Focal Ablative Therapy Research Articles

Focal prostate cancer therapy in the era of multiparametric MRI: a review of options and outcomes.

The goal of prostate cancer focal therapy is to achieve oncologic control while reducing the rate of adverse events associated with whole-gland treatments. Numerous focal therapy modalities are currently available with early data demonstrating highly variable rates of cancer control and preservation of sexual/urinary function. All English language clinical trial publications evaluating various focal therapies for localized prostate cancer were reviewed. The literature search was limited to studies from the modern era of MRI-guided treatment, as MRI is hypothesized to improve tumor localization and targeting. Primary outcomes were post-treatment cancer-free rates, in-field/out-of-field recurrence rates, and rates of conversion to radical therapy. Secondary outcomes were related to functional status and adverse events. Numerous focal therapies were identified with clinical data including high-intensity focused ultrasound, transurethral ultrasound ablation, focal laser ablation, focal cryotherapy, irreversible electroporation, and photodynamic therapy. Recurrence rates among all technologies were low to moderate (0-51%) and rates of freedom from radical treatment were highly variable (46-98%). Rates of erectile dysfunction and incontinence generally ranged from 0 to 44% and 0 to 12%, respectively, with variability between focal therapy modalities. Caution should be exercised when comparing studies as outcomes are strongly associated with patient selection. No individual focal therapy is currently recommended by society guidelines. Randomized controlled trials are ongoing in search of a standard of care. For localized MRI-visible prostate cancer, early clinical trial data demonstrate that focal therapy can provide good to moderate cancer control while having preferable side effect profiles compared to whole-gland treatments. While current studies do not make head-to-head comparisons between technologies, early data suggest a potential for these technologies to provide adequate cancer control in a well-selected patient population. The oncologic outcomes of some focal therapies appear promising; however, longer-term follow-up data are needed to assess the durability of early outcomes.

A0965 - Comparative effectiveness analysis of oncological and functional outcomes after salvage radical treatment with surgery or radiotherapy following primary focal or whole-gland ablative therapy for localised prostate cancer

A0965 - Comparative effectiveness analysis of oncological and functional outcomes after salvage radical treatment with surgery or radiotherapy following primary focal or whole-gland ablative therapy for localised prostate cancer

Current evidence for focal laser ablation and vascular-targeted photodynamic therapy for localized prostate cancer: review of literature published in the last 2 years.

Currently, a significant number of patients are diagnosed with unilateral and apparently unifocal low or intermediate-risk prostate cancer (PCa). These patients are suitable for focal therapy, thus preventing radical treatment side effects without affecting cancer control. Among focal therapy energy sources, laser-based technologies have shown promising outcomes. We aimed to summarize recent data on focal laser ablation (FLA) and vascular-targeted photodynamic therapy (VTP) for PCa. We selected eight studies reporting data on 1155 patients with PCa who underwent laser-based focal therapy. Five studies were on FLA and three on VTP (six prospective and two retrospective series); four reported both oncologic and functional outcomes whereas in three only oncologic and one only functional outcomes were discussed. Follow-up protocols and durations varied widely among the studies. PCa recurrence rates ranged between 20 and 56%. Urinary and erectile function were preserved after treatment, and complications were mild and transient. A lack of high-quality data on long-term oncological outcomes still remains, thus further highlighting the need for prospective controlled studies. FLA and VTP are well tolerated procedures with excellent functional outcomes. However, both procedures showed a significant rate of PCa recurrence, thus demonstrating a certain grade of oncologic control failure of the procedure and/or nonoptimal patients' selection.

