Pier Luigi Di Paolo MD, Presenter: Nothing to Disclose

Gaia Cartocci MD, Abstract Co-Author: Nothing to Disclose

Fulvio Zaccagna MD, Abstract Co-Author: Nothing to Disclose

Gianluca Caliolo, Abstract Co-Author: Nothing to Disclose

Valeria Panebianco MD, Abstract Co-Author: Nothing to Disclose

Alessandro Napoli MD, Abstract Co-Author: Nothing to Disclose

To assess safety and initial effectiveness of non-invasive high intensity 3T MR guided focused Ultrasound (MRgFUS) treatment of localized prostate cancer in a phase I, treat and resection designed exploratory study.

On the basis of a power analysis, 11 patients with biopsy proven focal T2 prostate cancer (low-to-intermediate risk: PSA max 12 and Gleason max 3+4), confirmed on a previous multiparametric MR exam (Discovery 750, GE) including dynamic contrast enhanced (DCE) imaging (Gd-BOPTA, Bracco), underwent MRgFUS ablation (ExAblate, InSightec). All patients were scheduled to radical laparoscopic prostatectomy; MRgFUS treatment was carried out on the MR identifiable lesion (max 2) using a patient specific energy (3000-8500 J) and real time MR thermometry monitor for correct treatment location. Non-perfused volume (NPV) in the post-ablative MRI was than compared with excision pathology for necrosis assessment.

No significant complications were observed in all subjects during or immediately after the procedure. Procedure was validated by pathologist, that demonstrated extensive coagulative necrosis at the site of sonication surrounded by normal prostatic tissue with inflammatory changes; these features positively compared with immediate post-ablative MRI scan and NPV. At histology 10 patients were free of residual viable tumor within the treated area; in the remaining patient, 10% of residual tumor was observed within the NPV. There was a variable amount of isolated cancer tissue (Gleason max 7, 3+4) within the non-treated parenchyma that was neither identifiable at MRI nor at biopsy.

Results of our Phase I study suggest MR guided Focused Ultrasound as a safe and effective modality to determine >90% necrosis of identifiable prostate cancer; other prospective studies are needed to extend success rate in larger cohort.  

MR guided Focused Ultrasound is a safe and effective modality to determine >90% necrosis of identifiable prostate cancer.  

Di Paolo, P, Cartocci, G, Zaccagna, F, Caliolo, G, Panebianco, V, Napoli, A, Non-invasive Focal Therapy of Organ Confined Prostate Cancer: Phase I Study Using Magnetic Resonance Guided Focused Ultrasound Technology and Excision Pathology for Efficacy Assessment.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017085.html