1
|
Prabhakar P, Avudaiappan AP, Sandman M, Eldefrawy A, Caso J, Narayanan G, Manoharan M. Irreversible electroporation as a focal therapy for localized prostate cancer: A systematic review. Indian J Urol 2024; 40:6-16. [PMID: 38314081 PMCID: PMC10836445 DOI: 10.4103/iju.iju_370_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/10/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Irreversible electroporation (IRE) is a new and promising focal therapy for the treatment of localized prostate cancer. In this systematic review, we summarize the literature on IRE for prostate cancer published over the last decade. Methods PubMed and EMBASE were searched with the end date of May 2023 to find relevant publications on prostate cancer ablation using IRE. Original studies with focal IRE as the primary curative treatment which reported on functional or oncological outcomes were included. The bibliography of relevant studies was also scanned to identify suitable articles. Results A total of 14 studies reporting on 899 patients treated with IRE for localized prostate cancer were included. Of all the studies reviewed, 77% reported on recurrence within the zone of ablation, and it ranged from 0% to 38.9% for in-field and 3.6% to 28% for out-of-field recurrence. Although, a standardised follow-up protocol was not followed, all the studies employed serial prostate-specific antigen monitoring, a multiparametric magnetic resonance imaging, and a biopsy (6-12 months post-treatment). Across all the studies, 58% reported that the urinary continence returned to the pretreatment levels and 25% reported a minor decrease in the continence from the baseline at 12-months of follow-up. Erections sufficient for intercourse varied from 44% to 75% at the baseline to 55% to 100% at 12-months of follow-up across all the studies. Conclusion IRE, as a focal therapy, shows promising results with minimal complications and reasonably effective oncological control, but the data comparing it to the standard of care is still lacking. Future research should focus on randomized definitive comparisons between IRE, radical prostatectomy, and radiation therapy.
Collapse
Affiliation(s)
- Pushan Prabhakar
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
| | | | - Mayer Sandman
- Department of Urology, Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Ahmed Eldefrawy
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
- Department of Urology, Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Jorge Caso
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
- Department of Urology, Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Govindarajan Narayanan
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida, USA
| | - Murugesan Manoharan
- Division of Urologic Oncologic Surgery, Miami Cancer Institute, Miami, Florida, USA
- Department of Urology, Herbert Wertheim College of Medicine, Miami, Florida, USA
| |
Collapse
|
2
|
Ayerra Perez H, Barba Abad JF, Extramiana Cameno J. An Update on Focal Therapy for Prostate Cancer. Clin Genitourin Cancer 2023; 21:712.e1-712.e8. [PMID: 37258359 DOI: 10.1016/j.clgc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 06/02/2023]
Abstract
Radical treatments and active surveillance are valid therapeutic approaches for low-risk prostate cancer. The oncologic effectiveness and morbidity of Radical Prostatectomy (RP) and radiotherapy have been broadly validated. Focal therapies pursue to reduce the morbidity observed after radical treatments, while preserving the oncologic effectiveness. This study aims to review the state-of-the-art about principles, oncologic effectiveness, morbidity, and side-effects associated with leading focal therapies. We review and summarize articles related with Cryotherapy, High-Intensity Focal Ultrasound (HIFU), Photodynamic Therapy (PDT), and Irreversible Electroporating (IRE) published in MEDLINE from 2000 to 2022. There is a wide heterogeneity in terms of the measurement of effectiveness and morbidity. Hence, comparing different energies, strategies and protocols seem to be unprecise and controversial. Cryosurgery and HIFU have reported more clinical experience than PDT and IRE. Biochemical recurrence rate after the first session varied from 4.5% to 23%, and up to 20% of patients underwent a salvage radical treatment. The reported incidence of erectile disfunction and urinary incontinence ranges from 3% to 50% and 0% to 34%, respectively. None randomized clinical trial comparing any focal therapy to any radical treatment has been published. We conclude that the expansion of focal therapies requires the consolidation of MRI-guided fusion biopsies in everyday clinical practice. Short-term oncologic effectiveness has been proved and supports their usefulness in low-risk patients unfit for surgical treatment. However, long-term effects and the clinical experience in intermediate and high-risk patients remains limited. Currently none of the focal therapies can be considered the Gold Standard for low-risk patients.
Collapse
Affiliation(s)
- Hector Ayerra Perez
- Department of Urology, Araba University Hospital. OSI Araba, Osakidetza, Vitoria-Gasteiz, Spain.
| | | | | |
Collapse
|
3
|
Geboers B, Scheltema MJ, Blazevski A, Katelaris A, Doan P, Ali I, Agrawal S, Barreto D, Matthews J, Haynes AM, Delprado W, Shnier R, Thompson JE, Stricker PD. Median 4-year outcomes of salvage irreversible electroporation for localized radio-recurrent prostate cancer. BJU Int 2023; 131 Suppl 4:14-22. [PMID: 36594205 DOI: 10.1111/bju.15948] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate the safety, and short to mid-term oncological and quality-of-life (QoL) outcomes of focal irreversible electroporation (IRE) for radio-recurrent prostate cancer (PCa) at a median follow-up of 4 years. PATIENTS AND METHODS This was a single-centre series of men with biopsy-proven radio-recurrent PCa treated with IRE between December 2013 and February 2022, with a minimum follow-up of 6 months. Follow-up included magnetic resonance imaging at 6 months, and standard transperineal saturation template biopsies at 12 months. Further biopsies were guided by suspicion on serial imaging or prostate-specific antigen (PSA) levels. Validated questionnaires were used to measure functional outcomes. Significant local recurrence was defined as any International Society of Urological Pathology (ISUP) score ≥ 2 on biopsies. Progression-free survival was defined as no signs of local or systemic disease on either imaging or template biopsies, or according to the Phoenix criteria for biochemical recurrence. RESULTS Final analysis was performed on 74 men with radio-recurrent PCa (median age 69 years, median PSA level 5.4 ng/mL, 76% ISUP score 2/3). The median (range) follow-up was 48 (27-68) months. One rectal fistula occurred, and eight patients developed urethral sloughing that resolved with transurethral resection. Among patients who returned questionnaires (30/74, 41%), 93% (28/30) had preserved urinary continence and 23% (7/30) had sustained erectile function at 12-month follow-up. Local control was achieved in 57 patients (77%), who needed no further treatment. Biopsy diagnosed 41(55%) patients received follow up template biopsies, in-field recurrences occurred in 7% (3/41), and out-field recurrences occurred in 15% of patients (6/41). The metastasis-free survival rate was 91% (67/74), with a median (interquartile range) time to metastases of 8 (5-27) months. The Kaplan-Meier estimated 5-year progression-free survival rate was 60%. CONCLUSIONS These short- to mid-term safety, oncological and QoL outcome data endorse results from smaller series and show the ability of salvage focal IRE to safely achieve oncological control in patients with radio-recurrent PCa.
