Novel Automated 3D Surgical Planning Tool and MRI/Ultrasound Fusion Technology to Perform Nanoparticle Ablation and Cryoablation of the Prostate for Focal Therapy.

Although MRI/Ultrasound fusion has been primarily used to assist in the diagnosis of prostate cancer, this technology can also be used to focally treat localized prostate cancer. We present one case of nanoparticle directed ablation and two cases of cryoablation to focally treat prostate tumors.

Three patients underwent MRI/Ultrasound fusion transperineal prostate biopsies to confirm low to intermediate risk prostate cancer. The MRI lesions correlated with the biopsy proven disease. Pelvic MRI segmentation was performed with DynaCAD 5.0 workstation. The MRI lesion including a 6-10 mm margin, prostate, bladder, urethra, urethral sphincter, rectum, and pubic bone were segmented. MRI/Ultrasound fusion was performed with the novel Philips UroNav 4.0 system. Lesions were treated with focal nanoparticle ablation or focal cryoablation.

A 69-year-old male with a right posterior medial peripheral zone lesion positive for Gleason GG3 cancer was treated with focal nanoparticle ablation. The UroNav 4.0 system reported 100% ablation of the segmented tumor and 94% of the 6-10 mm margin at the end of the case. A 68-year-old male with a left anterior fibromuscular stroma lesion positive for Gleason GG2 cancer and a 71-year-old male with a right peripheral zone posterior lateral lesion positive for Gleason GG1 cancer, were treated with focal cryoablation. The UroNav 4.0 system reported 100% ablation of the segmented tumor and 82% of the 6-10mm margin at the end of the case.

Visualization of the prostate tumor(s), surrounding critical structures, and pelvis in 3 dimensions, along with the anticipated ablation zone, is one of the challenges of pelvic surgery and percutaneous ablation. The DynaCAD 5.0 Urology system can create an auto-segmented 3D rendering of critical structures and the tumor(s), as well as visualization and quantification of the anticipated ablation coverage, to facilitate preoperative planning of needle placement.

Journal of endourology. 2021 Aug 19 [Epub ahead of print]

Joshua S Jue, Sam Coons, Gilion Hautvast, Scott Thompson, Jack Geraats, Lee Richstone, Michael Schwartz, Ardeshir R Rastinehad

University of Miami Miller School of Medicine, Urology, 79 SW 12th St, Unit 2404, Miami, Florida, United States, 33130; ., Philips Research North America, Cambridge, Massachusetts, United States; ., Philips Research, 60994, Eindhoven, North Brabant, Netherlands; ., Philips Healthcare US, 37278, Cambridge, Massachusetts, United States; ., Philips Research, 60994, Eindhoven, North Brabant, Netherlands; ., The Smith Institute for Urology, 536758, New York, New York, United States; ., The Smith Institute for Urology, 536758, Lake Success, New York, United States; ., Icahn School of Medicine at Mt Sinai, Department of Urology/Radiology, one gustav levy place, po box 1272, new york, New York, United States, 10029; .