Advertisement

Multiparametric MRI (mpMRI): Guided Focal Therapy

  • Michele Fascelli
  • Amichai Kilchevsky
  • Arvin K. George
  • Peter A. PintoEmail author

Abstract

Approximately one in seven men will be diagnosed with prostate cancer during his lifetime. PSA screening has been blamed for increased rates of cancer detection, leading to subsequent overtreatment of disease. Overuse of definitive therapy has produced significant burdens, including excess costs, increasing patient morbidities, and decreased quality of life. Thus, there has been an increasing interest in minimally invasive focal therapies to treat prostate cancer. Advances in image-guided therapy have begun to emerge—utilizing the accurate tumor localization and improved disease staging of multiparametric MRI (mpMRI). MpMRI-guided therapies can potentially achieve equivalent oncologic efficacy to traditional whole gland therapies such as surgery and radiation, while avoiding the side effects of conventional treatment. The purpose of this chapter is to review briefly the basis of various focal therapy techniques such as cryotherapy, high intensity focused ultrasound, and laser interstitial therapy, and to discuss the results of recent clinical trials that demonstrate early outcomes in patients with prostate cancer treated with these methods.

Keywords

Multiparametric magnetic resonance imaging Focal therapy High-intensity focused ultrasound (HIFU) Cryotherapy Laser interstitial therapy (LIT) 

Notes

Disclosures

This work was supported by the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute, Center for Cancer Research, and the Center for Interventional Oncology. NIH and Philips Healthcare have a cooperative research and development agreement. NIH and Philips share intellectual property in the field.

This work was also made possible through the National Institutes of Health Medical Research Scholars Program, a public–private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from Pfizer Inc., The Doris Duke Charitable Foundation, The Alexandria Real Estate Equities, Inc. and Mr. and Mrs. Joel S. Marcus, and the Howard Hughes Medical Institute, as well as other private donors. For a complete list, please visit the Foundation website at: http://fnih.org/work/education-training-0/medical-research-scholars-program.

Supplementary material

Video 13.1

An example of real-time thermal monitoring of treatment effect during MRI-guided laser interstitial thermal therapy (MOV 14,581 kb)

