Focal Therapy For Prostate Cancer Research Articles

Bibliometric analysis of focal therapy in prostate cancer research

AbstractIntroductionThe use of focal therapies for prostate cancer (PCa) has soared, as it controls disease and is associated with minimal side effects. Bibliometric analysis examines the global research landscape on any topic to identify gaps in the research and areas for improvement and prioritize future research efforts. This study aims to examine the research outputs and trends and collaboration landscape in the field of focal therapy for PCa on a global scale.MethodsWe searched Medline, PubMed and Scopus for peer‐reviewed publications on our research topic using controlled keywords. Search results were limited to the period between 1980 and 2022, screened for duplicates and then included in our study based on prespecified eligibility criteria. The Bibliometrix Package was used for comprehensive science mapping analysis of co‐authorship, co‐citation and co‐occurrence analysis of countries, institutions, authors, references and keywords in this field.ResultsThis analysis included 2578 research articles. The annual scientific production increased from one article in 1982 to 143 in 2022 (13.21%). The average citation per year was incrementally increasing, and these documents were cited around 32.52 times. The documents included in this analysis were published in 633 sources. The international collaboration index was 22.7. In total, 6280 author keywords were identified. The most used keywords were ‘prostate cancer’, ‘focal therapy’, ‘prostate’ and ‘photodynamic therapy’.ConclusionThis bibliometric analysis has provided a comprehensive review of focal therapy in PCa research, highlighting both the significant growth in the field and the existing gaps that require further exploration. The study points to the need for more diverse international collaboration and exploration of various treatment modalities within the context of focal therapy.

(237) Patient Reported Outcomes in Men Received Focal Therapy for Prostate Cancer

Abstract Introduction Although focal therapy as a definite treatment modality for prostate cancer patients has been increasing in the United States, there has been paucity of patient reported outcome measures (PROM) specific to urinary, erectile, and sexual function Objective We aim to evaluate the long-term PROM in men undergone focal therapy for prostate cancer since 2019. Methods Web search was performed on the PubMed database. The search was limited to articles published in the English language and reporting focal therapy outcomes between 2019 and 2023, including randomized controlled trials, prospective and retrospective studies. The following data were extracted from each study: year, type of focal therapy, design, participants, demographic, IIEF, ED proportion, IPSS, EPIC, pad incontinence use, fistula rate, urinary retention rate, hematuria, Gleason scores, time to oncologic follow-up, recurrence, and presence of cancer after treatment. Results Twenty-three studies, consisting of cryotherapy, HIFU, TULSA, focal and microwave ablation where met the inclusion criteria and reviewed. Oncologic outcomes were reported in 17 of 23 studies. Median follow-up ranged from 3 to 42 months. Main oncologic outcomes analyzed were in-field/out-of-field recurrence and presence of prostate cancer after treatment. The two largest HIFU studies (n=90, n=101) had 9% and 24% respectively for clinically significant recurrence. The two focal microwave ablation studies (n=55, n=5) had 9% and 20% recurrence rates respectively. Functional outcomes were assessed by IPSS and IIEF. IPSS scores were consistent, with most studies reporting only minimal changes in IPSS after treatment. IIEF scores were generally consistent before and 6 months after procedure for all studies, with some reporting only marginal declines in erectile function. Complication rates among studies were low. Nine studies reported UTI rates ranging from 0% (n=6, n=41) to 30% (n=10) in a TULSA prospective study. Urinary retention rates were reported in 14 studies, with a range from 0% (n=41) to 30% (n=10). Conclusions This review suggests that focal therapies remain safe and effective treatment modality for patients with low-intermediate risk prostate cancer. PROM pertaining to urinary and erectile functions in men undergone focal therapy modality seems to be adequate without worse oncological or complication outcomes. Larger data with oncological and functional outcomes is warranted to further validate its safety and efficacy over longer follow up period. Disclosure No.

