Multiparametric MRI (mpMRI): Guided Focal Therapy
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.
KeywordsMultiparametric magnetic resonance imaging Focal therapy High-intensity focused ultrasound (HIFU) Cryotherapy Laser interstitial therapy (LIT)
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.
An example of real-time thermal monitoring of treatment effect during MRI-guided laser interstitial thermal therapy (MOV 14,581 kb)
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