MRI/TRUS-fusion guided focal HIFU-therapy of prostate cancer
MRI/TRUS-Fusion guided Focal HIFU-Therapy of Prostate Cancer
Jost von Hardenberg1, Niklas Westhoff1, Daniel Baumunk2#, 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.