Comparative Effectiveness Analyses of Salvage Prostatectomy and Salvage Radiotherapy Outcomes Following Focal or Whole-Gland Ablative Therapy (High-Intensity Focused Ultrasound, Cryotherapy or Electroporation) for Localised Prostate Cancer

AimsAblative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different salvage treatment outcomes. The aim of this study was to compare oncological and functional outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT). Materials and methodsData were collected prospectively and retrospectively on 100 consecutive SRARP cases and 100 consecutive SRT cases after ablative therapy failure in a high-volume tertiary centre. ResultsHigh-risk patients were over-represented in the SRARP group (66.0%) compared with the SRT group (48.0%) (P = 0.013). The median (interquartile range) follow-up after SRARP was 16.5 (10.0–30.0) months and 37.0 (18.5–64.0) months after SRT. SRT appeared to confer greater biochemical recurrence-free survival at 1, 2 and 3 years compared with SRARP in high-risk patients (year 3: 86.3% versus 66.0%), but biochemical recurrence-free survival was similar for intermediate-risk patients (year 3: 90.0% versus 75.6%). There was no statistical difference in pad-free continence at 12 and 24 months between SRARP (77.2 and 84.7%) and SRT (75.0 and 74.0%) (P = 0.724, 0.114). Erectile function was more likely to be preserved in men who underwent SRT. After SRT, cumulative bowel and urinary Radiation Therapy Oncology Group toxicity grade I were 25.0 and 45.0%, grade II were 11.0 and 11.0% and grade III or IV complications were 4.0 and 5.0%, respectively. ConclusionWe report the first comparative analyses of salvage prostatectomy and radiotherapy following ablative therapy. Men with high-risk disease appear to have superior oncological outcomes after SRT; however, treatment allocation does not appear to influence oncological outcomes for men with intermediate-risk disease. Treatment allocation was associated with a different spectrum of toxicity profile. Our data may inform shared decision-making when considering salvage treatment following focal or whole-gland ablative therapy.

Detectability Rates and Impact on Management From High-Sensitivity Total-Body 18F-Fluciclovine PET/CT Scans in Patients With Prostate Cancer Biochemical Recurrence

<h3>Purpose/Objective(s)</h3> ¹⁸F-fluciclovine, an FDA-approved synthetic amino acid radiopharmaceutical for assessment of prostate cancer (PCa) recurrence, may show modest lesion detectability rates on conventional PET/CT scanners, especially for low PSA levels (< 30%). A total-body PET/CT scanner can provide high-sensitivity imaging and may provide unique opportunity for detecting lower disease burden. In this pilot work, we explored the lesion detectability rates from ¹⁸F-fluciclovine total-body PET/CT in patients with biochemically recurrent PCa and impact on therapeutic decisions. <h3>Materials/Methods</h3> A single-institution, prospective IRB-approved study was conducted. From December 2019 to February 2021, 21 patients (age, 69.7 ± 7.5 yrs) with history of PCa, treated with radical prostatectomy (n = 18), external beam radiation therapy (n = 2) or brachytherapy (n = 1), subsequently presented with biochemical recurrence by American Urological Association criteria. All patients had standard of care¹⁸F-fluciclovine total-body PET/CT scans after a negative or equivocal cross-sectional conventional imaging. PET/CT images were interpreted on patient- and site-basis for any suspicious recurrent/metastatic lesions (prostate bed, N1, M1). Detection rate was measured as percentage per PSA category. A decision regarding treatment was recorded before and after ¹⁸F-fluciclovine PET/CT results and changes were noted. <h3>Results</h3> Fifteen (71%) patients showed detectable lesions in 24 sites: the prostate bed/seminal vesicles (n = 8), N1 station (n = 7), and M1 (n = 9). The latter included M1a (n = 3), M1b (n = 1) and M1c (n = 5) in different combinations. On a patient basis, detection rates were 2/4 (50%), 4/5 (80%), 2/4 (50%), 2/3 (67%) and 5/5 (100%) for the respective PSA categories of < 0.2, 0.2-0.5, 0.51-1.00, 1.01-2.00 and > 2.00 ng/mL. Overall, detection rate was 10/16 (63%) for PSA < 2 ng/mL (compared to published rates of 26% for fluciclovine and 56%for PSMA). Treatment decisions were changed in 18/21 (87%) of patients in the form of conversion to focal ablative radiation therapy (n = 13, 62%), systemic therapy (n = 2, 10%), or active surveillance (n = 1, 5%) or change in the currently received systemic therapy (n = 2, 10%). <h3>Conclusion</h3> Preliminary results demonstrated a promising role for high-sensitivity total-body PET/CT imaging using ¹⁸F-fluciclovine in patients with biochemically recurrent prostate cancer. In this small cohort, detection rates compared favorably to the published historical controls using fluciclovine or even PSMA on conventional PET/CT scanners. The current findings resulted in impactful changes of management in the majority of patients. A larger study is ongoing to validate the current findings.

