Mediathek

Abstract

MRI/TRUS-Fusion guided Focal HIFU-Therapy of Prostate Cancer

Jost von Hardenberg¹, Niklas Westhoff¹, Daniel Baumunk^2#, Daniel Hausmann³, Thomas Martini⁴, Alexander Marx⁵, Stefan Porubsky⁵, Martin Schostak², Maurice Stephan Michel¹, Manuel Ritter¹

¹Department of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany, ²Department of Urology and Pediatric Urology, University Hospital Magdeburg, Germany, ³Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany, ⁴Department of Urology, University Hospital Ulm, Germany, ⁵Institute of Pathology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; ^#present address: Outpatient Urology Practice, Backnang, Germany

Background: MRI/TRUS-fusion guided focal HIFU-therapy of the prostate cancer has recently been developed as a selective HIFU-therapy technique.

Objective: To describe step by step the workflow of focal HIFU-therapy supported by MRI/TRUS - guided image fusion and its potential pitfalls, address controversies concerning the indications, and report a series of treated patients.
Design, setting and participants: This single-center prospective study reports outcomes of patients treated from September 2014 – March 2016. Patients had low to early-intermediate risk prostate cancer. Follow-up was a minimum of 12-months.

Surgical procedure: Targeted transrectal MRI/TRUS-fusion guided HIFU was performed under general anesthesia using the Focal One® device (EDAP, France). A comprehensive control biopsy at 12 months was taken using the MRI/TRUS-fusion biopsy platform Artemis™ (Eigen, USA) combining targeted and systematic cores.

Measurements: 12-months post-procedural biopsies, PSA changes from baseline, patient-reported outcome measures (PROMs), Clavien-Dindo-classification to report complications.

Results and limitations: 19 patients were treated by focal HIFU, five by zonal HIFU. 20 patients underwent biopsies at 12-months or before, 8 patients had a positive biopsy within the HIFU treated zone and three outside. PROMs showed continence preservation in all patients but a reduction in potency. Only one complication > grade II occurred.