Day clinic High-Intensity Focused Ultrasound focal therapy to primary treatment of localized prostate cancer
Number:27ESURABS0087
Type:Scientific Electronic Presentation
Authors: Carolina Zaghini, Beatriz Ahmad, Bruno Pasquini, Ricardo Azze Natel, Antonio Rahal Junior, Guilherme Mariotti Mariotti, Arie Carneiro, Rodrigo Gobbo Garcia
Keywords:Prostate; High-Intensity Focused Ultrasound; Prostate Neoplasms; Focal Ablative Therapy; Magnetic Resonance Image.
SECTIONS
Objectives

The aim of this project is to demonstrate the safety and feasibility of day clinicHigh-Intensity Focused Ultrasound (HIFU) focal therapy (FT) as a primary option of treatment in a prospective study of 39 patients.


Material and methods

To identify the candidates it was taken in consideration serum PSA (<15 ng/ml); mpMRI with no extracapsular extension; no seminal vesicle invasion or pelvic lymph node disease; targeted magnetic resonance image (MRI) transrectal ultrasound (TRUS) fusion biopsy with  Gleason score (ISUP 1-3); unilateral disease, negative bone scintigraphy or when available, Ga-PSMA PET/RM; prostate volume; mild lower urinary tract symptoms, patients who refuse gold standard radical treatment like prostatectomy or active surveillance.

This research consists in a single-center prospective analysis of 39 patients with unilateral PCa candidates for FT (Hemigland, Zonal or Focal ablation) as the primary treatment option from August 2018 to March 2021. Of those 39 patients, 13 were excluded and 26 included.

 


Results

HIFU has the potential to provide an alternative to radical surgery or radiotherapy with fewer complications and similar oncological outcomes in selected patients. The proposal is a focal ablative therapy, which consists of a non-invasive, radiation-free treatment using a robotic arm, with real time MRI-TRUS image fusion. It needs only a single-shot, but if needed can be repeated with non-cumulative effect. HIFU uses a focused beam of ultrasound waves that thermally ablate a selected portion of the prostate gland. The more the gland is ablated, the better oncological results appear, but with worse functional results.

Hemi-gland ablation was performed in 20 patients and Focal ablation in 6 patients. 2 patients (5.1%) had refractory urinary retention treated with Transurethral resection of the prostate (TURP). None patient had urinary incontinence, worsening of erectile...

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Conclusions

This study demonstrates a significant improvement in the performance of prostate biopsy with MRI-TRUS fusion compared to random US-guided biopsies, detecting more high risk and fewer low-risk cancers, with potential clinical impact.