Abstract Archives of the RSNA, 2011
Jin Wei Kwek MBBS,FRCR, Presenter: Nothing to Disclose
Christopher WS Cheng MBBS,MRCS, Abstract Co-Author: Nothing to Disclose
Choon Hua Thng MBBS, Abstract Co-Author: Nothing to Disclose
Weber Kam On Lau, Abstract Co-Author: Nothing to Disclose
James Khoo MD, Abstract Co-Author: Nothing to Disclose
To evaluate safety and short term efficacy of focal therapy using MRgFUS and real time MR thermometry for treatment of the patients with low-risk, early-stage organ-confined prostate cancer, who may currently be on active surveillance.
An IRB approved prospective single-arm phase 1 trial. Inclusion criteria: 50 to 75 year old patients with early-stage organ-confined prostate cancer (cT1c and cT2a, N0, M0), diagnosed with TRUS guided transperineal biopsy (TPBx), one or two lesions each less than 10mm; Gleason score <= 6, PSA < 10 ng/dl and no contraindications to MR. CT pelvis performed to identify pelvic calcifications and multiparametric MR imaging for identification of tumour foci and radiological staging. Under regional anesthesia, MR localization of target based on mapping biopsy findings and MR identified tumour focus (if present) followed by MRgFUS ablation with real time thermometry. The critical areas of the rectum, urethra, bladder base and neurovascular bundles were excluded from beam path. An immediate post treatment contrast-enhanced MR was performed to outline the non-perfused treated area, followed by a repeat MRI after 1 and 6 month and repeat TPBx mapping biopsy at 6 months.
7 patients underwent this procedure. Post-treatment MRI demonstrated the desired non-perfused areas corresponding to the plan and treated tumour volume ranged from 9.7 to 24.2 cc that remained stable after one month. A decrease of 10-22% in non-perfused volume was noted after 6 months for the first 3 patients but their repeat biopsies were negative. The follow-up multiparametric MRI scans were negative for tumour foci and none have experienced biochemical failure. All patients experience only minimal discomfort after treatment and voided normally after indwelling catheter was removed. No complications were observed. No significant change in the Quality of Life (QoL) score noted so far.
MRgFUS is a safe treatment with minimal morbidity and no complications experienced. Initial efficacy demonstrated by the non-perfusion on contrast-enhanced MRI corresponding to treatment plan and confirmed by repeat biopsy after 6 months for first 3 patients.
PSA screening results in increased detection of early prostate cancer and focal therapy with MRGgFUS can potentially eradicate all tumour foci while preserving urinary, sexual and bowel function.
Kwek, J,
Cheng, C,
Thng, C,
Lau, W,
Khoo, J,
Focal Therapy of Early Prostate Cancer with Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS). Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL.
http://archive.rsna.org/2011/11015621.html