Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer

Laurence Klotz, Christian P. Pavlovich, Joseph Chin, Gencay Hatiboglu, Michael Koch, David Penson, Steven Raman, Aytekin Oto, Jurgen Fütterer, Marc Serrallach, James Relle, Yair Lotan, Axel Heidenreich, David Bonekamp, Masoom Haider, Temel Tirkes, Sandeep Arora, Katarzyna J. Macura, Daniel N. Costa, Thorsten PersigehlAllan J. Pantuck, Joyce Bomers, Mathieu Burtnyk, Robert Staruch, Scott Eggener

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

PURPOSE: Magnetic resonance imaging-guided transurethral ultrasound ablation uses directional thermal ultrasound under magnetic resonance imaging thermometry feedback control for prostatic ablation. We report 12-month outcomes from a prospective multicenter trial (TACT). MATERIALS AND METHODS: A total of 115 men with favorable to intermediate risk prostate cancer across 13 centers were treated with whole gland ablation sparing the urethra and apical sphincter. The co-primary 12-month endpoints were safety and efficacy. RESULTS: In all, 72 (63%) had grade group 2 and 77 (67%) had NCCN® intermediate risk disease. Median treatment delivery time was 51 minutes with 98% (IQR 95-99) thermal coverage of target volume and spatial ablation precision of ±1.4 mm on magnetic resonance imaging thermometry. Grade 3 adverse events occurred in 9 (8%) men. The primary endpoint (U.S. Food and Drug Administration mandated) of prostate specific antigen reduction ≥75% was achieved in 110 of 115 (96%) with median prostate specific antigen reduction of 95% and nadir of 0.34 ng/ml. Median prostate volume decreased from 37 to 3 cc. Among 68 men with pretreatment grade group 2 disease, 52 (79%) were free of grade group 2 disease on 12-month biopsy. Of 111 men with 12-month biopsy data, 72 (65%) had no evidence of cancer. Erections (International Index of Erectile Function question 2 score 2 or greater) were maintained/regained in 69 of 92 (75%). Multivariate predictors of persistent grade group 2 at 12 months included intraprostatic calcifications at screening, suboptimal magnetic resonance imaging thermal coverage of target volume and a PI-RADS™ 3 or greater lesion at 12-month magnetic resonance imaging (p <0.05). CONCLUSIONS: The TACT study of magnetic resonance imaging-guided transurethral ultrasound whole gland ablation in men with localized prostate cancer demonstrated effective tissue ablation and prostate specific antigen reduction with low rates of toxicity and residual disease.

Original languageEnglish (US)
Pages (from-to)769-779
Number of pages11
JournalThe Journal of Urology
Volume205
Issue number3
DOIs
StatePublished - Mar 1 2021

Keywords

  • image guided
  • magnetic resonance imaging
  • minimally invasive surgical procedures
  • prostatic neoplasms
  • radiotherapy
  • transurethral resection of prostate

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer'. Together they form a unique fingerprint.

Cite this