Current status and future prospective of focal therapy for localized prostate cancer: development of multiparametric MRI, MRI-TRUS fusion image-guided biopsy, and treatment modalities

AbstractMultiparametric magnetic resonance imaging (mpMRI) has been increasingly used to diagnose clinically significant prostate cancer (csPC) because of its usefulness in combination with anatomic and functional data. MRI-targeted biopsy, such as MRI-transrectal ultrasound (TRUS) fusion image-guided prostate biopsy, has high accuracy in the detection and localization of csPC. This novel diagnostic technique contributes to the development of tailor-made medicine as focal therapy, which cures the csPC while preserving the anatomical structures related to urinary and sexual function. In the early days of focal therapy, TRUS-guided systematic biopsy was used for patient selection, and treatment was performed for patients with low-risk PC. With the introduction of mpMRI and mapping biopsy, the treatment range is now determined based on individualized cancer localization. In recent prospective studies, 87.4% of treated patients had intermediate- and high-risk PC. However, focal therapy has two main limitations. First, a randomized controlled trial would be difficult to design because of the differences in pathological features between patients undergoing focal therapy and radical treatment. Therefore, pair-matched studies and/or historical controlled studies have been performed to compare focal therapy and radical treatment. Second, no long-term ( ≥ 10-year) follow-up study has been performed. However, recent prospective studies have encouraged the use of focal therapy ...
Source: International Journal of Clinical Oncology - Category: Cancer & Oncology Source Type: research

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CONCLUSION: Cognitive targeted prostate biopsy based on mpMRI presents a valuable addition to systematic biopsy in patients with repeated negative systematic biopsies but persistent clinical suspicion of prostate cancer. PMID: 32118378 [PubMed - in process]
Source: Croatian Medical Journal - Category: General Medicine Authors: Tags: Croat Med J Source Type: research
CONCLUSION: The frequency of histomorphological alterations is slightly higher in prostate tissues from TBs compared to SB. Only vascular alterations seem to be distinct for TBs. However, it has to be assumed that additional factors influence the false-negative rate of mpMRI/ultrasound fusion-guided TB. PMID: 32113858 [PubMed - as supplied by publisher]
Source: Urologic Oncology - Category: Urology & Nephrology Authors: Tags: Urol Oncol Source Type: research
The 3 Tesla (3T) magnetic resonance imaging (MRI) combined ultrasound (TRUS) targeted biopsy plus 12-core systematic biopsy (TBx  + 12-SBx) was considered a reliable method for prostate cancer (PCa) diagnosis. To find another optimal sampling scheme with fewer cores and the same efficiency as TBx + 12-SBx for prostate biopsy, 113 patients who underwent five different hypothetical sampling schemes were analyzed and com pared with TBx + 12-SBx. The detection rates of targeted biopsy plus 6-core lateral systematic biopsy (TBx + lateral 6-SBx) for PCa and clinically significant prostate cancer (csPCa) (99.1% an...
Source: Ultrasound in Medicine and Biology - Category: Radiology Authors: Tags: Original Contribution Source Type: research
We report 12-month outcomes from the TULSA-PRO Ablation Clinical Trial (TACT) pivotal study.
Source: Journal of Vascular and Interventional Radiology : JVIR - Category: Radiology Authors: Tags: Scientific Session 37 Source Type: research
To evaluate the changes of 3 Tesla (3T) mpMRI and prostate-specific antigen (PSA) parameters before and during multiple time points after whole gland prostate cancer (PCa) treatment using MRI-guided directional transurethral ultrasound ablation (TULSA)
Source: Journal of Vascular and Interventional Radiology : JVIR - Category: Radiology Authors: Tags: Scientific Session 37 Source Type: research
Focal laser ablation (FLA) for prostate cancer is usually performed in an MRI gantry, but can be performed outside MRI with transrectal ultrasound (TRUS) –MRI fusion. Relative costs were compared between the two approaches.
Source: Journal of Vascular and Interventional Radiology : JVIR - Category: Radiology Authors: Tags: Scientific e-Poster Source Type: research
Publication date: Available online 18 February 2020Source: Seminars in Ultrasound, CT and MRIAuthor(s): Devaki Shilpa Sudha Surasi, Brian Chapin, Chad Tang, Gregory Ravizzini, Tharakeswara Kumar BathalaAbstractProstate cancer (PCa) is the most common non-cutaneous malignancy in men and the second leading cause of cancer related death in the United States. Men with clinical suspicion of PCa undergo tissue sampling and based on features including the Gleason score, Prostate Specific antigen (PSA) levels and clinical tumor (T) stage, patients are risk stratified into 6 major groups based on National Comprehensive Cancer Netwo...
Source: Seminars in Ultrasound, CT and MRI - Category: Radiology Source Type: research
Abstract PURPOSE: Prostate cancer (PCa) is one of the most common cancers in elderly men worldwide. Systematic biopsy guided by transrectal ultrasound remains the standard for PCa diagnosis; however, the false negative rate is 10-20%. Multiparametric magnetic resonance imaging (mpMRI) allows PCa visualization with a more precise localization and a higher accuracy and specificity for the detection of PCa. The physician can mentally relocate the most appropriate area detected on the prebiopsy mpMRI, based on its zonal topography and anatomical landmarks, called cognitive fusion. Herein, we concentrated on the accura...
Source: Clinical Hemorheology and Microcirculation - Category: Hematology Authors: Tags: Clin Hemorheol Microcirc Source Type: research
Abstract OBJECTIVE: To analyze prostatic-specific antigen density (PSAD) according to the Prostate Imaging Reporting and Data System (PIRADSv.2) score, in order to determine how it should be used. METHODS: This correlative series considered 952 men with prostatic-specific antigen>3 ng/ml and/or abnormal digital rectal examination who were subjected to prostatic biopsy (PB) between 2016 and 2017. Of these men, 768 had no previous 5-α-reductase inhibitor use or history of prostate cancer (CaP) and had previously undergone 3-T multiparametric magnetic resonance imaging (mpMRI). In this sample, 549 men w...
Source: Urologic Oncology - Category: Urology & Nephrology Authors: Tags: Urol Oncol Source Type: research
ConclusionIn patients with PSA serum levels of 4∼10 ng/mL, bpMRI and bpMRI combined with PSAD achieve better performance than mpMRI in detecting csPCa; bpMRI has a higher specificity than mpMRI, which could decrease unnecessary biopsy, and may serve as a potential alternative to mpMRI to optimize clinical workup.
Source: Diagnostic and Interventional Imaging - Category: Radiology Source Type: research
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