Percutaneous MR-guided cryoablation of prostate cancer: initial experience
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We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance.
Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason score: 6.45, mean prostate-specific antigen (PSA): 6.21 ng/ml, T1-2c/N0/M0, mean: prostate volume 36.44 ml). Free-hand probe positioning was performed under real-time MR imaging. Four to seven cryoprobes were inserted into the prostate, depending on gland volume. The ice ball was monitored using real-time and high-resolution BLADE multi-planar imaging. Patients were followed at 1, 3, 6, 9 and 12 months after the procedure with serum PSA level and post-ablation MRI.
Prostate cryoablation was technically feasible in 10/11 patients. The ice ball was clearly and sharply visualised in all cases as a signal-void area. Mean ice-ball volume was 53.3 ml. Mean follow-up was 15 months (range: 1–25). Mean PSA nadir was 0.33 ng/ml (range: 0.02–0.94 ng/ml). Mean hospitalisation was 5 days (range: 3–13). Complications included a urethro-rectal fistula, urinary infection, transient dysuria and scrotal pain.
MR-guided prostate cryoablation is feasible and promising, with excellent monitoring of the ice ball. Future perspectives could include the use of MR guidance for focal prostate cancer cryotherapy.
• Magnetic resonance allows precise positioning of cryoprobes with real-time imaging.
• High-resolution MRI allows excellent monitoring of the developing ice ball.
• Cryoablation of prostate cancer under MR guidance is technically feasible.
• Further work will refine the procedure and make it even safer.
KeywordsProstate cancer Percutaneous thermal ablation MR guidance Cryoablation Rectal thermal protection
- 5.Heidenreich A, Bolla M, Joniau S et al (2011) Guidelines on Prostate Cancer. European Association of Urology. www.uroweb.org