(017) Patient Reported Outcome Measures in Prostate Cancer Patients Treated with Focal Therapy Modality

Abstract Introduction Although focal therapy as a treatment modality for prostate cancer patients has been increasing in the United States, there has been a paucity of patient reported outcome measures (PROM) specific to urinary, erectile, and sexual function. Objective We aimed to systematically review the data of long-term PROM in men undergoing focal therapy for prostate cancer since 2019. Methods A web search was performed on the PubMed database. The search was limited to articles published in the English language and reporting focal therapy outcomes between 2019 and 2023, including randomized controlled trials, prospective and retrospective studies. The following data were extracted from each study: year, type of focal therapy, design, participants, demographic, IIEF, ED proportion, IPSS, EPIC, pad incontinence use, fistula rate, urinary retention rate, hematuria, Gleason scores, time to oncologic follow-up, recurrence, and presence of cancer after treatment. Results Twenty-three studies, consisting of cryotherapy, HIFU, TULSA, focal and microwave ablation met the inclusion criteria and were reviewed. Oncologic outcomes were reported in 17 of 23 studies. Median follow-up ranged from 3 to 42 months. Main oncologic outcomes analyzed were in-field/out-of-field recurrence and presence of prostate cancer after treatment. The two largest HIFU studies (n=90, n=101) had 9% and 24% respectively for clinically significant recurrence. The two focal microwave ablation studies (n=55, n=5) had 9% and 20% recurrence rates respectively. Functional outcomes were assessed by IPSS and IIEF. IPSS scores were consistent, with most studies reporting only minimal changes in IPSS after treatment. IIEF scores were generally consistent before and 6 months after procedure for all studies, with some reporting only marginal declines in erectile function. Complication rates among studies were low. Nine studies reported UTI rates ranging from 0% (n=6, n=41) to 30% (n=10) in a TULSA prospective study. Urinary retention rates were reported in 14 studies, with a range from 0% (n=41) to 30% (n=10). Conclusions This review suggests that focal therapies remain safe and effective treatment modality for patients with low-intermediate risk prostate cancer. PROM pertaining to urinary and erectile functions in men undergone focal therapy modality seems to be adequate without worse oncological or complication outcomes. Larger data with oncological and functional outcomes is warranted to further validate its safety and efficacy over a longer follow up period. Disclosure No.

MRI-guided Minimally Invasive Focal Therapies for Prostate Cancer.

Two cases involving patients diagnosed with localized prostate cancer and treated with MRI-guided focal therapies are presented. Patient selection procedures, techniques, outcomes, challenges, and future directions of MRI-guided focal therapies, as well as their role in the treatment of low- to intermediate-risk localized prostate cancer, are summarized.

A Review of Energy Modalities Used for Focal Therapy of Prostate Cancer

A Review of Energy Modalities Used for Focal Therapy of Prostate Cancer

Follow-Up of Men Who Have Undergone Focal Therapy for Prostate Cancer with HIFU-A Real-World Experience.

To determine oncological and functional outcomes and side effects after focal therapy of prostate cancer (PCa) with high-intensity focused ultrasound (HIFU). This retrospective single-center study included 57 consecutive patients with localised PCa. Aged 18-80 with ≤2 suspicious lesions on mpMRI (PIRADS ≥ 3), PSA of ≤15 ng/mL, and an ISUP GG of ≤2. HIFU was performed between November 2014 and September 2018. All men had an MRI/US fusion-guided targeted biopsy (TB) combined with a TRUS-guided 10-core systematic biopsy (SB) prior to focal therapy. HIFU treatment was performed as focal, partial, or hemiablative, depending on the prior histopathology. Follow-up included Questionnaires (IIEF-5, ICIQ, and IPSS), prostate-specific antigen (PSA) measurement, follow-up mpMRI, and follow-up biopsies. The median age of the cohort was 72 years (IQR 64-76), and the median PSA value before HIFU was 7.3 ng/mL (IQR 5.75-10.39 ng/mL). The median follow-up was 27.5 (IQR 23-41) months. At the time of the follow-up, the median PSA value was 2.5 ng/mL (IQR 0.94-4.96 ng/mL), which shows a significant decrease (p < 0.001). In 17 (29.8%) men, mpMRI revealed a suspicious lesion, and 19 (33.3%) men had a positive biopsy result. Only IIEF values significantly decreased from 16 (IQR 10.75-20.25) to 11.5 (IQR 4.5-17) (p < 0.001). The rate of post-HIFU complications was low, at 19.3% (11 patients). The limitation of this study is the lack of long-term follow-up. HIFU as a therapy option for nonmetastatic, significant prostate cancer is effective in the short term for carefully selected patients and shows a low risk of adverse events and side effects.

