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Oderda M, Marquis A, Calleris G, D'Agate D, Faletti R, Gatti M, Marra G, Gontero P. Safety and Feasibility of Transperineal Targeted Microwave Ablation for Low- to Intermediate-risk Prostate Cancer. EUR UROL SUPPL 2022; 46:3-7. [PMID: 36304751 PMCID: PMC9594111 DOI: 10.1016/j.euros.2022.10.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Background Focal therapy has emerged as an interesting option for localized low- to intermediate-risk prostate cancer (PCa). Targeted microwave ablation (TMA) is a novel FT modality involving targeted delivery of microwave energy under multiparametric magnetic resonance imaging (MRI)/ultrasound guidance. Objective To describe the step-by-step procedure for TMA and report early functional outcomes. Design, setting, and participants This was an experimental phase 1–2 trial in 11 patients diagnosed with a single, MRI-visible PCa lesion of up to 12 mm, scored as International Society of Urological Pathology grade group (GG) 1 or 2. Surgical procedure Transperineal TMA under MRI/ultrasound image fusion guidance. Measurements We recorded patient and PCa features; intraoperative and postoperative parameters; pain (Visual Analog Scale [VAS]) and adverse events (Common Terminology Criteria for Adverse Events v5.0); and prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) scores at 1 wk and 1, 3, and 6 mo. Results and limitations The median patient age was 67 yr (interquartile range [IQR] 18). Median PSA was 5.4 ng/ml (IQR 1.8), median prostate volume was 51 cm3 (IQR 35), and median lesion size on MRI was 10 mm (IQR 4). Ten patients had GG 2 PCa and one had GG 1 disease. The median procedure time was 40 min (IQR 30). No intraoperative complications were reported. All treatments were performed on a day-case basis and no patients were discharged with a urinary catheter. Postoperatively, no grade ≥2 complications were reported. No significant changes in PSA (p = 0.46), IPSS (p = 0.39), or IIEF-5 scores (p = 0.18) scores were reported. The postoperative VAS score at 24 h was 0 for all patients. Conclusions TMA is safe, feasible, and well tolerated in patients with low- to intermediate-risk PCa. Oncological outcomes are still awaited. Patient summary Targeted microwave therapy is safe and feasible for selected patients with low- to intermediate-risk prostate cancer. The procedure is well tolerated and does not require a urinary catheter after the procedure. Cancer control outcomes are still awaited.
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Affiliation(s)
- Marco Oderda
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy,Corresponding author. Department of Surgical Sciences-Urology, University of Turin, Turin, Italy. Tel. +39 34 7938 3465.
| | - Alessandro Marquis
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Giorgio Calleris
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Daniele D'Agate
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Division of Radiology, Molinette Hospital, University of Turin, Turin, Italy
| | - Marco Gatti
- Division of Radiology, Molinette Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy
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Oderda M, Marra G, Albisinni S, Altobelli E, Baco E, Beatrici V, Dellabella M, Descotes JL, Eldred-Evans D, Fasolis G, Ferriero M, Fiard G, Giacobbe A, Kumar P, Lacetera V, Mozer P, Muto G, Papalia R, Peltier A, Piechaud T, Pierangeli T, Simone G, Roche JB, Roupret M, Gontero P. Elastic fusion biopsy versus systematic biopsy for prostate cancer detection: Results of a multicentric study on 1,119 patients. Actas Urol Esp 2019; 43:431-438. [PMID: 31155373 DOI: 10.1016/j.acuro.2019.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the accuracy of targeted and systematic biopsies for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in the everyday practice, evaluating the need for additional systematic biopsies at the time of targeted biopsy. PATIENTS AND METHODS From our multicentric database gathering data on 2,115 patients who underwent fusion biopsy with Koelis™ system between 2010 and 2017, we selected 1,119 patients who received targeted biopsies (a median of 3 for each target), followed by systematic sampling of the prostate (12 to 14 cores). Overall and clinically significant cancer detection rate (CDR) of Koelis™ fusion biopsies were assessed, comparing target and systematic biopsies. Secondary endpoint was the identification of predictors of PCa detection. RESULTS The CDR of targeted biopsies only was 48% for all cancers and 33% for csPCa. The performance of additional, systematic prostate sampling improved the CDR of 15% for all cancers and of 12% for csPCa. PCa was detected in 35%, 69%, and 92% of patients with lesions scored as PI-RADS 3, 4 and 5, respectively. Elevated PI-RADS score and positive digital rectal examination were predictors of PCa, whereas biopsy-naïve status was associated with csPCa. CONCLUSION In the everyday practice target biopsy with Koelis™ achieves a good CDR for all PCa and csPCa, which is significantly improved by subsequent systematic sampling of the prostate. The outstanding outcomes of fusion biopsy are confirmed also in biopsy-naïve patients. Elevated PI-RADS score and positive digital rectal examination are strongly associated with presence of PCa.
