Palliative radiofrequency ablation for recurrent prostate cancer

Abstract

Percutaneous radiofrequency ablation (RFA) is a minimally invasive local therapy for cancer. Its efficacy is now becoming well documented in many different organs, including liver, kidney, and lung. The goal of RFA is typically complete eradication of a tumor in lieu of an invasive surgical procedure. However, RFA can also play an important role in the palliative care of cancer patients. Tumors which are surgically unresectable and incompatible for complete ablation present the opportunity for RFA to be used in a new paradigm. Cancer pain runs the gamut from minor discomfort relieved with mild pain medication to unrelenting suffering for the patient, poorly controlled by conventional means. RFA is a tool which can potentially palliate intractable cancer pain. We present here a case in which RFA provided pain relief in a patient with metastatic prostate cancer with pain uncontrolled by conventional methods.

Fig. 1

Contrast-enhanced pre-RFA CT scan with the patient in the supine position shows a painful perirectal tumor (arrow).

Fig. 2

CT scan with the patient in the prone position during probe insertion. The RFA probe (thick arrow) is on the way to the distal edge of the perirectal tumor (thin arrow). Treatment was performed after deeper insertion to the distal edge of the tumor (thin arrow).

Fig. 3

Contrast-enhanced CT scan immediately after RFA with the patient in the prone position. The necrotic area in the center of the perirectal tumor enhancement post-RFA, but there is minimal residual enhancement at the periphery (arrow). Pain relief occurred despite residual enhancement.

Fig. 4

Contrast-enhanced CT scan 8 months after RFA with the patient in the supine position. The perirectal tumor (arrow) is unchanged in size but there is interval development of enhancement signifying tumor growth.