References

  1. 1.
    Klotz L. Active surveillance: patient selection. Curr Opin Urol. 2013;23(3):239–44.PubMedGoogle Scholar
  2. 2.
    Chou R, Croswell JM, Dana T, Bougatsos C, Blazina I, Fu R, et al. Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(11):762–71.CrossRefPubMedGoogle Scholar
  3. 3.
    Schröder FH, Hugosson J, Roobol MJ, Tammela TLJ, Zappa M, Nelen V, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384(9959):2027–35.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367(3):203–13.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Stephenson SK, Chang EK, Marks LS. Screening and detection advances in magnetic resonance image-guided prostate biopsy. Urol Clin North Am. 2014;41(2):315–26.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Da Rosa MR, Milot L, Sugar L, Vesprini D, Chung H, Loblaw A, et al. A prospective comparison of MRI-US fused targeted biopsy versus systemic ultrasound-guided biopsy for detecting clinically significant prostate cancer in patients on active surveillance. J Magn Reson Imaging. 2014;21:00.Google Scholar
  7. 7.
    Fradet V, Kurhanewicz J, Cowan JE, Karl A, Coakley FV, Shinohara K, et al. Prostate cancer managed with active surveillance: role of anatomic MR imaging and MR spectroscopic imaging. Radiology. 2010;256(1):176–83.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Turkbey B, Rastinehad AR, Linehan WM, Wood BJ, Pinto PA. Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? Radiology. 2013;268(1):144–52.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Turkbey B, Mani H, Shah V, Rastinehad AR, Bernardo M, Pohida T, et al. Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol. 2011;186(5):1818–24.CrossRefPubMedGoogle Scholar
  10. 10.
    Yerram NK, Volkin D, Turkbey B, Nix J, Hoang AN, Vourganti S, et al. Low suspicion lesions on multiparametric magnetic resonance imaging predict for the absence of high-risk prostate cancer. BJU Int. 2012;110(11 Pt B):E783–8.Google Scholar
  11. 11.
    Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. Comparison of MR/ultrasound fusion–guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 2015;313(4):390.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Baco E, Ukimura O, Rud E, Vlatkovic L, Svindland A, Aron M, et al. Magnetic resonance imaging-transectal ultrasound image-fusion biopsies accurately characterize the index tumor: correlation with step-sectioned radical prostatectomy specimens in 135 patients. Eur Urol. 2014;17.Google Scholar
  13. 13.
    Turkbey B, Mani H, Aras O, Rastinehad AR, Shah V, Bernardo M, et al. Correlation of magnetic resonance imaging tumor volume with histopathology. J Urol. 2012;188(4):1157–63.CrossRefPubMedGoogle Scholar
  14. 14.
    Cornud F, Khoury G, Bouazza N, Beuvon F, Peyromaure M, Flam T, et al. Tumor target volume for focal therapy of prostate cancer-does multiparametric magnetic resonance imaging allow for a reliable estimation? J Urol. 2014;191(5):1272–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Cooper SM, Dawber RP. The history of cryosurgery. J R Soc Med. 2001;94(4):196–201.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Copper IS. Cryogenic surgery: a new method of destruction or extirpation of benign or malignant tissues. N Engl J Med. 1963;268:743–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Finley DS, Pouliot F, Miller DC, Belldegrun AS. Primary and salvage cryotherapy for prostate cancer. Urol Clin North Am. 2010;37(1):67–82. Table of Contents.CrossRefPubMedGoogle Scholar
  18. 18.
    Rees J, Patel B, MacDonagh R, Persad R. Cryosurgery for prostate cancer. BJU Int. 2004;93(6):710–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Tatli S, Acar M, Tuncali K, Morrison PR, Silverman S. Percutaneous cryoablation techniques and clinical applications. Diagn Interv Radiol. 2010;16(1):90–5.PubMedGoogle Scholar
  20. 20.
    Gangi A, Tsoumakidou G, Abdelli O, Buy X, de Mathelin M, Jacqmin D, et al. Percutaneous MR-guided cryoablation of prostate cancer: initial experience. Eur Radiol. 2012;22(8):1829–35.CrossRefPubMedGoogle Scholar
  21. 21.
    Abdelaziz S, Esteveny L, Renaud P, Bayle B, Barbé L, De Mathelin M, et al. Design considerations for a novel MRI compatible manipulator for prostate cryoablation. Int J Comput Assist Radiol Surg. 2011;6(6):811–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Caviezel A, Terraz S, Schmidlin F, Becker C, Iselin CE. Percutaneous cryoablation of small kidney tumours under magnetic resonance imaging guidance: medium-term follow-up. Scand J Urol Nephrol. 2008;42(5):412–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Josan S, Bouley DM, van den Bosch M, Daniel BL, Butts PK. MRI-guided cryoablation: In vivo assessment of focal canine prostate cryolesions. J Magn Reson Imaging. 2009;30(1):169–76.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Van den Bosch MAAJ, Josan S, Bouley DM, Chen J, Gill H, Rieke V, et al. MR imaging-guided percutaneous cryoablation of the prostate in an animal model: in vivo imaging of cryoablation-induced tissue necrosis with immediate histopathologic correlation. J Vasc Interv Radiol. 2009;20(2):252–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Woodrum DA, Kawashima A, Karnes RJ, Davis BJ, Frank I, Engen DE, et al. Magnetic resonance imaging-guided cryoablation of recurrent prostate cancer after radical prostatectomy: initial single institution experience. Urology. 2013;82(4):870–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Babaian RJ, Donnelly B, Bahn D, Baust JG, Dineen M, Ellis D, et al. Best practice statement on cryosurgery for the treatment of localized prostate cancer. J Urol. 2008;180:1993–2004.Google Scholar
