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Collaborative Treatment by Urology and Radiology Holds Promise for Prostate Cancer Patients

November 20, 2020
by Jane E. Dee

A promising new treatment for prostate cancer that poses little risk of injury to organs surrounding the prostate gland will soon be providing Yale urologists and interventional radiologists with a new tool for treating patients, who often must weigh the benefits of invasive procedures that can result in a diminished quality of life.

Guided by magnetic resonance imaging (MRI), the treatment uses a device that delivers thermal ultrasound ablation to the diseased prostate with little impact on the nearby bladder, rectum, urethra, and erectile nerves. The minimally invasive treatment does not require a surgical incision or radiation therapy, and can target large and small regions of the prostate, said Raj Ayyagari, MD, Associate Professor of Radiology & Biomedical Imaging at Yale School of Medicine (YSM) and Radiology Director for Male Interventional Health.

“For men with low- to intermediate-risk prostate cancer, current treatments such as surgery and radiation therapy can lead to life-altering complications such as urinary incontinence and erectile dysfunction,” Dr. Ayyagari explained.

Bringing this technology to Yale adds an additional treatment arm to Yale’s nationally recognized prostate imaging and targeted therapeutics program, which has been performing targeted prostate biopsies and treatments since 2012, said Program Director and Urologist Preston Sprenkle, MD, Associate Professor of Urology at YSM.

The new procedure takes place while the patient is undergoing MRI scanning, which provides the urologist and interventional radiologist with real-time high-resolution images of the prostate gland. The device includes a robotically driven transurethral ultrasound, and closed-loop temperature feedback to prevent damage to the urethra, bladder and rectum.

Prostate cancer is the second leading cause of cancer death in men in the United States. About one in nine men will be diagnosed with prostate cancer, which is more likely to develop in older men and African American men. The suspicion of prostate cancer usually arises from an elevated prostate-specific antigen (PSA) blood level test and can be confirmed by a biopsy.

Treating cancer in the prostate is challenging because the gland, which surrounds the urethra, can be hard to see. With its sophisticated image guidance and temperature monitoring, the new ablation device allows prostate cancer to be targeted in a more selective and precise manner, said Sandeep Arora, MBBS, Assistant Professor of Radiology & Biomedical Imaging at YSM. Dr. Arora explained that the procedure requires the use of a rod-shaped device that is inserted into the urethra. Therapeutic ultrasound beams heat and destroy the cancerous prostate tissue. The direction, shape and strength of the ultrasound beams are automatically controlled by a computer according to a plan created by the treating physicians, so that only the prostate tissue is treated. The thermal energy applied to the prostate is constantly measured and automatically adjusted while the urethra and rectum are cooled, Dr. Arora added.

Dr. Arora previously participated in a multinational trial at Vanderbilt University that investigated the new device and procedure. The results of the trial recently were reported in the Journal of Urology, which led to FDA approval. “Even after whole-gland therapy, 75% of previously potent individuals were able to preserve their erections, which is truly remarkable,” Dr. Arora said.

Drs. Sprenkle, Ayyagari, and Arora are planning to launch a clinical trial at Yale using the new therapy. Dr. Arora recently received an RSNA Scholar Award to analyze response to the treatment.

Submitted by Angel Machon on November 20, 2020