News and Resources
Below are key points from recent articles published on prostate cancer from top research groups. These articles help explain the role of MRI in biopsy, benefits of MRI and why focal treatment is the future of prostate cancer treatment. You can click on the links below to go directly to the source if you are interested in.
The Role of MRI in Biopsy
Current gold standard for biopsy is a transrectal ultrasound guided biopsy or “blind biopsy” which typically consists of 12 cores (A). TRUS biopsy routinely misses significant prostate cancers (B, C) and underestimates Gleason scores in up to half of patients (D) which has created a need for improved imaging and diagnosis technique. Recently, multi-parametric MRI has been shown to increase the diagnosis rate of significant prostate cancers while decreasing the diagnosis rate of insignificant prostate cancers (E, F). In addition, in-bore MR-guided biopsies have high yield of detection of clinically significant cancer in both patients with no prior prostate cancer and in active surveillance groups (O). Results with MR-guided biopsies are typically better and require fewer needed sticks (4 vs.10 samples) since the imaging is better.
Why Focal Laser Ablation?
Because of the high quality 3D images and state of the art capabilities of MRI, targeting of specific, diseased prostate tissue is possible. This has paved the way for focal laser ablation treatment of prostate cancer. FLA is a minimally-invasive modality that by utilizing MRI guidance can target the cancerous tissue and destroy it. A benefit of utilizing real-time MRI imaging is the temperature monitoring and feedback. This ensures safety for the surrounding anatomy. Studies have proven the excellent ability for the MRI guided LITT system to ablate and destroy targeted tissue while protecting surrounding critical structures (L, M). In fact, MRI guided laser ablation is being used in critical areas of the body to ablate epileptic foci in pediatric patients. Neurosurgeons are finding that it is safe to use in the brain, treating primary or metastatic tumors, mesial temporal lobe epilepsy and hypothalamic hemartomas which can cause frequent seizures in children. Most of these patients were discharged within one day and had minimal surgical complications or deficits, demonstrating the safety of the laser ablation and importance of temperature monitoring (L) .
Focal Laser Ablation is ground breaking treatment for men with low grade organ confined prostate cancer (Gleason score 6-7). FLA offers several benefits that traditional, whole gland therapies do not.
This includes (N):
Real-time MR imaging
Ability of MRI to almost ALWAYS find the target lesion
It is the most precise way to deliver ablative energy to tissue
It delivers homogenous tissue necrosis with sharp ablation margins ~ 1 mm
Employs MR thermometry (allows for optimal heat for ablation, while monitoring critical surrounding structures)
Real-time visualization of ablation
Immediate confirmation of treatment success
Repeatable and does not hamper other treatments in the future like surgery and radiation
Preserves urinary and erectile function
Outpatient setting with minimal recovery time
Want to Learn More?
If you’d like to learn more, here are some resources for further reading
- American Urological Association.
- Management of an Increasing Prostate-Specific Antigen Level Axer Negative Prostate Biopsy.
- How Reliable Is 12-Core Prostate Biopsy Procedure In The Detection Of Prostate Cancer?
- Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy
- Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance? http://www.ncbi.nlm.nih.gov/pubmed/25480312
- Prostate cancer detection rates of negative MP-MRIs.
- Optimization of Prostate Biopsy: the Role of Magnetic Resonance Imaging Targeted Biopsy in Detection, Localization and Risk Assessment. https://www.ncbi.nlm.nih.gov/pubmed/24769030
- American Cancer Society.
- Hypothalamic hamartomas: Optimal approach to clinical evaluation and diagnosis.
- Prostate MRI: diffusion-weighted imaging at 1.5T correlates better with prostatectomy Gleason Grades than TRUS-guided biopsies in peripheral zone tumours.
- Multi-parametric Magnetic Resonance Imaging (MRI) and Subsequent MRI/ultrasonography Fusion-guided Biopsy Increase the Detection of Anteriorly Located Prostate Cancers.
- Focal Laser Ablation for Localized Prostate Cancer: Principles, Clinical Trials, and Our Initial Experience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080850/