MRI-guided, transrectal, intraprostatic steam application as potential focal therapeutic modality for prostatic diseases in a large animal translational model: A feasibility follow-up study

Autoři: Adriano Wang-Leandro aff001;  Florian Willmitzer aff002;  Agnieszka Karol aff003;  Beat Porcellini aff004;  Peter Kronen aff005;  Emile M. Hiltbrand aff006;  Daniel Rüfenacht aff004;  Patrick R. Kircher aff001;  Henning Richter aff001
Působiště autorů: Clinic for Diagnostic Imaging, Department for Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland aff001;  Vetzentrum AG, Zurich, Switzerland aff002;  Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland aff003;  Radiology Department, Hirslanden Clinic, Zurich, Switzerland aff004;  Veterinary Anaesthesia Services-International (VAS-int.), Winterthur, Switzerland aff005;  Cermavein, Archamps, France aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article


Parallel to establishment of diagnostic surveillance protocols for detection of prostatic diseases, novel treatment strategies should be developed. The aim of the present study is to evaluate the feasibility and possible side effects of transrectal, MRI-targeted intraprostatic steam application in dogs as an established large animal translational model for prostatic diseases in humans. Twelve healthy experimental, intact, male beagle dogs without evidence of prostatic pathology were recruited. An initial MRI examination was performed, and MRI-targeted steam was applied intraprostatically immediately thereafter. Serum levels of C-reactive protein (CRP), clinical and ultrasonographic examinations were performed periodically following the procedure to assess treatment effect. Four weeks after treatment, all dogs underwent follow-up MRI examinations and three needle-core biopsies were obtained from each prostatic lobe. Descriptive statistics were performed. MRI-guided intraprostatic steam application was successfully performed in the study population. The first day after steam application, 7/12 dogs had minimal signs of discomfort (grade 1/24 evaluated with the short-form Glasgow Composite Measure Pain Scale) and no dogs showed any sign of discomfort by day 6. CRP elevations were detected in 9/12 dogs during the first week post steam application. Mild to moderate T2 hyperintense intraparenchymal lesions were identified during follow-up MRI in 11/12 dogs four weeks post procedure. Ten of these lesions enhanced mild to moderately after contrast administration. Coagulative necrosis or associated chronic inflammatory response was detected in 80.6% (58/72) of the samples obtained. MRI-targeted intraprostatic steam application is a feasible technique and displays minimal side effects in healthy dogs as translational model for human prostatic diseases. This opens the possibility of minimally invasive novel treatment strategies for intraprostatic lesions.

Klíčová slova:

Biopsy – Dogs – Inflammation – Magnetic resonance imaging – Necrosis – Prostate cancer – Prostate gland – Ultrasound imaging


1. Torre LA, Siegel RL, Ward EM, Jemal A. Global Cancer Incidence and Mortality Rates and Trends—An Update. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2016;25(1):16–27.

2. Haas GP, Delongchamps N, Brawley OW, Wang CY, de la Roza G. The worldwide epidemiology of prostate cancer: perspectives from autopsy studies. The Canadian journal of urology. 2008;15(1):3866–71. 18304396

3. Woodrum DA, Gorny KR, Mynderse LA. MR-Guided Prostate Interventions. Topics in magnetic resonance imaging: TMRI. 2018;27(3):141–51. doi: 10.1097/RMR.0000000000000155 29870466

4. Cooperberg MR, Lubeck DP, Meng MV, Mehta SS, Carroll PR. The changing face of low-risk prostate cancer: trends in clinical presentation and primary management. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2004;22(11):2141–9.

