MRI targeted single fraction HDR Brachytherapy for localized Prostate Carcinoma: a feasibility study of focal radiation therapy (ProFocAL)

Fischbach, Frank; Hass, Peter; Schindele, Daniel; Genseke, Philipp; Geisendorf, Lisa; Stehning, Christian; Schostak, Martin; Brunner, Thomas; Pech, Maciej; Fischbach, Katharina

doi:10.1007/s00330-019-06505-0

Cited by 13 publications

(11 citation statements)

References 25 publications

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“…The reduction rate of PSA after ultrafocal HDR-BT in this study was 56.9%, whereas, in the study by Fischbach et al, it was 80.6%. 7 Dankulchai et al reported that in HDR-BT for prostate cancer, the group with fewer needles had lower conformity. 20 Therefore, in the D99 prescription, the irradiated volume is expected to be larger when fewer needles are used.…”

Section: Discussionmentioning

confidence: 99%

“…Dose constraints for risk organs were set at D1 cm 3 ≤ 12 Gy for the rectum and bladder and D0.1 cm 3 ≤ 21 Gy for the urethra. 11,13,14 In our study, the time between lumbar anesthesia, replacement of applicator needles, CT scanning, and the end of dose planning was recorded as "in-room-time," and the time between CT scanning and end of dose planning was recorded as "planning time," based on the study by Fischbach et al 7…”

Section: Treatmentmentioning

confidence: 99%

“…5 Specifically, there are many reports of focal cryotherapy and HIFU, but only a few reports of focal HDR-BT. [6][7][8] In our institution, HDR-BT has been adopted for the treatment of prostate cancer since 1998, and an MRI-US fusion-guided system has been introduced to enable targeted prostate cancer biopsies, which allows accurate identification of clinically significant prostate cancer before treatment. 9 To the best of our knowledge, there are no studies on the use of ultrafocal HDR-BT for prostate cancer in Japanese patients.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of magnetic resonance imaging‐ultrasound guided high‐dose‐rate brachytherapy for localized prostate cancer: Preliminary results from a prospective study

et al. 2022

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This study aimed to investigate preliminary outcomes of a prospective trial of magnetic resonance imaging-ultrasound fusion-guided ultrafocal high-dose-rate brachytherapy in localized prostate cancer. Methods: In our prospective study, data from patients who underwent this treatment between April 1, 2020 and March 31, 2021 were analyzed. In the procedure, the applicator needle was inserted through the perineum to target the lesion on the multiparametric magnetic resonance imaging, which was fused onto the transrectal ultrasound image. The prescription dose was set at a single fraction of 19 Gy. Data from patients who received whole-gland high-dose-rate brachytherapy were extracted and compared with data from patients who received ultrafocal high-dose-rate brachytherapy, to evaluate the frequency of acute adverse events. Results: Eight patients underwent ultrafocal high-dose-rate brachytherapy with a median observation period of 7.75 months (range 5.96-15.36 months). No acute genitourinary or gastrointestinal adverse events were observed in this cohort. The planned procedure was completed in all patients, and no unexpected adverse events were observed; however, prostate-specific antigen failure was detected in one patient. In the 25 patients who underwent whole-gland high-dose-rate brachytherapy, acute genitourinary and gastrointestinal adverse events were observed in 88% and 20% of the patients, respectively. Ultrafocal high-dose-rate brachytherapy was a significant factor in avoiding acute adverse genitourinary events in univariate and multivariate analyses (P < 0.001 and P = 0.032, respectively). Conclusions: Magnetic resonance imaging-ultrasound fusion-guided ultrafocal highdose-rate brachytherapy in localized prostate cancer is a safe and feasible treatment without acute genitourinary and gastrointestinal adverse events. Long-term observation and further investigation are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of magnetic resonance imaging‐ultrasound guided high‐dose‐rate brachytherapy for localized prostate cancer: Preliminary results from a prospective study

et al. 2022

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“…Fischbach et al. [ 70 ] has been currently working on this workflow with nine patients treated so far. Their current findings showed that mean PSA decreased from 8.8 ng/mL to 1.7 ng/mL with a 34-min intervention time.…”

Section: New Technologymentioning

confidence: 99%

“…With regards to morbidity, both nanoparticles and focal radiation have proven to be safe as no side effects have been reported in early studies [ 50 , 70 ]. This is comparable to FLA where recent studies have shown that patients experienced no significant changes to their sexual or urinary function [ 71 , 75 ].…”

Section: New Technologymentioning

confidence: 99%

Future perspective of focal therapy for localized prostate cancer

O’Connor

Ramedani

Daneshvar

et al. 2021

Asian Journal of Urology

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Objective To summarize the recent literature discussing focal therapy for localized prostate cancer. Methods A thorough literature review was performed using PubMed to identify recent studies involving focal therapy for the treatment of localized prostate cancer. Results In an effort to decrease the morbidity associated with prostate cancer treatment, many urologists are turning to focal therapy as an alternative treatment option. With this approach, the cancer bearing portion of the prostate is targeted while leaving the benign tissue untouched. Multiparametric magnetic resonance imaging remains the gold standard for visualization during focal therapy, but new imaging modalities such as prostate specific membrane antigen/positron emission tomography and contrast enhanced ultrasound are being investigated. Furthermore, several biomarkers, such as prostate cancer antigen 3 and prostate health index, are used in conjunction with imaging to improve risk stratification prior to focal therapy. Lastly, there are several novel technologies such as nanoparticles and transurethral devices that are under investigation for use in focal therapy. Conclusion Focal therapy is proving to be a promising option for the treatment of localized prostate cancer. However, further study is needed to determine the true efficacy of these exciting new technologies.

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