Short-duration dynamic [18F]DCFPyL PET and CT perfusion imaging to localize dominant intraprostatic lesions in prostate cancer: validation against digital histopathology and comparison to [18F]DCFPyL PET/MR at 120 minutes

PurposeLocalized prostate cancer (PCa) in patients is characterized by a dominant focus in the gland (dominant intraprostatic lesion, DIL). Accurate DIL identification may enable more accurate diagnosis and therapy through more precise targeting of biopsy, radiotherapy and focal ablative therapies. The goal of this study is to validate the performance of [18F]DCFPyL PET and CT perfusion (CTP) for detecting and localizing DIL against digital histopathological images.MethodsMulti-modality image sets: in vivo T2-weighted (T2w)-MRI, 22-min dynamic [18F]DCFPyL PET/CT, CTP, and 2-h post-injection PET/MR were acquired in patients prior to radical prostatectomy. The explanted gland with implanted fiducial markers was imaged with T2w-MRI. All images were co-registered to the pathologist-annotated digital images of whole-mount mid-gland histology sections using fiducial markers and anatomical landmarks. Regions of interest encompassing DIL and non-DIL tissue were drawn on the digital histopathological images and superimposed on PET and CTP parametric maps. Logistic regression with backward elimination of parameters was used to select the most sensitive parameter set to distinguish DIL from non-DIL voxels. Leave-one-patient-out cross-validation was performed to determine diagnostic performance.Results[18F]DCFPyL PET and CTP parametric maps of 15 patients were analyzed. SUVLate and a model combining Ki and k4 of [18F]DCFPyL achieved the most accurate performance distinguishing DIL from non-DIL voxels. Both detection models achieved an AUC of 0.90 and an error rate of < 10%. Compared to digital histopathology, the detected DILs had a mean dice similarity coefficient of 0.8 for the Ki and k4 model and 0.7 for SUVLate.ConclusionsWe have validated using co-registered digital histopathological images that parameters from kinetic analysis of 22-min dynamic [18F]DCFPyL PET can accurately localize DILs in PCa for targeting of biopsy, radiotherapy, and focal ablative therapies. Short-duration dynamic [18F]DCFPyL PET was not inferior to SUVLate in this diagnostic task.Clinical trial registration number: NCT04009174 (ClinicalTrials.gov).

Optimization of polyethylene glycol-based hydrogel rectal spacer for focal laser ablation of prostate peripheral zone tumor.

Focal Laser ablation therapy is a technique that exposes the prostate tumor to hyperthermia ablation and eradicates cancerous cells. However, due to the excessive heating generated by laser irradiation, there is a possibility of damage to the adjacent healthy tissues. This paper through in silico study presents a novel approach to reduce collateral effects due to heating by the placement of polyethylene glycol (PEG) spacer between the rectum and tumor during laser irradiation. The PEG spacer thickness is optimized to reduce the undesired damage at common laser power used in the clinical trials. Our study also encompasses novelty by conducting the thermal analysis based on the porous structure of prostate tumor. The thermal parameters and two thermal phase lags between the temperature gradient and the heat flux, are determined by considering the vascular network of prostate tumor. The Nelder-Mead algorithm is applied to find the minimum thickness of the PEG spacer. In the absence of the spacer, the predicted results for the laser power of 4W, 8W, and 12W show that the temperature of the rectum rises up to 58.6 °C, 80.4 °C, and 101.1 °C, while through the insertion of 2.59mm, 4mm, and 4.9mm of the PEG spacer, it dramatically reduces below 42 °C. The results can be used as a guideline to ablate the prostate tumors while avoiding undesired damage to the rectal wall during laser irradiation, especially for the peripheral zone tumors.