Transrectal Ultrasound as Real-Time Confirmation of Adequate Needle Positioning During Irreversible Electroporation in Focal Therapy of Prostate Cancer

Transrectal Ultrasound as Real-Time Confirmation of Adequate Needle Positioning During Irreversible Electroporation in Focal Therapy of Prostate Cancer

P021 - The value of PSMA-PET in Addition to mpMRI and Systematic Biopsies to Select Patients for Hemi-ablative Focal Therapy in Prostate Cancer

P021 - The value of PSMA-PET in Addition to mpMRI and Systematic Biopsies to Select Patients for Hemi-ablative Focal Therapy in Prostate Cancer

Oncological results and cancer control definition in focal therapyfor Prostate Cancer: a systematic review.

Focal therapy (FT) is a promising alternative to whole-gland treatments for Localized Prostate Cancer. Ten different FT modalities have been described in literature. However, FT is not yet recommended by the International Guidelines, due to the lack of robust data on Oncological Outcomes. The objective of our Narrative Review is to evaluate the oncological profile of the available FT modalities and to offer a comprehensive overview of the definitions of Cancer Control for FT. Literature search was performed on 21stFebruary 2023 using PubMed, EMBASE, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Articles reporting whole gland-treatments were excluded. All articles reporting oncological outcomes were included. One-hundred-twenty-four studies, reporting data on more than 8000 patients treated with FT, were included. Overall, 40 papers were on High Intensity Focal Ultrasound (HIFU), 24 on Focal Cryotherapy, 13 on Irreversible Electroporation (IRE), 11 on Focal brachytherapy, 10 on Focal Laser Ablation (FLA), 8 on Photo-Dynamic Therapy (PDT), 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation (bRFA), 1 on Prostatic Artery Embolization (PAE) and 9 comparative papers. Overall, the Biochemical Recurrence (BCR) rate ranged from 0% (Focal Brachytherapy) to 67.5% (HIFU); the Salvage treatment rate ranged from 1% (IRE) to 54% (HIFU) considering re-treatment with FT and from 0% (Focal Brachytherapy) to 66.7% considering standard Radical Treatments. There is no univocal definition of Cancer Control, however the "Phoenix criteria" for BCR were the most commonly used. FT is a promising alternative treatment for localized prostate cancer in terms of Oncological Outcomes, however there is a wide heterogeneity in the definition of cancer control, the reporting of oncological outcomes and a lack of high-quality clinical trials. Solid comparative studies with standard treatments and an unambiguous consensus on how to describe Cancer Controlin the field of Focal Therapyare needed.

Functional outcomes and safety of focal therapy for prostate cancer: a systematic review on results and patient-reported outcome measures (PROMs).

