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World Journal of Urology

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Open Access 01-07-2015 | Topic Paper

Histological outcomes after focal high-intensity focused ultrasound and cryotherapy

Authors: Taimur T. Shah, Veeru Kasivisvanathan, Charles Jameson, Alex Freeman, Mark Emberton, Hashim U. Ahmed

Published in: World Journal of Urology | Issue 7/2015

Abstract

Introduction

Focal therapy has increasingly become an accepted treatment option for patients with localised prostate cancer. Most follow-up protocols use a mixture of protocol biopsies or “for cause” biopsies triggered by a rising PSA. In this paper, we discuss the histological outcomes from these biopsies and their use in guiding subsequent management and trial development.

Methods

We conducted a literature search and reviewed the post-treatment biopsy results from studies on focal HIFU and focal cryotherapy. We subsequently reviewed the results of three recently published consensus statements released discussing many of the issues concerning focal therapy.

Results

Research suggests that 1 in 5 of all post-treatment biopsies after focal therapy are positive. However, the majority of these seemed to be from the untreated portion of the gland or met criteria for clinically insignificant disease. The histological outcomes from focal therapy are promising and confirm its effectiveness in the short to medium term. Furthermore re-treatment is possible whilst maintaining a low-side-effect profile.

Conclusion

Debate is ongoing about the clinical significance of various levels of residual disease after focal therapy and the exact threshold at which to call failure within a patient who has had focal therapy.

FDA (2014) Executive summary: Ablatherm^® integrated imaging high intensity focused ultrasound (HIFU). Meeting of the Gastroenterology and Urology Devices Panel. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/Gastroenterology-UrologyDevicesPanel/UCM406819.pdf

Valerio M, Emberton M, Ahmed HU (2014) Re: Jarow et al: Drug and device development for localized prostate cancer: report of a Food and Drug Administration/American Urological Association public workshop (Urology 2014;83:975–979). Urology 84(3):732–733PubMedCrossRef

Ward JF, Jones JS (2012) Focal cryotherapy for localized prostate cancer: a report from the national Cryo On-Line Database (COLD) registry. BJU Int 109(11):1648–1654PubMedCrossRef

Ahmed HU (2009) The index lesion and the origin of prostate cancer. N Engl J Med 361(17):1704–1706PubMedCrossRef

Ahmed HU et al (2012) Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy? Lancet Oncol 13(11):e509–e517PubMedCrossRef

Moore CM, Azzouzi AR, Barret E, Villers A, Muir GH, Barber NJ, Bott S, Trachtenberg J, Arumainayagam N, Gaillac B, Allen C, Schertz A, Emberton M (2014) Determination of optimal drug dose and light dose index to achieve minimally invasive focal ablation of localised prostate cancer using WST11-vascular-targeted photodynamic (VTP) therapy. BJU Int. doi:10.1111/bju.12816

Moore CM et al (2011) Light penetration in the human prostate: a whole prostate clinical study at 763 nm. J Biomed Opt 16(1):015003PubMedCrossRef

Valerio M et al (2014) A prospective development study investigating focal irreversible electroporation in men with localised prostate cancer: nanoknife electroporation ablation trial (NEAT). Contemp Clin Trials 39(1):57–65PubMedCentralPubMedCrossRef

Shariat SF et al (2005) Pilot study of radiofrequency interstitial tumor ablation (RITA) for the treatment of radio-recurrent prostate cancer. Prostate 65(3):260–267PubMedCrossRef

10.

Johannsen M et al (2007) Thermotherapy of prostate cancer using magnetic nanoparticles: feasibility, imaging, and three-dimensional temperature distribution. Eur Urol 52(6):1653–1661PubMedCrossRef

11.

Mynderse L, Dixon C, Cabanas C, Rijo Cedano E, Huidobro C, Larson T (2014) Novel convective thermal water vapor therapy for prostate cancer: uniquely suited to zonal anatomy of the prostate—preliminary gross and microscopic findings using ex vivo and acute in vivo, surgical ablative studies. In: 7th international symposium on focal therapy and imaging in prostate and kidney cancer. Pasadena, LA, USA

12.