  27. 27.
    Lynn JG, Zwemer RL, Chick AJ. The biological application of focused ultrasonic waves. Science. 1942;96(2483):119–20.CrossRefPubMedGoogle Scholar
  28. 28.
    Bradley WG. MR-guided focused ultrasound: a potentially disruptive technology. J Am Coll Radiol. 2009;6(7):510–3.CrossRefPubMedGoogle Scholar
  29. 29.
    Hynynen K, Damianou C, Darkazanli A, Unger E, Schenck JF. The feasibility of using MRI to monitor and guide noninvasive ultrasound surgery. Ultrasound Med Biol. 1993;19(1):91–2.CrossRefPubMedGoogle Scholar
  30. 30.
    Cline HE, Hynynen K, Watkins RD, Adams WJ, Schenck JF, Ettinger RH, et al. Focused US system for MR imaging-guided tumor ablation. Radiology. 1995;194(3):731–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Napoli A, Anzidei M, De Nunzio C, Cartocci G, Panebianco V, De Dominicis C, et al. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. Eur Urol. 2013;63(2):395–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Dickinson L, Ahmed HU, Kirkham AP, Allen C, Freeman A, Barber J, et al. A multi-centre prospective development study evaluating focal therapy using high intensity focused ultrasound for localised prostate cancer: the INDEX study. Contemp Clin Trials. 2013;36(1):68–80.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Dickinson L, Hu Y, Ahmed HU, Allen C, Kirkham AP, Emberton M, et al. Image-directed, tissue-preserving focal therapy of prostate cancer: a feasibility study of a novel deformable magnetic resonance-ultrasound (MR-US) registration system. BJU Int. 2013;112(5):594–601.PubMedCentralCrossRefPubMedGoogle Scholar
  34. 34.
    Partanen A, Yerram NK, Trivedi H, Dreher MR, Oila J, Hoang AN, et al. Magnetic resonance imaging (MRI)-guided transurethral ultrasound therapy of the prostate: a preclinical study with radiological and pathological correlation using customised MRI-based moulds. BJU Int. 2013;112(4):508–16.CrossRefPubMedGoogle Scholar
  35. 35.
    Funaki K, Fukunishi H, Sawada K. Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound Obstet Gynecol. 2009;34(5):584–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Furusawa H, Namba K, Thomsen S, Akiyama F, Bendet A, Tanaka C, et al. Magnetic resonance-guided focused ultrasound surgery of breast cancer: reliability and effectiveness. J Am Coll Surg. 2006;203(1):54–63.CrossRefPubMedGoogle Scholar
  37. 37.
    Liberman B, Gianfelice D, Inbar Y, Beck A, Rabin T, Shabshin N, et al. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. Ann Surg Oncol. 2009;16(1):140–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Kopelman D, Inbar Y, Hanannel A, Dank G, Freundlich D, Perel A, et al. Magnetic resonance-guided focused ultrasound surgery (MRgFUS). Four ablation treatments of a single canine hepatocellular adenoma. HPB (Oxford). 2006;8(4):292–8.CrossRefGoogle Scholar
  39. 39.
    Jolesz FA. MRI-guided focused ultrasound surgery. Annu Rev Med. 2009;60:417–30.PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Siddiqui K, Chopra R, Vedula S, Sugar L, Haider M, Boyes A, et al. MRI-guided transurethral ultrasound therapy of the prostate gland using real-time thermal mapping: initial studies. Urology. 2010;76(6):1506–11.CrossRefPubMedGoogle Scholar
  41. 41.
    Chopra R, Burtnyk M, N’djin WA, Bronskill M. MRI-controlled transurethral ultrasound therapy for localised prostate cancer. Int J Hyperthermia. 2010;26(8):804–21.CrossRefPubMedGoogle Scholar
  42. 42.
    Chopra R, Colquhoun A, Burtnyk M, N’djin WA, Kobelevskiy I, Boyes A, et al. MR imaging-controlled transurethral ultrasound therapy for conformal treatment of prostate tissue: initial feasibility in humans. Radiology. 2012;265(1):303–13.CrossRefPubMedGoogle Scholar
  43. 43.
    Rouvière O, Souchon R, Salomir R, Gelet A, Chapelon J-Y, Lyonnet D. Transrectal high-intensity focused ultrasound ablation of prostate cancer: effective treatment requiring accurate imaging. Eur J Radiol. 2007;63(3):317–27.CrossRefPubMedGoogle Scholar
  44. 44.
    Uchida T, Shoji S, Nakano M, Hongo S, Nitta M, Murota A, et al. Transrectal high-intensity focused ultrasound for the treatment of localized prostate cancer: eight-year experience. Int J Urol. 2009;16(11):881–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Deckers R, Rome C, Moonen CTW. The role of ultrasound and magnetic resonance in local drug delivery. J Magn Reson Imaging. 2008;27(2):400–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Rahmathulla G, Recinos PF, Kamian K, Mohammadi AM, Ahluwalia MS, Barnett GH. MRI-guided laser interstitial thermal therapy in neuro-oncology: a review of its current clinical applications. Oncology. 2014;87(2):67–82.CrossRefPubMedGoogle Scholar
