Image-Guided focal Laser therapies for prostate cancer

Given the increased incidence of prostate cancer low-risk, focal therapies appear as an attractive alternative between active surveillance and radical treatments. Laser therapies (photodynamic therapy [PDT] and interstitial laser thermotherapy [LITT]) could be modalities of application of this focal therapy. In the first section of this thesis, we discuss the concept of focal therapy, and the place of laser therapies compared to several other energy modalities. The first chapter of this section is devoted to the emergence of focal therapy, its histopathologic bases and the importance of imaging in its application. Ultrasonography and magnetic resonance imaging (MRI) are essential tools to aid diagnosis, patient selection and guidance of focal treatment. The advantages and disadvantages and the main clinical outcomes of different energy modalities used for focal therapy are presented in the second chapter of this section. We summarize a state of the art of PDT and LITT for the focal treatment in a third chapter. These Laser therapies are currently in clinical development. Both treatment modalities are based on different physical principles but their application to focal therapy raises identical issues (treatment planning, guiding interstitial treatment). We specify the developments currently underway to address these issues and particularly the work of our research unit. The second section of this thesis is dedicated to the experimental development of LITT for prostate cancer conducted in our research unit. In the first chapter of this section, we present the development of an animal model (rat Copenhagen with heterotopic and syngenic prostatic adenocarcinoma transplant Dunning R3327 -AT2) for processing focal LITT. We describe the monitoring of this therapy under ultrasonography and MRI and demonstrate the reproducibility of the volumes of necrosis induced for one given energy level. The second chapter of this section is devoted to the establishment of a treatment planning tools adapted to our in vivo model and based on tissue heat diffusion and calculation of induced cell damages. Finally in the third chapter, we propose the establishment of an anatomically valid prostate phantom to simulate and test focal LITT procedures. This phantom compatible with ultrasonography and MRI monitoring could also be used for the development of other focal therapy energy modalities. (author)