5. Esserman LJ, Thompson IM, Reid B, Nelson P, Ransohoff DF, Welch HG, et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. The Lancet Oncology. 2014;15(6):e234–42. doi: 10.1016/S1470-2045(13)70598-9 24807866

6. Wu F, ter Haar G, Chen WR. High-intensity focused ultrasound ablation of breast cancer. Expert review of anticancer therapy. 2007;7(6):823–31. doi: 10.1586/14737140.7.6.823 17555392

7. Behan JW, Sutton A, Wysong A. Management of Skin Cancer in the High-Risk Patient. Current treatment options in oncology. 2016;17(12):60. doi: 10.1007/s11864-016-0435-z 27766546

8. Ginzburg S, Tomaszewski JJ, Kutikov A. Focal ablation therapy for renal cancer in the era of active surveillance and minimally invasive partial nephrectomy. Nature reviews Urology. 2017;14(11):669–82. doi: 10.1038/nrurol.2017.143 28895562

9. Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet (London, England). 2017;389(10071):815–22.

10. Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. The New England journal of medicine. 2018;378(19):1767–77. doi: 10.1056/NEJMoa1801993 29552975

11. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging—Reporting and Data System: 2015, Version 2. European urology. 2016;69(1):16–40. doi: 10.1016/j.eururo.2015.08.052 26427566

12. Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ, et al. Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. European urology. 2011;59(4):477–94. doi: 10.1016/j.eururo.2010.12.009 21195536

13. Pesapane F, Patella F, Fumarola EM, Zanchetta E, Floridi C, Carrafiello G, et al. The prostate cancer focal therapy. Gland surgery. 2018;7(2):89–102. doi: 10.21037/gs.2017.11.08 29770305

14. Dixon CM, Rijo Cedano E, Mynderse LA, Larson TR. Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezum((R)) system: evaluation of acute ablative capabilities in the human prostate. Research and reports in urology. 2015;7:13–8. doi: 10.2147/RRU.S74040 25674555

15. Feng C, Hu B, Hu B, Chen L, Li J, Huang J. Comparative study of conventional US, contrast enhanced US and enhanced MR for the follow-up of prostatic radiofrequency ablation. Experimental and therapeutic medicine. 2017;13(6):3535–42. doi: 10.3892/etm.2017.4399 28588677

16. Nour SG. Magnetic Resonance Image-Guided Focal Prostate Ablation. Seminars in interventional radiology. 2016;33(3):206–16. doi: 10.1055/s-0036-1586153 27582608

17. Turkbey B, Hoyt RF Jr., Agarwal HK, Bernardo M, Sankineni S, Johnson L, et al. Magnetic resonance sentinel lymph node imaging of the prostate with gadofosveset trisodium-albumin: preliminary results in a canine model. Academic radiology. 2015;22(5):646–52. doi: 10.1016/j.acra.2014.12.021 25683498

18. Pauly KB, Diederich CJ, Rieke V, Bouley D, Chen J, Nau WH, et al. Magnetic resonance-guided high-intensity ultrasound ablation of the prostate. Topics in magnetic resonance imaging: TMRI. 2006;17(3):195–207. doi: 10.1097/RMR.0b013e31803774dd 17414077

19. Burtnyk M, Hill T, Cadieux-Pitre H, Welch I. Magnetic Resonance Image Guided Transurethral Ultrasound Prostate Ablation: A Preclinical Safety and Feasibility Study with 28-Day Followup. The Journal of urology. 2015;193(5):1669–75. doi: 10.1016/j.juro.2014.11.089 25464003

20. Siddiqui K, Chopra R, Vedula S, Sugar L, Haider M, Boyes A, et al. MRI-guided transurethral ultrasound therapy of the prostate gland using real-time thermal mapping: initial studies. Urology. 2010;76(6):1506–11. doi: 10.1016/j.urology.2010.04.046 20709381

21. Chen JC, Moriarty JA, Derbyshire JA, Peters RD, Trachtenberg J, Bell SD, et al. Prostate cancer: MR imaging and thermometry during microwave thermal ablation-initial experience. Radiology. 2000;214(1):290–7. doi: 10.1148/radiology.214.1.r00ja06290 10644139

22. Sommer G, Bouley D, Gill H, Daniel B, Pauly KB, Diederich C. Focal ablation of prostate cancer: four roles for magnetic resonance imaging guidance. The Canadian journal of urology. 2013;20(2):6672–81. 23587506