  47. 47.
    Sander S, Beisland HO. Laser in the treatment of localized prostatic carcinoma. J Urol. 1984;132(2):280–1.PubMedGoogle Scholar
  48. 48.
    Sander S, Beisland HO, Fossberg E. Neodymion YAG laser in the treatment of prostatic cancer. Urol Res. 1982;10(2):85–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Raz O, Haider MA, Davidson SRH, Lindner U, Hlasny E, Weersink R, et al. Real-time magnetic resonance imaging-guided focal laser therapy in patients with low-risk prostate cancer. Eur Urol. 2010;58(1):173–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Woodrum DA, Gorny KR, Mynderse LA, Amrami KK, Felmlee JP, Bjarnason H, et al. Feasibility of 3.0T magnetic resonance imaging-guided laser ablation of a cadaveric prostate. Urology. 2010;75(6):1514.e1–6.Google Scholar
  51. 51.
    Stafford RJ, Shetty A, Elliott AM, Klumpp SA, McNichols RJ, Gowda A, et al. Magnetic resonance guided, focal laser induced interstitial thermal therapy in a canine prostate model. J Urol. 2010;184(4):1514–20.PubMedCentralCrossRefPubMedGoogle Scholar
  52. 52.
    Peters RD, Chan E, Trachtenberg J, Jothy S, Kapusta L, Kucharczyk W, et al. Magnetic resonance thermometry for predicting thermal damage: an application of interstitial laser coagulation in an in vivo canine prostate model. Magn Reson Med. 2000;44(6):873–83.CrossRefPubMedGoogle Scholar
  53. 53.
    Hoang AN, Volkin D, Yerram NK, Vourganti S, Nix J, Linehan WM, et al. Image guidance in the focal treatment of prostate cancer. Curr Opin Urol. 2012;22(4):328–35.CrossRefPubMedGoogle Scholar
  54. 54.
    Oto A, Sethi I, Karczmar G, McNichols R, Ivancevic MK, Stadler WM, et al. MR imaging-guided focal laser ablation for prostate cancer: phase I trial. Radiology. 2013;267(3):932–40.CrossRefPubMedGoogle Scholar
  55. 55.
    Cepek J, Chronik BA, Lindner U, Trachtenberg J, Davidson SRH, Bax J, et al. A system for MRI-guided transperineal delivery of needles to the prostate for focal therapy. Med Phys. 2013;40(1):012304.CrossRefPubMedGoogle Scholar
  56. 56.
    Colin P, Nevoux P, Marqa M, Auger F, Leroy X, Villers A, et al. Focal laser interstitial thermotherapy (LITT) at 980 nm for prostate cancer: treatment feasibility in Dunning R3327-AT2 rat prostate tumour. BJU Int. 2012;109(3):452–8.CrossRefPubMedGoogle Scholar
  57. 57.
    Lindner U, Lawrentschuk N, Weersink RA, Davidson SRH, Raz O, Hlasny E, et al. Focal laser ablation for prostate cancer followed by radical prostatectomy: validation of focal therapy and imaging accuracy. Eur Urol. 2010;57(6):1111–4.CrossRefPubMedGoogle Scholar
  58. 58.
    Viswanath S, Toth R, Rusu M, Sperling D, Lepor H, Futterer J, et al. Identifying quantitative in vivo multi-parametric MRI features for treatment related changes after laser interstitial thermal therapy of prostate cancer. Neurocomputing. 2014;144:13–23.CrossRefPubMedGoogle Scholar
  59. 59.
    Wenger H, Yousuf A, Oto A, Eggener S. Laser ablation as focal therapy for prostate cancer. Curr Opin Urol. 2014;24(3):236–40.PubMedCentralCrossRefPubMedGoogle Scholar
  60. 60.
    Lee T, Mendhiratta N, Sperling D, Lepor H. Focal laser ablation for localized prostate cancer: principles, clinical trials, and our initial experience. Rev Urol. 2014;16(2):55–66.PubMedCentralPubMedGoogle Scholar
  61. 61.
    Bozzini G, Colin P, Nevoux P, Villers A, Mordon S, Betrouni N. Focal therapy of prostate cancer: energies and procedures. Urol Oncol. 2013;31(2):155–67.CrossRefPubMedGoogle Scholar
  62. 62.
    Betrouni N, Lopes R, Puech P, Colin P, Mordon S. A model to estimate the outcome of prostate cancer photodynamic therapy with TOOKAD soluble WST11. Phys Med Biol. 2011;56(15):4771–83.CrossRefPubMedGoogle Scholar
  63. 63.
    Da Rosa MR, Trachtenberg J, Chopra R, Haider MA. Early experience in MRI-guided therapies of prostate cancer: HIFU, laser and photodynamic treatment. Cancer Imaging. 2011;11 Spec No:S3–8.Google Scholar
  64. 64.
    Chen JC, Moriarty JA, Derbyshire JA, Peters RD, Trachtenberg J, Bell SD, et al. Prostate cancer: MR imaging and thermometry during microwave thermal ablation-initial experience. Radiology. 2000;214(1):290–7.CrossRefPubMedGoogle Scholar
  65. 65.
    Terraz S, Cernicanu A, Lepetit-Coiffé M, Viallon M, Salomir R, Mentha G, et al. Radiofrequency ablation of small liver malignancies under magnetic resonance guidance: progress in targeting and preliminary observations with temperature monitoring. Eur Radiol. 2010;20(4):886–97.CrossRefPubMedGoogle Scholar
  66. 66.
    Onik G, Vaughan D, Lotenfoe R, Dineen M, Brady J. The “male lumpectomy”: focal therapy for prostate cancer using cryoablation results in 48 patients with at least 2-year follow-up. Urol Oncol. 2008;26(5):500–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Michele Fascelli
    • 1
  • Amichai Kilchevsky
    • 1
  • Arvin K. George
    • 1
  • Peter A. Pinto
    • 2
    Email author
  1. 1.Urologic Oncology BranchNational Cancer Institute—National Institutes of HealthBethesdaUSA
  2. 2.Prostate Cancer Division, Urologic Oncology BranchNational Cancer InstituteBethesdaUSA

Personalised recommendations