Collapse
Affiliation(s)
- Bart Geboers
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Athos Katelaris
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Paul Doan
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Imran Ali
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Daniela Barreto
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Jayne Matthews
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | | | | | - James E Thompson
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Phillip D Stricker
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
4
|
Real-World Comparative Safety and Effectiveness of Irreversible Electroporation and High-Intensity Focused Ultrasound for Prostate Cancer Ablation. Urology 2023; 174:7-17. [PMID: 36736917 DOI: 10.1016/j.urology.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To assess the comparative safety and effectiveness of 2 prostate cancer treatment ablation modalities: irreversible electroporation (IRE) and high-intensity focused ultrasound (HIFU). METHODS: Two systematic literature reviews (SLRs) and meta-analyses (MAs) on IRE and HIFU were conducted in accordance with PRISMA guidelines. Searches were conducted in PubMed and EMBASE. Independent reviewers assessed literature eligibility and abstracted safety and effectiveness data. Oncological, safety, functional, and quality of life (QOL) outcomes were examined for each technology. MAs were conducted where data quality and availability allowed, using normal methods and a random/mixed effects model, and quality assessments performed. RESULTS Fifty-five publications (n = 22 IRE; n = 33 HIFU) were included in the SLRs, and MAs were conducted on negative in-field post-procedure biopsy, prostate-specific antigen (PSA) level reduction, potency, urinary continence, and AE rate outcomes. MAs revealed that IRE patients had lower mean percent PSA level reductions, higher mean rates of in-field negative post-treatment biopsy, and higher rates of potency maintenance than HIFU patients. Most adverse events (AEs) reported were comparable and minor (Grades I, II), with urinary tract infection, dysuria, hematuria, and incontinence or urgency most frequently reported. The proportion of patients experiencing a severe AE (≥Grade III) ranged from 0 to 8% after IRE and HIFU. Both modalities were associated with positive functional outcomes as well as maintenance of QOL after treatment. CONCLUSIONS Both IRE and HIFU were found to produce favorable effectiveness outcomes and have low complication rates while minimally impacting patient urinary and erectile function and maintaining overall QOL. These real-world findings can help guide clinical decision making and improve disease management for patients with prostate cancer.
Collapse
|
5
|
Gielchinsky I, Lev-Cohain N. Focal Irreversible Electroporation for Localized Prostate Cancer - Oncological and Safety Outcomes Using mpMRI and Transperineal Biopsy Follow-Up. Res Rep Urol 2023; 15:27-35. [PMID: 36714797 PMCID: PMC9880010 DOI: 10.2147/rru.s393243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/18/2023] [Indexed: 01/23/2023] Open
Abstract
Introduction Irreversible electroporation (IRE) technology for prostate cancer (PC) generates consecutive electrical pulses between pairs of electrodes which move through tumorous cells, irreversibly perforate their membranes and eventually lead to cell death, while avoiding tissue thermal effect. The technique is used for primary focal lesions as well as for focal salvage cases. This series reports short term oncological control, quality of life and safety results. Methods Retrospective data were collected from 45 consecutive cases of primary (N=38) and salvage (N=7) PC patients treated with IRE. All patients had transperineal MRI/US fusion biopsy and PET-PSMA scan prior to treatment, to verify single lesion. Transperineal Nano-Knife IRE system was used in day-care theatre. Patients had 6 months mpMRI, blood PSA and 1 year confirmatory biopsy following procedure. Quality of life was recorded during the first year. Results Median primary subgroup analysis (N=38): age 69 years, initial PSA 5.6 ng/dL, lesion size 0.8 mL and ISUP Group 2 (1-3). Median salvage subgroup analysis (N=7): age 76 years, initial PSA 11.9 ng/dL, lesion size 2.0 mL and ISUP Group 4 (1-5). Median catheter time 5 (3-7) days. No Clavien-Dindo>1 complications were reported nor re-admissions, incontinence, strictures or fistulas. 5% of patients were given PDE-5i drugs. Primary group PSA dropped by 39%, mpMRI clearance in 84%, out-field new lesion in 12%, in-field lesion in 4%. Biopsy at 1 year: 4 patients had out-field clinically significant PC, thus 3 had re-IRE and 1 had radiation therapy. Salvage subgroup MRI clearance was 60%, and 52% remained on active surveillance by 1 year. Conclusion IRE treatment for focal PC is safe for primary and salvage cases, if done by a meticulously skilled and trained team, and under strict protocols. The short term oncological results are promising especially for primary lesions. Long term oncological results will be published over time.
Collapse
Affiliation(s)
- Ilan Gielchinsky
- Research Branch, Meuhedet Health Services, Tel-Aviv, Israel,Department of Urology, Assaf Harofeh Medical Center, Tzrifin, Israel,Correspondence: Ilan Gielchinsky, Research Branch, Meuhedet Health Services, Tel-Aviv, Israel, Medica Medical Center, Habarzel 28 street, Suit 203, Tel-Aviv, Israel, Tel +972-50-4048489, Email
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Center, Jerusalem, Israel
| |
Collapse
|
6
|
Blazevski A, Geboers B, Scheltema MJ, Gondoputro W, Doan P, Katelaris A, Agrawal S, Baretto D, Matthews J, Haynes AM, Delprado W, Shnier R, van den Bos W, Thompson JE, Lawrentschuk N, Stricker PD. Salvage irreversible electroporation for radio-recurrent prostate cancer - the prospective FIRE trial. BJU Int 2022. [PMID: 36495482 DOI: 10.1111/bju.15947] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To prospectively assess the safety, functional- and oncological-outcomes of irreversible electroporation (IRE) as salvage therapy for radio-recurrent focal prostate cancer in a multicenter setting. PATIENTS AND METHODS Men with focal recurrent PCa after external beam radiation or brachytherapy without metastatic disease on staging imaging and co-registration between mpMRI and biopsies were prospectively included in this multicenter trial. Adverse events were reported following the Clavien-Dindo classification. Validated questionnaires were used for patient-reported functional outcomes. Follow-up consisted of 3 monthly prostate specific antigen (PSA) levels, a 6-month mpMRI and standardised transperineal template mapping biopsies at 12-months. Thereafter follow-up was guided by MRI and/or PSMA-PET/CT and PSA. Local recurrence was defined as any ISUP score ≥2 on biopsies. RESULTS 37 patients were analysed with a median (interquartile range (IQR)) follow up of 29 (22-43) months. Median age was 71 (53-83), median PSA was 3.5 ng/mL (2.7-6.1). 28 (75.5%) patients harboured intermediate risk and 9 patients (24.5%) high risk PCa. Seven patients (19%) reported self-limiting urgency, frequency, or hematuria (grade 1-2). Seven patients (19%) developed a grade 3 AE; urethral sludge requiring transurethral resection. At 12 months post treatment 93% of patients remained continent and erectile function sufficient for intercourse deteriorated from 35% to 15% (4/27). Local control was achieved in 29 patients (78%) and 27 patients (73%) were clear of local and systemic disease. Four (11%) patients had local recurrence only. Six (16%) patients developed metastatic disease with a median time to metastasis of 8 months. CONCLUSION The FIRE trial shows that salvage IRE after failed radiation therapy for localised PCa is safe with minimal toxicity, and promising functional and oncological outcomes. Salvage IRE can offer a possible solution for notoriously difficult to manage radio recurrent prostate tumours.
