Handbook of Focal Therapy for Prostate and Renal Cancer Truls E Bjerklund Johansen, Damien Greene, David J Breen, Vladimir Mouraviev
INDEX
Note: Page numbers in bold or italic refer to tables or figures, respectively.
A
Ablatherm device 243
Ablation 24 see also specific techniques
non-thermal 2932
thermal 2328, 24, 357358
Active surveillance (AS) 6, 8, 41
prostate cancer 8, 53, 62, 91, 99, 102
renal tumors 113118, 141142
Aerobic glycolysis 22
Alpha-blockers 375
American Society for Therapeutic Radiology and Oncology (ASTRO)
on biochemical recurrence after radiation therapy 67
criteria, prostate cancer 47
on radiorecurrent prostate cancer 281
American Urological Association (AUA)
focal therapy for renal cancer, guidelines on 305306
on nephron-sparing surgery for small renal masses 337
prostate cancer, guidelines on 53
on treatment of kidney cancer 4041
Angioembolization (AE), for bleeding 370
Angiogenesis 21
Apoptosis 21, 22
ASTRO see American Society for Therapeutic Radiology and Oncology (ASTRO)
AUA see American Urological Association (AUA)
Autophagy 22
B
Benign prostatic hyperplasia (BPH) 164, 198, 231, 294
Biochemical recurrence (BCR) 33, 47, 67, 102, 193, 292, 294
Biomarkers, prostate cancer 91 see also specific biomarkers
blood 9698
cost/efficacy considerations 103, 103104
phases of development 92
requirements for 92
tissue 98103
types of 93
urine 9296
Birt-Hogg Dubé syndrome 111, 111
Bleeding, focal treatment of renal cancer and
focal ablation and 371372
intraoperative bleeding 369370
kidney function, effects on 372
postoperative bleeding 370, 371
Bowel injury, renal focal therapy and 372373
BPH see Benign prostatic hyperplasia (BPH)
Brachytherapy 259260, 260 see also Radiation therapy
dose distributions 260, 260
guideline recommendations for 274275
high dose rate 259, 259, 262264, 276
low dose rate 259, 275277
outcome data 262264
real-time approach 259
salvage treatment for recurrent prostate cancer 285
side effects 274277
Breast cancer
local recurrence after breast conserving therapy 45
radical mastectomy vs. breast-conserving lumpectomy 4
Breast conserving therapy (BCT) 4
C
Cancer biology 1924
Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE), on radical prostatectomy 56
Carey index 312
Cavitation 241
Cell cycle progression (CCP) score 101
Centrality index (C-index) 127128, 128
Chronic kidney disease (CKD) 140, 144145, 376377, 393394
C-index see Centrality index (C-index)
CKD see Chronic kidney disease (CKD)
Comprehensive geriatric assessment (CGA) 311
Cryoablation (CA), of renal cell carcinoma 351354, 352
advantages of 354
evaluation and follow-up 353
outcomes and complications 353354, 354
planning and monitoring 352, 352353
Cryosurgery 2728, 33
mechanisms of cryoablative damage 28, 2829
Cryotherapy, prostate 4647, 187189, 194195, 195, 269270
adverse events and complications 193
equipment for 189, 189190, 190
erectile function after 272273
patient selection 188189
postsurgical follow-up period 192193
rectourethral fistula, development of 272
salvage treatment for recurrent prostate cancer 286, 286287
side effects 270273
surgical technique 190191, 191, 192
urinary functional outcomes 270272
whole-gland 270
Curietherapy see Brachytherapy
D
Diffusion weighted MR imaging
apparent diffusion coefficient (ADC) map 164
limitations of 165
in prostate mpMRI 164165
Digital rectal examination (DRE) 6
DNA methylation markers 100, 100
Dynamic contrast-enhanced MR imaging (DCE-MRI), in prostate mpMRI 165
E
Erectile dysfunction 49, 53, 61, 272273, 287
cryoablation and 194
focal laser ablation and 208
radiation therapy and 6061
