V12-12: Office Based Magnetic Resonance Imaging-Ultrasound Fusion Guided Focal Cryotherapy of Prostate Cancer
The emergence of MRI-Ultrasound (MR/US) fusion biopsies has led to greater accuracy in targeting the prostate. Cryoablation for prostate cancer is well-established for partial or whole gland prostate ablation. NCT02381990 is a protocol aimed to evaluate outcomes of MR/US fusion targeted prostate cryoablation. While prostate cryoablation has been typically performed under general anesthesia, we patented a local anesthesia approach that enables cryoablation in an office setting (U.S. Provisional Patent 62/476,751). In this video, we demonstrate a pilot study of the feasibility and reproducibility of performing MR/US cryoablation in clinic using the MR/US fusion imaging.
Six men were diagnosed with clinically significant (Gleason grade ≥7) prostate cancer confined to the region of interest using Artemis® MR/US fusion biopsy. Men were positioned in lithotomy, and the perineum was prepped with betadine. The perineal nerves were infiltrated with 1% lidocaine followed by a peri-prostatic block. A Foley catheter was inserted. MR/US fusion was performed and then the cryotherapy probes were transperineally inserted into the regions of interest. Two freeze thaw cycles were performed and were monitored in real time. Four/six (67%) of men were discharged home with the Foley catheter for a median of 2 days, while it was removed following completion of cryotherapy in the remainder.
All six men underwent successful MR/US cryoablation under local anesthesia. Mean age was 74.1 (range 63-80) years. Mean prostate specific antigen was 8.7 (range 6.1-16.3). Median Gleason grade group was 2 (range 2-5). 2 cryotherapy probes were utilized in 5 men and 1 man required 3 probes. No Clavien classified complications, emergency room visits or readmissions were recorded within 30 days.
Transperineal MR/US fusion guided cryotherapy is safe and feasible under local anesthesia in the office setting. Longer follow-up is necessary to determine long-term functional and oncologic outcomes. This in-office paradigm has the potential to decrease costs.in the setting of value-based care.