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Misuraca L, Lugnani F, Brassetti A, Cacciatore L, Tedesco F, Anceschi U, Bove AM, D'Annunzio S, Ferriero M, Guaglianone S, Mastroianni R, Tuderti G, Panebianco V, Sentinelli S, Simone G. Single-Setting 3D MRI/US-Guided Frozen Sectioning and Cryoablation of the Index Lesion: Mid-Term Oncologic and Functional Outcomes from a Pilot Study. J Pers Med 2023; 13:978. [PMID: 37373967 DOI: 10.3390/jpm13060978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Our study explored frozen section reliability in prostate cancer (PCa) diagnoses and described surgical steps of a 3D magnetic resonance imaging (MRI)-ultrasound (US)-guided prostate biopsy (PB) and focal cryoablation of the index lesion (IL) in a single-setting procedure. Patients with a suspicious prostatic specific antigen (PSA) value, with a PIRADS 4 or 5 single lesion, were enrolled for trans perineal 3D MRI-US-guided PB and TRUS-guided focal cryoablation. Three cores were taken from the IL, three cores from the surrounding area, while systematic sampling was performed for the rest of the gland. After confirmation of PCa in frozen sections, focal cryoablation was performed. The 1st-year follow-up schedule included a PSA test at a 3-month interval, MRI 3 months and 1 year postoperatively and PB of the treated area at 1 year. Following the follow-up schedule, an involved PSA test at a 3-month interval and yearly MRI were performed. The PCa diagnosis was histologically confirmed in all three patients with frozen sections. At final histology, a single Gleason score upgrade from 6 (3 + 3) to 7 (3 + 4) was observed. All patients were discharged on postoperative day 1. At the 3-month evaluation, mean PSA values decreased from 12.54 (baseline) to 1.73 ng/mL and MRI images showed complete ablation of the IL in all patients. Urinary continence and potency were preserved in all patients. At the 1-year follow-up, one patient had suspicious ipsilateral recurrence on MRI and underwent a new analogous procedure. Post follow-up was uneventful and PSA remained stable in all patients. Three-dimensional MRI-US-guided frozen sectioning and focal cryoablation of the IL is a step forward towards a "patient-tailored" minimally invasive approach to the diagnosis and cure of PCa.
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Affiliation(s)
- Leonardo Misuraca
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Franco Lugnani
- Department of Urology, Hippocrates D.O.O, 6215 Divaca, Slovenia
| | - Aldo Brassetti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Simone D'Annunzio
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | | | - Salvatore Guaglianone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
| | | | - Steno Sentinelli
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy
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