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USING MRI IMAGING TO GUIDE TARGETED PROSTATE CANCER HIFU TREATMENT

  • In the evolving world of prostate cancer diagnosis and treatment, urologists are increasingly aware of the need to sharpen their imaging skills. Nowhere was this more evident than at the American Urological Association's 2013 annual meeting in San Diego, CA. The outdoor serenity of sun-bathed palm trees stood in contrast to the high energy buzz taking place inside the convention center. The role of advanced imaging in targeting prostate cancer biopsies and treatments was in the spotlight.

    Imaging technologies have rapidly improved to the point where they are virtual "eyesight" that can distinguish between healthy tissue and tumors. No scalpel is needed for analysis deep within the body. I am proficient at using an innovative imaging technology that unites urologic imaging (ultrasound) with advanced MRI. I use the Artemis® biopsy equipment with its own software that co-registers ("fuses") prostate MRI images and ultrasound. Just as light waves coming into the human eye are transmitted to the brain, which organizes them into a recognizable picture, the patterns picked up by ultrasound and MRI are transmitted to the software, which fuses them into an accurate 3-dimensional model of each patient's unique prostate gland. The model shows the exact location of any suspicious area within the gland. I can determine if a needle biopsy is warranted. If so, the same model enables me to guide the Artemis biopsy directly into the core of the apparent tumor. This is important, because if cancer is present, the center is where the most aggressive cells are likely to be, thus giving an accurate idea of how aggressive it may be.

    What if the same type of fusion imaging, combining ultrasound with multiparametric MRI, could be built into a device to guide tumor ablation (destruction)? The AUA convention offers an opportunity to see new technology in the exhibit hall, where industry breakthroughs are displayed. It also offers a chance to attend lectures and presentations announcing the results of using these innovations in clinical trials. I discover ways to improve my practice by acquiring and learning such advances.

    In fact, the integration of fusion imaging into thermal ablation devices is under development. For example, SonaCare Medical (Charlotte, NC) has issued a press release about a promising partnership with University College London (UCL) to integrate UCL's SmartTarget image registration and fusion software into their own HIFU (High Intensity Focused Ultrasound) ablation systems. UCL has now used SmartTarget not only to guide biopsies, but also for successful targeted, tissue-sparing ablation. (http://sonacaremedical.com/sonacare-medical-partners-with-university-college-london-to-create-center-of-exc)

    As we move into the future, targeted ablation continues to claim a clinical position as an alternative to surgery. Imaging advances like SmartTarget and Artemis fusion software mean that targeted biopsies and focused tumor destruction are becoming ever more available to patients who are medically qualified for such procedures, and who want the lifestyle advantages that they afford. These include quick recovery, minimal-to-no side effects, repeatability if necessary, and preserving all future treatment options. With the ability to guide a precise knockout punch to a prostate tumor, fusing ultrasound and MRI is a happy marriage. I have made a commitment to work with both SonaCare Medical and scientists at University College of London to speed integration of SmartTarget into the Sonablate 500 devices that I use in Nassau and Bermuda.