Collapse
Affiliation(s)
- Alexandar Blazevski
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Bart Geboers
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - William Gondoputro
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Paul Doan
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Athos Katelaris
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Daniela Baretto
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Jayne Matthews
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Warick Delprado
- Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
| | - Ron Shnier
- I-MED Radiology, Sydney, New South Wales, Australia
| | - Willemien van den Bos
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - James E Thompson
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Melbourne, Victoria, Australia
- EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, Victoria, Australia
| | - Phillip D Stricker
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Wang H, Xue W, Yan W, Yin L, Dong B, He B, Yu Y, Shi W, Zhou Z, Lin H, Zhou Y, Wang Y, Shi Z, Ren S, Gao X, Wang L, Xu C. Extended Focal Ablation of Localized Prostate Cancer With High-Frequency Irreversible Electroporation: A Nonrandomized Controlled Trial. JAMA Surg 2022; 157:693-700. [PMID: 35793110 PMCID: PMC9260646 DOI: 10.1001/jamasurg.2022.2230] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/26/2022] [Indexed: 09/12/2023]
Abstract
IMPORTANCE Focal therapy of prostate cancer must balance the oncologic outcome and functional outcome. High-frequency irreversible electroporation (H-FIRE) can destroy cancer cells while selectively preserving surrounding nerves and blood vessels, but no clinical trials have been conducted, to our knowledge. OBJECTIVE To evaluate the efficacy and safety of H-FIRE in the treatment of localized prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS This was a single-group, objective performance criteria, nonrandomized controlled trial. Recruitment began on May 2, 2018, and ended March 27, 2019. The follow-up duration was 6 months. This was a multicenter trial conducted at 4 tertiary teaching hospitals in China. Patients with low or intermediate risk of biochemical recurrence of localized and locally advanced PCa were eligible. Key inclusion criteria were serum prostate-specific antigen (PSA) level less than 20 ng/mL, clinical stage of T2c or less, and Gleason score of 7 or less. Data were analyzed from January 20 to February 20, 2021. INTERVENTION H-FIRE ablation of all lesions identified with biopsy. MAIN OUTCOMES AND MEASURES The primary end point was 6-month clinically significant PCa (csPCa), which was defined as any biopsy core with Gleason score of greater than or equal to 7, or Gleason score of 6 plus maximum cancer core length of greater than 3 mm or an increase from the original cancer burden. Secondary outcomes were calculated in patients who actually received H-FIRE treatment. RESULTS A total of 117 patients (median [IQR] age, 67 [62-73] years) were recruited from 4 centers, and 109 patients (27 [24.8%] low risk and 82 [75.2%] intermediate risk) actually received H-FIRE. Median (IQR) PSA level was 9.0 (6.0-12.7) ng/mL. Among the 100 patients who underwent biopsy at 6 months, the 6-month csPCa rate was 6.0% (95% CI, 2.2%-12.6%; P < .001; 1 in the treatment zone and 5 outside the treatment zone). Superiority criteria vs the historical control of 20% was achieved. PCa was detected in 14 patients, with a Gleason score of 7 in 2 patients and 6 in the remaining 12 patients. At 6 months, median (IQR) PSA level was 1.08 (0.4-3.2) ng/mL, median (IQR) International Prostate Symptom Score was 4.5 (2.0-9.5), and median (IQR) International Index of Erectile Function 5 score was 2.0 (0.5-12.5). Superiority vs the 20% historical control was also met in the subgroup analysis that only included the 57 patients with Gleason score of 7 at baseline (3.5% 6-month csPCa; 95% CI, 0.4%-12.1%). CONCLUSIONS AND RELEVANCE The rate of 6-month csPCa with H-FIRE ablation was lower than the historical control using other energy platforms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03838432.
Collapse
Affiliation(s)
- Haifeng Wang
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Yin
- Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Baijun Dong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Biming He
- Department of Urology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yongwei Yu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wentao Shi
- Clinical Research Center, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Zhien Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hengzhi Lin
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yi Zhou
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanqing Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhenkai Shi
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shancheng Ren
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Linhui Wang
- Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
8
|
Marra G, Shah TT, D’Agate D, Marquis A, Calleris G, Lunelli L, Filippini C, Oderda M, Gatti M, Valerio M, Sanchez-Salas R, Bossi A, Gomez-Rivas J, Conte F, Deandreis D, Cussenot O, Ricardi U, Gontero P. The SAFE Pilot Trial—SAlvage Focal Irreversible Electroporation—For Recurrent Localized Prostate Cancer: Rationale and Study Protocol. Front Surg 2022; 9:900528. [PMID: 35747441 PMCID: PMC9209638 DOI: 10.3389/fsurg.2022.900528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionCurrently, the majority of prostate cancer (PCa) recurrences after non-surgical first-line treatment are managed with androgen-deprivation therapy (ADT). Salvage radical prostatectomy (sRP) is a curative alternative to ADT but yields significant morbidity. Preliminary evidence from focal salvage treatments shows similar oncological control but lower morbidity compared to sRP. Among available ablative focal energies, irreversible electroporation (IRE) is a treatment modality that proved promising, especially in treating apical lesions, where PCa most often recurs. Our aim is to test the safety of salvage IRE for recurrent PCa.MethodsWe performed a single-arm pilot feasibility study (IDEAL stage 2a): SAFE, SAlvage Focal irreversible Electroporation for recurrent localized PCa. Twenty patients with biopsy-proven PCa recurrence after primary non-surgical (radiation or ablation) treatment were included. All men will undergo mpMRI ± targeted biopsies, pre-operative PSMA-PET staging before inclusion and sIRE. Outcomes will be evaluated through internationally validated questionnaires and morbidity scales. All men will undergo a control biopsy at one year.ResultsPrimary objectives were the evaluation of the safety of sIRE (and patients’ quality of life) after treatment. Secondary objectives were the evaluation of functional outcomes, namely, continence and erectile function changes and evaluation of short-term oncological efficacy.ConclusionsSAFE is the second pilot study to evaluate sIRE and the first one performed according to the most recent diagnostic and staging imaging standards. sIRE may provide a curative option for recurrent PCa together with lower comorbidities compared to sRP.
