Evaluation of Focal Ablation of Magnetic Resonance Imaging Defined Prostate Cancer Using Magnetic Resonance Imaging Controlled Transurethral Ultrasound Therapy with Prostatectomy as the Reference Standard

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• 作者：Elizabeth Ramsay^a ; Charles Mougenot^f ; ^&lowast ; ; Robert Staruch^g ; ^&lowast ; ; Aaron Boyes^a ; Mohammad Kazem^a ; Michael Bronskill^a ; ^&dagger ; ; Harry Foster^e ; Linda Sugar^b ; Masoom Haider^c ; ^&Dagger ; ; Laurence Klotz^d ; ^&dagger ; ; Rajiv Chopra^h ; ^&dagger ; ; ^{Rajiv.chopra@utsouthwestern.edu}
• 关键词：prostatic neoplasms ; high-intensity focused ultrasound ablation ; magnetic resonance imaging ; transurethral resection of prostate ; minimally invasive surgical procedures
• 刊名：The Journal of Urology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：197
• 期：1
• 页码：255-261
• 全文大小：3193 K
• 卷排序：197

文摘

We evaluated magnetic resonance imaging controlled transurethral ultrasound therapy as a treatment for magnetic resonance imaging defined focal prostate cancer using subsequent prostatectomy and histology as the reference standard.Materials and MethodsFive men completed this pilot study, which was approved by the institutional review board. Prior to radical prostatectomy focal tumors identified by magnetic resonance imaging were treated by coagulating targeted subtotal 3-dimensional volumes of prostate tissue using magnetic resonance imaging controlled transurethral focused ultrasound. Treatment was performed with a 3 Tesla clinical magnetic resonance imaging unit combined with modified clinical planning software for high intensity focused ultrasound therapy. After prostatectomy whole mount histological sections parallel to the magnetic resonance imaging treatment planes were used to compare magnetic resonance imaging measurements with thermal damage at the cellular level and, thus, evaluate treatment and target accuracy.ResultsThree-dimensional target volumes of 4 to 20 cc and with radii up to 35 mm from the urethra were treated successfully. Mean ± SD temperature control accuracy at the target boundary was −1.6 ± 4.8C and the mean spatial targeting accuracy achieved was −1.5 ± 2.8 mm. Mean treatment accuracy with respect to histology was −0.4 ± 1.7 mm with all index tumors falling inside the histological outer limit of thermal injury.ConclusionsMagnetic resonance imaging guided transurethral ultrasound therapy is capable of generating thermal coagulation and tumor destruction in targeted 3-dimensional angular sectors out to the prostate capsule for prostate glands up to 70 cc in volume. Ultrasound parameters needed to achieve ablation at the prostate capsule were determined, providing a foundation for future studies.