European radiology · 2026
Optimizing prostate cancer treatment with MR-guided focused ultrasound: the role of expanded ablation-to-lesion volume ratio.
СтатьяМногоцентровое исследованиеКлиническое исследование II фазыНазвание и аннотация: Перевод в очереди
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Bitton Rachelle R, Vertosick Emily, Khandwala Yash, Korol Gena, Vickers Andrew, Ehdaie Behfar, Sonn Geoffrey, Ghanouni Pejman
Аннотация
OBJECTIVE: To determine which treatment parameters optimize focal therapy for intermediate-risk prostate cancer by balancing oncologic control with healthy tissue preservation, in a phase 2b multicenter trial of MRI-guided Focused Ultrasound (MRgFUS). Additionally, to assess the relationship of ablation volume relative to lesion volume with oncologic outcomes, urinary, and erectile function.
MATERIALS AND METHODS: In this retrospective interpretation of prospectively acquired data, the non-perfused volume (NPV) of prostate tissue encompassing the MRI-visible lesion volume defined the ablation-volume-to-lesion-volume ratio (ALVR). Oncologic efficacy was assessed as the absence of clinically significant (GGG ≥ 2) cancer in the treatment zone at 24-month biopsy. Associations between ALVR and outcomes were assessed using Student's t-tests. Baseline characteristics were compared using Kruskal-Wallis tests.
RESULTS: Eighty-nine men (mean age, 63 years ± 7) had MRI-visible lesions with a volume of 0.47 mL (IQR: 0.20-0.95), with a surrounding NPV of 6.9 mL (IQR: 5.2-10.4). Men achieving oncologic efficacy had twice the ALVR compared to those with recurrence at the treatment site (17 vs 8, mean difference 8.8, 95% CI: 2.1, 16, p = 0.013). Increasing NPV relative to total prostate volume did not improve oncologic outcomes. Baseline characteristics did not significantly differ between men with and without GGG ≥ 2 at 24-month biopsy. ALVR did not differ in men with new erectile dysfunction (mean difference in ALVR: 2.1, 95% CI: -12, 16, p = 0.8) or urinary symptoms (mean difference in ALVR 4.0, 95% CI: -21, 29, p = 0.71).
CONCLUSIONS: In patients with intermediate-risk prostate cancer, higher ALVR was associated with superior 2-year oncologic outcomes without increased risk of urinary or erectile dysfunction.
KEY POINTS: Question What treatment parameters optimize focal therapy for prostate cancer by balancing healthy tissue preservation with favorable oncologic outcomes? Findings Patients without residual cancer at 24-month biopsy had twice the ALVR of those with recurrence, with no adverse impact on erectile or urinary function. Clinical relevance While fixed intra-prostatic margins (e.g., 5 mm or 10 mm) are commonly prescribed in focal therapy, this study highlights the importance of scaling the ALVR in the treatment plan to achieve sufficient oncologic coverage.
MATERIALS AND METHODS: In this retrospective interpretation of prospectively acquired data, the non-perfused volume (NPV) of prostate tissue encompassing the MRI-visible lesion volume defined the ablation-volume-to-lesion-volume ratio (ALVR). Oncologic efficacy was assessed as the absence of clinically significant (GGG ≥ 2) cancer in the treatment zone at 24-month biopsy. Associations between ALVR and outcomes were assessed using Student's t-tests. Baseline characteristics were compared using Kruskal-Wallis tests.
RESULTS: Eighty-nine men (mean age, 63 years ± 7) had MRI-visible lesions with a volume of 0.47 mL (IQR: 0.20-0.95), with a surrounding NPV of 6.9 mL (IQR: 5.2-10.4). Men achieving oncologic efficacy had twice the ALVR compared to those with recurrence at the treatment site (17 vs 8, mean difference 8.8, 95% CI: 2.1, 16, p = 0.013). Increasing NPV relative to total prostate volume did not improve oncologic outcomes. Baseline characteristics did not significantly differ between men with and without GGG ≥ 2 at 24-month biopsy. ALVR did not differ in men with new erectile dysfunction (mean difference in ALVR: 2.1, 95% CI: -12, 16, p = 0.8) or urinary symptoms (mean difference in ALVR 4.0, 95% CI: -21, 29, p = 0.71).
CONCLUSIONS: In patients with intermediate-risk prostate cancer, higher ALVR was associated with superior 2-year oncologic outcomes without increased risk of urinary or erectile dysfunction.
KEY POINTS: Question What treatment parameters optimize focal therapy for prostate cancer by balancing healthy tissue preservation with favorable oncologic outcomes? Findings Patients without residual cancer at 24-month biopsy had twice the ALVR of those with recurrence, with no adverse impact on erectile or urinary function. Clinical relevance While fixed intra-prostatic margins (e.g., 5 mm or 10 mm) are commonly prescribed in focal therapy, this study highlights the importance of scaling the ALVR in the treatment plan to achieve sufficient oncologic coverage.