Collapse
Affiliation(s)
- Giancarlo Marra
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
- Department of Urology and Clinical Research Group on Predictive Onco-Urology, APHP, Sorbonne University Paris, Paris, France
- Correspondence: Giancarlo Marra
| | - Taimur T. Shah
- Department of Urology, Imperial College, London, United Kingdom
| | - Daniele D’Agate
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Marquis
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Calleris
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Luca Lunelli
- Department of Urology and Clinical Research Group on Predictive Onco-Urology, APHP, Sorbonne University Paris, Paris, France
| | - Claudia Filippini
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Oderda
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Marco Gatti
- Department of Surgical Sciences and Radiology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier-Universitaire Vaudois, CHUV, Lausanne, Switzerland
| | | | - Alberto Bossi
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - Juan Gomez-Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Francesca Conte
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Desiree Deandreis
- Department of Nuclear Medicine, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Olivier Cussenot
- Department of Urology and Clinical Research Group on Predictive Onco-Urology, APHP, Sorbonne University Paris, Paris, France
| | - Umberto Ricardi
- Division of Radiotherapy and Department of Oncology, University of Turin and Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Surgical Sciences and Urology Clinic, University of Turin and Città della Salute e della Scienza, Turin, Italy
| |
Collapse
|
9
|
Yaxley WJ, Gianduzzo T, Kua B, Oxford R, Yaxley JW. Focal therapy for prostate cancer with irreversible electroporation: Oncological and functional results of a single institution study. Investig Clin Urol 2022; 63:285-293. [PMID: 35534217 PMCID: PMC9091832 DOI: 10.4111/icu.20210472] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Materials and Methods Results Conclusions
Collapse
Affiliation(s)
- William John Yaxley
- Department of Urology, QEII Jubilee Hospital, Brisbane, Australia
- The University of Queensland, School of Medicine, Brisbane, Australia
| | - Troy Gianduzzo
- The University of Queensland, School of Medicine, Brisbane, Australia
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
| | - Boon Kua
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
| | - Rachel Oxford
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
| | - John William Yaxley
- The University of Queensland, School of Medicine, Brisbane, Australia
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
- Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| |
Collapse
|
10
|
van Luijtelaar A, Fütterer JJ, Bomers JG. Minimally invasive magnetic resonance image-guided prostate interventions. Br J Radiol 2021; 95:20210698. [PMID: 34723623 PMCID: PMC8978246 DOI: 10.1259/bjr.20210698] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Whole gland prostate cancer treatment, i.e. radical prostatectomy or radiation therapy, is highly effective but also comes with a significant impact on quality of life and possible overtreatment in males with low to intermediate risk disease. Minimal-invasive treatment strategies are emerging techniques. Different sources of energy are used to aim for targeted treatment in order to reduce treatment-related complications and morbidity. Imaging plays an important role in targeting and monitoring of treatment approaches preserving parts of the prostatic tissue. Multiparametric magnetic resonance imaging (mpMRI) is widely used during image-guided interventions due to the multiplanar and real-time anatomical imaging while providing an improved treatment accuracy. This review evaluates the available image-guided prostate cancer treatment options using MRI or magnetic resonance imaging/transrectal ultrasound (MRI/TRUS)-fusion guided imaging. The discussed minimal invasive image-guided prostate interventions may be considered as safe and feasible partial gland ablation in patients with (recurrent) prostate cancer. However, most studies focusing on minimally invasive prostate cancer treatments only report early stages of research and subsequent high-level evidence is still needed. Ensuring a safe and appropriate utilization in patients that will benefit the most, and applied by physicians with relevant training, has become the main challenge in minimally invasive prostate cancer treatments.
Collapse
Affiliation(s)
- Annemarijke van Luijtelaar
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joyce Gr Bomers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
11
|
Wang YF, Tadimalla S, Hayden AJ, Holloway L, Haworth A. Artificial intelligence and imaging biomarkers for prostate radiation therapy during and after treatment. J Med Imaging Radiat Oncol 2021; 65:612-626. [PMID: 34060219 DOI: 10.1111/1754-9485.13242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/18/2021] [Accepted: 05/02/2021] [Indexed: 12/15/2022]
Abstract
Magnetic resonance imaging (MRI) is increasingly used in the management of prostate cancer (PCa). Quantitative MRI (qMRI) parameters, derived from multi-parametric MRI, provide indirect measures of tumour characteristics such as cellularity, angiogenesis and hypoxia. Using Artificial Intelligence (AI), relevant information and patterns can be efficiently identified in these complex data to develop quantitative imaging biomarkers (QIBs) of tumour function and biology. Such QIBs have already demonstrated potential in the diagnosis and staging of PCa. In this review, we explore the role of these QIBs in monitoring treatment response during and after PCa radiotherapy (RT). Recurrence of PCa after RT is not uncommon, and early detection prior to development of metastases provides an opportunity for salvage treatments with curative intent. However, the current method of monitoring treatment response using prostate-specific antigen levels lacks specificity. QIBs, derived from qMRI and developed using AI techniques, can be used to monitor biological changes post-RT providing the potential for accurate and early diagnosis of recurrent disease.
