Abstract
Objective The study aimed at investigating the outcome of prostate HIFU focal therapy using the MRI-US fusion platform for treatment localization and delivery. Methods It is a prospectively designed case series of HIFU focal therapy for localized prostate cancer. The inclusion criteria include clinical tumor stage ≤T2, visible index lesion on multiparametric MRI less than 20 mm in diameter, absence of Gleason 5 pattern on prostate biopsy, and PSA ≤ 20 ng/ml. HIFU focal therapy was performed in the conventional manner in the beginning 50% of the series, whereas the subsequent cases were performed with MRI-US fusion platform. The primary outcome was treatment failure rate which is defined by the need of salvage therapy. Secondary outcomes included tumor recurrence in follow-up biopsy, PSA change, perioperative complications, and postoperative functional outcomes. Results Twenty patients underwent HIFU focal ablation. HIFU on an MRI-US fusion platform had a trend of a longer total operative time than the conventional counterpart (124.2 min vs. 107.1 min, p=0.066). There was no difference in the mean ablation volume to lesion volume ratio between the two. The mean PSA percentage change from baseline to 6-month is more significant in the conventional group (63.3% vs. 44.6%, p=0.035). No suspicious lesion was seen at 6-month mpMRI in all 20 patients. Two patients, one from each group, eventually underwent radical treatment because of the presence of clinically significant prostate cancer in the form of out-of-field recurrences during follow-up biopsy. No significant difference was observed before and after HIFU concerning uroflowmetry, SF-12 score, and EPIC-26 score. It was observed that energy used per volume was positively correlated with PSA density of the patient (r = 0.6364, p=0.014). Conclusion In conclusion, HIFU with conventional or MRI-US fusion platform provided similar oncological and functional outcomes.
Highlights
High-intensity focused ultrasound (HIFU) has been evaluated for the treatment of several benign and malignant conditions, such as uterine fibroids, thyroid nodules, and breast cancers. e first experience with the use of HIFU for prostate cancer management was reported in 1996 [1], and the initial role of HIFU was for whole-gland ablation when patients refused or were not eligible for radical prostatectomy [2, 3]. e use of HIFU for focal treatment represents a more recent concept aiming to provide the best balance between oncological control and minimizing the side effect profile
Twelve patients had lesions belonging to ISUP grade group 1, of which 10 of them had tumor volume >0.5 cm3 on MRI images. e other two patients with tumor volume
HIFU focal therapy for prostate cancer resulted in an early tumor clearance on MRI assessment, with a significant drop in PSA and PHI after treatment
Summary
High-intensity focused ultrasound (HIFU) has been evaluated for the treatment of several benign and malignant conditions, such as uterine fibroids, thyroid nodules, and breast cancers. e first experience with the use of HIFU for prostate cancer management was reported in 1996 [1], and the initial role of HIFU was for whole-gland ablation when patients refused or were not eligible for radical prostatectomy [2, 3]. e use of HIFU for focal treatment represents a more recent concept aiming to provide the best balance between oncological control and minimizing the side effect profile. While precision of prostate biopsy has been improved by the MRI-US fusion platform, such precision in lesion localization has not been incorporated in the conventional focal therapy delivery. Our study aimed to describe the results and change in prostate parameters after MRI-US fusion HIFU focal therapy. While conventional HIFU ablation was performed with cognitive recognition of lesion location, fusion of MRI and ultrasound images for the localization of lesion during HIFU treatments was per-. E Sonafuse -MIM TM Symphony platform adopted a similar fusion process as in TM bkFusion for prostate biopsy, with prior installation of MRI images and subsequent contouring of the gland and index lesions. A p value of
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