Maya B. Mueller-Wolf MD, Presenter: Nothing to Disclose

Matthias Roethke MD, Abstract Co-Author: Nothing to Disclose

Sascha Pahernik MD, Abstract Co-Author: Nothing to Disclose

Boris Hadaschik, Abstract Co-Author: Nothing to Disclose

Timur Kuru MD, Abstract Co-Author: Nothing to Disclose

Gencay Hatiboglu, Abstract Co-Author: Nothing to Disclose

Ionel Valentin Popeneciu MD, Abstract Co-Author: Nothing to Disclose

Joseph Chin MD, Abstract Co-Author: Nothing to Disclose

Michele Billia MD, Abstract Co-Author: Nothing to Disclose

James D. Relle MD, Abstract Co-Author: Nothing to Disclose

Jason M. Hafron MD, Abstract Co-Author: Nothing to Disclose

Kiran R. Nandalur MD, Abstract Co-Author: Nothing to Disclose

Mathieu Burtnyk DIPLPHYS, Abstract Co-Author: Nothing to Disclose

Heinz-Peter Schlemmer MD, Abstract Co-Author: Nothing to Disclose

MRI-guided transurethral ultrasound ablation (MR-TULSA) is a novel minimally-invasive technology to treat organ-confined prostate cancer (PCa), aiming to provide local disease control with a low side-effect profile. Directional plane-wave high-intensity ultrasound generates a continuous volume of thermal coagulation shaped accurately to the prostate using real-time MR-thermometry and active temperature feedback control. A prospective, multi-institutional Phase I clinical study investigated safety, feasibility, and assessed efficacy of MR-TULSA treatment for PCa.

30 patients with biopsy-proven, low-risk prostate cancer (age ≥ 65y, T1c/T2a, PSA ≤ 10ng/ml, Gleason 6 (3+3)) were enrolled. MR-TULSA was performed for whole-gland prostate ablation using the PAD-105 (Profound Medical Inc., Canada) and a 3T MRI (Siemens, Germany). One treatment session was delivered under general anaesthesia and 3D active MR-thermometry feedback control. Thermal coagulation was confirmed on CE-MRI immediately after MR-TULSA and at 12 months.

MR-TULSA was well-tolerated by all patients. There were no intraoperative complications. Normal micturition resumed after catheter removal. Median (range) treatment time and prostate volume were 36 (24–61) min and 44 (21–95) ml, respectively. Maximum temperature measured during treatment depicted a continuous region of heating shaped accurately to the prostate to within 0.1 ± 1.3 mm, with average over- and under-targeted volumes of 0.8 and 1.0 ml, respectively. Immediate post-treatment cell kill, visualized by the peripheral region of enhancement surrounding the non-perfused volume, correlated well with the acute cell kill regions on MR-thermometry. Successful treatment was further indicated by a median PSA decrease from 5.8 to 0.7 ng/ml at 1 month (n=24), remaining stable to 0.7 ng/ml at 6 months (n=12).

MRI-guidance enables accurate treatment planning, real-time dosimetry and control of the thermal ablation volume. The Phase I clinical trial showed that whole-gland ablation of the prostate for localized PCa is feasible, safe, and accurate using MR-TULSA.

Whole-gland ablation can be safely and accurately achieved using MR-TULSA, which represents a minimally-invasive treatment option for organ-confined prostate cancer.

Mueller-Wolf, M, Roethke, M, Pahernik, S, Hadaschik, B, Kuru, T, Hatiboglu, G, Popeneciu, I, Chin, J, Billia, M, Relle, J, Hafron, J, Nandalur, K, Burtnyk, M, Schlemmer, H, MRI-Guided Transurethral Ultrasound Ablation for Treatment of Localized Prostate Cancer.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017262.html