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Percutaneous MR-guided cryoablation of prostate cancer: initial experience

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Abstract

Objective

We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance.

Methods

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.

Results

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.

Conclusions

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.

Key Points

• 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.

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Authors and Affiliations

  1. Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091, Strasbourg, France

    Afshin Gangi, Georgia Tsoumakidou, Omar Abdelli & Xavier Buy

  2. Lsiit, University of Strasbourg, Strasbourg, France

    Michel de Mathelin

  3. Department of Urology, University Hospital of Strasbourg, Strasbourg, France

    Didier Jacqmin & Hervé Lang

Authors
  1. Afshin Gangi
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  2. Georgia Tsoumakidou
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  3. Omar Abdelli
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  4. Xavier Buy
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  5. Michel de Mathelin
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  6. Didier Jacqmin
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  7. Hervé Lang
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Correspondence to Afshin Gangi.

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Gangi, A., Tsoumakidou, G., Abdelli, O. et al. Percutaneous MR-guided cryoablation of prostate cancer: initial experience. Eur Radiol 22, 1829–1835 (2012). https://doi.org/10.1007/s00330-012-2411-8

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  • DOI: https://doi.org/10.1007/s00330-012-2411-8

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