Diagnostic and Interventional Radiology
Interventional Radiology - Original Article

Magnetic resonance imaging-guided focal laser ablation of prostate cancer: a prospective single arm, single center trial with 3 years of follow-up

1.

Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany

2.

Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA

3.

Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA

4.

Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA

5.

Houston Metro Urology, Houston, Texas, USA

6.

Department of Urology, University of Alabama, Birmingham, Alabama, USA

7.

Department of Radiology, University of Alabama, Birmingham, Alabama, USA

8.

Mount Sinai Urology Associates, Mount Sinai Hospital, New York, USA

9.

University of Maryland Medical Center, Baltimore

10.

Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA

11.

Division of Cancer Treatment and Diagnosis, Biometric Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA

12.

Center for Interventional Oncology, National Cancer Institute and Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA

Diagn Interv Radiol 2020; 1: -
Read: 109 Published: 24 June 2020

PURPOSE: To assess post-interventional and 36-month follow-up results of a single-center, single-arm, in-bore phase I trial of focal laser ablation (FLA) guided by multiparametric magnetic resonance imaging (mpMRI).

METHODS: FLA procedures were done in-bore in MRI using a transperineal approach. Primary endpoints were feasibility and safety expressed as lack of grade 3 complications. Secondary endpoints were changes in International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), Quality of life (QoL) scores, and serum Prostate Specific Antigen (PSA) levels. Treatment outcomes were assessed by combined mpMRI-ultrasound fusion-guided and extended sextant systematic biopsy after 12, 24, and optionally after 36 months.

RESULTS: Fifteen participants were included. Seven out of 15 (46.67%) had Gleason 3+3 and 8/15 (53.33%) had Gleason 3+4 cancer. All patients tolerated the procedure well, and no grade 3/4 complications occurred. All grade 1 and 2 complications were transient and resolved completely. There was no significant change in mean IPSS from baseline (-1, P = 0.460) and QoL (0, P = 0.441) scores following FLA but there was a significant drop in mean SHIM scores (-2, P = 0.010) compared to pretreatment baselines. Mean PSA significantly decreased after FLA (-2.5, P < 0.001). Seven out of 15 patients (46.67%) had residual cancer in, adjacent, or in close proximity to the treatment area (1 x 4+3=7, 1 x 3+4=7, and 5 x 3+3=6). Of these patients 4/15 (26.67%) underwent salvage therapy (2 repeat FLA, 2 radical prostatectomy).

CONCLUSION: After 3 years of follow up we conclude focal laser ablation is safe and feasible without significant complications.

EISSN 1305-3612