18F-DCFPyL (PSMA) PET in the Management of Men with Biochemical Failure after Primary Therapy: Initial Clinical Experience of an Academic Cancer Center.

Purpose: To describe the initial experience of an academic center using 18F-DCFPyL PET in managing men with recurrent prostate cancer. Materials & Methods: This prospective, single-arm IRB-approved study included men with biochemical failure after primary therapy for prostate cancer and negative/equivocal CT and bone scintigraphy who were candidates for salvage therapy, as determined by a multidisciplinary panel of experts. 18F-DCFPyL PET was assessed for the presence and extent of recurrence: local, oligometastatic (≤4), or extensive. Post-PET management and clinical outcome, including PSA response, was documented. For patients who received PET-directed ablative therapies, response was categorized as “complete” if PSA became undetectable or “favorable” if PSA decreased ≥50%. Results: Forty-seven men with biochemical failure after radical prostatectomy (n = 29), primary radiotherapy (n = 15) or focal tumor ablation (n = 3) were included. PET was positive in (43/47) 91.5%, including local recurrence in (9/47) 19.2%; oligometastatic disease in (16/47) 34%; and extensive metastatic disease in (18/47) 38.3%. PET-directed focal ablative therapies without systemic therapy were given to (13/29) 44.8% of patients without extensive metastases on PET with a mean PSA response of 69% (median, 74.5%; range: 35–100). Favorable biochemical response was observed in (10/13) 76.9% of patients with limited recurrence on PET, and in 23.1% (3/13), there was complete response. Conclusion: 18F-DCFPyL PET was positive in >90% of patients with biochemical failure. For those with limited recurrence, PSMA PET-directed local ablative therapies resulted in favorable outcome in more than 3 in 4 patients, and in nearly a quarter of them, there was complete biochemical response.

Single-Center Experience of Focal Thermo-Ablative Therapy After Pelvic Radiotherapy for In-Field Prostate Cancer Oligo-Recurrence.

PurposeIn-field prostate cancer (PCa) oligo-recurrence after pelvic radiotherapy is a challenging situation for which metastasis-directed treatments may be beneficial, but options for focal therapies are scarce.MethodsWe retrospectively reviewed data for patients with three or less in-field oligo-recurrent nodal, bone and/or locally recurrent (prostate, seminal vesicles, or prostatic bed) PCa lesions after radiation therapy, identified with molecular imaging (PET and/or MRI) and treated by focal ablative therapy (cryotherapy or radiofrequency) at the Institut Bergonié between 2012 and 2020. Chosen endpoints were the post-procedure PSA response (partially defined as a >50% reduction, complete as a PSA <0.05 ng/ml), progression-free survival (PFS) defined as either a biochemical relapse (defined as a rise >25% of the Nadir and above 2 ng/ml), radiological relapse (on any imaging technique), decision of treatment modification (hormonotherapy initiation or line change) or death, and tolerance.ResultsForty-three patients were included. Diagnostic imaging was mostly 18F-Choline positron emission tomography/computerized tomography (PET/CT) (75.0%), prostate specific membrane antigen (PSMA) PET/CT (9.1%) or a combination of pelvic magnetic resonance imaging (MRI), CT, and 99 mTc-bone scintigraphy (11.4%). PSA response was observed in 41.9% patients (partial in 30.3%, complete in 11.6%). In the hormone-sensitive exclusive focal ablation group (n = 31), partial and complete PSA responses were 32.3 and 12.9% respectively. Early local control (absence of visible residual active target) on the post-procedure imaging was achieved with 87.5% success. After a median follow-up of 30 months (IQR 13.3–56.8), the median PFS was 9 months overall (95% CI, 6–17), and 17 months (95% CI, 11–NA) for PSA responders. Complications occurred in 11.4% patients, with only one grade IIIb Dindo–Clavien event (uretral stenosis requiring endoscopic uretrotomy).ConclusionIn PCa patients showing in-field oligo-recurrence after pelvic radiotherapy, focal ablative treatment is a feasible option, possibly delaying a systemic treatment initiation or modification. These invasive strategies should preferably be performed in expert centers and discussed along other available focal strategies in multi-disciplinary meetings.

