V14-03 TRANSPERINEAL MICROWAVE NEEDLE THERMOABLATION OF PROSTATE CANCER GUIDED BY MRI ULTRASOUND FUSION AND ORGAN BASED TRACKING TECHNOLOGY

Abstract

INTRODUCTION AND OBJECTIVE: The objective of this video is to show the technique of a novel transperineal microwave needle thermoablation of localized prostate cancer (PCa) guided by MRIUltrasound fusion and Organ-based tracking (OBT) technology. METHOD(S): The case was an obese 70 year-old man with history of diabetes, hypertension, hyperlipidemia, and radiological cerebral infarcts without symptom. He has excellent performance status. His PSA was 5.7 ng/mL and Prostate Health Index (PHI) was 42.8. MRI prostate showed a 15x10 mm PI-RADS 5 lesion at left anterior transitional zone in a 35ml prostate without extra-capsular extension. Transperineal MRI-Ultrasound fusion biopsy of the target lesion showed Gleason 3+3 PCa in all 3 cores with 70% core involvement. 15 Systematic biopsy cores in other sectors were all benign. Focal therapy using microwave needle ablation was planned. Before treatment, fleet enema and a dose of IV antibiotic was given. The patient received spinal anaesthesia and was placed in lithotomy position. The MRI images marked with the target lesion were displayed on the screen of the MRI-Ultrasound fusion machine. The 3D side-fire transrectal probe was inserted, positioned at prostate level and fixed with a probe holder. A full grid was applied to the probe. MRI and Ultrasound fusion was performed with automatic 3D ultrasound scanning and OBT technology to provide accurate prostate tracking and target localization. The expected ellipsoid treatment zones of multiple Microwave needle ablations were planned on screen. A 17G microwave needle was inserted at the planned path in the fullgrid and the exact needle position was confirmed with repeated 3D ultrasound scanning and OBT image fusion. In the current case, 3 sequential needle ablations (Two 5-minute and one 3- minute) at 12 Watts were done to cover the lesion with margin. The whole treatment including planning took 65 minutes. A Foley's catheter was inserted at the end. RESULT(S): The Foley's catheter was removed the next day and he was discharged home. MRI prostate with contrast was repeated on day 12 and the necrotic foci correlated well with the planned ellipsoid ablation zones without residual tumor seen. Individual needle tracks were also visualized on MRI images. Microwave needle ablation therapy has so far been successfully performed in 3 patients and all tolerated the procedure well. CONCLUSION(S): Transperineal microwave needle ablation of prostate cancer can be precisely and safely performed under the guidance of MRI-Ultrasound fusion and Organ based tracking.