radical prostatectomy and 220
after salvage radical prostatectomy 83, 86
surgical treatment and 5960
whole-gland HIFU and 242, 247
after whole gland treatment of prostate cancer 5961, 63
European Association of Urology (EAU) guidelines, on focal therapy for renal cancer 306
European Organization for Research and Treatment of Cancer (EORTC QLQ-C-30) 58
EXO106 assay 95
Exosome analysis 95
Expanded Prostate Cancer Index Composite (EPIC) 80
Externally delivered radiation therapy (EBRT) 255256 see also Radiation therapy
F
Fascial dehiscence, after laparoscopic partial nephrectomy 373374, 374
Fluorescence in situ hybridization (FISH) assay 98
Focal laser ablation (FLA), of prostate tumors 197198
ablation procedure 203, 205
advantages of 201
clinical studies 207208
correct sequence for placing laser fiber into lesion 204
future implications 208209
history of 198200
image guidance and tracking of clinical effect 200201, 201
mechanism of tissue destruction 198
MRI and 200201, 201, 202
patient preparation 202
patient selection 206
post-ablation and follow-up 204, 205, 206
procedure 202204
results 206207
system components 200
target localization 202, 203, 204
Focal prostate cancer therapy 267
biopsy of prostate after 297300
cryosurgical ablation 187195
follow-up after 291300, 293
high-intensity focused ultrasound 241253, 246, 247
imaging of prostate after 294296, 296298
irreversible electroporation 223231, 228229
laser ablation 197209, 233239
MRI and image fusion-guided biopsies 163173
patient selection for 175183
PSA values after 292, 294
radiation therapy 255265
salvage treatment, for recurrent prostate cancer 281288, 289 (see also Salvage therapy, for recurrent prostate cancer)
side effects of 267278, 269278
TRUS-guided prostate biopsy 149159, 160
vapor technology 231233
vascular-targeted photodynamic therapy 213221
Focal prostate laser ablation (FPLA) see Laser interstitial thermotherapy
Future directions in focal therapy 49
Focal therapy for renal cancer 3840, 305315 see also specific type
contraindications to 306, 306
follow-up imaging after 391401
high intensity focused ultrasound 361366
indications for 305
laparoscopic-guided cryoablation and radio frequency ablation 337343
microwave ablation 358361
modalities for 305
patient selection for 307315
percutaneous ablation 345355
robotic partial nephrectomy, advances in 319334
salvage therapy 381389
side effects of 369378
Formalin-fixed paraffin-embedded (FFPE) needle biopsy 101
G
Gastrointestinal toxicity, after radiation therapy 6162
Genitofemoral nerve, injury to 377
Genomic prostate score (GPS) 102
Gleason score 68, 44, 68, 86, 91, 98
H
Health related quality of life (HRQoL), after prostate treatment 5354, 187
cancer control 5657
cryotherapy and 5657
erectile dysfunction 5961
factors influencing patient outcome 54, 55
focal therapy and 62
gastrointestinal toxicity 6162
potency definitions and rates of potency in same patient 55, 55
radiation vs. surgery 56
surgery vs. observation 56
treatment decision-making and effect on survivorship 5456, 55, 55
urinary symptoms 5759, 60
whole gland therapy, and focal therapy 63
Hematuria, cryotherapy and 193
Hem-o-Lok clips 323
Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) 111, 111
Hernia, after renal focal ablation 373
High-intensity focused ultrasound (HIFU) 26, 4748, 241, 241242 see also High intensity focused ultrasound for prostate cancer and for renal ablation
High-intensity focused ultrasound for prostate cancer 26, 4748, 241242, 273
Ablatherm device 243
clinical trials and outcomes 245, 246, 247
devices, development of 243
