Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer

Steve R. Zhou, Demetrios Simopoulos, Rajiv Jayadevan, Ely R. Felker, Merdie K. Delfin, Danielle E. Barsa, Lorna Kwan, Leonard S. Marks

Research output: Contribution to journalArticle

Abstract

Objective: To investigate safety, efficacy, and quality of life impact of hemi-gland cryotherapy for clinically-significant prostate cancer (CaP), when patient selection and follow-up includes MRI-guided biopsy. Methods: Twenty-nine men with unilateral CaP (all clinically significant with prostate volume <60 cc) were enrolled in a prospective observational trial of hemi-gland cryotherapy. Mean patient age was 68.7 years. Median prostate-specific antigen (PSA) was 6.6 ng/mL. MRI-guided biopsy (3T-MRI, Artemis US fusion) was used for diagnosis and repeated at 6-month follow-up in all men. Treatment was under general anesthesia using the BTG/Galil system. Validated questionnaires were used to determine effects of treatment on urinary and sexual function and quality of life. Results: Cryotherapy was completed satisfactorily in all 29 cases in <60 minutes with no intraoperative complications. Significant decreases in PSA (median decrease 5.6 ng/mL) and PSA density (median decrease 0.14 ng/mL/cc) were observed (P <.01). At 6 months, 23 patients (79%) demonstrated no residual cancer on follow-up MRI-guided biopsy of the treated side. Three patients (10%) revealed micro-residual disease. Three patients (10%) had residual cancer and underwent further treatment. Ipsilateral MRI lesions were present before treatment in 26 patients and after treatment in only 2, reflecting the gross ablative effect; however, MRI showed disappearance of lesions in 4 patients with residual tumor on biopsy. The single complication was 1 case of transient urinary retention; 85% of men who were sexually active continued without change after treatment. Voiding function was unchanged. Conclusion: Hemi-gland cryoablation for clinically-significant CaP is well-tolerated, and when patients are selected and followed by MRI/US fusion biopsy, cancer control appears promising at 6 months.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Cryosurgery
Prostatic Neoplasms
Biopsy
Cryotherapy
Residual Neoplasm
Prostate-Specific Antigen
Therapeutics
Quality of Life
Urinary Retention
Intraoperative Complications
General Anesthesia
Patient Selection
Prostate
Safety

ASJC Scopus subject areas

  • Urology

Cite this

Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer. / Zhou, Steve R.; Simopoulos, Demetrios; Jayadevan, Rajiv; Felker, Ely R.; Delfin, Merdie K.; Barsa, Danielle E.; Kwan, Lorna; Marks, Leonard S.

In: Urology, 01.01.2019.

Research output: Contribution to journalArticle

Zhou, Steve R. ; Simopoulos, Demetrios ; Jayadevan, Rajiv ; Felker, Ely R. ; Delfin, Merdie K. ; Barsa, Danielle E. ; Kwan, Lorna ; Marks, Leonard S. / Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer. In: Urology. 2019.
@article{3ebc52874fbc4b60ae7aeabee620cdf2,
title = "Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer",
abstract = "Objective: To investigate safety, efficacy, and quality of life impact of hemi-gland cryotherapy for clinically-significant prostate cancer (CaP), when patient selection and follow-up includes MRI-guided biopsy. Methods: Twenty-nine men with unilateral CaP (all clinically significant with prostate volume <60 cc) were enrolled in a prospective observational trial of hemi-gland cryotherapy. Mean patient age was 68.7 years. Median prostate-specific antigen (PSA) was 6.6 ng/mL. MRI-guided biopsy (3T-MRI, Artemis US fusion) was used for diagnosis and repeated at 6-month follow-up in all men. Treatment was under general anesthesia using the BTG/Galil system. Validated questionnaires were used to determine effects of treatment on urinary and sexual function and quality of life. Results: Cryotherapy was completed satisfactorily in all 29 cases in <60 minutes with no intraoperative complications. Significant decreases in PSA (median decrease 5.6 ng/mL) and PSA density (median decrease 0.14 ng/mL/cc) were observed (P <.01). At 6 months, 23 patients (79{\%}) demonstrated no residual cancer on follow-up MRI-guided biopsy of the treated side. Three patients (10{\%}) revealed micro-residual disease. Three patients (10{\%}) had residual cancer and underwent further treatment. Ipsilateral MRI lesions were present before treatment in 26 patients and after treatment in only 2, reflecting the gross ablative effect; however, MRI showed disappearance of lesions in 4 patients with residual tumor on biopsy. The single complication was 1 case of transient urinary retention; 85{\%} of men who were sexually active continued without change after treatment. Voiding function was unchanged. Conclusion: Hemi-gland cryoablation for clinically-significant CaP is well-tolerated, and when patients are selected and followed by MRI/US fusion biopsy, cancer control appears promising at 6 months.",
author = "Zhou, {Steve R.} and Demetrios Simopoulos and Rajiv Jayadevan and Felker, {Ely R.} and Delfin, {Merdie K.} and Barsa, {Danielle E.} and Lorna Kwan and Marks, {Leonard S.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.urology.2018.11.052",
language = "English (US)",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer

AU - Zhou, Steve R.