Meschenmoser K et al (2013) Targeting cancer with a bi-functional peptide: in vitro and in vivo results. In Vivo 27(4):431–442PubMed

13.

Polders DL, Steggerda M, van Herk M, Nichol K, Witteveen T, Moonen L, Nijkamp J, van der Heide UA (2015) Establishing implantation uncertainties for focal brachytherapy with I-125 seeds for the treatment of localized prostate cancer. Acta Oncol. doi:10.3109/0284186X.2014.995312 PubMed

14.

Ahmed HU et al (2011) Focal therapy for localized prostate cancer: a phase I/II trial. J Urol 185(4):1246–1254PubMedCrossRef

15.

Van Leenders GJ et al (2000) Histopathological changes associated with high intensity focused ultrasound (HIFU) treatment for localised adenocarcinoma of the prostate. J Clin Pathol 53(5):391–394PubMedCentralPubMedCrossRef

16.

Napoli A et al (2013) Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. Eur Urol 63(2):395–398PubMedCrossRef

17.

Onik G et al (1991) Percutaneous transperineal prostate cryosurgery using transrectal ultrasound guidance: animal model. Urology 37(3):277–281PubMedCrossRef

18.

Larson TR et al (2000) In vivo interstitial temperature mapping of the human prostate during cryosurgery with correlation to histopathologic outcomes. Urology 55(4):547–552PubMedCrossRef

19.

Koppie TM et al (1999) The efficacy of cryosurgical ablation of prostate cancer: the university of California, San Francisco experience. J Urol 162(2):427–432PubMedCrossRef

20.

Crouzet S et al (2014) Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. Eur Urol 65(5):907–914PubMedCrossRef

21.

Donnelly BJ et al (2010) A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer. Cancer 116(2):323–330PubMedCrossRef

22.

Barqawi AB et al (2014) Targeted focal therapy for the management of organ confined prostate cancer. J Urol 192(3):749–753PubMedCrossRef

23.

Bahn D et al (2012) Focal cryotherapy for clinically unilateral, low-intermediate risk prostate cancer in 73 men with a median follow-up of 3.7 years. Eur Urol 62(1):55–63PubMedCrossRef

24.

Truesdale MD et al (2010) An evaluation of patient selection criteria on predicting progression-free survival after primary focal unilateral nerve-sparing cryoablation for prostate cancer: recommendations for follow up. Cancer J 16(5):544–549PubMedCrossRef

25.

Lambert EH et al (2007) Focal cryosurgery: encouraging health outcomes for unifocal prostate cancer. Urology 69(6):1117–1120PubMedCrossRef

26.

Ellis DS, Manny TB Jr, Rewcastle JC (2007) Focal cryosurgery followed by penile rehabilitation as primary treatment for localized prostate cancer: initial results. Urology 70(6 Suppl):9–15PubMedCrossRef

27.

Onik G et al (2007) “Male lumpectomy”: focal therapy for prostate cancer using cryoablation. Urology 70(6 Suppl):16–21PubMedCrossRef

28.

Bahn DK et al (2006) Focal prostate cryoablation: initial results show cancer control and potency preservation. J Endourol 20(9):688–692PubMedCrossRef

29.

Muto S et al (2008) Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. Jpn J Clin Oncol 38(3):192–199PubMedCrossRef

30.

Fegoun ABE et al (2011) Focal therapy with high-intensity focused ultrasound for prostate cancer in the elderly. A feasibility study with 10 years follow-up. Int Braz J Urol 37(2):213–219 discussion 220-2 PubMed

31.

Ahmed HU et al (2012) Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Lancet Oncol 13(6):622–632PubMedCentralPubMedCrossRef

32.

Dickinson L, Ahmed HA, McCartan N, Freeman A, Kirkham A, Allen C, Hindley R, Emberton M (2012) Medium term out-comes following primary focal therapy using HIFU for localised prostate cancer. BJU Int 109(Suppl S7):6

33.