Collapse
Affiliation(s)
- Yu-Feng Wang
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sirisha Tadimalla
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Wentworthville, New South Wales, Australia
- Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Lois Holloway
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Ong S, Leonardo M, Chengodu T, Bagguley D, Lawrentschuk N. Irreversible Electroporation for Prostate Cancer. Life (Basel) 2021; 11:life11060490. [PMID: 34071934 PMCID: PMC8230282 DOI: 10.3390/life11060490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 01/04/2023] Open
Abstract
Although it can be lethal in its advanced stage, prostate cancer can be effectively treated when it is localised. Traditionally, radical prostatectomy (RP) or radiotherapy (RT) were used to treat all men with localised prostate cancer; however, this has significant risks of post-treatment side effects. Focal therapy has emerged as a potential form of treatment that can achieve similar oncological outcomes to radical treatment while preserving functional outcomes and decreasing rates of adverse effects. Irreversible electroporation (IRE) is one such form of focal therapy which utilises pulsatile electrical currents to ablate tissue. This modality of treatment is still in an early research phase, with studies showing that IRE is a safe procedure that can offer good short-term oncological outcomes whilst carrying a lower risk of poor functional outcomes. We believe that based on these results, future well-designed clinical trials are warranted to truly assess its efficacy in treating men with localised prostate cancer.
Collapse
Affiliation(s)
- Sean Ong
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Richmond, VIC 3121, Australia; (S.O.); (T.C.); (D.B.)
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia;
| | - Matthew Leonardo
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia;
- Fakultas Kedokteran, Universitas Indonesia, Jakarta Pusat 10430, Indonesia
| | - Thilakavathi Chengodu
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Richmond, VIC 3121, Australia; (S.O.); (T.C.); (D.B.)
| | - Dominic Bagguley
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Richmond, VIC 3121, Australia; (S.O.); (T.C.); (D.B.)
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia;
| | - Nathan Lawrentschuk
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Richmond, VIC 3121, Australia; (S.O.); (T.C.); (D.B.)
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia;
- Department of Urology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Correspondence: ; Tel.: +61-03-9329-1197
| |
Collapse
|
13
|
van Son M, Peters M, Moerland M, van de Pol S, Eppinga W, Lagendijk J, van der Voort van Zyp J. Determining the safety of ultrafocal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer: A toxicity assessment of 150 patients. Clin Transl Radiat Oncol 2020; 27:1-7. [PMID: 33364450 PMCID: PMC7750686 DOI: 10.1016/j.ctro.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
Severe toxicity is as low as 3% (GU), 0% (GI) and 15% (ED). Lower impact is predicted for patients with favorable function at baseline. Lower dose to the urethra (D10% <17 Gy) may prevent urinary symptoms.
Background and purpose Local re-treatment of radiorecurrent prostate cancer is potentially curative. However, the increased risk of severe toxicity may outweigh the opportunity of cancer control. This study aims to evaluate treatment-related toxicity from ultrafocal salvage high-dose-rate brachytherapy (HDR-BT) and to investigate potential risk factors. Materials and methods Toxicity data from 150 treated patients (July 2013–November 2019) was collected from a prospective registry. The treatment aim was to deliver a single dose of 19 Gy to the recurrent lesion as identified on multiparametric MRI and PET-CT. Treating physicians graded genitourinary (GU) and gastro-intestinal (GI) toxicity and erectile dysfunction (ED) using the Common Terminology Criteria for Adverse Events (CTCAE) 4.0, at baseline and during follow-up. Domains with substantial (≥10%) new-onset grade ≥ 2 toxicity were further evaluated using mixed effects logistic regression to find potential risk factors. Results Median follow-up time was 20 months (IQR 12–31). Over time, new-onset grade 2 and 3 toxicity was recorded in 41% and 3% (GU), 5% and 0% (GI) and 22% and 15% (ED). While GI toxicity remained stably low, grade ≥ 2 GU toxicity and ED were seen twice as frequent in the late phase (>3 months after treatment). Significant risk factors for grade ≥ 2 toxicity were baseline GU toxicity (grade ≥ 2), baseline ED (grade ≥ 2), IPSS (cut-off ≥ 14) and urethral dose (D10%, cut-off ≥ 17 Gy). Conclusion Ultrafocal salvage HDR-BT is a safe re-treatment option, especially in patients with a favorable symptom profile at baseline. Adherence to urethral dose constraints is important to avoid GU toxicity.
Collapse
Affiliation(s)
- Marieke van Son
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Marinus Moerland
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Sandrine van de Pol
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Wietse Eppinga
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Jan Lagendijk
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Jochem van der Voort van Zyp
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| |
Collapse
|
14
|
Anttinen M, Mäkelä P, Viitala A, Nurminen P, Suomi V, Sainio T, Saunavaara J, Taimen P, Sequeiros RB, Boström PJ. Salvage Magnetic Resonance Imaging-guided Transurethral Ultrasound Ablation for Localized Radiorecurrent Prostate Cancer: 12-Month Functional and Oncological Results. EUR UROL SUPPL 2020; 22:79-87. [PMID: 34337481 PMCID: PMC8317885 DOI: 10.1016/j.euros.2020.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 02/08/2023] Open
Abstract
Background Up to half of all men who undergo primary radiotherapy for localized prostate cancer (PCa) experience local recurrence. Objective To evaluate the safety and early functional and oncological outcomes of salvage magnetic resonance imaging-guided transurethral ultrasound ablation (sTULSA) for men with localized radiorecurrent PCa. Design setting and participants This prospective, single-center phase 1 study (NCT03350529) enrolled men with biopsy-proven localized PCa recurrence after radiotherapy. Multiparametric magnetic resonance imaging (mpMRI) and 18F prostate-specific membrane antigen-1007 (18F PSMA-1007) positron emission tomography (PET)-computed tomography (CT) were used to confirm organ-confined disease localization. Patients underwent either whole-gland or partial sTULSA, depending on their individual tumor characteristics. Outcome measurements and statistical analysis Patients were followed at 3-mo intervals. Adverse events (AEs, Clavien-Dindo scale), functional status questionnaires (Expanded Prostate Cancer Index [EPIC]-26, International Prostate Symptom Score, International Index of Erectile Function-5), uroflowmetry, and prostate-specific antigen (PSA) were assessed at every visit. Disease control was assessed at 1 yr using mpMRI and 18F-PSMA-1007 PET-CT, followed by prostate biopsies. Results and limitations Eleven patients (median age 69 yr, interquartile range [IQR] 68-74) underwent sTULSA (3 whole-gland, 8 partial sTULSA) and have completed 12-mo follow-up. Median PSA was 7.6 ng/ml (IQR 4.9-10) and the median time from initial PCa diagnosis to sTULSA was 11 yr (IQR 9.5-13). One grade 3 and three grade 2 AEs were reported, related to urinary retention and infection. Patients reported a modest degradation in functional status, most significantly a 20% decline in the EPIC-26 irritative/obstructive domain at 12 mo. A decline in maximum flow rate (24%) was also observed. At 1 yr, 10/11 patients were free of any PCa in the targeted ablation zone, with two out-of-field recurrences. Limitations include the nonrandomized design, limited sample size, and short-term oncological outcomes. Conclusions sTULSA appears to be safe and feasible for ablation of radiorecurrent PCa, offering encouraging preliminary oncological control. Patient summary We present safety and 1-yr functional and oncological outcomes of magnetic resonance imaging-guided transurethral ultrasound ablation (TULSA) as a salvage treatment for local prostate cancer recurrence after primary radiation. Salvage TULSA is safe and shows the ability to effectively ablate prostate cancer recurrence, with acceptable toxicity.