effectiveness of, evaluation of 252253
focal salvage 273
hemiablation of prostate 247248
history of 242243
lesion-targeted ablation of prostate 248249
MRI-TRUS fusion image-guided focal HIFU 249250, 250
primary focal hemi-ablation 274
primary subtotal 273
prostatic swelling and shift, control of 250251, 251
safety alerting system 244245
salvage treatment for recurrent prostate cancer 285286
side effects 273274
Sonablate device 243
subtotal ablation of prostate 247
therapeutic technology 244
treatment planning 243244
urethra-sparing HIFU 245, 247
High intensity focused ultrasound for renal ablation 361, 364365
clinical studies related to 366
complications 364
as ideal focal therapy 365
I
IGA see Image-guided ablation (IGA)
Image-guided ablation (IGA) 346347
adjunctive techniques 348349, 349
biopsy, role of 348
indications for 347348
pre-ablation assessment 348
procedural considerations 348
small renal masses and 347, 347
Image registration assisted biopsy 171
software registration (MRI-TRUS fusion) 172173, 173
visual registration (cognitive fusion) 172
Imaging, follow-up, after focal treatment of renal cancer 391401
Immunohistochemical (IHC) assay 98
Immunosuppressive agents, by cancer cells 22
Incidentalomas 109110 see also Small renal masses (SRMs)
to small renal masses 109111
Index lesion 10, 4546, 291
as driver of tumor progression 1012, 11
International Index of Erectile Function (IIEF) 58, 60
Interstitial laser therapy see Laser therapy
Irreversible electroporation (IRE) 223231, 226
direct current electrical pulses, transmission of 223, 224
electrical schematic of 225
Nanoknife IRE system 225, 226
outcome data 227230, 228229
side effects 277278
K
4Kscore test 9697, 97
L
Laparoscopic-guided cryoablation and radio frequency ablation, for renal cancer 337343
as ideal focal technology 343
oncological outcome 339341, 341
procedure specific selection criteria 337338
side effects 341342
surgical technique 338339, 339, 340
Laser-induced interstitial thermotherapy (LITT) 2627
Laser interstitial thermotherapy 233238, 238, 239
side effects 278
Visualase Thermal Therapy System 235, 236
Laser therapies 2627
breast cancer and 26, 27
lasers used 27
for localized prostate cancer 27
LDR-BT 61
Lee prognostic index 311312
Light density index (LDI) 220
M
Magnetic resonance-guided focused ultrasound (MRgFUS) ablation 156
Magnetic resonance imaging, for renal tumors 123
Microwave ablation (MWA) 26, 358361, 360
clinical studies of 362363
components 358, 359
as ideal focal technology 361
and radiofrequency ablation 360
technological aspects and experience 360361
Minimally invasive salvage radical prostatectomy 7678, 8084, 83
MI-Prostate Score 95
Mount Sinai Erectile Function (MSEF) scoring system 60
mpMRI see Multiparametric magnetic resonance imaging (mpMRI)
MRI-targeted biopsy 170
direct in-bore biopsy 170, 170171, 171
image registration assisted biopsy 171173, 173
MRI-TRUS image-guided fusion HIFU ablation 249250, 250
Multidetector computed tomography (CT), for renal mass 123
Multiparametric magnetic resonance imaging (mpMRI) 156, 157, 163165, 268
aggressiveness, assessment of 167168
anatomical T2-weighted MR imaging 163164
diffusion weighted MR imaging 164165
dynamic contrast-enhanced MR imaging 165
localization and local staging of prostate cancer 165167, 166, 167
normal prostate 164
recurrence and follow up after focal therapy 168170, 169, 295296, 296298
targeted biopsy approach 170173 (see also MRI-targeted biopsy)
MWA see Microwave ablation (MWA)
N
Nanoknife system 225, 226, 277278
National Comprehensive Cancer Network (NCCN) guidelines, on treatment of kidney cancer 4042
