Urology

Case of the Month

Aquablation: The Versatile ‘Swiss Army Knife’

Dr. Christopher Kelly presents a case of a 160-gram benign prostate hyperplasia treated using Aquablation.

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Complex Case Spotlight

Targeted Salvage Cryoablation Resolves Radio-Recurrent Prostate Cancer

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Advanced Imaging Localizes Lesion & Rules Out Metastatic Disease

About 11 years after a diagnosis of prostate cancer treated with radiation therapy, a patient presented with progressively rising PSA levels. Multiparametric MRI revealed a lesion in the left medial posterior base peripheral zone; a subsequent MRI-ultrasound fusion biopsy demonstrated prostate cancer in 1 of 12 systematic cores and 3 of 3 targeted cores obtained from the lesion. An 18F-fluciclovine whole-body PET CT supported the conclusion of a local recurrence and found no evidence of metastatic disease.

Prostate imaging. A) Axial T2 MRI scan showing PI-RADS 5 lesion. B) Apparent diffusion coefficient map with corresponding region of restricted diffusion. C) 18F-fluciclovine PET demonstrating uptake in the left posterior prostate.
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Salvage Cryoablation Treats Prostate Cancer Recurrence

Salvage partial gland cryoablation deploys the energy in a smaller and more focal treatment volume and at a slower rate to minimize the higher risk for side effects in a post-radiation setting. For the procedure, six V-probes were placed into the left posterior hemi-prostate, with six thermocouple probes at treatment boundaries to provide intraoperative temperature assessment of the margins.

Post-ablation imaging. A) Pretreatment MRI. B) Four-year post-ablation MRI showing no evidence of tumor.
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Patient’s PSA Levels Post-Radiation Therapy and PSA Levels Post-Salvage Cryoablation

Post-Treatment PSA Monitoring Affirms Successful Cancer Therapy

To be successful, salvage focal cryoablation requires careful patient selection and a meticulous treatment application; in addition, monitoring patients with serial PSA and MRI can provide essential clinical endpoints. Four years after the salvage cryoablation procedure, regular PSA monitoring has found no evidence of prostate cancer in the patient.

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The patient’s PSA levels.
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