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
fustherapysymposium2011.org
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