A21 Session 6: Case studies in ablative therapy : Utilizing multiparametric mri and 3-D transperineal mapping biopsies to localize, target and ultimately destroy prostate cancer with cryosurgery

Abstract

Prostate cancer screening trials have shown a 30% reduction of prostate cancer mortality. However, the USPSTF has recommended against PSA screening because the harms outweigh the benefits. Indeed, screening has increased over-diagnosis and subsequent over-treatment of indolent disease that might not benefit from primary therapy, particularly when treatment-related side effects have a considerable impact on a man’s quality of life. In this context, we have focused our efforts on improving patient selection by integrating multiparametric MRI [mpMRI], 3-dimensional transperineal prostate mapping biopsies and targeted MRI/TRUS fusion biopsy techniques to aid in disease characterization. In this fashion, we can better determine those cancers that may be followed under an active surveillance protocol compared to those that require treatment. Active surveillance has been developed with the aim of postponing therapy in lower-risk patients. Focal therapy, or targeted ablation, offers the benefits of eradicating the known area(s) of cancer with the ability to employ active surveillance for the untreated areas of the gland. Following such a path should decrease the chance of over-treatment while still preserving a man’s continence and potency. The aim of our clinical protocol is to evaluate men willing to participate in focal therapy/active surveillance trials using mpMRI, which has been shown to have excellent performance in identifying large and poorly differentiated tumors. Multi-parametric MRI findings have been combined with ultrasound images to perform targeted biopsies, showing an improved detection of clinically significant cancers that harbor greater tumor volumes and often display more aggressive biologic behavior. We utilize 3 dimensional transperineal mapping biopsies, mp-MRI and targeted biopsy findings to improve patient selection, treatment planning and ultimately physiologic and cancer outcomes with targeted cryosurgery.