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Single-Setting 3D MRI/US-Guided Frozen Sectioning and Cryoablation of the Index Lesion: Mid-Term Oncologic and
Leonardo Misuraca1, Franco Lugnani2, Aldo Brassetti1
1Department of Urology, IRCCS Regina Elena National Cancer Institute, 00128 Rome, Italy.
Abstract:
Our study explored frozen section reliability in prostate cancer (PCa) diagnoses and described surgical steps of a 3D magnetic resonance imaging (MRI)-ultrasound (US)-guided prostate biopsy (PB) and focal cryoablation of the index lesion (IL) in a single-setting procedure. Patients with a suspicious prostatic specific antigen (PSA) value, with a PIRADS 4 or 5 single lesion, were enrolled for trans perineal 3D MRI-US-guided PB and TRUS-guided focal cryoablation. Three cores were taken from the IL, three cores from the surrounding area, while systematic sampling was performed for the rest of the gland. After confirmation of PCa in frozen sections, focal cryoablation was performed. The 1st-year follow-up schedule included a PSA test at a 3-month interval, MRI 3 months and 1 year postoperatively and PB of the treated area at 1 year. Following the follow-up schedule, an involved PSA test at a 3-month interval and yearly MRI were performed. The PCa diagnosis was histologically confirmed in all three patients with frozen sections. At final histology, a single Gleason score upgrade from 6 (3 + 3) to 7 (3 + 4) was observed. All patients were discharged on postoperative day 1. At the 3-month evaluation, mean PSA values decreased from 12.54 (baseline) to 1.73 ng/mL and MRI images showed complete ablation of the IL in all patients. Urinary continence and potency were preserved in all patients. At the 1-year follow-up, one patient had suspicious ipsilateral recurrence on MRI and underwent a new analogous procedure. Post follow-up was uneventful and PSA remained stable in all patients. Three-dimensional MRI-US-guided frozen sectioning and focal cryoablation of the IL is a step forward towards a "patient-tailored" minimally invasive approach to the diagnosis and cure of PCa.
Insights
This study confirms frozen section accuracy for prostate cancer (PCa) diagnosis. A novel 3D MRI-US-guided biopsy and focal cryoablation procedure offers a minimally invasive, tailored treatment for PCa.
Area of Science:
- Urology
- Oncology
- Medical Imaging
Background:
- Prostate cancer (PCa) diagnosis and treatment require precise localization and minimally invasive techniques.
- Frozen section analysis is crucial for intraoperative decision-making during oncological procedures.
- 3D magnetic resonance imaging (MRI)-ultrasound (US) fusion technology enhances the accuracy of targeted prostate biopsies.
Purpose of the Study:
- To evaluate the reliability of frozen section analysis in diagnosing PCa during a single-setting procedure.
- To describe the surgical technique of 3D MRI-US-guided prostate biopsy (PB) and focal cryoablation of the index lesion (IL).
- To assess the early outcomes of this minimally invasive approach for localized PCa.
Main Methods:
- Patients with suspicious PSA and PIRADS 4/5 lesions underwent transperineal 3D MRI-US-guided PB and transrectal ultrasound (TRUS)-guided focal cryoablation.
- Frozen sections were analyzed intraoperatively to confirm PCa before cryoablation.
- A standardized 1-year follow-up protocol included PSA monitoring, serial MRIs, and repeat biopsy of the treated area.
Main Results:
- Frozen section diagnosis of PCa was histologically confirmed in all patients.
- A single case of Gleason score upgrade from 6 to 7 was noted at final pathology.
- Mean PSA levels significantly decreased post-procedure (12.54 to 1.73 ng/mL at 3 months).
- Complete ablation of the index lesion was confirmed by MRI in all patients at 3 months.
- Urinary continence and potency were preserved in all treated patients.
Conclusions:
- 3D MRI-US-guided frozen sectioning and focal cryoablation is a reliable and effective minimally invasive approach for PCa diagnosis and treatment.
- This technique facilitates a patient-tailored strategy for managing localized prostate cancer.
- The procedure demonstrates favorable short-term oncological and functional outcomes.
