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A new modality of treatment of localized prostate cancer: Initial experience with radio frequency interstitial tumor ablation (RITA) through a transperineal ultrasound-guided approach

par Schulman, Claude ;Zlotta, Alexandre ;Wildschutz, Thierry;Noël, Jean Christophe ;Silverman, David;Djavan, Bob ;Marberger, Michael Johann
Référence British journal of urology, 80, SUPPL. 2, page (267)
Publication Publié, 1997

Article révisé par les pairs

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Résumé :

Radiofrequency energy (RF) creates very localized controlled necrotic lesions and has already been used therefore to ablate, among others, liver metastasis and benign prostatic tissue. This study was intended to determine the feasibility, safety and pathology of the lesions induced by RF energy delivered interstitially in patients with prostate cancer (PCa) scheduled for radical prostatectomy. RITA was performed in 16 patients with localized PCa prior to surgery. RF energy was delivered into the prostate by active needles (monopolar or bipolar) placed through a transperineal approach under transrectal ultrasound guidance. Needles are covered by retractable shields thus allowing to deliver the energy on a chosen and controlled area. In 15 patients, the procedure was performed just before radical prostatectomy. The last patient was treated by RITA under spinal anesthesia 1 week prior to surgery. Two lesions were performed per prostate. NADPH staining and Hematoxylin-Eosin (HE) were used to assess the extent of the necrotic lesions. Average energy delivered ranged from 3000 to 11000 Joules with maximum central temperatures reaching 106°C for 12 minutes of ablation. No complications were encountered, especially no damage to the urethral sphincter or rectal wall. Macroscopic examination showed marked lesions including the prostate capsule of up to 2.2×1.5×4.5 cm. Microscopic examination showed clear delineated lesions both with NADPH (in prostates immediately removed after surgery) and HE (at 1 week after RITA). In 1 patient, no residual cancer was found on the specimen. Transperineally delivered RF is capable of creating safely reproducible controlled necrotic lesions in PCa. The data presented provide basic information for the potential future application of RITA for localized prostate cancer.