focal-laser-ablation-of-prostate-cancer-an-office-procedure

Focal Laser Ablation of Prostate Cancer: An Office Procedure

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually ...

University of California Los Angeles

We have developed a system for evaluating magnetic resonance imaging of prostate cancer, using patient-specific 3D printed molds to facilitate MR-histology correlation. Prior to radical prostatectomy a patient receives a multiparametric MRI, which an expert genitourinary radiologist uses to identify and contour regions suspicious for disease. The same MR series is used to generate a prostate contour, which is the basis for design of a patient-specific mold. The 3D printed mold contains a series of evenly spaced parallel slits, each of which corresponds to a known MRI slice. After surgery, the patient's specimen is enclosed within the mold, and all whole-mount levels are obtained simultaneously through use of a multi-bladed slicing device. The levels are then formalin fixed, processed, and delivered to an expert pathologist, who identifies and grades all lesions within the slides. Finally, the lesion contours are loaded into custom software, which elastically warps them to fit the MR prostate contour. The suspicious regions on MR can then be directly compared to lesions on histology. Furthermore, the false-negative and false-positive regions on MR can be retrospectively examined, with the ultimate goal of developing methods for improving the predictive accuracy of MRI. This work presents the details of our analysis method, following a patient from diagnosis through the MR-histology correlation process. For this patient MRI successfully predicted the presence of cancer, but true lesion volume and extent were underestimated. Most cancer-positive regions missed on MR were observed to have patterns of low T2 signal, suggesting that there is potential to improve sensitivity. 

A system for evaluating magnetic resonance imaging of prostate cancer using patient-specific 3D printed molds.

We evaluated the accuracy of magnetic resonance imaging in determining the size and shape of localized prostate cancer.

Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient Specific Molds to Correlate Images with Whole Mount Pathology.

Herein, we describe a case of a 63-year-old male who underwent magnetic resonance imaging (MRI)-guided biopsy of a suspicious lesion in the prostate followed by focal laser ablation. Radical prostatectomy was performed 15 months following focal laser ablation for persistent cancer adjacent to the treatment zone. We provide images from the initial MRI, postablation MRI, and the whole-mount radical prostatectomy specimen. The present case demonstrates the confined, localized effect of focal laser ablation, and also illustrates the advantage of expanded treatment margins.

Focal Laser Ablation of Prostate Cancer.

Focal laser ablation is a potential treatment in some men with prostate cancer. Currently focal laser ablation is performed by radiologists in a magnetic resonance imaging unit (in bore). We evaluated the safety and feasibility of performing focal laser ablation in a urology clinic (out of bore) using magnetic resonance imaging-ultrasound fusion for guidance.

Focal Laser Ablation of Prostate Cancer: Feasibility of Magnetic Resonance Imaging-Ultrasound Fusion for Guidance.

We assessed focal therapy eligibility in men who underwent multiparametric magnetic resonance imaging and targeted biopsy with correlation to whole mount histology after radical prostatectomy.

Focal Therapy Eligibility Determined by Magnetic Resonance Imaging/Ultrasound Fusion Biopsy.

Patient-specific 3D-printed molds and ex vivo MRI of the resected prostate have been two important strategies to align MRI with whole-mount histopathology (WMHP) for prostate cancer (PCa) research, but the combination of these two strategies has not been systematically evaluated.

A system using patient-specific 3D-printed molds to spatially align in vivo MRI with ex vivo MRI and whole-mount histopathology for prostate cancer research.

The SPARED CRN (Study of Prostate Ablation Related Energy Devices Coordinated Registry Network) is a private-public partnership between academic and community urologists, the FDA (U.S. Food and Drug Administration), the Medical Device Epidemiology Network and device manufacturers to examine the safety and effectiveness of technologies for partial gland ablation in men with localized prostate cancer.

Article	Year
A system for evaluating magnetic resonance imaging of prostate cancer using patient-specific 3D printed molds. American journal of clinical and experimental urology\| PubMed ID: 25374914	2014
Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient Specific Molds to Correlate Images with Whole Mount Pathology. The Journal of urology\| PubMed ID: 27484386	2017
Focal Laser Ablation of Prostate Cancer. Urology\| PubMed ID: 27720973	2017
Focal Laser Ablation of Prostate Cancer: Feasibility of Magnetic Resonance Imaging-Ultrasound Fusion for Guidance. The Journal of urology\| PubMed ID: 28396184	2017
Focal Therapy Eligibility Determined by Magnetic Resonance Imaging/Ultrasound Fusion Biopsy. The Journal of urology\| PubMed ID: 28830754	2018
A system using patient-specific 3D-printed molds to spatially align in vivo MRI with ex vivo MRI and whole-mount histopathology for prostate cancer research. Journal of magnetic resonance imaging : JMRI\| PubMed ID: 30069968	2019
SPARED Collaboration: Patient Selection for Partial Gland Ablation in Men with Localized Prostate Cancer. The Journal of urology\| PubMed ID: 31144591	2019
Reply by Authors. The Journal of urology\| PubMed ID: 31364932	2019

Alan Priester

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