MP46-12 REPEAT PARTIAL GLAND ABLATION OF PROSTATE CANCER

ObjectivesPartial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy-proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS).Design92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semistructured telephone interviews on PGA.SettingSingle tertiary care center located in New York City.Participants20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews.Main outcome measuresEmerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology.ResultsFour themes were derived from 20 interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while nine men (45%) expressed interest at the current moment.ConclusionsAlthough an emerging treatment modality, patients were broadly accepting of PGA for PCa, with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men’s preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.

Download Full-text

Phase 2b trial results of padeliporfin (WST11 or Tookad) vascular-targeted photodynamic therapy for partial gland ablation in men with intermediate-risk prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e17006 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e17006-e17006

Author(s):

Jonathan Coleman ◽

Daniel D. Sjoberg ◽

Quinlan Demac ◽

Catriona ODea ◽

Marlena McGill ◽

...

Keyword(s):

Prostate Cancer ◽

Primary Endpoint ◽

Low Risk ◽

Gleason Grade ◽

Intermediate Risk ◽

Function Score ◽

Trus Biopsy ◽

Risk Prostate Cancer ◽

Partial Gland Ablation ◽

Targeted Photodynamic Therapy

e17006 Background: Padeliporfin (WST11) vascular-targeted photodynamic therapy (VTP) has shown significant clinical benefit as a localized partial gland ablation (PGA) therapy when compared to active surveillance for low-risk prostate cancer, by curbing progression and the need for radical treatment, leading to its regulatory approval in Europe. This phase 2b trial prospectively investigated WST11-VTP for intermediate-risk cancers. Methods: Men with unilateral Grade Group 2 (GG2) cancers (Gleason 3+4), evaluated with MRI and ultrasound-guided (TRUS) biopsy, underwent up to two WST11-VTP PGA sessions. Eligibility criteria included <cT2b, PSA < 10, and fusion biopsy for PIRADS 3+ lesions on pretreatment MRI. Contralateral very low–risk disease was observed. The primary endpoint was prevalence of any Gleason Grade 4 or 5 (≥GG2) cancer, determined by MRI and systematic, 14-core TRUS biopsy of the entire gland (+/- fusion) at 3 and 12 months after treatment. Treatment safety and patient-reported quality of life for sexual and urinary function were assessed with validated questionnaires (IIEF-15 and IPSS, respectively). The study was powered using β = 0.2 to reject the null hypothesis (r≤70%), using a one-sided exact binomial test with 5% alpha risk. To be valid, 44 evaluable patients were required for the 12-month primary endpoint assessment. Results: Of the 50 men treated, 46 were evaluable for the 12-month primary endpoint. Before 12 months, 1 man proceeded to prostatectomy (treatment failure), 2 men refused 12-month biopsy, and 1 man died of COVID-19. At 3 months, 12/49 (24%) men underwent per protocol second WST11-VTP PGA session for GG2 tumor: 9 for residual cancer and 4 for newly identified contralateral GG2 tumors (1 bilateral). The 12-month biopsy was performed in 45 men; 38 (83%) had no Gleason grade 4 or 5 cancer, including 11/12 (92%) patients who underwent 2 PGA sessions. By 3 months, median decline in erectile function score (IIEF-5) from baseline was -1.0 (IQR -7,0). Median improvement in urinary function score (IPSS) was -1.0 (IQR -1,5), with pad-free continence observed in all patients. Median change in IIEF score by 12-months was -1.0 (IQR -5,0). Grade 3 treatment-related adverse events occurred in 6 (12%) patients. All procedure-related prostate/pelvic pain resolved by 3 weeks. Conclusions: The positive results from this trial show that WST11-VTP is effective for PGA of intermediate-risk prostate cancer, with minimal toxicity or impact on urinary and sexual function, consistent with the phase 3 trial results in low-risk disease. Based on these data, this therapy bears consideration for approval as a conservative therapeutic option for selected cases of intermediate-risk disease. Clinical trial information: NCT03315754.

Download Full-text

Standardized Nomenclature and Surveillance Methodologies After Focal Therapy and Partial Gland Ablation for Localized Prostate Cancer: An International Multidisciplinary Consensus

European Urology ◽

10.1016/j.eururo.2020.05.018 ◽

2020 ◽

Vol 78 (3) ◽

pp. 371-378 ◽

Cited By ~ 7

Author(s):

Amir H. Lebastchi ◽

Arvin K. George ◽

Thomas J. Polascik ◽

Jonathan Coleman ◽

Jean de la Rosette ◽

...

Keyword(s):

Prostate Cancer ◽

Focal Therapy ◽

Localized Prostate Cancer ◽

Partial Gland Ablation

Download Full-text

MP70-03 CLINICAL PERFORMANCE OF MULTI PARAMETRIC MAGNETIC RESONANCE IMAGING IN THE FOLLOW-UP OF PARTIAL GLAND ABLATION FOR PROSTATE CANCER

The Journal of Urology ◽

10.1016/j.juro.2017.02.2279 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Arjun Sivaraman ◽

Melissa Assel ◽

Andreas Hoetker ◽

Govindarajan Srimathveeravalli ◽

Behfar Ehdaie ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Clinical Performance ◽

Resonance Imaging ◽

Partial Gland Ablation

Download Full-text

Focal High-intensity Focussed Ultrasound Partial Gland Ablation for the Treatment of Localised Prostate Cancer: A Report of Medium-term Outcomes From a Single-center in the United Kingdom