Focal therapy (FT) is a promising alternative with curative intent for Low- to Intermediate-risk localized Prostate Cancer (PCa), claiming better functional outcomes and safety profile than standard whole-gland treatments. Ten different FT modalities have been described in the literature. The objective of our narrative review is to evaluate the safety profile and functional outcomes of these different modalities and the currentmost used tools of assessment for those outcomes. Literature search was performed on 21stFebruary 2023 using PubMed, EMBASE, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Articles reporting whole-gland treatments were excluded. All articles reporting functional outcomes were included. One-hundred-seven studies, reporting data on 6933 patients, were included (26 on High Intensity Focal Ultrasound, 22 on Focal Cryotherapy, 14 on Irreversible Electroporation, 11 on Focal brachytherapy, 10 on Focal Laser Ablation, 8 on Photodynamic Therapy, 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation, 1 on Prostatic Artery Embolization, and 7 studies comparing different FTs). Post-operative pad-free rate ranged between 92.3-100%. Greater heterogeneity exists considering the Change in Erectile Function, with Changing in Erectile function- rates ranging between 0-94.4% (Cryotherapy). The most used Patient-Reported Outcome Measures (PROMs) were the International Prostate Symptom Score and the International Index of Erectile Function for incontinence/urinary function and potency, respectively. The most common reportedcomplications were hematuria, infections, and urethral strictures, with rates widely ranging among different treatments. The Clavien-Dindo Classification was the most used (40/88 papers) to describe adverse events. FT is a promising treatment for localized PCa, achieving excellent results in terms of safety and functional outcomes. There is a wide heterogeneity in the definition of PROMS and time of collection between studies. High quality comparative studies with standard treatments are needed to reinforce these findings.

Factors affecting the selection of eligible candidates for focal therapy for prostate cancer.

Focal therapy (FT) is a treatment modality for prostate cancer that aims to reduce side effects. However, it remains difficult to select eligible candidates. We herein examined eligibility factors for hemi-ablative FT for prostate cancer. We identified 412 patients who were diagnosed with unilateral prostate cancer by biopsy and had undergone radical prostatectomy between 2009 and 2018. Among these patients, 111 underwent MRI before biopsy, had 10-20 core biopsies performed, and did not receive other treatments before surgery. Fifty-seven patients with prostate-specific antigen ≥ 15ng/mL and biopsy Gleason score (GS) ≥ 4 + 3 were excluded. The remaining 54 patients were evaluated. Both lobes of the prostate were scored using Prostate Imaging Reporting and Data System version 2 on MRI. Ineligible patients for FT were defined as those with ≥ 0.5mL GS6 or GS ≥ 3 + 4 in the biopsy-negative lobe, ≥ pT3, or lymph node involvement. Selected predictors of eligibility for hemi-ablative FT were analyzed. Among our cohort of 54 patients, 29 (53.7%) were eligible for hemi-ablative FT. A multivariate analysis identified a PI-RADS score < 3 in the biopsy-negative lobe (p = 0.016) as an independent predictor of eligibility for FT. Thirteen out of 25 ineligible patients had GS ≥ 3 + 4 tumors in the biopsy-negative lobe, half of whom (6/13) also had a PI-RADS score < 3 in the biopsy-negative lobe. The PI-RADS score in the biopsy-negative lobe may be important in the selection of eligible candidates for FT. The findings of this study will help reduce missed significant prostate cancers and improve FT outcomes.

Abstract A051: The spatial landscape of clonal somatic copy number alterations in benign and malignant prostate epithelia