Necrosis 22
Nephron sparing surgery (NSS), minimally invasive 139
impact on quality of life and mortality 144145
renal function after 144
NeuroBlate system (laser system) 200
Non-thermal ablation 29
alcohol injection 2930
electroporation 3031
radiation therapy 3121
Novilase system (laser system) 200
Nuclear imaging, for small renal tumor 124
O
Organ-preserving ablative technologies 6
P
PADUA score 125127, 126, 126
Pain, renal focal ablation and 377378
Pancreatic injuries, renal focal therapy and 373
Paresthesia, renal focal ablation and 377
Partial nephrectomy (PN), for renal masses 37, 4042, 139, 319
vs. radical nephrectomy 3738
Patient selection for focal treatment
prostate cancer 175183, 177
renal cancer 305315, 308, 309
PDT see Photodynamic therapy (PDT)
Phoenix criteria, definition for radiorecurrent prostate cancer 281
Photodynamic therapy (PDT) 27
clinical experience with 215216
interstitial (iPDT) 214
photosensitizers in 213214, 214
principles of 213, 213215
vascular-targeted (see Vascular-targeted photodynamic (VTP) therapy)
Pleural injury, renal focal therapy and 373
Polar line, renal tumors 125, 126, 127
Positive surgical margin (PSM) 140141, 375376
Post-focal therapy prostate biopsy protocols 159, 160
Prolaris 101, 101
ProMark marker panel 99100
Prostate biopsies 149, 150
combining biopsy and clinical parameters 155
combining biopsy and MRI data 156158, 158
in post-focal therapy follow-up 159, 160, 294296, 296298
transperineal vs. transrectal biopsy 154155
transrectal biopsies, effectiveness of 149152
transrectal saturation biopsy 152153
Prostate cancer (PCa) 53
biochemical disease-free survival (bDFS) after RP 78
difficulties with detection of 4243
focal therapy for 34, 4548, 46, 49
in-field/out-of-field residual/recurrent disease 294
kinetics 89, 10
localized 43
low-risk disease 67
multiparametric MRI for 43, 4445
percent of tumor involvement (PTI) 7
potential hemiablation of prostate, concept of 8
radical treatment of 68
risk calculators for 42
screening for 6
trend toward smaller volume of disease 7
TRUS biopsies for, concerns with 44
tumor biology of 1015
tumor unilaterality 8
Prostate cancer antigen 3 (PCA3) marker 9293, 94, 95
Prostate cancer genomic classifier 102103
Prostate Core Mitomic Test (PCMT) 98
Prostate health index (PHI) 96
Prostate-specific antigen (PSA) 6, 53, 67, 175, 192193, 292, 294
PSM see Positive surgical margin (PSM)
PTEN gene marker 9899
Q
Quality of life outcome and assessment 3, 13, 58, 268 (also see Health related quality of life (HRQoL), after prostate treatment)
R
Radiation, internally delivered see Brachytherapy
Radiation therapy 255257
α/β ratio 256
brachytherapy 259, 259260, 260
dose-response relationships 256, 257
as ideal focal technology 264265
organs at risk from radiation damage 255
outcome data 261264
patient considerations 260261
radiation, biologic effects of 256
stereotactic 256, 257, 257259, 258
Radical nephrectomy (RN) 139
Radical prostatectomy (RP) 4, 6, 56, 6768
bladder neck reconstruction and completion of 7576, 81, 82
complications 57, 8485
control of lateral vascular pedicle of prostate 73, 77
dissection of prostate off rectum 7475
functional outcomes 86
hemostasis control after dorsal vein complex transection 74
ligation of dorsal vein complex 72
minimally invasive 7678, 8084, 83
neurovascular bundle (NVB), lateral dissection of 7273, 75
oncologic outcomes 8586
open salvage, outcomes of 71
patient positioning and initial incision 70
patient selection for 6870
pelvic lymph node dissection 70
preservation of left neurovascular bundle 73, 76
