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

This publication reflects the next step in advances in image-guided surgery and briefly highlights a few of the multiple different methodologies for focal prostatic ablation that are in development. The most mature of these technologies is cryoablation, which has had an indication for prostate cancer treatment since the 1960s. Many urologists abandoned this technique, as whole-gland prostatic ablation was associated with an unappealing rate of complications including erectile dysfunction, urinary stress incontinence, and fistula formation. Fortunately, modern-day cryoablation technology is vastly improved compared to the initial devices that many urologists used in the 1960s for whole gland ablation, namely due to improved image-guidance.

The idea of image-guided focal therapy has been around for more than a decade, but ultrasound-based treatments were limited by their inability to clearly identify tumors. The initial technical challenges were overcome in 2009 with early research at the National Institutes of Health and the National Cancer Institute which produced a Magnetic Resonance Imaging and Ultrasound (MR/US) fusion biopsy device. Using MR/US fusion as an adjunct, one was then able to locate the diseased portion of the prostate with increased certainty. This technology allowed for real-time monitoring during focal treatment, leading to increased accuracy of lesion targeting, as well as better preservation of critical structures such as the rectum and urethra. The most fundamental technical difference in the application of image-guided focal ablation was that a physician must trace out the region of interest to biopsy or treat. Of note, the treatment lesion typically included the lesion plus an area of margin.

This approach was adequate but lacked the ability to truly create a detailed treatment plan using software. Our current publication outlines the initial work creating a treatment agnostic MR/US fusion-guided ablation device. This software adds a refined level of complexity to the initial idea of using fusion for treatment guidance. One can now use manufactured specifications to create ablation zones that can be visualized using image fusion, as well as automate the creation of a margin in three dimensions (3D). Additionally, this software can create a full 3D model of the patient’s pelvis to help the clinician visualize the exact tumor location in anatomic proximity to critical structures that could be damaged or that could limit one’s ability to approach the tumor.

Prostate cancer research and treatment is a dynamic field, and currently, there is a significant push to find improved ways to treat low-risk and low-volume disease. This has paved the way for the development of technologies such as nanoparticle ablation and focal cryoablation, amongst others.

With the advent and implementation of these new methodologies for the focalized treatment of prostate cancer, MR/US fusion technology has the potential to completely revolutionize the way isolated prostate cancer lesions are managed. MR/US fusion guidance technology is an exciting and integral facet of focal prostatic ablation, and it will continue to be at the forefront of this field.

Written by: Tavya G. R. Benjamin, MD & Ardeshir R. Rastinehad, D.O. FACOS, Northwell Health Physician Partners Smith Institute for Urology at Lenox Hill, New York, NY

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