Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center

Sivaraman, Arjun; Marra, Giancarlo; Stabile, Armando; Mombet, Annick; Macek, Petr; Lanz, Camille; Cathala, Nathalie; Moschini, Marco; Carneiro, Ariê; Sánchez-Salas, Rafael; Cathelineau, Xavier

doi:10.1590/s1677-5538.ibju.2019.0682

Cited by 10 publications

(7 citation statements)

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“…All three machines have been used in some of the studies included in this review: the Sonablate 500 device in 8 studies, the Ablatherm device in 8 studies, and the Focal One device in 6 studies. Some differences in technical characteristics exist between these devices, what could also have affected treatment outcomes (34). The Ablatherm and Focal One device use coupling liquid to protect the rectum; thus, patients should be placed in a lateral position to allow gas bubbles to rise outside the imaging and therapy fields.…”

Section: Discussionmentioning

confidence: 99%

Available evidence on HIFU for focal treatment of prostate cancer: a systematic review

et al. 2022

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Purpose: Prostate cancer (PCa) is the second most common oncologic disease among men. Radical treatment with curative intent provides good oncological results for PCa survivors, although definitive therapy is associated with significant number of serious side-effects. In modern-era of medicine tissue-sparing techniques, such as focal HIFU, have been proposed for PCa patients in order to provide cancer control equivalent to the standard-of-care procedures while reducing morbidities and complications. The aim of this systematic review was to summarise the available evidence about focal HIFU therapy as a primary treatment for localized PCa. Material and methods: We conducted a comprehensive literature review of focal HIFU therapy in the MEDLINE database (PROSPERO: CRD42021235581). Articles published in the English language between 2010 and 2020 with more than 50 patients were included. Results: Clinically significant in-field recurrence and out-of-field progression were detected to 22% and 29% PCa patients, respectively. Higher ISUP grade group, more positive cores at biopsy and bilateral disease were identified as the main risk factors for disease recurrence. The most common strategy for recurrence management was definitive therapy. Six months after focal HIFU therapy 98% of patients were totally continent and 80% of patients retained sufficient erections for sexual intercourse. The majority of complications presented in the early postoperative period and were classified as low-grade.

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Section: Discussionmentioning

confidence: 99%

Available evidence on HIFU for focal treatment of prostate cancer: a systematic review

et al. 2022

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“…It thus results in a larger ablation volume and a bigger PSA drop after HIFU treatment. Sivaraman et al retrospectively reviewed their cohort of HIFU patients with Ablatherm® (no fusion platform) and Focal-One® (with fusion platform) [ 16 ]. No significant difference was found with respect to perioperative complications, but the group with fusion platform had significantly lower urine leak at 3 months.…”

Section: Discussionmentioning

confidence: 99%

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

Yee

Chiu

Teoh

et al. 2021

Advances in Urology

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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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“…As per the recommended standards according to clinical practice and the latest evidence to maximize oncological results and PCa assessment and detection: mpMRI at 4 months ( 29 , 38 , 41 , 42 ) and mpMRI ( 29 , 38 , 41 , 42 ), PSMA-PET ( 43 ), and prostate biopsy (14-core systematic biopsy in the case of negative mpMRI) at 12 months—earlier in the case of PSA rise. …”

Section: Methods and Analysesmentioning

confidence: 99%

“…mpMRI ( 29 , 38 , 41 , 42 ), PSMA-PET ( 43 ), and prostate biopsy (14-core systematic biopsy in the case of negative mpMRI) at 12 months—earlier in the case of PSA rise.…”

Section: Methods and Analysesmentioning

confidence: 99%

The SAFE Pilot Trial—SAlvage Focal Irreversible Electroporation—For Recurrent Localized Prostate Cancer: Rationale and Study Protocol

et al. 2022

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IntroductionCurrently, the majority of prostate cancer (PCa) recurrences after non-surgical first-line treatment are managed with androgen-deprivation therapy (ADT). Salvage radical prostatectomy (sRP) is a curative alternative to ADT but yields significant morbidity. Preliminary evidence from focal salvage treatments shows similar oncological control but lower morbidity compared to sRP. Among available ablative focal energies, irreversible electroporation (IRE) is a treatment modality that proved promising, especially in treating apical lesions, where PCa most often recurs. Our aim is to test the safety of salvage IRE for recurrent PCa.MethodsWe performed a single-arm pilot feasibility study (IDEAL stage 2a): SAFE, SAlvage Focal irreversible Electroporation for recurrent localized PCa. Twenty patients with biopsy-proven PCa recurrence after primary non-surgical (radiation or ablation) treatment were included. All men will undergo mpMRI ± targeted biopsies, pre-operative PSMA-PET staging before inclusion and sIRE. Outcomes will be evaluated through internationally validated questionnaires and morbidity scales. All men will undergo a control biopsy at one year.ResultsPrimary objectives were the evaluation of the safety of sIRE (and patients’ quality of life) after treatment. Secondary objectives were the evaluation of functional outcomes, namely, continence and erectile function changes and evaluation of short-term oncological efficacy.ConclusionsSAFE is the second pilot study to evaluate sIRE and the first one performed according to the most recent diagnostic and staging imaging standards. sIRE may provide a curative option for recurrent PCa together with lower comorbidities compared to sRP.

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Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center

Cited by 10 publications

References 20 publications

Available evidence on HIFU for focal treatment of prostate cancer: a systematic review

Available evidence on HIFU for focal treatment of prostate cancer: a systematic review

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

The SAFE Pilot Trial—SAlvage Focal Irreversible Electroporation—For Recurrent Localized Prostate Cancer: Rationale and Study Protocol

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