Abstract
Introduction:
Focal therapy modalities have shown effectiveness in the treatment of localized prostate cancer. Nevertheless, each modality presents specific technical limitations, particularly when treating anterior lesions. Herein, we present step-by-step fusion-guided treatment techniques for anterior prostate cancer lesions, using irreversible electroporation (IRE) and focal cryotherapy (CRYO).
Materials and Methods:
In this video, two patients who were diagnosed with localized anterior prostate cancer lesions are presented. The first case is a 69-year-old man with favorable intermediate-risk disease and a 21 mm PIRADS-5 anterior prostate lesion who underwent IRE. The second case is an 81-year-old man with unfavorable intermediate-risk disease and a 24 mm PIRADS-5 anterior prostate lesion who underwent partial gland CRYO. The treatment modality was selected based on the surgeon’s expertise and shared decision-making.
Results:
MRI/ultrasound fusion imaging was used to visualize the index lesions, needle placement planning, and treatment monitoring. The IRE was performed using five electrodes, which created three treatment triangles. The double freeze-thaw technique was used for CRYO. Both surgeries were accomplished without intraoperative complications. The treatment success was ensured using post-procedure contrast-enhanced ultrasound demonstrating a lack of enhancement on the treated side. Operative time was 58 minutes for IRE and 146 minutes for CRYO. No 90-day complications were reported. PSA values showed a significant decrease postoperatively, and both patients reported favorable urination and erection after surgery.
Conclusions:
IRE and CRYO are both acceptable focal therapy modalities in patients with anterior prostate cancer lesions. MRI/ultrasound fusion imaging can optimize real-time treatment planning and monitoring.
Patient Consent Statement:
The authors confirm that written informed consent has been obtained from the involved patients, and they have given approval for this information to be published in this video.
Author Disclosure Statement:
Amir Lebastchi is a consultant for Koelis; Niranjan Nayar is a clinical director at Koelis.
Runtime of video: 7 mins 53 secs.