Mäkelä Pietari, Anttinen Mikael, Wright Cameron, Sainio Teija, Boström Peter J, Sequeiros Roberto Blanco
Department of Diagnostic Radiology, Turku University Hospital, Turku, Finland.
Department of Urology, Turku University Hospital, Turku, Finland.
Eur J Radiol Open. 2023 Jul 6;11:100506. doi: 10.1016/j.ejro.2023.100506. eCollection 2023 Dec.
A detailed understanding of the non-perfused volume (NPV) evolution after prostate ablation therapy is lacking. The impact of different diseased prostate tissues on NPV evolution post-ablation is unknown.
To characterize the NPV evolution for three treatment groups undergoing heat-based prostate ablation therapy, including benign prostatic hyperplasia (BPH), primary prostate cancer (PCa), and radiorecurrent PCa.
Study design and data analysis were performed retrospectively. All patients received MRI-guided transurethral ultrasound ablation (TULSA). 21 BPH, 28 radiorecurrent PCa and 40 primary PCa patients were included. Using the T1-weighted contrast-enhanced MR image, the NPV was manually contoured by an experienced radiologist. All patients received an MRI immediately following the ablation. Follow-up included MRI at 3- and 12 months for BPH and radiorecurrent PCa patients and at 6- and 12 months for primary PCa patients.
A significant difference between BPH and radiorecurrent PCa patients was observed at three months (p < 0.0001, Wilcoxon rank sum test), with the median NPV decreasing by 77 % for BPH patients but increasing by 4 % for radiorecurrent PCa patients. At six months, the median NPV decreased by 97 % for primary PCa. Across all groups, although 40 % of patients had residual NPV at 12 months, it tended to be < 1 mL.
The resolution of necrotic tissue after ablation was markedly slower for irradiated than treatment-naïve prostate tissue. These results may account for the increased toxicity observed after radiorecurrent salvage therapy. By 12 months, most necrotic prostate tissue had disappeared in every treatment group.
目前缺乏对前列腺消融治疗后无灌注体积（NPV）演变的详细了解。不同病变前列腺组织对消融后NPV演变的影响尚不清楚。
对接受热消融前列腺治疗的三个治疗组（包括良性前列腺增生（BPH）、原发性前列腺癌（PCa）和放射性复发性PCa）的NPV演变进行特征描述。
回顾性进行研究设计和数据分析。所有患者均接受磁共振成像（MRI）引导下经尿道超声消融（TULSA）。纳入21例BPH患者、28例放射性复发性PCa患者和40例原发性PCa患者。由经验丰富的放射科医生在T1加权对比增强MR图像上手动勾勒出NPV。所有患者在消融后立即接受MRI检查。随访包括BPH和放射性复发性PCa患者在3个月和12个月时的MRI检查，以及原发性PCa患者在6个月和12个月时的MRI检查。
在三个月时观察到BPH和放射性复发性PCa患者之间存在显著差异（p < 0.0001，Wilcoxon秩和检验），BPH患者的NPV中位数下降了77%，而放射性复发性PCa患者的NPV中位数增加了4%。在六个月时，原发性PCa患者的NPV中位数下降了97%。在所有组中，尽管40%的患者在12个月时有残留NPV，但往往<1 mL。
与未接受过治疗的前列腺组织相比，接受过放疗的前列腺组织消融后坏死组织的消退明显较慢。这些结果可能解释了放射性复发性挽救治疗后观察到的毒性增加。到12个月时，每个治疗组中大多数坏死前列腺组织已消失。