prostate mobilization and control of dorsal vein complex (DVC) 7172, 7274
and radiation therapy 56
salvage 6786
seminal vesicles 75, 79, 80
transection of dorsal vein complex 73
urethra division, and placement of anastomotic sutures 7374, 78, 79
urethrovesical anastomosis 82
Radiofrequency ablation (RFA) 2426, 33, 38
adjunctive therapy with 26
of breast cancers 25
and cryosurgery 33
of kidney tumors 25
of liver tumors 25
of renal cancer 3839, 349351, 351
RAPN see Robot-assisted partial nephrectomy (RAPN)
Rectourethral fistula, development of 272
Renal biopsies 315
Renal cancer 5, 109, 345 see also Small renal masses (SRMs)
ablative therapies, anatomic classification systems and 133134
active surveillance for 141142
anatomical classification scoring systems (ACSs) 124128
chromophobe 111
C index 127128, 128
clear cell RCC 111
cryoablation of 3839, 39, 351354
epidemiology 111112
familial and hereditary forms 111, 111
focal therapy for 3840
follow-up in patients with focal therapy for 4142
guidelines on treatment of 4041
hereditary 111, 111
imaging of 123124
incidental detection of 110
open partial nephrectomy for 5, 56
origin of 110
PADUA score 125127, 126, 126
papillary RCC 111
partial nephrectomy vs. radical nephrectomy 3738
progression from surgery to renal ablative techniques 3740
radical nephrectomy for 5
from radical nephrectomy to image-guided ablation 346347
radiofrequency ablation of 3839, 39, 349351
RENAL nephrometry score 124125, 125, 126, 127
risk factors for 111
role of anatomic classification systems 128132
side effects of focal treatment for 369378
small renal masses, detection of 5
Renal cell carcinomas (RCC) see Renal cancer
Renal failure, after kidney surgery 376377
RENAL nephrometry score 124125, 125, 126, 310
and PADUA score 127
Renal tumor biopsy (RTB) 112, 112113, 135136
Retrograde ejaculation 194
RFA see Radiofrequency ablation (RFA)
Robot-assisted laparoscopic prostatectomy (RALP), salvage 76
Robot-assisted partial nephrectomy (RAPN) 319334
complications 331332
ice slush technique 325327, 326
indications for 327330, 329, 331
mid-term outcomes 330331
readmission rate 332
retroperitoneal approach 323324
transperitoneal approach 319323, 320324
V-hilar technique 325, 325
vs. laparoscopic cryoablation 333334
vs. laparoscopic PN 332333, 333
zero ischemia technique 327, 328
RP see Radical prostatectomy (RP)
S
Salvage therapy, for recurrent prostate cancer 281288
algorithm for 284
biopsy evaluation 283
brachytherapy 285
cryoablation of prostate 286, 286287
focal vs. total ablation 287288, 289
high intensity focused ultrasound 285286
metastatic disease, assessment for 281282
patient selection 281283
prostatectomy 284285
and quality of life 282283
repeat focal treatment 288
Salvage therapy for renal cancer, primary treatment failure and 381388, 383
ablative failure, management of 384397
active surveillance 384385
algorithm for management of ablation failures 387, 387388
cryoablation, local recurrence after 384
definition of success after ablative therapy 382383
high intensity focused ultrasound, local recurrence after 384
primary tumor ablation, methods of 381382, 382
radiofrequency ablation, local recurrence after 383384
repeat thermal ablation 385386
surgical salvage therapy 386387
Satellite lesions, role of 12
SBRT see Stereotactic radiation therapy (SBRT)
Senescence 21
Sequential preplaced suture (SPS) renorrhaphy 327, 328
Sexual Health Inventory for Men 80
Short Form (SF-12) 58
Single nucleotide polymorphisms (SNPs) 9798
Small renal masses (SRMs) 109, 110, 123, 337, 345 see also Renal cancer