23. Sun F, Baez-Diaz C, Sanchez-Margallo FM. Canine prostate models in preclinical studies of minimally invasive interventions: part I, canine prostate anatomy and prostate cancer models. Translational andrology and urology. 2017;6(3):538–46. doi: 10.21037/tau.2017.03.61 28725597

24. Sun F, Baez-Diaz C, Sanchez-Margallo FM. Canine prostate models in preclinical studies of minimally invasive interventions: part II, benign prostatic hyperplasia models. Translational andrology and urology. 2017;6(3):547–55. doi: 10.21037/tau.2017.03.62 28725598

25. Leroy BE, Northrup N. Prostate cancer in dogs: comparative and clinical aspects. Veterinary journal (London, England: 1997). 2009;180(2):149–62.

26. Reid J, Nolan AM, Hughes JML, Lascelles D, Pawson P, Scott EM. Development of the short-form Glasgow Composite Measure Pain Scale (CMPS-SF) and derivation of an analgesic intervention score. Animal Welfare. 2007;16(2):97–104.

27. Wiesner E, Zwingenberger A. Reproductive Tract. Atlas of Small Animal CT and MRI. Ames, Iowa: John Wiley & Sons, Inc; 2015. p. 604–14.

28. Thurner EM, Krenn-Pilko S, Langsenlehner U, Stojakovic T, Pichler M, Gerger A, et al. The elevated C-reactive protein level is associated with poor prognosis in prostate cancer patients treated with radiotherapy. European journal of cancer (Oxford, England: 1990). 2015;51(5):610–9.

29. Liu ZQ, Chu L, Fang JM, Zhang X, Zhao HX, Chen YJ, et al. Prognostic role of C-reactive protein in prostate cancer: a systematic review and meta-analysis. Asian journal of andrology. 2014;16(3):467–71. doi: 10.4103/1008-682X.123686 24589465

30. Kim Y, Jeon Y, Lee H, Lee D, Shim B. The Prostate Cancer Patient Had Higher C-Reactive Protein Than BPH Patient. Korean journal of urology. 2013;54(2):85–8. doi: 10.4111/kju.2013.54.2.85 23549045

31. Kaufmann S, Kruck S, Kramer U, Gatidis S, Stenzl A, Roethke M, et al. Direct comparison of targeted MRI-guided biopsy with systematic transrectal ultrasound-guided biopsy in patients with previous negative prostate biopsies. Urologia internationalis. 2015;94(3):319–25. doi: 10.1159/000365397 25227711

32. Geller RL, Nour SG, Osunkoya AO. Pathologic findings in patients with targeted magnetic resonance imaging-guided prostate needle core biopsies. International journal of clinical and experimental pathology. 2015;8(9):9790–5. 26617689

33. Leveillee RJ, Pease K, Salas N. Emerging needle ablation technology in urology. Current opinion in urology. 2014;24(1):98–103. doi: 10.1097/MOU.0000000000000017 24247176

34. McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. The Journal of urology. 2016;195(5):1529–38. doi: 10.1016/j.juro.2015.10.181 26614889

35. Roberts WW. New technologies in benign prostatic hyperplasia management. Current opinion in urology. 2016;26(3):254–8. doi: 10.1097/MOU.0000000000000277 26859557

36. Romero Otero J, Garcia Gomez B, Campos Juanatey F, Touijer KA. Prostate cancer biomarkers: an update. Urologic oncology. 2014;32(3):252–60. doi: 10.1016/j.urolonc.2013.09.017 24495450

37. Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. The New England journal of medicine. 2008;358(12):1250–61. doi: 10.1056/NEJMoa074311 18354103

38. Bass EJ, Ahmed HU. Focal therapy in prostate cancer: A review of seven common controversies. Cancer treatment reviews. 2016;51:27–34. doi: 10.1016/j.ctrv.2016.07.004 27846402

39. Mantziaras G, Alonge S, Faustini M, Luvoni GC. Assessment of the age for a preventive ultrasonographic examination of the prostate in the dog. Theriogenology. 2017;100:114–9. doi: 10.1016/j.theriogenology.2017.06.010 28708525

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden