Location of residual cancer after transrectal high‐intensity focused ultrasound ablation for clinically localized prostate cancer

Boutier, R.; Girouin, N.; Cheikh, A. Ben; Belot, Aurélien; Rabilloud, Muriel; Gelet, A.; Chapelon, Jean‐Yves; Rouvière, Olivier

doi:10.1111/j.1464-410x.2011.10251.x

Cited by 32 publications

(19 citation statements)

References 34 publications

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“…The apex is difficult to treat because of its close proximity to the striated sphincter causing several groups to begin their HIFU 6 mm above the apex of the gland. This creates a theoretical 6 mm ‘safety margin’ to protect the sphincter [6]. Boutier et al .…”

Section: Discussionmentioning

confidence: 99%

“…Boutier et al . [6] evaluated the largest series of patients that were treated with HIFU with systemic biopsies 3–6 months after treatment. The apex was positive in 60% of patients with positive biopsy post‐treatment.…”

Section: Discussionmentioning

confidence: 99%

“…High intensity focused ultrasound (HIFU) treatment for prostate cancer has gained increasing popularity as a new minimally invasive approach for treatment of localized disease. However, a study examining the location of residual disease after HIFU treatment has shown that the apex is the predominant site, possibly related to treatment safety zones established at the sphincter [6]. These issues have led many institutions to evaluate the utility of multiparametric MRI (mpMRI) in improving localization and detection of prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

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Very distal apical prostate tumours: identification on multiparametric MRI at 3 Tesla

Nix¹,

Türkbey²,

Hoang³

et al. 2012

BJU International

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What ' s known on the subject? and What does the study add? MRI has been shown to improve prostate cancer detection rates. Pinto et al . ( J Urol 2011; 86: 1281 -5) reported their outcomes on 101 patients with low, moderate or high suspicion lesions on multiparametric MRI that were subsequently targeted via an MRI/ ultrasound fusion biopsy platform. The prostate cancer detection rates were 27%, 66% and 89% respectively. Sciarra et al . ( Clin Cancer Res 2010; 16: 1875 -83) performed a prospective trial in 180 patients with prior negative biopsy and persistent PSA elevation. Patients were randomized to either MRI targeted biopsy followed by random 12-core TRUS biopsy vs random TRUS guided biopsy alone. Prostate cancer detection in the MRI targeted group was 45.5% vs 24.4% in the random group.Although MRI has been shown to improve prostate cancer detection rates, there has not previously been any work looking at the ability of MRI to detect prostate cancer localized to the very distal apex of the prostate. This is an important topic in that it might lead clinicians to counsel their patients in treatment decisions if it is felt that a treatment might not treat this section of the prostate well, e.g. high intensity focused ultrasound therapy that might spare the distal apex. OBJECTIVE• To describe an undescribed ' very distal ' apical prostate cancer on multiparametric MRI (mpMRI) since apical prostate cancer can be diffi cult to detect in transrectal ultrasound guided biopsy and might therefore be missed in treatment decisions such as high intensity focused ultrasound or surgical therapy. PATIENTS AND METHODS• From January 2011 to December 2012 a total of 210 consecutive patients underwent 3 T mpMRI with endorectal coil followed by our previously described MRI/ ultrasound image fused and directed TRUS biopsies.• Patients also underwent 12-core TRUS sextant biopsies.• The inclusion criteria required at least one distal apical prostate lesion visualized on mpMRI and targeted for biopsy. RESULTS• A total of 38 men (median age 62 years, median PSA 7.68 ng/dL) were identifi ed as having distal apical prostate cancer on mpMRI.• Thirteen patients (34%) had a prior diagnosis of cancer and were on active surveillance protocols while 25 (66%) did not. Of those patients, 21 (55%) had undergone a median of two prior negative biopsies.• Twenty-two patients (58%) were positive on biopsy for prostate cancer. On breakdown of patients who were positive, 17 (77%) were positive on TRUS random biopsies and 21 (95%) were positive on MRI targeted biopsies with the majority of patients having multifocal disease.• At the distal apical lesions of interest, 80% were positive on MRI targeted biopsy. In addition 33% of these patients were upgraded based on MRI targeted biopsy at the distal lesion. CONCLUSIONS• Very distal apical prostate cancer can be accurately detected and sampled with mpMRI and subsequent MRI/ultrasound fusion biopsy.• This may aid clinicians and patients in decision making for therapeutic modalities. KEYWORDSprostate ca...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Very distal apical prostate tumours: identification on multiparametric MRI at 3 Tesla

Nix¹,

Türkbey²,

Hoang³

et al. 2012

BJU International

View full text Add to dashboard Cite

show abstract

“…Nevertheless, retreatment in the sense of a hemiablation of the 1 lobe is possible in case of failed focal therapy. The analysis of cancer recurrence regions by Boutier et al [20] showed that the apex is the main location for residual or recurrent disease after HIFU treatment if a 6-mm safety margin to the external sphincter is used. Therefore, adequate patient selection is mandatory to avoid residual disease by adding a distinguished safety margin on the one hand and not threatening risk structures like the external sphincter or larger parts of the bladder neck on the other hand.…”

Section: Discussionmentioning

confidence: 99%

Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer

et al. 2015

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Overtreatment of prostate cancer (PC) remains one of the main burdens in uro-oncology. Focal therapy may be a reasonable alternative with less side effects and morbidity. Application of high-intensity focused ultrasound (HIFU) induces immediate and irreversible coagulation. The treatment leads to consecutive necrosis with sharply delineated margins, making HIFU a promising tool for the focal therapy of localized PC. Unlike radiation, the treatment leaves no collateral damage outside of the heated tissue, allowing repeated use of HIFU, if necessary. In case of non-organ-confined relapse, additional radical salvage therapy can be performed. This review gives an overview of the existing evidence on focal HIFU. Today, 3 HIFU devices are approved for the treatment of localized PC: Sonablate™, Ablatherm™ and the FocalOne™ device. In summary, the first published results of focal HIFU are promising. The quality of life and potency of the patients are well preserved. Therefore, HIFU treatment, and especially focal ablation of tumor foci, seems to be a safe alternative to standard treatment, with low side effects. The oncologic results seem satisfactory but need further follow-up to validate this practice of PC control.

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“…Bouiter et al evaluated the risk of incomplete transrectal HIFU ablation in terms of the location of PCa (basis/mid/apex) 35 . Th ey analysed the outcomes of 99 patients undergoing HIFU ablation (Ablatherm ® ) with a 6mm safety margin at the apex.…”

Section: Miscellaneous Modalitiesmentioning

confidence: 99%

Focal Treatment Alternatives in Prostate Cancer

Karadağ¹,

Çeçen²,

Demir³

et al. 2015

Kafkas J Med Sci

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Location of residual cancer after transrectal high‐intensity focused ultrasound ablation for clinically localized prostate cancer

Abstract: • When a 6-mm apical safety margin is used, residual cancer after HIFU ablation is found significantly more frequently in the apex.

Cited by 32 publications

References 34 publications

Very distal apical prostate tumours: identification on multiparametric MRI at 3 Tesla

Very distal apical prostate tumours: identification on multiparametric MRI at 3 Tesla

Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer

Focal Treatment Alternatives in Prostate Cancer

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