Abstract Defining the transition from benign to malignant tissue is fundamental to improve early diagnosis of cancer. We provide an unsupervised approach (SpatialInferCNV) to study spatial genome integrity, in situ, to gain molecular insight into clonal relationships. We employed spatially resolved transcriptomics (Visium, 10x Genomics) to infer spatial copy number variations in &amp;gt;120 000 spatial regions across multiple organs, tissues and tumors, including three whole axial prostates. We used this information to deduce clonal relationships between regions harboring 5-20 cells. We perform an in-depth spatial analysis of prostate cancer that includes an unprecedented interrogation of up to 50,000 tissue domains in a single patient. For these domains we inferred genome-wide information, which facilitated data driven clustering in a tissue wide fashion at high resolution. We observed that genome-wide somatic copy number alterations revealed distinct clonal patterns benign tissue and nearby tumours. In a tissue section from patient 1 (section H2_1), we observed that many CNVs occurred in clone C, most notably in chromosomes 8 and 10 encoding a MYC amplification and a PTEN deletion. This clone constituted a region of exclusively benign acinar cells branching off a duct lined by largely diploid cells in clones A and B. The unobserved ancestor to clone C then gave rise to a further unobserved clone, and then clones E, F and G. Our results suggest a model for how genomic instability arises in histologically benign tissue that may represent early events in prostate cancer evolution. Furthermore the spatial information allowed us to identify small clonal units not evident from morphology and hence would be overlooked by pathologists. We present the first comprehensive, large-scale, atlas of genomic evolution at high spatial resolution in prostate cancer. Our study adds an important new approach to the armamentarium of cancer molecular pathology. We highlight the power of an unsupervised approach to capture the molecular and spatial continuums in a tissue context and challenge the rationale for focal therapy in prostate cancer. Citation Format: Andrew Erickson, Mengxiao He, Emelie Berglund, Maja Marklund, Reza Mirzazadeh, Niklas Schultz, Linda Kvastad, Alma Andersson, Ludvig Bergenstråhle, Joseph Bergenstråhle, Ludvig Larsson, Leire Alonso Galicia, Alia Shamikh, Elisa Basmaci, Teresita Díaz De Ståhl, Timothy Rajakumar, Dimitrios Doultsinos, Kim Thrane, Andrew L. Ji, Paul A. Khavari, Firaz Tarish, Anna Tanoglidi, Jonas Maaskola, Richard Colling, Tuomas Mirtti, Freddie C. Hamdy, Dan J. Woodcock, Thomas Helleday, Ian G. Mills, Alastair D. Lamb, Joakim Lundeberg. The spatial landscape of clonal somatic copy number alterations in benign and malignant prostate epithelia [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr A051.

Focal Therapy for Prostate Cancer: Evolutionary Parallels to Breast Cancer Treatment. Letter.

