1.5T MRI-guided trans-perineal laser ablation of locally recurrent prostate adenocarcinoma

Introduction: Biochemical recurrence of prostate cancer after definitive therapy with radical prostatectomy (RP) is known to occur between 25-30%. We present the first known case of 1.5T MRI guided ablation using laser interstitial thermal therapy (LITT) for locally recurrent prostate cancer following RP. Methods: The patient elected to undergo MRI-guided LITT of the biopsy proven cancer recurrence using an FDAapproved MRI compatible, 980nm, 15-watt laser system with MR thermometry. Under T2-weighted MR(1.5T Siemens) imaging, guidance and targeting of the lesions with trans-perineal placement of laser applicators. Multiple cycles of laser energy were used to ablate the tumor. A MRI-compatible urethral cooling catheter was placed to prevent urethral thermal damage. Results: Intra-procedural temperature mapping allowed continuous monitoring of the ablation zone and permitted ablation control until tumor coverage was achieved. Additionally, the protective cooling effects of the urethral cooling catheter could also be seen with the temperature mapping. Post-ablation gadolinium and T2 weighted MR imaging demonstrated an ablation defect encompassing the recurrent tumor with no residual hyper-enhancing nodules. Three month follow-up shows no residual or recurrent tumor seen on MR imaging. Conclusion: This represents the first known, successful, MRI-guided, LITT procedures at 1.5T for locally recurrent prostate adenocarcinoma following RP.