P1197 - Focal ablative salvage therapy for radio-recurrent prostate cancer: 6 year oncological and safety outcomes

P1197 - Focal ablative salvage therapy for radio-recurrent prostate cancer: 6 year oncological and safety outcomes

Detection of clinically significant prostate cancer with 18F-DCFPyL PET/multiparametric MR

To assess whether 18F-DCFPyL PET/multiparametric (mp)MR contributes to the diagnosis of clinically significant (cs) prostate cancer (PCa) compared to mpMR in patients with suspicion of PCa, or patients being considered for focal ablative therapies (FT). This ethics review board-approved, prospective study included 55 men with suspicion of PCa and negative systematic biopsies or clinically discordant low-risk PCa (n = 21) or those being considered for FT (n = 34) who received 18F-DCFPyL PET/mpMR. Each modality, PET, mpMR, and PET/MR (using the PROMISE classification), was assessed independently. All suspicious lesions underwent PET/MR-ultrasound fusion biopsies. There were 45/55 patients (81.8%) that had histologically proven PCa and 41/55 (74.5%) were diagnosed with csPCa. Overall, 61/114 lesions (53.5%) identified on any modality were malignant; 49/61 lesions (80.3%) were csPCa. On lesion-level analysis, for detection of csPCa, the sensitivity of PET was higher than that of mpMR and PET/MR (86% vs 67% and 69% [p = 0.027 and 0.041, respectively]), but at a lower specificity (32% vs 85% and 86%, respectively [p < 0.001]). The performance of MR and PET/MR was comparable. For identification of csPCa in PI-RADS ≥ 3 lesions, the AUC (95% CI) for PET, mpMR, and PET/MR was 0.75 (0.65-0.86), 0.69 (0.56-0.82), and 0.78 (0.67-0.89), respectively. The AUC for PET/MR was significantly larger than that of mpMR (p = 0.04). PSMA PET detects more csPCa than mpMR, but at low specificity. The performance PET/MR is better than mpMR for detection of csPCa in PI-RADS ≥ 3 lesions. NCT03149861.

PT069 - EAU PCa Guideline Panel: Systematic review of focal ablative therapy for localised prostate cancer compared with standard therapies

PT069 - EAU PCa Guideline Panel: Systematic review of focal ablative therapy for localised prostate cancer compared with standard therapies

Intraprostatic Cancer Recurrence following Radical Radiotherapy on Transperineal Template Mapping Biopsy: Implications for Focal Ablative Salvage Therapy.

Men in whom external beam radiotherapy fails are usually placed on delayed hormone therapy. Some of these men have localized recurrence that might be suitable for further local therapy. We describe patterns of recurrence and suitability for focal ablative therapy in those undergoing transperineal template prostate mapping biopsies. The study included 145 consecutive patients (December 2007 to May 2014) referred with suspicion of recurrence due to rising prostate specific antigen after external beam radiotherapy or brachytherapy who underwent transperineal template prostate mapping biopsies. Suitability for focal ablative therapy required the cancer to be unifocal or unilateral, or bilateral/multifocal with 1 dominant index lesion and secondary lesions with Gleason score 3+3=6 with no more than 3 mm cancer core involvement. Mean patient age was 70.7 (SD 5.8) years. Median prostate specific antigen at time of transperineal template prostate mapping biopsy was 4.5 ng/ml (IQR 2.5-7.7). Overall 75.9% (110) were suitable for a form of focal salvage treatment, 40.7% (59) were suitable for quadrant ablation, 14.5% (21) hemiablation, 14.5% (21) bilateral focal ablation and 6.2% (9) for index lesion ablation. Three-quarters of patients who have localized radiorecurrent prostate cancer may be suitable for focal ablative therapy to the prostate based on transperineal template prostate mapping biopsies.