You have accessJournal of UrologyLetters to the Editor1 May 2023Focal Therapy for Prostate Cancer: Evolutionary Parallels to Breast Cancer Treatment. Letter. Pier Paolo Avolio, Thomas J. Polascik, Ardeshir Rastinehad, Jean de la Rosette, and Rafael Sanchez-Salas Pier Paolo AvolioPier Paolo Avolio https://orcid.org/0000-0002-7497-265X Department of Surgery, Division of Urology, McGill University, Montréal, Canada More articles by this author , Thomas J. PolascikThomas J. Polascik Department of Urology, Duke Cancer Institute, Duke University, Durham, North Carolina More articles by this author , Ardeshir RastinehadArdeshir Rastinehad Department of Urology, Lenox Hill Hospital, New York, New York More articles by this author , Jean de la RosetteJean de la Rosette Department of Urology, Istanbul Medipol University, Istanbul, Turkey More articles by this author , and Rafael Sanchez-SalasRafael Sanchez-Salas Department of Surgery, Division of Urology, McGill University, Montréal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003423AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail J Urol. 2023;209(1):49-57. To the Editor: We read with great interest the recent manuscript by Labbate et al reviewing the development of focal therapy in breast and prostate cancer (PCa).1 Breast focal therapy (bFT) represents a successful model for organ-sparing cancer treatment, so as urologists sensible to prostate focal therapy (pFT) we can learn much about the complex process of bFT recognition by the scientific community. In 2017, we wrote about the analogy between bFT and pFT, and much has changed since our publication.2 Labbate et al elegantly described latest updates on the comparison between bFT and pFT. Still, we would like to report some evidence coming from recently published retrospective and prospective studies on pFT: First, PCa screening based on PSA levels alone has led to an ethical dilemma in that a large proportion of patients undergo radical treatment, suffering permanent side effects by treating a disease that might never have progressed in their lifetime. A recent study showed that cancers invisible on multiparametric magnetic resonance imaging (mpMRI) are at lower risk of progressing than mpMRI-positive cancers.3 Thus, systematic biopsy might be able to be avoided in favor of mpMRI-directed targeted biopsy that could decrease overdiagnosis and subsequent overtreatment of PCa.3 Second, similarly to bFT, criteria for pFT patient selection have changed. Recently, clinical trials on pFT only enrolled patients with biopsy-proven Gleason Grade (GG) 3+4 or GG 4+3 cancers, with patients having GG 3+3 cancer allocated to active surveillance (AS) programs.4 Of note, pFT is a good option for patients not eligible for up-front AS, providing the chance to undergo an AS regimen following successful ablation. Third, similar to bFT, limitations associated with mpMRI are leading to the development of new imaging modalities aimed to better characterize intraprostatic disease burden, and more accurately guide treatment planning and surveillance for pFT. Combining micro-US targeted biopsy with mpMRI-targeted biopsy could better select patients eligible for pFT.5 Prostate-specific membrane antigen–targeted radiotracers combined with mpMRI may improve index lesion detection, intraprostatic gross tumor volume, and better predict the presence of adverse pathology.5 Using contrast-enhanced US for real-time evaluation of tissue microvasculature, focal therapists may be potentially able to intraoperatively determine the adequacy of ablation and perform an immediate re-treatment, as needed.5 Similar to breast cancer, PCa outcomes of interest are changing over time. We believe that defining oncologic outcome by progression-free survival is a milestone in the history of pFT, leading to a higher quality of results.4 In addition, quality of life outcomes are becoming increasingly important, and, as for bFT, pFT has a much lower rate of adverse effects compared to radical techniques.5 Finally, we should learn from the work of our breast colleagues that a better understanding of the disease biology will lead to effective combinations of local and systemic therapies for PCa, and this will be the key to prevent, detect, and treat the recurrence in pFT.2 A comprehensive, biological-based, and multimodal approach to pFT will help to improve progression-free survival and patient quality of life. REFERENCES 1. . Focal therapy for prostate cancer: evolutionary parallels to breast cancer treatment. J Urol. 2023; 209(1):49-57. Link, Google Scholar 2. Evolution in the concept of focal therapy: the story of breast cancer and prostate cancer. In: , ed. Imaging and Focal Therapy of Early Prostate Cancer. Springer International Publishing; 2017;3-19. Crossref, Google Scholar 3. . Prostate cancer screening with PSA and MRI followed by targeted biopsy only. N Engl J Med. 2022; 387(23):2126-2137. Crossref, Medline, Google Scholar 4. . MRI-guided focused ultrasound focal therapy for patients with intermediate-risk prostate cancer: a phase 2b, multicentre study. Lancet Oncol. 2022; 23(7):910-918. Crossref, Medline, Google Scholar 5. . Therapies for clinically localized prostate cancer: a comparative effectiveness review. J Urol. 2021; 205(4):967-976. Link, Google Scholar Submitted February 2, 2023; accepted March 6, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 5May 2023Page: 848-849 Peer Review Report Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pier Paolo Avolio Department of Surgery, Division of Urology, McGill University, Montréal, Canada More articles by this author Thomas J. Polascik Department of Urology, Duke Cancer Institute, Duke University, Durham, North Carolina More articles by this author Ardeshir Rastinehad Department of Urology, Lenox Hill Hospital, New York, New York More articles by this author Jean de la Rosette Department of Urology, Istanbul Medipol University, Istanbul, Turkey More articles by this author Rafael Sanchez-Salas Department of Surgery, Division of Urology, McGill University, Montréal, Canada More articles by this author Expand All Submitted February 2, 2023; accepted March 6, 2023; published 000. Advertisement Advertisement PDF downloadLoading ...

