, IPSS, and SHIM scores. Results: The mean age was 62.4 years. The mean (SD) prostate size at the time of mapping biopsy was 39 ±14.8g. After mapping biopsy all patients reported time limited hematuria and 2 patients developed urinary retention and were managed successfully with Foley’s catheter for 5 days. Mean PSA before treatment was 5.2 ± 4.1 ng/dl. 10/12 patients had Gleason score (GS) of 3+3, the remaining 2 patients had GS of 3+4. At 3 months follow-up. A median drop of PSA of 1.9 (0, 9.5) ng/dl. All patients reported full urinary continence post operatively. IPSS median drop of 0 (2, -16). Sexual health as assessed by SHIM score showed a median drop of 6 (1, -15) points. In general 4 patients reported a significant change in sexual performance. 2 of which opted for PDE inhibitor with successful regaining of erection at 6 months follow-up. Overall EPIC QOL scores showed no change in rectal, urinary and hormonal components. Sexual component registered a drop of 5 points. Conclusions: The current initial early results appear to be encouraging for future implementation of TFT on select patients with organ confined early stage cancer. Future larger randomized studies are needed to better understand the value of this alternative option in the management of prostate cancer. No significant financial relationships to disclose.

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