Collapse
Affiliation(s)
- Mikael Anttinen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pietari Mäkelä
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Antti Viitala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.,Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pertti Nurminen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Visa Suomi
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Teija Sainio
- Department of Medical Physics, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
15
|
Morozov A, Taratkin M, Barret E, Singla N, Bezrukov E, Chinenov D, Enikeev M, Gomez Rivas J, Shpikina A, Enikeev D. A systematic review of irreversible electroporation in localised prostate cancer treatment. Andrologia 2020; 52:e13789. [DOI: 10.1111/and.13789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/26/2020] [Accepted: 07/04/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Eric Barret
- Department of Urology Institut Mutualiste Montsouris Paris France
| | - Nirmish Singla
- Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
| | - Evgeniy Bezrukov
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Denis Chinenov
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Mikhail Enikeev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | | | - Anastasia Shpikina
- International School ‘Medicine of the Future’ Sechenov University Moscow Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| |
Collapse
|
16
|
Kiełbik A, Szlasa W, Saczko J, Kulbacka J. Electroporation-Based Treatments in Urology. Cancers (Basel) 2020; 12:E2208. [PMID: 32784598 PMCID: PMC7465806 DOI: 10.3390/cancers12082208] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
The observation that an application of a pulsed electric field (PEF) resulted in an increased permeability of the cell membrane has led to the discovery of the phenomenon called electroporation (EP). Depending on the parameters of the electric current and cell features, electroporation can be either reversible or irreversible. The irreversible electroporation (IRE) found its use in urology as a non-thermal ablative method of prostate and renal cancer. As its mechanism is based on the permeabilization of cell membrane phospholipids, IRE (as well as other treatments based on EP) provides selectivity sparing extracellular proteins and matrix. Reversible EP enables the transfer of genes, drugs, and small exogenous proteins. In clinical practice, reversible EP can locally increase the uptake of cytotoxic drugs such as cisplatin and bleomycin. This approach is known as electrochemotherapy (ECT). Few in vivo and in vitro trials of ECT have been performed on urological cancers. EP provides the possibility of transmission of genes across the cell membrane. As the protocols of gene electrotransfer (GET) over the last few years have improved, EP has become a well-known technique for non-viral cell transfection. GET involves DNA transfection directly to the cancer or the host skin and muscle tissue. Among urological cancers, the GET of several plasmids encoding prostate cancer antigens has been investigated in clinical trials. This review brings into discussion the underlying mechanism of EP and an overview of the latest progress and development perspectives of EP-based treatments in urology.
Collapse
Affiliation(s)
- Aleksander Kiełbik
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.K.); (W.S.)
| | - Wojciech Szlasa
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.K.); (W.S.)
| | - Jolanta Saczko
- Department of Molecular and Cellular Biology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| |
Collapse
|
17
|
Mantica G, Chierigo F, Suardi N, Gomez Rivas J, Kasivisvanathan V, Papalia R, Fiori C, Porpiglia F, Terrone C, Esperto F. Minimally invasive strategies for the treatment of prostate cancer recurrence after radiation therapy: a systematic review. MINERVA UROL NEFROL 2020; 72:563-578. [PMID: 32748617 DOI: 10.23736/s0393-2249.20.03783-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The aim of this review was to conduct a comprehensive analysis of the role of minimally invasive salvage modalities in radio-recurrent prostate cancer and the associated clinical outcomes and toxicity profiles. EVIDENCE ACQUISITION A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Scopus databases in January 2020. All papers published after 2000, concerning studies conducted on humans for radio-recurrent prostate cancer were considered for the review. EVIDENCE SYNTHESIS Overall, 545 studies were identified. After duplicate exclusion, initial screening, and eligibility evaluation, a total of 80 studies were included in the qualitative analysis, corresponding to a cohort of 6681 patients. The median age at initial diagnosis ranged from 59 to 75.5. Pre-treatment PSA ranged from 6.2 to 27.4 ng/mL. All patients underwent primary radiotherapy for localized prostate cancer. Cryotherapy, Brachytherapy, EBRT, HIFU were the minimally invasive options mostly used as salvage therapy. They showed to be promising approaches for recurrent prostate cancer (PCa) control, with acceptable toxicities. CONCLUSIONS Minimally invasive therapeutic options offer promising results in terms of biochemical control in the local recurrence setting. Unfortunately, the absence of high quality and comparative studies makes it difficult to establish which method is the best in terms of oncological and safety outcomes.
