“Super-active surveillance”: MRI ultrasound fusion biopsy and ablation for less invasive management of prostate cancer

Bloom, Jonathan; Gold, Samuel; Hale, Graham; Rayn, Kareem; Sabarwal, Vikram; Bakhutashvili, Ivane; Valera, Vladimir; Türkbey, Barış; Pinto, Peter A.; Wood, Bradford J.

doi:10.21037/gs.2018.03.06

Cited by 18 publications

(10 citation statements)

References 101 publications

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“…For certain well selected patients, the prospect of focal therapy in place of radical surgery or active surveillance may be an attractive alternative, or may be an adjunct to active surveillance. 41 At present, the lack of long term oncologic outcomes, imaging and navigation shortcomings, and uncertainties about the clinical efficacy of focal treatment for high grade lesions has led organizations such as the American Urologic Association/ American Society for Radiation Oncology/Society of Urologic Oncology(AUA/ASTRO/SUO) and European Association of Urology (EAU) to recommend against focal therapy as part of standard of care treatment at this time. 29,54 New guidelines and advancements require evidence-based medicine to better study the long term results of focal therapy in the setting of clinical trials or registries.…”

Section: Resultsmentioning

confidence: 99%

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Contemporary treatments in prostate cancer focal therapy

Ahdoot

Lebastchi

Türkbey

et al. 2019

Current Opinion in Oncology

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Purpose: Radical treatments for prostate cancer are associated with significant morbidity, including incontinence and erectile dysfunction. Advances in the field of prostate MRI and desire to reduce treatment morbidities have led to a rapid growth in focal treatments for prostate cancer. Here, we review novel focal prostate cancer treatments and their associated recent clinical data, with a particular focus on data reported within the last 24 months. Recent findings: High Intensity Focal Ultrasound (HIFU), Focal Laser Ablation (FLA), Irreversible Electroporation (IRE), Focal Cryotherapy, and Photodynamic Therapy (PDT) have been used as treatment modalities for localized prostate cancer treatment. Despite the great variety of treatment techniques, each of these modalities is characterized by a significant rate of prostate cancer persistence within treatment zones (6–50%) and the presence of residual cancer within the prostate on re-biopsy (24–49%). These treatments, however, are associated with very low rates of high-grade complications, rare incontinence, and only mild or transient reductions in erectile function. The most common adverse events are urinary tract infections, hematuria, and urinary retention. Summary: Prostate cancer focal therapy is an attractive option for well selected patients due to its low complication profile, however long-term oncologic outcome is still lacking and early recurrence rates are high, limiting the ability of most urologic associations from endorsing its routine use.

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Section: Resultsmentioning

confidence: 99%

“…MRI-TRUS fusion guidance platforms have been developed (at the NIH and UCLA) for transrectal ultrasound MRI fusion guidance, but broadly available FLA platforms are not available. 34,41…”

Section: Contemporary Treatments In Prostate Cancer Focal Therapymentioning

confidence: 99%

Contemporary treatments in prostate cancer focal therapy

Ahdoot

Lebastchi

Türkbey

et al. 2019

Current Opinion in Oncology

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“…Hwang et al found that fusion biopsy improved the detection rate of carcinoma in patients with prostate‐specific antigen levels of less than 10 ng/mL. All of these methods allow patients to choose focal therapy combined with active surveillance rather than higher‐risk invasive surgical or radiation therapy procedures for low‐ to intermediate‐risk carcinomas that are contained within the prostate capsule …”

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confidence: 99%

Histotripsy: The Next Generation of High‐Intensity Focused Ultrasound for Focal Prostate Cancer Therapy

Dubinsky

Khokhlova

et al. 2019

J of Ultrasound Medicine

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This article reviews the most current methods and technological aspects of highintensity focused ultrasound (HIFU), which is termed histotripsy. The rationale for focal therapy for prostate carcinoma rather than prostatectomy, which is being used extensively throughout Europe and Asia, is presented, and an argument for why HIFU is the modality of choice for primary therapy and recurrent disease is offered. The article presents a review of the technical advances including higher ultrasound beam energy than current thermal HIFU which allows for more accurate tissue targeting, less collateral tissue damage, and faster treatment times. Finally, the article presents a discussion about the advantage of ultrasound guidance for histotripsy in preference to magnetic resonance imaging guidance primarily based on cost, ease of application, and portability.

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“…Some are calling “super-active surveillance” a partial gland ablation (22), we don't necessarily agree this might be the precise term. However, we do with the notion that alternatives are needed to fill the gap between the yin and yang - traditional AS vs. radical treatment.…”

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confidence: 99%

Super active surveillance for low-risk prostate cancer | Opinion: Yes

Reis

Andrade

Bianco³

2019

Int. braz j urol.

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Prostate cancer is the most common solid tumor in men in western countries. Notwithstanding, its high incidence, most patients survive their prostate cancer diagnosis and die from other causes (1). This low cancer death event rate poses remarkable challenges for both patients and their treating physicians. Fundamentally the "overs", meaning overdiagnosis and overtreatment (2). Both particularly important as significant issues for patients arise as consequences of treatment. Distastefully, urinary incontinence and erectile dysfunction, among other, both exerting substantial impact in quality of life (3). This decade has witnessed results from three randomized trials. These robust studies clearly pointed to a limited benefit of definitive intervention such as surgery or radiation vs. surveillance modalities. The lack of differences in all cause survival and the relative low rate of metastasis 10 and 15 years after diagnosis have changed dramatically our knowledge on what is best to do when a man presents with a newly diagnosed prostate cancer (4-6). Not surprisingly, active surveillance (AS) has become a definitive alternative and common option. This strategy of management certainly decreased the morbidity rates associated to radical surgery or radiation (7). Specifically, AS is now a preferred option for many men with low-risk prostate cancer, gaining worldwide adoption due to robust data and is currently highlighted by many guidelines as the best treatment strategy for men with low risk (8, 9). What constitutes the best approach to AS is an open question, as many protocols currently exists. However, to the patient selection questions, the field of urology sets the tone in low risk-PSA <10 ng/ml, WHO GG1 and a clinical stage T1c/T2a. There are several stricter protocols that have been developed and tested for AS. The Epstein criteria of ≤2 positive cores, <50% core involvement, and PSA density <0.15 ng/ml/cm³ carries 10 years rates of overall survival, cancer-specific survival, and metastasis-free survival of 94%, 99.9%, and 99.4%, respectively. Importantly, at 15 years, oncological outcomes such as metastasis-free survival and cancer specific survival change little (10). In Canada, specifically Klotz and collaborators have reported on single-arm cohorts of low-risk patients (Gleason score ≤6 and serum PSA level ≤10 ng/mL) and favorable intermediate-risk patients (serum PSA ≤15 ng/mL or a Gleason score of 7 [3+4]). The investigators reported 10-and 15-year metastasis-free survival rates of 96% and 95% vs 91% and 82% for low vs. intermediate

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“Super-active surveillance”: MRI ultrasound fusion biopsy and ablation for less invasive management of prostate cancer

Cited by 18 publications

References 101 publications

Contemporary treatments in prostate cancer focal therapy

Contemporary treatments in prostate cancer focal therapy

Histotripsy: The Next Generation of High‐Intensity Focused Ultrasound for Focal Prostate Cancer Therapy

Super active surveillance for low-risk prostate cancer | Opinion: Yes

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