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Affiliation(s)
- M Oderda
- Departamento de Ciencias Quirúrgicas, Urología, Universitad de Turín, Turín, Italia; Departamento de Urología, Hospital San Lázaro, Alba, Italia.
| | - G Marra
- Departamento de Ciencias Quirúrgicas, Urología, Universitad de Turín, Turín, Italia
| | - S Albisinni
- Departamento de Urología, Hospital Eraste, Universidad Libre de Bruselas, Bruselas, Bélgica
| | - E Altobelli
- Departamento de Urología, Campus Biomédico Universidad, Roma, Italia
| | - E Baco
- Departamento de Urología, Hospital Universitario de Oslo, Oslo, Noruega
| | - V Beatrici
- Departamento de Urología, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italia
| | - M Dellabella
- Departamento de Urología, INRCA-IRCCS, Ancona, Italia
| | - J L Descotes
- Departamento de Urología, Centre Hospitalier Universitaire de Grenoble, Grenoble, Francia
| | - D Eldred-Evans
- Departamento de Urología, Hospital Royal Marsden, Londres, Reino Unido
| | - G Fasolis
- Departamento de Urología, Hospital San Lázaro, Alba, Italia
| | - M Ferriero
- Departamento de Urología, Regina Elena National Cancer Institute, Roma, Italia
| | - G Fiard
- Departamento de Urología, Centre Hospitalier Universitaire de Grenoble, Grenoble, Francia
| | - A Giacobbe
- Departamento de Urología, Humanitas Gradenigo Hospital, Turín, Italia
| | - P Kumar
- Departamento de Urología, Hospital Royal Marsden, Londres, Reino Unido
| | - V Lacetera
- Departamento de Urología, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italia
| | - P Mozer
- Departamento de Urología, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, París, Francia
| | - G Muto
- Departamento de Urología, Humanitas Gradenigo Hospital, Turín, Italia
| | - R Papalia
- Departamento de Urología, Campus Biomédico Universidad, Roma, Italia
| | - A Peltier
- Departamento de Urología, Instituto Jules Bordet, Universidad Libre de Bruselas, Bruselas, Bélgica
| | - T Piechaud
- Departamento de Urología, Clinique Saint Augustin, Burdeos, Francia
| | - T Pierangeli
- Unidad de Cáncer de Próstata, INRCA-IRCCS, Ancona, Italia
| | - G Simone
- Departamento de Urología, Regina Elena National Cancer Institute, Roma, Italia
| | - J B Roche
- Departamento de Urología, Clinique Saint Augustin, Burdeos, Francia
| | - M Roupret
- Departamento de Urología, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, París, Francia
| | - P Gontero
- Departamento de Ciencias Quirúrgicas, Urología, Universitad de Turín, Turín, Italia
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Oderda M, Marra G, Albisinni S, Altobelli E, Baco E, Beatrici V, Cantiani A, Carbone A, Ciccariello M, Descotes JL, Dubreuil-Chambardel M, Eldred-Evans D, Fasolis G, Ferriero M, Fiard G, Forte V, Giacobbe A, Kumar P, Lacetera V, Mozer P, Muto G, Papalia R, Pastore A, Peltier A, Piechaud T, Simone G, Roche JB, Roupret M, Rouviere O, Van Velthoven R, Gontero P. Accuracy of elastic fusion biopsy in daily practice: Results of a multicenter study of 2115 patients. Int J Urol 2018; 25:990-997. [PMID: 30187529 DOI: 10.1111/iju.13796] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 05/29/2018] [Accepted: 08/05/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the accuracy of Koelis fusion biopsy for the detection of prostate cancer and clinically significant prostate cancer in the everyday practice. METHODS We retrospectively enrolled 2115 patients from 15 institutions in four European countries undergoing transrectal Koelis fusion biopsy from 2010 to 2017. A variable number of target (usually 2-4) and random cores (usually 10-14) were carried out, depending on the clinical case and institution habits. The overall and clinically significant prostate cancer detection rates were assessed, evaluating the diagnostic role of additional random biopsies. The cancer detection rate was correlated to multiparametric magnetic resonance imaging features and clinical variables. RESULTS The mean number of targeted and random cores taken were 3.9 (standard deviation 2.1) and 10.5 (standard deviation 5.0), respectively. The cancer detection rate of Koelis biopsies was 58% for all cancers and 43% for clinically significant prostate cancer. The performance of additional, random cores improved the cancer detection rate of 13% for all cancers (P < 0.001) and 9% for clinically significant prostate cancer (P < 0.001). Prostate cancer was detected in 31%, 66% and 89% of patients with lesions scored as Prostate Imaging Reporting and Data System 3, 4 and 5, respectively. Clinical stage and Prostate Imaging Reporting and Data System score were predictors of prostate cancer detection in multivariate analyses. Prostate-specific antigen was associated with prostate cancer detection only for clinically significant prostate cancer. CONCLUSIONS Koelis fusion biopsy offers a good cancer detection rate, which is increased in patients with a high Prostate Imaging Reporting and Data System score and clinical stage. The performance of additional, random cores seems unavoidable for correct sampling. In our experience, the Prostate Imaging Reporting and Data System score and clinical stage are predictors of prostate cancer and clinically significant prostate cancer detection; prostate-specific antigen is associated only with clinically significant prostate cancer detection, and a higher number of biopsy cores are not associated with a higher cancer detection rate.
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Affiliation(s)
- Marco Oderda
- Department of Surgical Sciences - Urology, University of Turin, Turin, Italy.,Department of Urology, San Lazzaro Hospital, Alba, Italy
| | - Giancarlo Marra
- Department of Surgical Sciences - Urology, University of Turin, Turin, Italy
| | - Simone Albisinni
- Department of Urology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | | | - Antonio Carbone
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Mauro Ciccariello
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Jean-Luc Descotes
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Marine Dubreuil-Chambardel
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Université de Lyon, Lyon, France
| | | | | | | | - Gaelle Fiard
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Valerio Forte
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Pardeep Kumar
- Department of Urology, Royal Marsden Hospital, London, UK
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro-Fano, Italy
| | - Pierre Mozer
- Department of Urology, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, Paris, France
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University, Rome, Italy
| | - Antonio Pastore
- Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Morgan Roupret
- Department of Urology, Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris, Universités Paris Sorbonne, Paris, France
| | - Olivier Rouviere
- Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Université de Lyon, Lyon, France
| | - Roland Van Velthoven
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Paolo Gontero
- Department of Surgical Sciences - Urology, University of Turin, Turin, Italy
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