Collapse
Affiliation(s)
- Guglielmo Mantica
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Francesco Chierigo
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy -
| | - Nazareno Suardi
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain.,Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid, Spain
| | - Veeru Kasivisvanathan
- UCL Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Hospital, School of Medicine, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Hospital, School of Medicine, University of Turin, Orbassano, Turin, Italy
| | - Carlo Terrone
- Department of Urology, San Martino University Hospital, University of Genoa, Genoa, Italy
| | | | | |
Collapse
|
18
|
Blazevski A, Scheltema MJ, Amin A, Thompson JE, Lawrentschuk N, Stricker PD. Irreversible electroporation (IRE): a narrative review of the development of IRE from the laboratory to a prostate cancer treatment. BJU Int 2019; 125:369-378. [DOI: 10.1111/bju.14951] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alexandar Blazevski
- St. Vincent's Prostate Cancer Centre; Darlinghurst New South Wales Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst New South Wales Australia
- St. Vincent's Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - Matthijs J. Scheltema
- St. Vincent's Prostate Cancer Centre; Darlinghurst New South Wales Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst New South Wales Australia
- Department of Urology; Amsterdam UMC; Amsterdam The Netherlands
| | - Amer Amin
- St. Vincent's Prostate Cancer Centre; Darlinghurst New South Wales Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst New South Wales Australia
| | - James E. Thompson
- St. Vincent's Prostate Cancer Centre; Darlinghurst New South Wales Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst New South Wales Australia
- St. Vincent's Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - Nathan Lawrentschuk
- EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; Olivia Newton-John Cancer Centre; Austin Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Phillip D. Stricker
- St. Vincent's Prostate Cancer Centre; Darlinghurst New South Wales Australia
- Garvan Institute of Medical Research; Kinghorn Cancer Centre; Darlinghurst New South Wales Australia
- St. Vincent's Clinical School; University of New South Wales; Sydney New South Wales Australia
| |
Collapse
|
19
|
Roberts MJ, Papa N, Perera M, Scott S, Teloken PE, Joshi A, Vela I, Pryor D, Martin J, Woo H. A contemporary, nationwide analysis of surgery and radiotherapy treatment for prostate cancer. BJU Int 2019; 124 Suppl 1:31-36. [DOI: 10.1111/bju.14773] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Matthew J. Roberts
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Nepean Urology Research Group; Kingswood NSW Australia
| | - Nathan Papa
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Marlon Perera
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Department of Urology; Austin Health; Heidelberg Vic. Australia
| | - Susan Scott
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
| | - Patrick E. Teloken
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Andre Joshi
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - Ian Vela
- Faculty of Medicine; University of Queensland; Brisbane Qld Australia
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | - David Pryor
- Princess Alexandra Hospital; Brisbane Qld Australia
- Australian Prostate Cancer Research Centre; Queensland University of Technology; Brisbane Qld Australia
| | | | - Henry Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Sydney NSW Australia
- Department of Uro-Oncology; Chris O'Brien Lifehouse; Sydney NSW Australia
| |
Collapse
|
20
|
|
21
|
Lee JM, Choi HS, Kim ES, Keum B, Seo YS, Jeen YT, Lee HS, Chun HJ, Um SH, Kim CD, Kim HB. Characterization of irreversible electroporation on the stomach: A feasibility study in rats. Sci Rep 2019; 9:9094. [PMID: 31235753 PMCID: PMC6591231 DOI: 10.1038/s41598-019-45659-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/11/2019] [Indexed: 12/12/2022] Open
Abstract
Irreversible electroporation (IRE) is a newly developed non-thermal ablative therapy. During the IRE procedure, the permeability of the cell membrane is irreversibly changed by application of high-energy pulses across the tissue. This induces the breakdown of cell homeostasis, and thereby cell death. Here, we present an in vivo study to demonstrate IRE ablation of gastric tissue and characterize the changes that occur with time therein. No significant complications were observed in the test rats during the experiment. The electroporated tissues exhibited apoptosis at 10, 24 and 48 h after IRE ablation. The apoptosis peaked at 10 h after IRE and then declined, suggesting that the ablated tissue rapidly recovered owing to intense metabolic activity. In addition, the electroporated tissues exhibited morphological changes such as pyknosis and karyorrhexis, while histological analysis showed that the blood vessels were preserved. Interestingly, electroporation greatly affected the mucosa and muscularis propria, but not the submucosa and serosa. This study suggests that IRE could potentially be used as a minimally invasive treatment for early gastric cancer that does not exhibit lymph node metastasis or dysplasia.
Collapse
Affiliation(s)
- Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea.
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Hong Bae Kim
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, 08826, Republic of Korea
| |
Collapse
|
22
|
Devos B, Al Hajj Obeid W, Andrianne C, Diamand R, Peltier A, Everaerts W, Van Poppel H, Van Velthoven R, Joniau S. Salvage high-intensity focused ultrasound versus salvage radical prostatectomy for radiation-recurrent prostate cancer: a comparative study of oncological, functional, and toxicity outcomes. World J Urol 2019; 37:1507-1515. [PMID: 30666400 DOI: 10.1007/s00345-019-02640-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 01/11/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To compare oncological, functional, and toxicity outcomes of patients with radiation-recurrent prostate cancer (PCa) after external beam radiation therapy (EBRT) or brachytherapy (BT) treated with salvage high-intensity focused ultrasound (S-HIFU) or salvage radical prostatectomy (S-RP). METHODS This retrospective study compared 52 patients with radiation-recurrent PCa after EBRT or BT treated with S-HIFU (n = 27) or S-RP (n = 25) between 1998 and 2016. We estimated overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) at 5 years. Incontinence after local salvage therapy (LST) was scored according to the number of pads used per day. Complications were graded according to the Clavien-Dindo classification. RESULTS Both groups were similar for pre-LST tumor features, however, no S-HIFU patients received BT and S-RP patients were younger and healthier. Median follow-up was 45 months for S-HIFU and 43 months for S-RP. No significant differences were found in estimated 5-year OS (80.9% vs. 61.9%, p = 0.24), 5-year CSS (84.0% vs. 74.0%, p = 0.36), and 5-year MFS (60.3% vs. 55.2%, p = 0.55) for S-HIFU vs. S-RP, respectively. We observed a significant difference in pad-dependent status at 12 months (22.2% vs. 56.0%, p = 0.01) and in the number of Clavien ≥ III complications [9 (7/27 patients) vs. 16 (12/25 patients), p = 0.027] in favor of S-HIFU vs. S-RP, respectively. CONCLUSION S-HIFU and S-RP could both be considered valuable LST options for patients with radiation-recurrent nonmetastatic PCa with sufficient life expectancy. S-RP is associated with more pad-dependent patients at 12 months.
