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Transurethral microwave thermotherapy of the prostate - Evaluation with MRI and analysis of parameters relevant to outcome.

Artikel i vetenskaplig tidskrift
Författare Stepan Vesely
Markus Müller
Tomas Knutson
Ralph Peeker
Mikael Hellström
Christer Dahlstrand
Publicerad i Scandinavian Journal of Urology and Nephrology
Volym 42
Nummer/häfte 1
Sidor 53-58
ISSN 0036-5599
Publiceringsår 2008
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för radiologi
Sidor 53-58
Språk en
Länkar dx.doi.org/10.1080/0036559070154707...
Ämnesord Microwave thermotherapy, prostatic hyperplasia, MRI
Ämneskategorier Urologi och andrologi

Sammanfattning

Objectives. To evaluate morphological changes in the hyperplastic prostate tissue following transurethral microwave thermotherapy and to investigate the dependence of the treatment outcome on structural and physiological features of the prostate. Material and methods. In this prospective study, 13 patients with chronic urinary retention due to benign prostatic hyperplasia (BPH) underwent Coretherm (ProstaLund, Lund, Sweden) microwave thermotherapy. Prior to the treatment and 1 week and 6 months after, the patients were examined with MRI using morphologic, contrast medium-enhanced perfusion and diffusion-weighted imaging. Such advanced MRI techniques permit an assessment of parameters that have a hypothetical influence on microwave thermotherapy (e.g. prostate blood perfusion, water content and prostate microstructure). Results. Morphologic and perfusion MRI showed a clear prostatic tissue defect in all 13 patients after 1 week and in all 12 patients at 6 months' follow-up. The mean size of the defect was 22.5 cm3 (27%) (range 3.7-47.3 cm3) and 4.1 cm3 (1.1-10.1 cm3) at 1 week and 6 months, respectively. The cell kill volume was estimated to be 20.5±7.4 cm3 and correlated significantly with the size assessed by MRI at 1 week (r=0.8; p=0.002) and 6 months (r=0.69; p=0.05). At 6 months, the mean decrease in prostate volume was 20.1 cm3 (p<0.0001). The microstructure of the prostate expressed as the apparent diffusion coefficient was shown to have a strong influence on the treatment process. All patients (n=12) were catheter-free at 6 months. Another patient experienced persistent obstruction and underwent transurethral resection of the prostate. Conclusions. Coretherm microwave treatment leads to significant intraprostatic necrosis, which is detectable with MRI even 6 months after the treatment. Diffusion-weighted MRI is capable of identifying structural features of the prostate that can predict the length of treatment and the amount of energy needed.

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