AU - Simopoulos, Demetrios

AU - Jayadevan, Rajiv

AU - Felker, Ely R.

AU - Delfin, Merdie K.

AU - Barsa, Danielle E.

AU - Kwan, Lorna

AU - Marks, Leonard S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To investigate safety, efficacy, and quality of life impact of hemi-gland cryotherapy for clinically-significant prostate cancer (CaP), when patient selection and follow-up includes MRI-guided biopsy. Methods: Twenty-nine men with unilateral CaP (all clinically significant with prostate volume <60 cc) were enrolled in a prospective observational trial of hemi-gland cryotherapy. Mean patient age was 68.7 years. Median prostate-specific antigen (PSA) was 6.6 ng/mL. MRI-guided biopsy (3T-MRI, Artemis US fusion) was used for diagnosis and repeated at 6-month follow-up in all men. Treatment was under general anesthesia using the BTG/Galil system. Validated questionnaires were used to determine effects of treatment on urinary and sexual function and quality of life. Results: Cryotherapy was completed satisfactorily in all 29 cases in <60 minutes with no intraoperative complications. Significant decreases in PSA (median decrease 5.6 ng/mL) and PSA density (median decrease 0.14 ng/mL/cc) were observed (P <.01). At 6 months, 23 patients (79%) demonstrated no residual cancer on follow-up MRI-guided biopsy of the treated side. Three patients (10%) revealed micro-residual disease. Three patients (10%) had residual cancer and underwent further treatment. Ipsilateral MRI lesions were present before treatment in 26 patients and after treatment in only 2, reflecting the gross ablative effect; however, MRI showed disappearance of lesions in 4 patients with residual tumor on biopsy. The single complication was 1 case of transient urinary retention; 85% of men who were sexually active continued without change after treatment. Voiding function was unchanged. Conclusion: Hemi-gland cryoablation for clinically-significant CaP is well-tolerated, and when patients are selected and followed by MRI/US fusion biopsy, cancer control appears promising at 6 months.

AB - Objective: To investigate safety, efficacy, and quality of life impact of hemi-gland cryotherapy for clinically-significant prostate cancer (CaP), when patient selection and follow-up includes MRI-guided biopsy. Methods: Twenty-nine men with unilateral CaP (all clinically significant with prostate volume <60 cc) were enrolled in a prospective observational trial of hemi-gland cryotherapy. Mean patient age was 68.7 years. Median prostate-specific antigen (PSA) was 6.6 ng/mL. MRI-guided biopsy (3T-MRI, Artemis US fusion) was used for diagnosis and repeated at 6-month follow-up in all men. Treatment was under general anesthesia using the BTG/Galil system. Validated questionnaires were used to determine effects of treatment on urinary and sexual function and quality of life. Results: Cryotherapy was completed satisfactorily in all 29 cases in <60 minutes with no intraoperative complications. Significant decreases in PSA (median decrease 5.6 ng/mL) and PSA density (median decrease 0.14 ng/mL/cc) were observed (P <.01). At 6 months, 23 patients (79%) demonstrated no residual cancer on follow-up MRI-guided biopsy of the treated side. Three patients (10%) revealed micro-residual disease. Three patients (10%) had residual cancer and underwent further treatment. Ipsilateral MRI lesions were present before treatment in 26 patients and after treatment in only 2, reflecting the gross ablative effect; however, MRI showed disappearance of lesions in 4 patients with residual tumor on biopsy. The single complication was 1 case of transient urinary retention; 85% of men who were sexually active continued without change after treatment. Voiding function was unchanged. Conclusion: Hemi-gland cryoablation for clinically-significant CaP is well-tolerated, and when patients are selected and followed by MRI/US fusion biopsy, cancer control appears promising at 6 months.

UR - http://www.scopus.com/inward/record.url?scp=85060526019&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060526019&partnerID=8YFLogxK

U2 - 10.1016/j.urology.2018.11.052

DO - 10.1016/j.urology.2018.11.052

M3 - Article

C2 - 30659903

AN - SCOPUS:85060526019

JO - Urology

JF - Urology

SN - 0090-4295

ER -