MR guided Focused Ultrasound in Locally Non-Advanced

Prostate Cancer

Sapienza

MRgFUSDpt of Radiological Sciences

Alessandro Napoli

MR guided non-invasive Lumpectomy

Focused Therapy

MR guided non-invasive Lumpectomy

Focused Therapy

MR guided non-invasive Lumpectomy

Focused Therapy

Phase I TrialTreat and Resect Protocol

To verify if MRgFUS ablation can determine necrosis of focal, locally non-advanced prostate cancer

and if these alterations can be identified using dynamic contrast enhanced (DCE) MRI.

Comparison with histopathology findings following RP

INCLUSION CRITERIA

• Patient of age between 50 to 75

• Patient with organ-confined Pca (cT1c and cT2a, N0, M0), diagnosed with TRUS biopsy (min:12 cores)

• Patient with PSA ≤ 10 ng/mL

• Gleason score 7 (3+4)

• Up to two (2) MR identifiable lesions

• No definite evidence of extracapsular extension

METHOD Prostate

EXCLUSION CRITERIA

• Patient under medications that can affect PSA for the last 3 months prior to MRgFUS treatment (Androgen Deprivation Treatment; alpha reductase inhibitors)

• Any rectal pathology, anomaly or previous treatment

• Identified calcification of 2 mm or more in largest diameter neighboring the rectal wall

• Bladder cancer

• Seminal vesicle/lymph node

• Prostate with multiple cystic lesions

METHOD Prostate

990 Elements

12 C

METHOD Prostate

METHOD Prostate

71 yo

Gleason 6 (3+3)

METHOD Prostate

71 yo

Gleason 6 (3+3)

METHOD Prostate

71 yo

Gleason 6 (3+3)

Planning

Thermometry

Real Time T mapping

Results Prostate

Results Prostate

Results Prostate

Pt Age Gleason MRI NPV(%) RP Histology (%)*

1 65 6(3+3) +++(2) 20 RRP 0

2 65 6(3+3) ++ 19 RRP 10

3 55 7(3+4) +++ 23 RRP 0

4 71 6(3+3) +++ 15 RRP 0

5 61 6(3+3) ++ 80 LRP 0

6 67 6(3+3) +++ 85 LRP 0

* Residual Cancer into the Treated Area

Results Prostate

67 yo

Gleason 6 (3+3)

PSA 9

Results Prostate

Base

Apex

Results Prostate

Discussion

Focal Therapy for Prostate: are we ready?

• Identify Index Lesion• Long term efficacy• Follow-up• PSA level - limitation

Conclusion

MR guided Focused Ultrasound in

Locally non-advanced Prostate Cancer

• Safe - Effective - Well Tolerated

• Long Procedure Set-up

• Ready for Clinical Implementation

RADIOLOGY

Roberto Passariello

Carlo Catalano

Valeria Panebianco

Beatrice Marincola Cavallo

Eugenio Marotta

Federica Ciolina

Gaia Cartocci

UROLOGY

Carlo De Dominicis

Costantino Leonardo

Federico Petrucci

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