Van Velthoven R et al (2014) Primary zonal high intensity focused ultrasound for prostate cancer: results of a prospective phase IIa feasibility study. Prostate Cancer 2014:756189PubMedCentralPubMed

34.

Berge V et al (2014) Morbidity associated with primary high intensity focused ultrasound and redo high intensity focused ultrasound for localized prostate cancer. J Urol 191(6):1764–1769PubMedCrossRef

35.

Blana A et al (2006) Morbidity associated with repeated transrectal high-intensity focused ultrasound treatment of localized prostate cancer. World J Urol 24(5):585–590PubMedCrossRef

36.

Klotz L et al (2010) Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 28(1):126–131PubMedCrossRef

37.

Klotz L et al (2015) Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33(3):272–277PubMedCrossRef

38.

D’Alimonte L, Helou J, Sherman C, Loblaw A, Chung HT, Ravi A, Deabreu A, Zhang l, Morton G (2014) The clinical significance of persistent cancer cells on prostate biopsy after high dose-rate brachytherapy boost for intermediate-risk prostate cancer. Brachytherapy. doi:10.1016/j.brachy.2014.10.003 PubMed

39.

Zelefsky MJ et al (2008) Influence of local tumor control on distant metastases and cancer related mortality after external beam radiotherapy for prostate cancer. J Urol 179(4):1368–1373 discussion 1373 PubMedCentralPubMedCrossRef

40.

Yossepowitch O et al (2014) Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol 65(2):303–313PubMedCrossRef

41.

Onik G, Miessau M, Bostwick DG (2009) Three-dimensional prostate mapping biopsy has a potentially significant impact on prostate cancer management. J Clin Oncol 27(26):4321–4326PubMedCrossRef

42.

Radtke JP, Kuru TH, Boxler S, Alt CD, Popeneciu IV, Huettenbrink C, Klein T, Steinemann S, Bergstraesser C, Roethke M, Roth W, Schlemmer HP, Hohenfellner M, Hadaschik BA (2015) Comparative analysis of transperineal template saturation prostate biopsy versus magnetic resonance imaging targeted biopsy with magnetic resonance imaging-ultrasound fusion guidance. J Urol 193(1):87–94. doi:10.1016/j.juro.2014.07.098 PubMedCrossRef

43.

Kasivisvanathan V et al (2013) Transperineal magnetic resonance image targeted prostate biopsy versus transperineal template prostate biopsy in the detection of clinically significant prostate cancer. J Urol 189(3):860–866PubMedCrossRef

44.

Siddiqui MM et al (2013) Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy. Eur Urol 64(5):713–719PubMedCrossRef

45.

Wysock JS et al (2014) A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial. Eur Urol 66(2):343–351PubMedCrossRef

46.

Cool DW et al (2015) Evaluation of MRI-TRUS fusion versus cognitive registration accuracy for MRI-targeted, TRUS-guided prostate biopsy. AJR Am J Roentgenol 204(1):83–91PubMedCrossRef

47.

Crawford ED et al (2013) Clinical-pathologic correlation between transperineal mapping biopsies of the prostate and three-dimensional reconstruction of prostatectomy specimens. Prostate 73(7):778–787PubMedCrossRef

48.

Hu Y et al (2012) A biopsy simulation study to assess the accuracy of several transrectal ultrasonography (TRUS)-biopsy strategies compared with template prostate mapping biopsies in patients who have undergone radical prostatectomy. BJU Int 110(6):812–820PubMedCrossRef

49.

Ross HM et al (2012) Do adenocarcinomas of the prostate with Gleason score (GS) </=6 have the potential to metastasize to lymph nodes? Am J Surg Pathol 36(9):1346–1352PubMedCentralPubMedCrossRef

50.

Eggener SE et al (2011) Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol 185(3):869–875PubMedCentralPubMedCrossRef

51.

