MRI/US fusion-guided ultrafocal cryotherapy for localized prostate cancer: Technique and shortterm outcome

301914.09.20196 MinutenEnglisch


MRI/US fusion-guided ultrafocal cryotherapy for localized prostate cancer: Technique and shortterm outcome

M. Wolters1, A. Tiemeyer1, M.J. Peperhove2, U. Witzsch3, H. Tezval1, C.A. von Klot1, M.A. Kuczyk1, I. Peters1
Medizinische Hochschule Hannover, Klinik für Urologie und Urologische Onkologie, Hannover, Deutschland, 2Medizinische Hochschule Hannover, Institut für Diagnostische und Interventionelle Radiologie, Hannover, Deutschland, 3Krankenhaus Nordwest, Klinik für Urologie und Kinderurologie, Frankfurt am Main, Deutschland

Introduction: Cryotherapy in patients with localized prostate cancer (PCa) is mainly used in patients at low risk and usually performed as a hemiablation. Recent studies could demonstrate that hemiablation offers acceptable disease control with minor side effects. In this video, we demonstrate the technique of MRI/US fusion-guided ultrafocal cryoablation and present our initial results.
Material and methods: Between 2017 and 2018, we performed cryotherapy in 20 patients with low (n=6) and intermediate (n=14) risk PCa. 12 patients were treated focally (hemiablation) and 8 patients with an ultrafocal approach. All patients refused radical prostatectomy or radiation therapy .Informed consent for cryotherapy was signed. Ultrafocal ablation was carried out with the BioJet® fusion software (DK Technologies) and the Visual Ice™ cryoablation system (Galil Medical). Oncological (PSA) and functional (IPSS, Quality of life, IIEF and ICIQ) outcome was analyzed at 3, 6 and 12 months of follow up. Depending on PSA level, a control MRI and biopsy was performed at 6 or 12 months after intervention.
Results: Mean PSA level dropped significantly after 3 months (decrease >60%, p< 0.001). Until now, 6 patients have received a control biopsy after MRI at 6 or 12 months. In-field recurrence occurred in 2/6 (33%) patients (1 Gleason score 6 and 1 with 7a). Urinary symptoms remain unchanged, no high-grade incontinence was observed, IIEF score decreased significantly, but without impact on quality of life . Minor complications were observed in 3/20 (15%). 
Conclusion: Ultrafocal cryoablation with MRI/US guidance is technically feasible. Short-term results regarding QoL are similar to those recently published; oncological outcomes are very preliminary due to the small number of patients (6/20) receiving a control biopsy so far.



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