Imaging and Focal Therapy of Early Prostate Cancer by Thomas J. Polascik

Author:Thomas J. Polascik
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Image-Based Tracking

The Urostation platform (Koelis, Grenoble, France), widely utilized across clinical centers in Europe, is an interesting platform in that tracking of the TRUS probe and needles is conducted with TRUS-TRUS registration. Thus, additional hardware such as an electromagnetic field generator or robotic arms is not necessary. The process begins with acquisition of prostate MRI as in other fusion platforms. At time of biopsy procedure, a 3D panorama TRUS volume is obtained via sweep of the prostate, and this model is fused to pre-procedural MRI data using elastic registration. Then, after each biopsy core is taken, a 3D TRUS image is acquired with the needle in place and registered to the original sweep TRUS volume to confirm proper needle placement. Similar to UroNav, this platform is advantageous as the biopsies are performed utilizing a standard freehand approach. However, one important drawback is that needles must be held in place without movement for 3–5 s to allow for 3D TRUS acquisition in order to acquire an accurate needle location. As technology improves, real-time 3D US image acquisition may make the process seamless.

Initial studies with phantom models conducted by Ukimura et al. at the University of Southern California (USC) in Los Angeles, California, USA , demonstrated an accuracy of 84 % (24/27 lesions hit) with this platform and a mean procedural targeting error of 2.09 ± 1.28 mm [40]. In a study of 80 patients with 115 MRI suspicious lesions, the hit rate for the Urostation platform was 97 % (112/115 lesions with confirmed biopsy inside target), and 60/115 (52 %) targets were positive for cancer [60]. Mozer et al., in a prospective study utilizing the Urostation platform in 152 biopsy-naïve men, found that the proportion of positive cores and proportion of men with clinically significant prostate cancer were significantly higher with the targeted-core protocol relative to a systematic 12-core protocol (p < 0.001 and p = 0.03, respectively). Therefore, initial work with this platform seems promising.

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