Haffner MC et al (2013) Tracking the clonal origin of lethal prostate cancer. J Clin Investig 123(11):4918–4922PubMedCentralPubMedCrossRef

52.

Bostwick DG et al (1993) Staging of early prostate cancer: a proposed tumor volume-based prognostic index. Urology 41(5):403–411PubMedCrossRef

53.

Biermann K et al (2010) Histopathological findings after treatment of prostate cancer using high-intensity focused ultrasound (HIFU). Prostate 70(11):1196–1200PubMedCrossRef

54.

Muller BG et al (2014) Role of multiparametric magnetic resonance imaging (MRI) in focal therapy for prostate cancer: a Delphi consensus project. BJU Int 114(5):698–707PubMedCrossRef

55.

Punwani S et al (2014) Prostatic cancer surveillance following whole-gland high-intensity focused ultrasound: comparison of MRI and prostate-specific antigen for detection of residual or recurrent disease. Br J Radiol 2012(85):720–728

56.

Kim CK et al (2008) MRI techniques for prediction of local tumor progression after high-intensity focused ultrasonic ablation of prostate cancer. AJR Am J Roentgenol 190(5):1180–1186PubMedCrossRef

57.

Del Vescovo R et al (2013) Dynamic contrast-enhanced MR evaluation of prostate cancer before and after endorectal high-intensity focused ultrasound. Radiol Med 118(5):851–862PubMedCrossRef

58.

Rouviere O et al (2010) Prostate cancer transrectal HIFU ablation: detection of local recurrences using T2-weighted and dynamic contrast-enhanced MRI. Eur Radiol 20(1):48–55PubMedCrossRef

59.

Donaldson IA, Alonzi R, Barratt D, Barret E, Berge V, Bott S, Bottomley D, Eggener S, Ehdaie B, Emberton M, Hindley R, Leslie T, Miners A, McCartan N, Moore CM, Pinto P, Polascik TJ, Simmons L, van der Meulen J, Villers A, Willis S, Ahmed HU (2015) Focal therapy: patients, interventions, and outcomes—a report from a consensus meeting. Eur Urol 67(4):771–777. doi:10.1016/j.eururo.2014.09.018 PubMedCentralPubMedCrossRef

60.

Muller BG, van den Bos W, Brausi M, Fütterer JJ, Ghai S, Pinto PA, Popeneciu IV, de Reijke TM, Robertson C, de la Rosette JJ, Scionti S, Turkbey B, Wijkstra H, Ukimura O, Polascik TJ (2015) Follow-up modalities in focal therapy for prostate cancer: results from a Delphi consensus project. World J Urol 14(2):e829–e829b. doi:10.1016/s1569-9056(15)60818-1

61.

van den Bos W et al (2014) Focal therapy in prostate cancer: international multidisciplinary consensus on trial design. Eur Urol 65(6):1078–1083PubMedCrossRef

62.

Cooperberg MR et al (2010) Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer 116(22):5226–5234PubMedCentralPubMedCrossRef

63.

Zelefsky MJ et al (2010) Metastasis after radical prostatectomy or external beam radiotherapy for patients with clinically localized prostate cancer: a comparison of clinical cohorts adjusted for case mix. J Clin Oncol 28(9):1508–1513PubMedCentralPubMedCrossRef

64.

Valerio M et al (2014) The role of focal therapy in the management of localised prostate cancer: a systematic review. Eur Urol 66(4):732–751PubMedCentralPubMedCrossRef

65.

Barqawi AB et al (2014) Targeted focal therapy in the management of organ confined prostate cancer. J Urol 192:749–753PubMedCrossRef

Title: Histological outcomes after focal high-intensity focused ultrasound and cryotherapy
Authors: Taimur T. Shah
Veeru Kasivisvanathan
Charles Jameson
Alex Freeman
Mark Emberton
Hashim U. Ahmed
Publication date: 01-07-2015
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 7/2015
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1561-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Histological outcomes after focal high-intensity focused ultrasound and cryotherapy

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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