Urology ◽

10.1016/j.urology.2019.06.043 ◽

2019 ◽

Vol 133 ◽

pp. 175-181 ◽

Cited By ~ 10

Author(s):

Maximilian J. Johnston ◽

Amr Emara ◽

Mohamed Noureldin ◽

Simon Bott ◽

Richard G. Hindley

Keyword(s):

Prostate Cancer ◽

United Kingdom ◽

High Intensity ◽

Single Center ◽

Medium Term ◽

The United Kingdom ◽

Partial Gland Ablation ◽

Focussed Ultrasound

Download Full-text

Defining the index lesion for salvage partial gland ablation after radiation therapy for localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.105 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 105-105

Author(s):

Arjun Sivaraman ◽

Toshikazu Takaeda ◽

Hebert Alberto Vargas ◽

Samson Fine ◽

James Andrew Eastham ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Radical Prostatectomy ◽

Clinical Characteristics ◽

Localized Prostate Cancer ◽

Index Lesion ◽

Whole Mount ◽

Index Tumor ◽

Pre Treatment ◽

Partial Gland Ablation

105 Background: Our objective was to evaluate the impact of MRI and systematic biopsy characteristics to identify the index lesion for salvage partial gland ablation using tumor maps from whole mount slides of salvage radical prostatectomy (sRP) specimen. Methods: We identified 225 patients who underwent sRP between 2000 and 2014 and a tumor map was created from whole-mount slides in 77 patients. Among these patients, we selected men with a priori pre-treatment criteria considered eligible for PGA, including, biopsy proven unilateral disease concordant with a region of interest (ROI) on MRI, and excluding men with imaging suspicious for extra-capsular extension (ECE), seminal vesicle Invasion (SVI) or lymph node involvement (LNI). We describe the correlation between pre-treatment clinical characteristics and final radical prostatectomy whole mount specimen to select men eligible for PGA defined as hemi-gland ablation. Results: Among 77 patients with a tumor map of entirely-submitted and whole-mounted specimens, 15 patients were determined to be eligible for partial gland ablation based on pre-treatment clinical characteristics. The mean age was 60 years and median time from primary RT was 48 months. The median (IQR) tumor volume of the index lesion was 0.3 (0.4) cc. The location of the index lesion was determined to be the apex, mid-gland and base in 77%, 100% and 15% of patients, respectively. The median distance of the index tumor to the urethra was 0.5 (0.2) cm. The index tumor was confined to one lobe and concordant to the biopsy pathology and MRI data in all 15 patients (100%). There was no ECE, LNI or SVI identified in the sRP specimens. To account for those patients who did not have a tumor map of the whole-mount specimen, a sensitivity analysis was performed and determined that the clinical characteristics of the 77 patients with tumor maps were comparable to the entire 225 sRP cohort. Conclusions: Clinical characteristics guided by biopsy findings and MRI data can be used to select men for PGA with recurrent localized prostate cancer after radiation therapy and based on tumor maps from sRP specimen, we propose that salvage hemi-gland ablation including periurethral tissue is feasible.

Download Full-text

High intensity focused ultrasound ablation for prostate cancer: whole versus partial gland ablation

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2021.09.003 ◽

2021 ◽

Author(s):

Seok-Soo Byun ◽

Noh Jin ◽

Hakmin Lee

Keyword(s):

Prostate Cancer ◽

High Intensity ◽

Focused Ultrasound ◽

High Intensity Focused Ultrasound ◽

Ultrasound Ablation ◽

Partial Gland Ablation ◽

Focused Ultrasound Ablation

Download Full-text

Pilot Study to Assess Safety and Clinical Outcomes of Irreversible Electroporation for Partial Gland Ablation in Men with Prostate Cancer

The Journal of Urology ◽

10.1016/j.juro.2016.02.2986 ◽

2016 ◽

Vol 196 (3) ◽

pp. 883-890 ◽

Cited By ~ 26

Author(s):

Katie S. Murray ◽

Behfar Ehdaie ◽

John Musser ◽

Joseph Mashni ◽

Govindarajan Srimathveeravalli ◽

...

Keyword(s):

Prostate Cancer ◽

Pilot Study ◽

Clinical Outcomes ◽

Irreversible Electroporation ◽

Partial Gland Ablation

Download Full-text

Perceptions of partial gland ablation for prostate cancer among men on active surveillance: A qualitative study

10.1101/2020.09.15.20195388 ◽

2020 ◽

Author(s):

Sonia Hur ◽

Michael Tzeng ◽

Eliza Cricco-Lizza ◽

Miko Yu ◽

Jessica Ancker ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Qualitative Study ◽

Active Surveillance ◽

Treatment Modality ◽

Tertiary Care ◽

Low Risk ◽

Intermediate Risk ◽

Perceptions And Attitudes ◽

Partial Gland Ablation

Objectives - Partial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS). Design - 92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semi-structured telephone interviews on PGA. Setting - Single tertiary care center located in New York City. Participants - 20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews. Main outcome measures - Emerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology. Results - Four themes were derived from twenty interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while 9 men (45%) expressed interest at the current moment. Conclusions - Though an emerging treatment modality, patients were broadly accepting of PGA for PCa with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men's preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.

Download Full-text