Shyam Natarajan1, Tonye A Jones2, Alan M Priester3, Rory Geoghegan3, Patricia Lieu2, Merdie Delfin2, Ely Felker4, Daniel J A Margolis5, Anthony Sisk6, Allan Pantuck2, Warren Grundfest3, Leonard S Marks7. 1. Department of Urology, University of California-Los Angeles, Los Angeles, California; Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California. 2. Department of Urology, University of California-Los Angeles, Los Angeles, California. 3. Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California. 4. Department of Radiology, University of California-Los Angeles, Los Angeles, California. 5. Weill Cornell Medical College, New York, New York. 6. Department of Pathology, University of California-Los Angeles, Los Angeles, California. 7. Department of Urology, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California. Electronic address: lmarks@mednet.ucla.edu.
Abstract
PURPOSE: Focal laser ablation is a potential treatment in some men with prostate cancer. Currently focal laser ablation is performed by radiologists in a magnetic resonance imaging unit (in bore). We evaluated the safety and feasibility of performing focal laser ablation in a urology clinic (out of bore) using magnetic resonance imaging-ultrasound fusion for guidance. MATERIALS AND METHODS: A total of 11 men with intermediate risk prostate cancer were enrolled in this prospective, institutional review board approved pilot study. Magnetic resonance imaging-ultrasound fusion was used to guide laser fibers transrectally into regions of interest harboring intermediate risk prostate cancer. Thermal probes were inserted for real-time monitoring of intraprostatic temperatures during laser activation. Multiparametric magnetic resonance imaging (3 Tesla) was done immediately after treatment and at 6 months along with comprehensive fusion biopsy. RESULTS: Ten of 11 patients were successfully treated while under local anesthesia. Mean procedure time was 95 minutes (range 71 to 105). Posttreatment magnetic resonance imaging revealed a confined zone of nonperfusion in all 10 men. Mean zone volume was 4.3 cc (range 2.1 to 6.0). No CTCAE grade 3 or greater adverse events developed and no changes were observed in urinary or sexual function. At 6 months magnetic resonance imaging-ultrasound fusion biopsy of the treatment site showed no cancer in 3 patients, microfocal Gleason 3 + 3 in another 3 and persistent intermediate risk prostate cancer in 4. CONCLUSIONS: Focal laser ablation of prostate cancer appears safe and feasible with the patient under local anesthesia in a urology clinic using magnetic resonance imaging-ultrasound fusion for guidance and thermal probes for monitoring. Further development is necessary to refine out of bore focal laser ablation and additional studies are needed to determine appropriate treatment margins and oncologic efficacy.
PURPOSE: Focal laser ablation is a potential treatment in some men with prostate cancer. Currently focal laser ablation is performed by radiologists in a magnetic resonance imaging unit (in bore). We evaluated the safety and feasibility of performing focal laser ablation in a urology clinic (out of bore) using magnetic resonance imaging-ultrasound fusion for guidance. MATERIALS AND METHODS: A total of 11 men with intermediate risk prostate cancer were enrolled in this prospective, institutional review board approved pilot study. Magnetic resonance imaging-ultrasound fusion was used to guide laser fibers transrectally into regions of interest harboring intermediate risk prostate cancer. Thermal probes were inserted for real-time monitoring of intraprostatic temperatures during laser activation. Multiparametric magnetic resonance imaging (3 Tesla) was done immediately after treatment and at 6 months along with comprehensive fusion biopsy. RESULTS: Ten of 11 patients were successfully treated while under local anesthesia. Mean procedure time was 95 minutes (range 71 to 105). Posttreatment magnetic resonance imaging revealed a confined zone of nonperfusion in all 10 men. Mean zone volume was 4.3 cc (range 2.1 to 6.0). No CTCAE grade 3 or greater adverse events developed and no changes were observed in urinary or sexual function. At 6 months magnetic resonance imaging-ultrasound fusion biopsy of the treatment site showed no cancer in 3 patients, microfocal Gleason 3 + 3 in another 3 and persistent intermediate risk prostate cancer in 4. CONCLUSIONS: Focal laser ablation of prostate cancer appears safe and feasible with the patient under local anesthesia in a urology clinic using magnetic resonance imaging-ultrasound fusion for guidance and thermal probes for monitoring. Further development is necessary to refine out of bore focal laser ablation and additional studies are needed to determine appropriate treatment margins and oncologic efficacy.
Authors: Ely R Felker; Steven S Raman; David S K Lu; Mitch Tuttle; Daniel J Margolis; Fuad F ElKhoury; James Sayre; Leonard S Marks Journal: AJR Am J Roentgenol Date: 2019-07-30 Impact factor: 3.959
Authors: John R Heard; Aurash Naser-Tavakolian; Michael Nazmifar; Michael Ahdoot Journal: Prostate Cancer Prostatic Dis Date: 2022-03-04 Impact factor: 5.455
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Authors: R Geoghegan; A Santamaria; A Priester; L Zhang; H Wu; W Grundfest; L Marks; S Natarajan Journal: Int J Hyperthermia Date: 2019 Impact factor: 3.914
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Authors: A van Luijtelaar; B M Greenwood; H U Ahmed; A B Barqawi; E Barret; J G R Bomers; M A Brausi; P L Choyke; M R Cooperberg; S Eggener; J F Feller; F Frauscher; A K George; R G Hindley; S F M Jenniskens; L Klotz; G Kovacs; U Lindner; S Loeb; D J Margolis; L S Marks; S May; T D Mcclure; R Montironi; S G Nour; A Oto; T J Polascik; A R Rastinehad; T M De Reyke; J S Reijnen; J J M C H de la Rosette; J P M Sedelaar; D S Sperling; E M Walser; J F Ward; A Villers; S Ghai; J J Fütterer Journal: World J Urol Date: 2019-01-22 Impact factor: 4.226
Authors: Fabian Tollens; Niklas Westhoff; Jost von Hardenberg; Sven Clausen; Michael Ehmann; Frank G Zöllner; Anne Adlung; Dominik F Bauer; Stefan O Schoenberg; Dominik Nörenberg Journal: Radiologe Date: 2021-07-12 Impact factor: 0.635