Safety and Feasibility of Transperineal Targeted Microwave Ablation for Low- to Intermediate-risk Prostate Cancer

Marco Oderda; Alessandro Marquis; Giorgio Calleris; Daniele D'Agate; Riccardo Faletti; Marco Gatti; Giancarlo Marra; Paolo Gontero

doi:10.1016/j.euros.2022.10.004

Safety and Feasibility of Transperineal Targeted Microwave Ablation for Low- to Intermediate-risk Prostate Cancer

Eur Urol Open Sci. 2022 Oct 22:46:3-7. doi: 10.1016/j.euros.2022.10.004. eCollection 2022 Dec.

Authors

Marco Oderda¹, Alessandro Marquis¹, Giorgio Calleris¹, Daniele D'Agate¹, Riccardo Faletti², Marco Gatti², Giancarlo Marra¹, Paolo Gontero¹

Affiliations

¹ Division of Urology, Department of Surgical Sciences, Molinette Hospital, University of Turin, Turin, Italy.
² Division of Radiology, Molinette Hospital, University of Turin, Turin, Italy.

Abstract

Background: Focal therapy has emerged as an interesting option for localized low- to intermediate-risk prostate cancer (PCa). Targeted microwave ablation (TMA) is a novel FT modality involving targeted delivery of microwave energy under multiparametric magnetic resonance imaging (MRI)/ultrasound guidance.

Objective: To describe the step-by-step procedure for TMA and report early functional outcomes.

Design setting and participants: This was an experimental phase 1-2 trial in 11 patients diagnosed with a single, MRI-visible PCa lesion of up to 12 mm, scored as International Society of Urological Pathology grade group (GG) 1 or 2.

Surgical procedure: Transperineal TMA under MRI/ultrasound image fusion guidance.

Measurements: We recorded patient and PCa features; intraoperative and postoperative parameters; pain (Visual Analog Scale [VAS]) and adverse events (Common Terminology Criteria for Adverse Events v5.0); and prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) scores at 1 wk and 1, 3, and 6 mo.

Results and limitations: The median patient age was 67 yr (interquartile range [IQR] 18). Median PSA was 5.4 ng/ml (IQR 1.8), median prostate volume was 51 cm³ (IQR 35), and median lesion size on MRI was 10 mm (IQR 4). Ten patients had GG 2 PCa and one had GG 1 disease. The median procedure time was 40 min (IQR 30). No intraoperative complications were reported. All treatments were performed on a day-case basis and no patients were discharged with a urinary catheter. Postoperatively, no grade ≥2 complications were reported. No significant changes in PSA (p = 0.46), IPSS (p = 0.39), or IIEF-5 scores (p = 0.18) scores were reported. The postoperative VAS score at 24 h was 0 for all patients.

Conclusions: TMA is safe, feasible, and well tolerated in patients with low- to intermediate-risk PCa. Oncological outcomes are still awaited.

Patient summary: Targeted microwave therapy is safe and feasible for selected patients with low- to intermediate-risk prostate cancer. The procedure is well tolerated and does not require a urinary catheter after the procedure. Cancer control outcomes are still awaited.

Keywords: Focal therapy; Image fusion; Koelis; Microwave; Prostate cancer.