Some interesting information was presented at the Society of Interventional Radiology’s 35th Annual Scientific Meeting just held in Tampa, Fl. A potential future use of magnetic resonance (MR)-guided heat (laser interstitial thermal therapy) or cold (cryoablation) to treat the recurrence of prostate cancer after the surgical removal of the prostate gland (and in some cases after the failure of salvage radiation) was disclosed.
“Magnetic resonance-guided ablation may prove to be a promising new treatment for prostate cancer recurrences; it tailors treatment modality (imaging) and duration to lesion size and location and provides a less invasive and minimally traumatic alternative for men,” said David A. Woodrum, M.D., Ph.D., an interventional radiologist at the Mayo Clinic in Rochester, Minn. “The safe completion of four clinical cases using MR-guided ablation therapy to treat prostate cancer in patients who had failed surgery demonstrates this technology’s potential,” he said, stressing, however, that the application for using ablation therapy in treating prostate cancer is relatively new.
In the study four men with recurrent prostate cancer had previously been treated with a radical prostatectomy. The men then underwent salvage therapy using either MR-guided laser interstitial thermal therapy, which uses high temperatures generated by local absorption of laser energy, or cryoablation, generating freezing with extremely cold gas destroying cancerous tissue. The use of MR imaging with temperature mapping and/or ice ball growth monitoring, the researchers were able to tailor the individual treatments to specific lesion size and location. “Immediately after treatment, we found no definite residual tumor. The treatment preserved the patients’ baseline sexual and urinary function and had no major complications,” added Woodrum.
In this very small retrospective review, each of the four men was found to have post surgical recurrent prostate cancer detected by MR imaging. Two were treated with MR-guided laser interstitial thermal therapy; the other two were treated with cryoablation. Biopsy-proven cancer lesions ranged in size from 6 millimeters and were located in the prostate bed just inferior to the bladder and anterior to the rectum, where the prostate gland had previously resided. The men had no detectable metastases at the time of treatment. For both ablation methods, two to three probes or applicators were used in each case. Intermittent MR imaging was employed during the procedures for placement of the probes/applicators and to actively monitor ablation size during treatment to completely cover the lesion.
This type of treatment remains in the very early stages so additional study is needed to identify which men will be best suited for the ablation procedure and to follow up to evaluate its long term efficacy.
Abstract 156: “MR-Guided Trans-perineal Laser and Cryoablation of Locally Recurrent Prostate Adenocarcinoma Following Radical Prostatectomy,” D.A. Woodrum, L.A. Mynderse, A. Kawashima, K.R. Gorny, T.D. Atwell, K.K. Amrami, H. Bjarnason, M.R. Callstrom and E.F. McPhail, all at Mayo Clinic, Rochester, Minn.; and B. Bolster, Siemens, Rochester, Minn., SIR 35th Annual Scientific Meeting March 13, 2010, Tampa, Fla.
Joel T Nowak, MA, MSW
I would like to thank you for your website. Ironically I am a urologist and was diagnosed with Gleason 9 cancer with some signet ring cell formation with bone mets to the pelvis and ribs lat June. I am 58. Your site helps me keep up with some of the latest and greatest. My father actually calls me with items he reads in the Wall Street Jounal
My PSA had been stable at 1.8 for years and jumped to 5.8. I went on ADT and after 3 months later I underwent 4 cycles of Taxetere and Carboplatin up front rather than waiting for what they now call (horribly named) the inevitable castrate resistent tumor.
I was going to have pelvic radiation, but we found some rib mets that were initially missed and decided against it. I work full time, other some decrease of ER coverage. I force myself to workout with a personal trainer 3 times per week. Somehow I live through the fatique. I am the only man at the health clup buying soy protein trying to lower his testosterone:-) I do miss my hormones and so does my younger wife. i have a 3 year old child and a 28 year old.
I take my fish oil, green tea extract, POMx and lipitor(off label, soy protein shake every morning. I avoid animal fats and eat mostly fish. I will probably start metformin off label after my next 3 month imaging.
I have no regrets regarding geting chemo up front as I have seen enough patients with high grade tumors suddenly have widespread mets despite very low PSAs. Before I was diagnosed I sat at a meeting next to Phil Kantoff, who is now one of my oncologist along with his collegue May-Ellen Taplin, from Dana Farber and asked him why they don’t treat patients with the high grade tumors which are destined to fail up front. He gave me the standards answer at the time was that it was not done.
Despite the bullshit regarding the PSA and trend toward active survailence I hope that the experimental treatment will be offered up front prior to becoming hormone resistant in high risk patients. I lost weight with a diet and excercise prior to my chemo and was able to tolerate the full doeses. I don’t think I could have being sicker as most of the patients are.
Keep up the good work. I wish you well!
Marc Nierman, M.D.