active surveillance for, rationale and evidence for 113114
active surveillance vs. intervention 345346
age and 117118
biopsy before ablative therapy 134135
biopsy, role of 112, 112113
classification of 123136
focal therapy for, patient selection for 142144, 143, 143
growth rates 116, 116117, 117
histology and tumor heterogeneity 118119
incidence of 140
metastatic progression rate 114
natural history of 113
progression during active surveillance 114118
and renal cell carcinoma 110111
size at baseline 114116
zero net growth 117, 117
Sonablate device 243
Spleen, injury to, renal focal therapy and 373
SRMs see Small renal masses (SRMs)
Stereotactic radiation therapy (SBRT) 256, 257, 257259, 258 see also Radiation therapy
dose distributions plan 258
outcome data 261, 261262, 262
Surgical excision, for tumors 2324, 32
T
Telomerases, in cancer cells 22
Template-mapping biopsies 44
Testicular swelling, cryotherapy and 193
Thermal ablation 23, 24, 24
cryosurgery 2728
high-intensity focused ultrasound 26
laser therapy 2627
microwave ablation 26
radiofrequency ablation 2426
for small renal masses 357358
TMB see Transperineal mapping biopsy (TMB)
TMRPSS2:ERG urine assay 9395
TOOKAD Soluble VTP procedure see Vascular-targeted photodynamic (VTP) therapy
Transperineal mapping biopsy (TMB) 154155, 177, 178, 298299 see also Prostate biopsies
Bard biopsy device, use of 178
clinical case study 181182, 181183
intraprostatic staging, concept of 178180
patient selection on 177182
results 177, 179
software assisted 180181
Transrectal saturation biopsy 151153 see also Prostate biopsies
Transrectal ultrasound (TRUS) guided biopsy, for prostate cancer 43, 44, 149156, 175177 see also Prostate biopsies
Tumor biology, of prostate cancer
index lesion ablation to lethal clone ablation 1315
index lesion as driver of tumor progression 1012, 11
secondary satellite lesions, role of 12
unilaterality as prerequisite for hemiablation 1213
Tumorigenesis 9
Tumor kinetics 89, 10
Tumor microenvironment 2324
Tumor-seeding 378
U
Unilaterality, concept of 1213
United States Preventive Services Task Force (USPSTF) grades, on PSA testing use 53, 54, 91
University of California-Los Angeles Prostate Cancer Index (UCLA-PCI) 58, 59
Ureteral injuries, renal focal therapy and 373
Urethral warming devices 270271, 271
Urethrorectal fistulas, cryotherapy and 193
Urinary incontinence 13, 187, 271272
cryoablation and 193
high-intensity focused ultrasound treatment and 242, 247, 248
partial nephrectomy and 374375, 375
salvage radical prostatectomy and 77, 80, 85
after treatment for prostate cancer 5759, 63
V
Vapor technology 231233
clinical findings in prostate cancer 233, 234
convection and prostate anatomy 232233
convection vs. conduction 231232
phase-change in 232
principles of 231233
Revîv System 231, 231
Vascular-targeted photodynamic (VTP) therapy 214 see also Photodynamic therapy (PDT)
contraindications to 216
fiber insertion catheters (FICs) in prostate 217218, 218
mechanism of action 213
phase III studies 222
primary focal therapy 219221
procedure 216219
with TOOKAD Soluble 216221
treatment guidance by ultrasound 217, 217
V-hilar suture 325, 325
Visceral injuries, focal treatment of renal cancer and 372374
bowel injury 372373
diaphragmatic injuries and pneumothorax 373
infection and hernia 373374, 374
spleen and pancreatic injuries 373
ureteral injuries 373
Visualase system (laser system) 200
Visualase Thermal Therapy System 235, 236
Von Hippel-Lindau (VHL) syndrome 111, 111, 312313
VTP therapy see Vascular-targeted photodynamic (VTP) therapy
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