Collapse
Affiliation(s)
| | - Walid Al Hajj Obeid
- Department of Urology, Saint George Hospital University Medical Center, Beirut, Lebanon
- Department of Urology, Jules Bordet Institute, Brussels, Belgium
| | - Colin Andrianne
- Department of Urology, Jules Bordet Institute, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute, Brussels, Belgium
| | | | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hein Van Poppel
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| |
Collapse
|
23
|
Rendas-Baum R, D'Alessio D, Bjorner JB. Health-related quality of life predicted subsequent health care resource utilization in patients with active cancer. Qual Life Res 2018; 28:1085-1095. [PMID: 30543017 PMCID: PMC6439153 DOI: 10.1007/s11136-018-2085-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 12/21/2022]
Abstract
Purpose The objective of this study was to estimate the association between SF-12v2® Health Survey (SF-12v2) scores and subsequent health care resource utilization (HCRU) among patients with cancer. Methods We analyzed 18+ year participants in the Medical Expenditure Panel Survey, diagnosed with active cancer or malignancy (n = 647). HCRU was measured by total medical expenditures (MEs) and number of medical events (EVs) in the 6 months following the SF-12v2 assessment. The effect of SF-12v2 scores (physical (PCS) and mental (MCS) component summary scores and the SF-6D health-utility score) on HCRU was estimated using generalized linear models. Estimates were obtained for the entire sample and for the four cancer groups present in the sample: breast, prostate, skin, and lung. Results For PCS and MCS, a one-point better score was associated with 2% lower MEs (P < 0.001) and 2.5% lower MEs (P = 0.015), respectively. A 0.05-point better SF-6D score was associated with 7% lower MEs (P = 0.003). PCS and SF-6D were more strongly associated with MEs for prostate cancer patients (P = 0.009 and P = 0.003) and PCS was more strongly associated with MEs for skin cancer patients (P = 0.019), compared to other cancer groups. A 1-point better PCS predicted 1% lower EVs, while a 0.05 better SF-6D score predicted 4% lower EVs. Conclusions The significant associations between SF-12v2 scores from oncology patients and subsequent HCRU can guide interpretations of SF-12v2 scores in evaluation of therapies and in health policy decisions.
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW To present a perspective on the current status and future directions of focal therapy for prostate cancer (PCa). RECENT FINDINGS Focal therapy for localized PCa is a rapidly evolving field. Various recent concepts - the index lesion driving prognosis, the enhanced detection of clinically significant PCa using multiparametric MRI and targeted biopsy, improved risk-stratification using novel blood/tissue biomarkers, the recognition that reducing radical treatment-related morbidity (along with reducing pathologic progression) is a clinically meaningful end-point - have all led to a growing interest in focal therapy. Novel focal therapy modalities are being investigated, mostly in phase 1 and 2 studies. Recently, level I prospective randomized data comparing partial gland ablation with a standard-of-care treatment became available from one study. Recent developments in imaging, including 7-T MRI, functional imaging, radiomics and contrast-enhanced ultrasound show early promise. We also discuss emerging concepts in patient selection for focal therapy. SUMMARY PCa focal therapy has evolved considerably in the recent few years. Overall, these novel focal therapy treatments demonstrate safety and feasibility, low treatment-related toxicity and acceptable short-term and in some cases medium-term oncologic outcomes. As imaging techniques evolve, patient selection, detection of clinically significant PCa and noninvasive assessment of therapeutic efficacy will be further optimized. The aspirational goal of achieving oncologic control while reducing radical treatment-related morbidity will drive further innovation in the field.
Collapse
|
25
|
Lieng H, Hayden AJ, Christie DRH, Davis BJ, Eade TN, Emmett L, Holt T, Hruby G, Pryor D, Shakespeare TP, Sidhom M, Skala M, Wiltshire K, Yaxley J, Kneebone A. Radiotherapy for recurrent prostate cancer: 2018 Recommendations of the Australian and New Zealand Radiation Oncology Genito-Urinary group. Radiother Oncol 2018; 129:377-386. [PMID: 30037499 DOI: 10.1016/j.radonc.2018.06.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022]
Abstract
The management of patients with biochemical, local, nodal, or oligometastatic relapsed prostate cancer has become more challenging and controversial. Novel imaging modalities designed to detect recurrence are increasingly used, particularly PSMA-PET scans in Australia, New Zealand and some European countries. Imaging techniques such as MRI and PET scans using other prostate cancer-specific tracers are also being utilised across the world. The optimal timing for commencing salvage treatment, and the role of local and/or systemic therapies remains controversial. Through surveys of the membership, the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group (FROGG) identified wide variation in the management of recurrent prostate cancer. Following a workshop conducted in April 2017, the FROGG management committee reviewed the literature and developed a set of recommendations based on available evidence and expert opinion, for the appropriate investigation and management of recurrent prostate cancer. These recommendations cover the role and timing of post-prostatectomy radiotherapy, the management of regional nodal metastases and oligometastases, as well as the management of local prostate recurrence after definitive radiotherapy.
Collapse
Affiliation(s)
- Hester Lieng
- Central Coast Cancer Centre, Gosford Hospital, Australia.
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Australia
| | - David R H Christie
- Genesis Cancer Care, Australia; Department of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas N Eade
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - Louise Emmett
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia
| | - Tanya Holt
- University of Queensland, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - George Hruby
- Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Thomas P Shakespeare
- North Coast Cancer Institute, Coffs Harbour, Australia; University of New South Wales Rural Clinical School, Australia
| | - Mark Sidhom
- Liverpool Hospital Cancer Therapy Centre, Sydney, Australia; University of New South Wales, Australia
| | | | | | - John Yaxley
- University of Queensland, Australia; Royal Brisbane and Women's Hospital, Australia; Wesley Urology Clinic, Brisbane, Australia
| | - Andrew Kneebone
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| |
Collapse
|
26
|
Bloom JB, Gold SA, Hale GR, Rayn KN, Sabarwal VK, Bakhutashvili I, Valera V, Turkbey B, Pinto PA, Wood BJ. "Super-active surveillance": MRI ultrasound fusion biopsy and ablation for less invasive management of prostate cancer. Gland Surg 2018; 7:166-187. [PMID: 29770311 DOI: 10.21037/gs.2018.03.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric magnetic resonance imaging (mpMRI) of the prostate has allowed clinicians to better visualize and target suspicious lesions during biopsy. Targeted prostate biopsies give a more accurate representation of the true cancer volume and stage so that appropriate treatment or active surveillance can be selected. Advances in technology have led to the development of MRI and ultrasound fusion platforms used for targeted biopsies, monitoring cancer progression, and more recently for the application of focal therapy. Lesions visualized on mpMRI can be targeted for ablation with a variety of energy sources employed under both local and general anesthesia. Focal ablation may offer an alternative option for treating prostate cancer as compared to the well-established interventions of whole-gland radiation or prostatectomy. Focal ablation may also be an option for patients on active surveillance who wish to be even more "active" in their surveillance. In this review, we describe the advancements and development of fusion biopsies, the rationale behind focal therapy, and introduce focal ablative techniques for indolent prostate cancers ("super-active surveillance"), including cryoablation and focal laser ablation (FLA) and the subsequent MRI/biopsy surveillance.
Collapse
Affiliation(s)
- Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Samuel A Gold
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Graham R Hale
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Vikram K Sabarwal
- Department of Urology, George Washington University, Washington, DC, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
| | - Vladimir Valera
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|