MRI-guided focal laser ablation for prostate cancer followed by radical prostatectomy: correlation of treatment effects with imaging

• Published in: World journal of urology Vol. 35; no. 5; pp. 703 - 711
• Main Authors: Bomers, Joyce G. R., Cornel, Erik B., Fütterer, Jurgen J., Jenniskens, Sjoerd F. M., Schaafsma, H. Ewout, Barentsz, Jelle O., Sedelaar, J. P. Michiel, Hulsbergen-van de Kaa, Christina A., Witjes, J. Alfred
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2017; Springer Nature B.V
• Subjects: Aged; Humans; Laser Therapy - methods; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Nephrology; Oncology; Original; Original Article; Prostatectomy - methods; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Surgery, Computer-Assisted; Urology; Laser ablation; MRI; Prostate cancer; Focal therapy
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-016-1924-1

Purpose
To correlate treatment effects of MRI-guided focal laser ablation in patients with prostate cancer with imaging using prostatectomy as standard of reference.
Methods
This phase I study was approved by the Institutional Review Board. Three weeks prior to prostatectomy, five patients with histopathologically proven, low/intermediate grade prostate cancer underwent transrectal MRI-guided focal laser ablation. Per patient, only one ablation was performed to investigate the effect of ablation on the tissue rather than the effectiveness of ablation. Ablation was continuously monitored with real-time MR temperature mapping, and damage-estimation maps were computed. A post-ablation high-resolution T1-weighted contrast-enhanced sequence was acquired. Ablation volumes were contoured and measured on histopathology specimens (with a shrinkage factor of 1.15), T1-weighted contrast-enhanced images, and damage-estimation maps, and were compared.
Results
A significant volume correlation was seen between the ablation zone on T1-weighted contrast-enhanced images and the whole-mount histopathology section (
r
 = 0.94,
p
 = 0.018). The damage-estimation maps and histopathology specimen showed a correlation of
r
 = 0.33 (
p
 = 0.583). On histopathology, the homogeneous necrotic area was surrounded by a reactive transition zone (1–5 mm) zone, showing neovascularisation, and an increased mitotic index, indicating increased tumor activity.
Conclusions
The actual ablation zone was better indicated by T1-weighted contrast-enhanced than by damage-estimation maps. Histopathology results highlight the importance of complete tumor ablation with a safety margin.