V10-08 THE USE OF FOCAL IRREVERSIBLE ELECTROPORATION FOR PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023V10-08 THE USE OF FOCAL IRREVERSIBLE ELECTROPORATION FOR PROSTATE CANCER John Torosyan, Amy Cherry, Hasan Abbas, Shima Tayebi, and Abhinav Sidana John TorosyanJohn Torosyan More articles by this author , Amy CherryAmy Cherry More articles by this author , Hasan AbbasHasan Abbas More articles by this author , Shima TayebiShima Tayebi More articles by this author , and Abhinav SidanaAbhinav Sidana More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy of prostate cancer is a treatment strategy that aims to destroy the cancer-containing parts of the prostate while preserving uninvolved prostatic tissue in an attempt to preserve genitourinary function. Irreversible Electroporation (IRE) is a novel ablative modality which utilizes electrical pulses to induce cell apoptosis and can be applied to various malignancies, including prostate cancer. The objective of this video is to discuss the mechanism of action of IRE and describe the components, setup, and operative technique for performing IRE for the focal treatment of prostate cancer. METHODS: IRE is performed under general anesthesia with the patient placed in lithotomy position. Monopolar electrodes are inserted into the prostate under ultrasound guidance and using a brachytherapy grid. The probes are placed 1.5 to 2cm away from one another, and 3-5mm away from the prostatic capsule using cognitive fusion to cover the lesion and 5-10mm margin. After initially estimating voltage configurations, ten test impulses are fired between each probe pair to assess resulting currents. Using test results, final voltages are assigned, and the remaining 80 impulses are fired between each probe pair. RESULTS: This case involves a 74-year-old male with a history of hypertension and hyperlipidemia who presented with an elevated Prostate-Specific Antigen (PSA) of 6.35 and was found to have Gleason 3+4 cancer in the Prostate Imaging Reporting & Data System (PI-RADS) 4 lesion localized in the right mid gland to apex. The patient had a pre-treatment International Prostate Symptom Score (IPSS) of 4-1 and a Sexual Health Inventory for Men (SHIM) of 18 without the use of erectile dysfunction medication. The patient underwent a successful IRE ablation of the lesion along with the margin. The procedure was tolerated well, and the patient was discharged later that day. At his 6-week follow-up, PSA declined to 0.66 and he had an unchanged IPSS/SHIM. CONCLUSIONS: The use of focal therapy in prostate cancer is promising because of its effectiveness paired with minimal procedural side effects. Focal IRE provides a safe and effective way to achieve focal therapy of prostate cancer. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e928 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Torosyan More articles by this author Amy Cherry More articles by this author Hasan Abbas More articles by this author Shima Tayebi More articles by this author Abhinav Sidana More articles by this author Expand All Advertisement PDF downloadLoading ...

Patient-reported Satisfaction and Regret Following Focal Therapy for Prostate Cancer: A Prospective Multicenter Evaluation

