Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer

Zhou, Steve; Simopoulos, Demetrios N.; Jayadevan, Rajiv; Felker, Ely; Delfin, Merdie; Barsa, Danielle; Kwan, Lorna; Marks, Leonard S.

doi:10.1016/j.urology.2018.11.052

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…Participants underwent partial gland cryoablation under general anesthesia via trans‐perineal 14‐gauge Argon cryoprobes (Galil Medical, Inc.) as previously described. 18 Repeat treatments are not included and have been reported separately. 24 Images from the biopsy screen‐capture were used in the operating room “cognitively” to guide cryoprobe placement (eFigure 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…Participants underwent partial gland cryoablation under general anesthesia via trans‐perineal 14‐gauge Argon cryoprobes (Galil Medical, Inc.) as previously described 18 . Repeat treatments are not included and have been reported separately 24 .…”

Section: Methodsmentioning

confidence: 99%

“…The data from that trial, presented herein, differ from other trials in which cryotherapy was used to achieve PGA: A registered protocol was employed prospectively; per‐protocol biopsies (targeted, tracked, and systematic) were obtained before and after treatment at near‐ and intermediate‐term time points; all biopsies were guided by concomitant MRI using MRI/US fusion (MR‐guided biopsy, MRGB); all patients had clinically significant PCa (csPCa); and a detailed evaluation of sexual and urinary after‐effects was included. A partial analysis of early patients in the trial was included in two previous reports 18,19 …”

Section: Introductionmentioning

confidence: 99%

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Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

et al. 2023

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Background Partial gland ablation (PGA) is a new option for treatment of prostate cancer (PCa). Cryotherapy, an early method of PGA, has had favorable evaluations, but few studies have employed a strict protocol using biopsy endpoints in men with clinically significant prostate cancer (csPCa). Methods 143 men with unilateral csPCa were enrolled in a prospective, observational trial of outpatient PGA‐cryotherapy. Treatment was a 2‐cycle freeze of the affected prostate part. Participants were evaluated with MRI‐guided biopsy (MRGB) at baseline and at 6 months and 18 months after treatment. Absence of csPCa upon MRGB was the primary endpoint; quality‐of‐life at baseline and at 6 months after treatment was assessed by EPIC‐CP questionnaires in the domains of urinary and sexual function. Results Of the 143 participants, 136 (95%) completed MRGB at 6 months after treatment. In 103/136 (76%), the biopsy revealed no csPCa. Of the 103, 71 subsequently had an 18‐month comprehensive biopsy; of the 71 with 18‐month biopsies, 46 (65%) were found to have no csPCa. MRI lesions became undetectable in 96/130 (74%); declines in median serum PSA levels (6.9 to 2.5 ng/mL), PSA density (0.15 to 0.07), and prostate volume (42 to 34cc) were observed (all p < 0.01). Neither lesion disappearance on MRI nor PSA decline correlated with biopsy outcome. Urinary function was affected only slightly and sexual function moderately. Conclusion In the near to intermediate term, partial gland ablation with cryotherapy was found to be a safe and moderately effective treatment of intermediate‐risk prostate cancer. Eradication of cancer was better determined by MRI‐guided biopsy than by MRI or PSA.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

et al. 2023

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“…Furthermore, erectile dysfunction is one of the most common complications after cryotherapy [36]. Initial functional outcomes after cryotherapy have been discouraging, given the relatively high rate of erectile dysfunction in up to 95% of patient cohorts.…”