Oncological outcomes of 356 patients undergoing salvage focal ablative HIFU or cryotherapy following radiation failure.

5582 Background: Patients that have previously failed radiotherapy for prostate cancer is usually limited to systemic therapy due to morbidity from salvage prostatectomy. We reviewed the outcomes following focal salvage ablative therapy with HIFU or cryotherapy within the UK’s HEAT and ICE registries. Methods: 356 consecutive patients underwent focal ablative treatment after initial radiation treatment failure (28/1/2004-1/10/2019, 194 (54.5%) underwent HIFU (posterior recurrence) and 162 (45.5%) underwent cryotherapy (mostly anterior or T3b). Primary outcome was failure-free survival (FFS) defined as no systemic therapy, whole-gland treatment, metastases or prostate cancer-specific death. Secondary outcomes were adverse events and overall survival. Results: Median (IQR) age was 69years (65-73) and PSA (IQR) was 4.0ng/ml (1-7-7.2). Overall median (IQR) follow-up was 41.3 months (21.4-58.5). Quadrant ablation was performed in 128 (36.0%), hemi-ablation performed in 64 (18.0%), hockey-stick in 5 (1.4%) and 159 (43.8%) had unknown ablative patterns. Due to histological or MRI proven recurrence/residual disease, 31 (8.7%) underwent further focal salvage re-treatment. FFS (95%CI) at 3 and 6 years were 81% (76-87%) and 75% (68-83%) respectively. Median (IQR) time to failure was 15.5 months (19.7). Overall survival (95%CI) at 3 and 6 years were 97% (95-100%) and 88% (81-96%) respectively. Prostate-specific mortality was 2.8%. Overall 3 (0.8%) patients were managed for fistula formation, 16 (4.5%) were treated for UTIs. Conclusions: Salvage focal ablative therapy for radio-recurrent prostate cancer is safe and provides good short to medium-term oncological control. The FORECAST study is awaited to further determine oncological outcomes in this cohort.

PD17-05 LACK OF ACCURACY OF SELECTION CRITERIA IN LOW-RISK PROSTATE CANCER PATIENTS ELIGIBLE FOR FOCAL TREATMENT

INTRODUCTION AND OBJECTIVE:Radical treatment for localized prostate cancer (PC) could overtreat many clinically non-significant cases. Focal ablative therapies have been introduced for these cases....

