Focal Ablation of Prostate Cancer

Abstract

The challenge to the urology community is to reduce the risks of screening and treatment by reducing the number of men undergoing unnecessary biopsy and whole-gland curative treatment of low-risk disease. There is compelling evidence that focal ablation of prostate cancer is truly minimally invasive and offers major functional advantages over whole-gland treatment.

Keywords: Focal ablation; High-intensity focused ultrasound; Irreversible electroporation; Prostate cancer screening; Prostate cancer treatment; Vascular-targeted photodynamic therapy.

Figure 1

Diagnostic pathway for men with an elevated prostate-specific antigen (PSA) levels. Risk levels are based on age, race, family history, PSA, PSA velocity, and PSA density. Biomarker positivity represents a 10% risk of aggressive significant cancer. Multiparametric MRI (mpMRI) positivity indicates PI-RADS ≤3. Active surveillance includes follow-up PSA, digital rectal examination, and, when indicated, mpMRI. MRFTB, MRI fusion target biopsy; SB, TRUS-guided biopsy; TPTB, transperineal template biopsy; TRUS, transrectal ultrasonography.

Figure 2

(A) T2-weighted image showing low signal intensity MRI lesion. (B) Low signal intensity of diffusion-weighted imaging. (C) Rapid uptake of contrast on dynamic contrast enhancement imaging. (D) Absent uptake of contrast following focal high-intensity focused ultrasound (HIFU) ablation of the MRI lesion with a 5-mm margin. (E) PI-RADS 2 lesion observed on post-ablation multiparametric MRI that was negative for cancer following MRI fusion target biopsy (MRFTB). DRE, digital rectal examination; GGG, Gleason grade group; IPSS, International Prostate Symptom Score; PSA, prostate-specific antigen; SHIM, Sexual Health Inventory for Men.