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• W2069892897 abstract "Purpose/Objective(s)To describe a new treatment option for the management of recurrent prostate cancer after definitive brachytherapy.Materials/MethodsA 62-year-old gentleman with a history of cT1c Gleason 6(3+3) prostate cancer in 1 of 12 cores treated with brachytherapy in 2006 was referred in 2012 for clinical suspicion of recurrence. A multi-parametric prostate MRI (MP-MRI) that included T1-weighted, triplanar T2-weighted, diffusion weighted, dynamic contrast-enhanced, and MR spectroscopy sequences was performed and revealed a single 1.2 cm suspicious lesion in the right mid-base anterior central gland. Given the upward trend of his post-treatment PSA from a nadir of 1.1 mg/dL and MP-MRI findings, there was concern for biochemical failure. Subsequently, a MRI-guided biopsy was performed and confirmed Gleason 6 disease. After giving informed consent, the patient underwent treatment under a NIH institutional review board-approved protocol using a FDA-approved laser system. In gantry MRI provided guidance in locating the tumor lesion, guiding laser fiber placement, and confirming correct location. MR-thermal map imparted real-time monitoring of ablative zones.ResultsThe procedure was well-tolerated with no immediate intra- or post-operative complications. The patient stayed overnight for observation and was discharged the following day. Three month post-treatment MRI did not reveal any contrast uptake in the treatment area but only heterogeneous signal pattern consistent with necrosis. His 6-week and 3-month PSAs were 0.3 and 0.21 mg/dL, respectively. He continued to do well and reported no procedural-related urinary symptoms.ConclusionsMR-guided focal laser ablation appears to be a feasible and minimally-invasive option for small burden, recurrent disease after brachytherapy. Longer follow-up and a larger cohort of patients are required to demonstrate its safety and efficacy. This technique may give physicians more treatment options when managing their patients with recurrent cancer. Purpose/Objective(s)To describe a new treatment option for the management of recurrent prostate cancer after definitive brachytherapy. To describe a new treatment option for the management of recurrent prostate cancer after definitive brachytherapy. Materials/MethodsA 62-year-old gentleman with a history of cT1c Gleason 6(3+3) prostate cancer in 1 of 12 cores treated with brachytherapy in 2006 was referred in 2012 for clinical suspicion of recurrence. A multi-parametric prostate MRI (MP-MRI) that included T1-weighted, triplanar T2-weighted, diffusion weighted, dynamic contrast-enhanced, and MR spectroscopy sequences was performed and revealed a single 1.2 cm suspicious lesion in the right mid-base anterior central gland. Given the upward trend of his post-treatment PSA from a nadir of 1.1 mg/dL and MP-MRI findings, there was concern for biochemical failure. Subsequently, a MRI-guided biopsy was performed and confirmed Gleason 6 disease. After giving informed consent, the patient underwent treatment under a NIH institutional review board-approved protocol using a FDA-approved laser system. In gantry MRI provided guidance in locating the tumor lesion, guiding laser fiber placement, and confirming correct location. MR-thermal map imparted real-time monitoring of ablative zones. A 62-year-old gentleman with a history of cT1c Gleason 6(3+3) prostate cancer in 1 of 12 cores treated with brachytherapy in 2006 was referred in 2012 for clinical suspicion of recurrence. A multi-parametric prostate MRI (MP-MRI) that included T1-weighted, triplanar T2-weighted, diffusion weighted, dynamic contrast-enhanced, and MR spectroscopy sequences was performed and revealed a single 1.2 cm suspicious lesion in the right mid-base anterior central gland. Given the upward trend of his post-treatment PSA from a nadir of 1.1 mg/dL and MP-MRI findings, there was concern for biochemical failure. Subsequently, a MRI-guided biopsy was performed and confirmed Gleason 6 disease. After giving informed consent, the patient underwent treatment under a NIH institutional review board-approved protocol using a FDA-approved laser system. In gantry MRI provided guidance in locating the tumor lesion, guiding laser fiber placement, and confirming correct location. MR-thermal map imparted real-time monitoring of ablative zones. ResultsThe procedure was well-tolerated with no immediate intra- or post-operative complications. The patient stayed overnight for observation and was discharged the following day. Three month post-treatment MRI did not reveal any contrast uptake in the treatment area but only heterogeneous signal pattern consistent with necrosis. His 6-week and 3-month PSAs were 0.3 and 0.21 mg/dL, respectively. He continued to do well and reported no procedural-related urinary symptoms. The procedure was well-tolerated with no immediate intra- or post-operative complications. The patient stayed overnight for observation and was discharged the following day. Three month post-treatment MRI did not reveal any contrast uptake in the treatment area but only heterogeneous signal pattern consistent with necrosis. His 6-week and 3-month PSAs were 0.3 and 0.21 mg/dL, respectively. He continued to do well and reported no procedural-related urinary symptoms. ConclusionsMR-guided focal laser ablation appears to be a feasible and minimally-invasive option for small burden, recurrent disease after brachytherapy. Longer follow-up and a larger cohort of patients are required to demonstrate its safety and efficacy. This technique may give physicians more treatment options when managing their patients with recurrent cancer. MR-guided focal laser ablation appears to be a feasible and minimally-invasive option for small burden, recurrent disease after brachytherapy. Longer follow-up and a larger cohort of patients are required to demonstrate its safety and efficacy. This technique may give physicians more treatment options when managing their patients with recurrent cancer." @default.
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• W2069892897 date "2013-10-01" @default.
• W2069892897 modified "2023-10-14" @default.
• W2069892897 title "Salvage MR-Guided Focal Laser Ablation of Prostate Cancer After Brachytherapy" @default.
• W2069892897 doi "https://doi.org/10.1016/j.ijrobp.2013.06.918" @default.
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