MP18-11 MR-GUIDED FOCAL LASER ABLATION OF INTERMEDIATE RISK PROSTATE CANCER: PHASE I TRIAL

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy1 Apr 2016MP18-11 MR-GUIDED FOCAL LASER ABLATION OF INTERMEDIATE RISK PROSTATE CANCER: PHASE I TRIAL Shyam Natarajan, Steven Raman, Alan Priester, James Garritano, Daniel Margolis, Patricia Lieu, Maria Macairan, Jiaoti Huang, Warren Grundfest, and Leonard Marks Shyam NatarajanShyam Natarajan More articles by this author , Steven RamanSteven Raman More articles by this author , Alan PriesterAlan Priester More articles by this author , James GarritanoJames Garritano More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , Patricia LieuPatricia Lieu More articles by this author , Maria MacairanMaria Macairan More articles by this author , Jiaoti HuangJiaoti Huang More articles by this author , Warren GrundfestWarren Grundfest More articles by this author , and Leonard MarksLeonard Marks More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2712AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Focal laser ablation (FLA) under MRI guidance is a promising method to treat prostate cancer (CaP), but available information is limited. Prior work is largely unpublished and consists mostly of transperineal FLA performed by radiologists in low-risk patients. Herein we describe 6-month results from a prospective Phase I trial of transrectal FLA in an intermediate risk population. METHODS 8 men (58-73 y.o.) with biopsy-proven intermediate risk CaP (all but one Gleason 3+4), located in one MRI target (Fig., A), were enrolled in an IRB-approved clinical trial. FLA was performed under MRI guidance (in bore) transrectally; MRI-compatible thermal probes were also placed into the prostate transperineally under US guidance to determine treatment temperatures at intra-prostatic sites, independent of MR thermometry (MRT) (Fig., B,C). A 980-nm, 15 W fiber-coupled laser system was used to treat each target (4-9 laser applications per patient). Multi-parametric MRI was obtained immediately following treatment to determine ablation effect (Fig., D). RESULTS In-bore transrectal FLA was well-tolerated under conscious sedation. All patients were discharged within 4 hours of FLA and have been followed ≥ 6 months without any grade 3 adverse events. The non-perfused tissue, i.e. ablation zone, was confined to the intended region (Fig. D) and measured a median volume of 3 cc (range, 1.9-8.9 cc). Critical structures (rectum, sphincter, capsule, neurovascular bundle) were unaffected, and no differences in IIEF-5 or IPSS were observed at 6-months compared to baseline values. At 6-month follow-up MRI/US fusion biopsy, cancer was not detected in the ablation zone in 5 of 8 men, but tumor foci were often seen outside treatment zone. CONCLUSIONS In-bore transrectal FLA of the prostate can be performed safely in men with intermediate risk CaP, without serious adverse events or changes in sexual and urinary function. Interstitial thermal probes confirmed the limited extent of laser heat within the prostate. Follow-up biopsy indicates that larger margins may be necessary for effective FLA. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e196-e197 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Shyam Natarajan More articles by this author Steven Raman More articles by this author Alan Priester More articles by this author James Garritano More articles by this author Daniel Margolis More articles by this author Patricia Lieu More articles by this author Maria Macairan More articles by this author Jiaoti Huang More articles by this author Warren Grundfest More articles by this author Leonard Marks More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...