Focal Laser Ablation of Prostate Cancer: Phase I Clinical Trial

Natarajan, Shyam; Raman, Steven S.; Priester, Alan; Garritano, James; Margolis, Daniel; Lieu, Patricia; Macairan, Maria Luz; Huang, Jiaoti; Grundfest, Warren S.; Marks, Leonard S.

doi:10.1016/j.juro.2015.12.083

Cited by 94 publications

(70 citation statements)

References 18 publications

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“…IPSS results demonstrated no significant changes in urinary symptoms for up to 18 months after ablation compared to baseline readings. This finding is consistent with other studies …”

Section: Discussionsupporting

confidence: 94%

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Magnetic resonance image‐guided focal laser ablation in clinically localized prostate cancer: safety and efficacy

Al-Hakeem

Raz

Gacs

et al. 2019

ANZ Journal of Surgery

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Background To evaluate the safety and efficacy of focal laser ablation (FLA) in low‐intermediate risk prostate cancer. Methods Inclusion criteria were men aged 50–75 years, prostate‐specific antigen (PSA) ≤15 ng/mL, clinical stage T1c–T2a, one or two lesions (PI‐RADS ≥3) on magnetic resonance imaging (MRI), and Gleason score 6 (>3 mm) or Gleason 7 on targeted biopsy. Treatment success was defined as no clinically significant cancer in ablated areas. The study is prospective. Under MRI guidance, laser ablation was applied to the visible lesion(s). International Prostate Symptoms Score, Sexual Health Inventory in Men score and PSA levels were assessed at baseline and repeated at 1, 3, 6, 12 and 18 months. MRI was repeated at 3 and 12 months. Cancer control was assessed at 6 months using targeted and systematic biopsies. Results FLA was performed in 49 patients. Gleason scores were 3 + 3 in 13 patients (26.5%), 3 + 4 in 29 (59.2%) and 4 + 3 in 7 (14.3%). No significant complications were noticed. International Prostate Symptoms Score measurements up to 18 months were not different from baseline (all P > 0.05). Sexual Health Inventory in Men scores dropped in the first year (all P < 0.05), but were not different from baseline levels at 18 months (P = 0.097). PSA levels dropped significantly at 3–18 months (all P < 0.05). Treatment was successful in 39 patients (79.6%). Persistent cancer in treated areas was found in 10 patients (20.4%). Conclusions FLA is safe with no impact on urinary and sexual functions at 18 months follow‐up. Oncologic control is encouraging. Larger scale studies and longer follow‐up are required.

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“…IPSS results demonstrated no significant changes in urinary symptoms for up to 18 months after ablation compared to baseline readings. This finding is consistent with other studies …”

Section: Discussionsupporting

confidence: 94%

“…PSA measurements at 3–18 months following ablation demonstrated a significant decrease compared to baseline with a mean drop of 1.5 ng/mL at 18 months. Other studies also reported similar drop in PSA . This drop in PSA may be due to ablation of some benign prostatic tissue.…”

Section: Discussionsupporting

confidence: 56%

Magnetic resonance image‐guided focal laser ablation in clinically localized prostate cancer: safety and efficacy

Al-Hakeem

Raz

Gacs

et al. 2019

ANZ Journal of Surgery

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“…Using longitudinal coregistration, one could consistently re-visit the same gland location 57 , without limitations of implantable/imageable pellets proposed recently by Ghai et Tranchtenberg 58 . Recently, Natarajan et al 59 rose the question of assessment of treatment margin in their report of a phase 1 trial about focal therapy using in bore laser ablation with a transrectal approach. Our method may assist to discriminate infield/ outfield recurrence after focal therapy.…”

Section: Discussionmentioning

confidence: 99%

3D Registration of mpMRI for Assessment of Prostate Cancer Focal Therapy

et al. 2017

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Purpose To assess a novel method of 3D co-registration of prostate MRI exams performed before and after prostate cancer focal therapy. Material and method We developed a software platform for automatic 3D deformable coregistration of prostate MRI at different time points and applied this method to ten patients who underwent focal ablative therapy. MRI exams were performed preoperatively, as well as one week and six months posttreatment. Rigid registration served as reference for assessing coregistration accuracy and precision. Results Segmentation of preoperative and postoperative prostate revealed a significant post-operative volume decrease of the gland that averaged 6.49 cc (p=0.017). Applying deformable transformation based upon Mutual Information (MI) from 120 pairs of MRI slices, we refined by 2.9 mm (max 6.25mm) the alignment of the ablation zone (AZ), segmented from contrastenhanced images on the one-week post-operative exam, to the 6-month postoperative T2-weighted images. This represented a 500% improvement over the rigid approach (p=0.001), corrected by volume. The dissimilarity by Dice index of the mapped AZ using deformable transformation vs. rigid control was significantly (p=0.04) higher at the ablation site compared to the whole gland. Conclusion Our findings illustrate our method's ability to correct for deformation at the ablation site. The preliminary analysis suggests that deformable transformation computed from MI of preoperative and follow-up MRI is accurate in co-registration of MRI exams performed before and after focal therapy. The ability to localize the previously ablated tissue in 3D space may improve targeting for image-guided follow-up biopsy within focal therapy protocols.

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“…After a series of experiments on phantoms, ex vivo tissues, and on in vivo animal models [99], MR thermometry has been employed during LA of HCC and liver tumors , prostate cancer, and metastases during the last decade [100,101,102]. Recent studies have shown the possibility of obtaining good spatial and temporal resolution and good precision [103].…”

Section: New Solutions To Guide Laser Ablationmentioning

confidence: 99%

Laser Ablation for Cancer: Past, Present and Future

Schena

Saccomandi

Fong

2017

JFB

144

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Laser ablation (LA) is gaining acceptance for the treatment of tumors as an alternative to surgical resection. This paper reviews the use of lasers for ablative and surgical applications. Also reviewed are solutions aimed at improving LA outcomes: hyperthermal treatment planning tools and thermometric techniques during LA, used to guide the surgeon in the choice and adjustment of the optimal laser settings, and the potential use of nanoparticles to allow biologic selectivity of ablative treatments. Promising technical solutions and a better knowledge of laser-tissue interaction should allow LA to be used in a safe and effective manner as a cancer treatment.

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Focal Laser Ablation of Prostate Cancer: Phase I Clinical Trial

Cited by 94 publications

References 18 publications

Magnetic resonance image‐guided focal laser ablation in clinically localized prostate cancer: safety and efficacy

Magnetic resonance image‐guided focal laser ablation in clinically localized prostate cancer: safety and efficacy

3D Registration of mpMRI for Assessment of Prostate Cancer Focal Therapy

Laser Ablation for Cancer: Past, Present and Future

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