Effect of neoadjuvant androgen deprivation therapy on prostate and tumor morphology prior to MRI-guided transurethral ultrasound ablation of prostate cancer.
Thermal ablation is a minimally invasive treatment for localized prostate cancer (PCa). MRI-guided transurethral ultrasound ablation (TULSA) enables precise, temperature-controlled therapy, but its 3 cm ablation radius may limit coverage in large prostates or capsule-adjacent tumors. Neoadjuvant androgen deprivation therapy (nADT) may improve treatment feasibility by reducing prostate and tumor size.
In this prospective, single-arm pilot study (NCT05917860), 15 treatment-naïve patients with organ-confined, intermediate-risk ISUP 2-3 PCa and at least one biopsy-concordant PI-RADS ≥ 3 lesion received 3-month nADT with degarelix before whole-gland TULSA. Multiparametric MRI was performed at baseline and monthly thereafter to assess prostate and lesion volumes, tumor-capsule relationship, and urethra-capsule distance.
All patients completed nADT. Across 27 PI-RADS ≥ 3 lesions, four patients had unifocal disease, and 11 had multifocal disease (2-3 lesions). Twenty lesions were ISUP Grade Group 2 and three were Grade Group 3. PSA declined by 87% (-7.6 ng/mL; 95% CI. -9.7 to -5.7; p < 0.001), and all patients achieved castrate testosterone levels. Prostate volume decreased by 26% (-15 mL; 95% CI. -20 to -12; p < 0.001), index lesion volume by 69% (-0.8 mL; 95% CI. -1.2 to -0.5; p < 0.001), and index-lesion capsule contact length by 40% (-5 mm; 95% CI. -7 to -4; p < 0.001). Capsule bulging resolved in four of seven patients, and urethra-capsule distance decreased to ≤ 30 mm in all six patients with a baseline distance > 30 mm.
Short-term nADT with degarelix was associated with significant changes in prostate and tumor morphology. Future studies should determine whether these changes improve TULSA outcomes.
In this prospective, single-arm pilot study (NCT05917860), 15 treatment-naïve patients with organ-confined, intermediate-risk ISUP 2-3 PCa and at least one biopsy-concordant PI-RADS ≥ 3 lesion received 3-month nADT with degarelix before whole-gland TULSA. Multiparametric MRI was performed at baseline and monthly thereafter to assess prostate and lesion volumes, tumor-capsule relationship, and urethra-capsule distance.
All patients completed nADT. Across 27 PI-RADS ≥ 3 lesions, four patients had unifocal disease, and 11 had multifocal disease (2-3 lesions). Twenty lesions were ISUP Grade Group 2 and three were Grade Group 3. PSA declined by 87% (-7.6 ng/mL; 95% CI. -9.7 to -5.7; p < 0.001), and all patients achieved castrate testosterone levels. Prostate volume decreased by 26% (-15 mL; 95% CI. -20 to -12; p < 0.001), index lesion volume by 69% (-0.8 mL; 95% CI. -1.2 to -0.5; p < 0.001), and index-lesion capsule contact length by 40% (-5 mm; 95% CI. -7 to -4; p < 0.001). Capsule bulging resolved in four of seven patients, and urethra-capsule distance decreased to ≤ 30 mm in all six patients with a baseline distance > 30 mm.
Short-term nADT with degarelix was associated with significant changes in prostate and tumor morphology. Future studies should determine whether these changes improve TULSA outcomes.
Authors
Virtanen Virtanen, MÀkelÀ MÀkelÀ, Sainio Sainio, Högerman Högerman, Nurminen Nurminen, Ettala Ettala, Anttinen Anttinen
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