BackgroundSeveral reports are available regarding the treatment decision regret of patients receiving conventional treatments for localized prostate cancer (PCa); yet data on patients undergoing focal therapy (FT) are sparse. ObjectiveTo evaluate the treatment decision satisfaction and regret among patients who underwent FT for PCa with high-intensity focused ultrasound (HIFU) or cryoablation (CRYO). Design, setting, and participantsWe identified consecutive patients who underwent HIFU or CRYO FT as the primary treatment for localized PCa at three US institutions. A survey with validated questionnaires, including the five-question Decision Regret Scale (DRS), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5), was mailed to the patients. The regret score was calculated based on the five items of the DRS, and regret was defined as a DRS score of >25. Outcome measurements and statistical analysisMultivariable logistic regression models were applied to assess the predictors of treatment decision regret. Results and limitationsOf 236 patients, 143 (61%) responded to the survey. Baseline characteristics were similar between responders and nonresponders. During a median (interquartile range) follow-up of 43 (26–68) mo, the treatment decision regret rate was 19.6%. On a multivariable analysis, higher prostate-specific antigen (PSA) at nadir after FT (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.1–2, p = 0.009), presence of PCa on follow-up biopsy (OR 3.98, 95% CI 1.5–10.6, p = 0.006), higher post-FT IPSS (OR 1.18, 95% CI 1.01–1.37, p = 0.03), and newly diagnosed impotence (OR 6.67, 95% CI 1.57–27, p = 0.03) were independent predictors of treatment regret. The type of energy treatment (HIFU/CRYO) was not a predictor of regret/satisfaction. Limitations include retrospective abstraction. ConclusionsFT for localized PCa is well accepted by the patients, with a low regret rate. Higher PSA at nadir, presence of cancer on follow-up biopsy, bothersome postoperative urinary symptoms, and impotence after FT were independent predictors of treatment decision regret. Patient summaryIn this report, we looked at the factors affecting satisfaction and regret in patients with prostate cancer undergoing focal therapy. We found that focal therapy is well accepted by the patients, while presence of cancer on follow-up biopsy as well as bothersome urinary symptoms and sexual dysfunction can predict treatment decision regret.

MRI interpretation and assessment criteria for imaging after focal therapy for prostate cancer: A systematic review

MRI interpretation and assessment criteria for imaging after focal therapy for prostate cancer: A systematic review

Can a physician make the decision of focal therapy for prostate cancer based on the unilateral lesion on magnetic resonance Imaging/transrectal ulltrasound fusion guided transperineal prostate biopsy?

Can a physician make the decision of focal therapy for prostate cancer based on the unilateral lesion on magnetic resonance Imaging/transrectal ulltrasound fusion guided transperineal prostate biopsy?

Beyond the AJR: MRI-Guided Focused Ultrasound Focal Therapy for Intermediate-Risk Prostate Cancer.

Beyond the AJR: MRI-Guided Focused Ultrasound Focal Therapy for Intermediate-Risk Prostate CancerSangeet Ghai, MD1 and Nathan Perlis, MD2Audio Available | Share

Magnetic resonance imaging-guided ultrasound ablation for prostate cancer - A contemporary review of performance.

Prostate cancer (PCa) is one of the most common malignancies in men, but patient outcomes are varied depending on extent of disease. Radical, whole-gland therapies, such as prostatectomy or radiotherapy, are definitive treatments for PCa, but they are associated with significant morbidity, including erectile dysfunction and urinary incontinence. Focal therapies for PCa, whereby the part of gland harboring disease is selectively treated, spares the normal surrounding structures, and minimizes the morbidity associated with whole gland treatment. The use of magnetic resonance imaging (MRI) guidance provides advantages over ultrasound guidance, such as better localization and targeting of clinically significant PCa (csPCa), as well as MRI thermometry which optimizes tissue ablation temperatures. This review will discuss two MRI-guided high-intensity focused ultrasound (HIFU) techniques - transrectal MR-guided focused ultrasound (MRgFUS) and TULSA (transurethral ultrasound ablation) ablation for localized PCa. Overall, recent major trials for MRgFUS and TULSA have shown promising oncological and functional results in the treatment of low- to intermediate-risk PCa. Recent Phase II MRgFUS trials have shown better oncologic outcomes than the published results for focal ultrasound guided HIFU and may justify the additional costs associated with MRI guidance. While initial studies on TULSA have focused on subtotal gland ablation, recent trials assessing oncological outcomes for focal treatment of angular sectors have shown promise.

Comment on: "Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society".

article: Comment on: “Molecular biomarkers in the context of focal therapy for prostate cancer: recommendations of a Delphi Consensus from the Focal Therapy Society” - Minerva Urology and Nephrology 2022 December;74(6):816-8 - Minerva Medica - Journals