MP70-07 TRANSPERINEAL FOCAL CRYOABLATION AS A TREATMENT FOR CLINICALLY SIGNIFICANT PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy II (MP70)1 Apr 2020MP70-07 TRANSPERINEAL FOCAL CRYOABLATION AS A TREATMENT FOR CLINICALLY SIGNIFICANT PROSTATE CANCER Mark Kelly* and MD Jonatan Torrez Mark Kelly*Mark Kelly* More articles by this author and Jonatan TorrezJonatan Torrez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000950.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate multiparametric MRI (mpMRI) with Index Lesion identification has led to questioning the need for whole gland therapies for carefully selected men harboring well-defined clinically significant malignant lesions. This investigation sought to determine the safety and efficacy of targeted focal ablative therapy in a community based urological practice. Our goal was to test the image-guided paradigm and to determine whether targeted biopsies were sufficient in assessing prostate cancer risk and whether truly focal target ablative therapy offered our patients a safe and effective alternative to whole gland therapy. We present our experience with our first 35 patients, diagnosed with clinically significant prostate cancer (csPC) managed with transperineal Focal Cryoablation (FC). METHODS: Subject patients were referred for PC detection due to elevated serum PSA. All patients underwent a mpMRI prior to transperineal biopsy. Men with PIRAD 3, 4 and 5 targets underwent both target and template transperineal fusion biopsy. Men diagnosed with Grade Groups (GG) 2, 3, and 4 index lesions were offered focal ablative transperineal cryoablation. Our follow up protocol called for post-ablation clinical evaluation, serial PSA determinations, post-ablation mpMRI and confirmatory biopsy (cBx). All patients were queried with pre and post-ablation SHIM and IPSS scoring. RESULTS: Patients were assessed on an Intent to Treat basis. Of the original 35 patients, 33/35 (94%) underwent post-ablation mpMRI. 19/35 (54%) have undergone post-ablative confirmatory biopsy.With mean follow up of 24 months, 29/33 men (88%) had post-ablation PIRAD ≤ 2 Scores. 14/19 (74%) had no cancer on cBx. 3/5 (60%) of positive post-ablation cBxs were GG 1. 2/5 (40%) of cBxs were GG 2. 4/33 (12%) of men undergoing follow up mpMRI developed new PIRAD 3 lesions (2 patients) or 4 lesions (2 patients). Zero new PIRAD 5 lesions were detected. No men had observable PSA elevations beyond baseline PSA at diagnosis. No men developed locoregional or systemic progression. 32/35 men (91%) adhered to follow up serial PSA testing.With a mean followup of 24 months, 28/32 (88%) of men had a sustained low serum PSA, with an average value of 1.8 ng/mL. No new or worsening erectile dysfunction or urinary incontinence occurred. CONCLUSIONS: Focal Cryoablation is a promising alternative to Whole Gland Therapy for proven focal significant lesions.Strict attention to disease staging and careful follow-up is essential to an effective Focal Ablative program. Source of Funding: Chan Soon-Shiong Nanthealth Foundation. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1057-e1057 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Kelly* More articles by this author Jonatan Torrez More articles by this author Expand All Advertisement PDF downloadLoading ...

Focal Ablation Therapy for Prostate Cancer: A Literature Review

Focal Ablation Therapy for Prostate Cancer: A Literature Review

Low Intensity Focused Ultrasound (LOFU)-mediated Acoustic Immune Priming and Ablative Radiation Therapy for in situ Tumor Vaccines

Focal ablative therapies have been primarily used for local tumor ablation. However, they often fail to impact systemic disease. Here we propose the use of low intensity focused ultrasound (LOFU), a noninvasive, nontoxic, conformal therapy, to deliver acoustic stress to the tumor for immune priming. We demonstrate that LOFU significantly induces expression and cell surface localization of heat shock proteins in murine breast (4T1) and prostate adenocarcinoma (TPSA23) cancer cell lines. In vivo LOFU followed by ablative radiation therapy (RT) results in primary tumor cure, upregulation of a cytotoxic immune response and induction of immunological memory by inhibiting secondary tumor growth upon re-challenge with tumor cells. We, therefore, describe a regimen of a combination therapy with noninvasive, acoustic immune priming and ablative radiation therapy to generate an in situ tumor vaccine, induce CD8+ T cells against tumor-associated antigens and provide a viable oncologic treatment option for solid tumors.

Re: Focal Ablative Therapy for Renal Cell Carcinoma in Transplant Allograft Kidneys.

Re: Focal Ablative Therapy for Renal Cell Carcinoma in Transplant Allograft Kidneys.

Post-treatment analysis of irreversible electroporation waveforms delivered to human pancreatic cancer patients.

Irreversible electroporation (IRE) is a focal ablation therapy that uses high voltage, short electrical pulses to destroy tumor tissue. The success of treatment directly depends on exposure of the entire tumor to a lethal electric field magnitude. However, this exposure is difficult to predict ahead of time and it is challenging for clinicians to determine optimal treatment parameters. One method clinicians rely upon for the cessation of pulse delivery is to monitor the resistance value of the tissue, as the cells within the tissue will undergo changes during electroporation. This work presents a computational model which incorporates human pancreatic tumor conductivity, and compares predicted and measured output currents from IRE treatments of human patients. The measured currents vary widely from patient to patient, suggesting there may areas of high local conductivity in the treatment area.