Intra-prostatic vasculature studies: Can they predict the outcome of transurethral microwave thermotherapy for the management of bladder outflow obstruction?

Abstract

Background Blood perfusion regulates intraprostatic temperatures during transurethral microwave thermotherapy (TUMT). We evaluated baseline intraprostatic vasculature, as a predictor of efficacy of TUMT. Methods Twenty‐two patients, with lower urinary tract symptoms (LUTS) suggestive of bladder outflow obstruction, were treated with TUMT (Prostatron). At baseline, three‐dimensional contrast‐enhanced power‐flow‐Doppler prostate ultrasonography (3D‐CE‐PFD) was performed. Assuming that the percentage of perfused area (PPA) is a realistic measure of blood flow, it was used to quantify intraprostatic vasculature. Results The median (range) age, prostate size, and energy delivered were 66 years (48–80), 47 cm3 (30–121), 110 kJ (29–136), respectively. The response was 77% (5 failures). The median (range) PPA was 2.76% (0.7–11.3). No difference in PPA among good and poor responders was detected nor was any correlation between PPA and baseline parameters. Conclusions The baseline intraprostatic vascularization, documented by CE‐PFD studies, has no predictive value for the efficacy of TUMT. It seems that “static” baseline blood flow does not reflect the “dynamic” thermoregulatory role of blood flow during treatment. Prostate 46:200–206, 2001. © 2001 Wiley‐Liss, Inc.

Transurethral microwave thermotherapy of the prostate – Evaluation with MRI and analysis of parameters relevant to outcome

“…Prostate tissue exhibits a wide biological variability and several investigators have attempted to identify factors which may have a potential influence on microwave treatment. Floratos et al [1] performed a quantitative estimation of intraprostatic blood flow in patients before thermotherapy, using contrast medium-enhanced power-flow Doppler ultrasonography. Their study failed to show baseline vascularization to be a predictor of the outcome of thermotherapy and this result tallies with the findings obtained in this paper.…”

“…However, baseline intraprostatic vascularization as assessed by ultrasonography was not shown to have any impact on the efficacy of TUMT [1]. Differences in the heat sensitivity of epithelial and stromal components of hyperplastic prostate tissue were recently described in histological studies [2].…”

Application of External Microwave Thermotherapy in Urology: Past, Present, and Future

“…26 However, these features are only moderately predictive. In addition, Floratos and colleagues 27 showed that baseline intraprostatic vascularity, documented by three-dimensional contrast-enhanced power-flow Doppler studies, has no predictive value for the efficacy of TUMT. It seems that static baseline blood flow does not reflect the dynamic thermoregulatory role of blood flow during treatment.…”

“…It seems that static baseline blood flow does not reflect the dynamic thermoregulatory role of blood flow during treatment. 27 Controversial results have been published regarding the effectiveness of baseline prostate specific antigen (PSA) as a predictor of the clinical outcome following HE TUMT. Djavan and associates 28 demonstrated that baseline PSA could identify patients with favorable clinical results after TUMT with the Targis device.…”

Determination and validation of the actual 3D temperature distribution during interstitial hyperthermia of prostate carcinoma

“…Errors in the reconstruction of the geometry can be reduced, for example, by using the SPOT system (Nucletron BV, Veenendaal, The Netherlands), which provides 3D ultrasound imaging. Three-dimensional power Doppler with contrast agents can reveal angiographic and perfusion data and is currently investigated by Bogers et al (1999), Floratos et al (2001) andKruger Hagen et al (2001). The effective perfusion level as measured by each thermosensor can also be used to estimate a 3D heterogeneous perfusion map.…”