Section: Reasons For Systematic Reviewmentioning

confidence: 99%

Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer

Chin¹,

Lynn²

2022

Cureus

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Cryotherapy is one of the recognised ablative modalities for both primary and salvage therapy for prostate cancer. It presents an alternative, less invasive treatment for an organ-confined disease, improved preservation of surrounding tissue and a more suitable option for patients who are unfit for radical prostatectomy. Nevertheless, the currently available literature is relatively too scarce to provide definite conclusions regarding the treatment outcomes in cryotherapy. The present study aimed to review current oncological and survival outcomes in cryotherapy for primary and recurrent prostate cancer. Furthermore, this study aimed to establish the complications and functional outcomes of cryotherapy for prostate cancer. A literature search was performed on the PubMed, Cochrane and Google Scholar databases. Current guidelines and recommendations from the European Association of Urology were also reviewed. The search keywords used included 'Cryotherapy, Prostate Cancer', 'Cryoablation, Prostate Cancer' and 'Cryosurgery, Focal Prostate Cancer'. Truncations and Boolean operators were used with the keywords. All relevant studies from after 2015, including abstracts and non-English research assessing oncological and functional outcomes and complications, were included. Twenty-six studies consisting of 11,228 patients were reviewed. Fifteen studies assessed the outcomes of primary cryotherapy, whereas 11 studies reported the outcomes in salvage therapy. The patient's age ranged 55-85 years, and the pre-procedural prostate-specific antigen (PSA) ranged 0.01-49.33 ng/mL. A total of 2031 patients were classified to be at low risk, 2,995 were at moderate risk and 253 were at high risk on the D'Amico prostate cancer risk classification system. Followups ranged from 9.0 to 297.6 months. The disease-specific survival rate was 65.5%-100.0%, overall survival was 61.3%-99.1%, the PSA nadir was 0.01-2.63 ng/mL and the overall biochemical recurrence rate was 15.4%-62.0%. The complications included erectile dysfunction (3.7%-88.0%), urinary retention (2.13%-25.30%) and bladder neck stricture/stenosis (3.0%-16.7%). The functional assessment showed a mixture of improved, unchanged or worsened post-procedural outcomes in primary therapy. This systematic review did not find significant differences in the cancer-specific, overall and biochemical-free survival rate between the primary and salvage cryotherapy cohorts. The most common complications encountered in both cohorts were erectile dysfunction, urinary incontinence, lower urinary tract/bladder neck stricture and infection. More prospective and double-arm studies are critically needed to provide guidance on the careful selection of patient cohorts for cryotherapy, whether for curative or salvage intent.

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“…In contrast with traditional whole‐gland interventions, HGA leaves intact the contralateral neurovascular bundle and other critical anatomical structures, thus increasing the patient's chance for preserving sexual and urinary function. HGA using both cryotherapy and high‐intensity focussed ultrasound has shown excellent side‐effect profiles and very low complication rates, with promising intermediate‐term cancer control . Pending the delivery of long‐term mortality data, this can be an attractive alternative that preserves quality of life for appropriately selected patients .…”

Section: Introductionmentioning

confidence: 99%

Using spatial tracking with magnetic resonance imaging/ultrasound‐guided biopsy to identify unilateral prostate cancer

et al. 2019

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Objectives To create reliable predictive metrics of unilateral disease using spatial tracking from a fusion device, thereby improving patient selection for hemi‐gland ablation of prostate cancer. Patients and Methods We identified patients who received magnetic resonance imaging (MRI)/ultrasound‐guided biopsy and radical prostatectomy at a single institution between 2011 and 2018. In addition to standard clinical features, we extracted quantitative features related to biopsy core and MRI target locations predictive of tumour unilaterality. Classification and Regression Tree (CART) analysis was used to create a decision tree (DT) for identifying cancer laterality. We evaluated concordance of model‐determined laterality with final surgical pathology. Results A total of 173 patients were identified with biopsy coordinates and surgical pathology available. Based on CART analysis, in addition to biopsy‐ and MRI‐confirmed disease unilaterality, patients should be further screened for cancer detected within 7 mm of midline in a 40 mL prostate, which equates to the central third of any‐sized prostate by radius. The area under the curve for this DT was 0.82. Standard diagnostics and the DT correctly identified disease laterality in 73% and 80% of patients, respectively (P = 0.13). Of the patients identified as unilateral by standard diagnostics, 47% had undetected contralateral disease or were otherwise incorrectly identified. This error rate was reduced to 17% (P = 0.01) with the DT. Conclusion Using spatial tracking from fusion devices, a DT was more reliable for identifying laterality of prostate cancer compared to standard diagnostics. Patients with cancer detected within the central third of the prostate by radius are poor hemi‐gland ablation candidates due to the risk of midline extension of tumour.

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Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer

Cited by 7 publications

References 28 publications

Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes

Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer

Using spatial tracking with magnetic resonance imaging/ultrasound‐guided biopsy to identify unilateral prostate cancer

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