Gold nanoshell-localized photothermal ablation of prostate tumors in a clinical pilot device study

TLDR

Gold nanoparticles that absorb near‑infrared light and convert it to heat have been shown to induce localized hyperthermia and tumor remission in many preclinical cancer models. This study reports the first clinical results of using laser‑excited gold‑silica nanoshells guided by MRI‑ultrasound fusion to focally ablate low‑ to intermediate‑grade prostate tumors, aiming for precise regional control with minimal morbidity and better functional outcomes. In a pilot device trial of 16 low‑ or intermediate‑risk prostate cancer patients, GSNs were infused, followed by high‑precision laser ablation, then mpMRI at 48–72 h and targeted fusion biopsies at 3 and 12 months, plus a systematic biopsy at 12 months. GSN‑mediated focal laser ablation succeeded in 94 % (15/16) of cases, with no significant changes in International Prostate Symptom Score or Sexual Health Inventory for Men, indicating a safe and feasible protocol without serious complications or adverse genitourinary function.

Abstract

Biocompatible gold nanoparticles designed to absorb light at wavelengths of high tissue transparency have been of particular interest for biomedical applications. The ability of such nanoparticles to convert absorbed near-infrared light to heat and induce highly localized hyperthermia has been shown to be highly effective for photothermal cancer therapy, resulting in cell death and tumor remission in a multitude of preclinical animal models. Here we report the initial results of a clinical trial in which laser-excited gold-silica nanoshells (GSNs) were used in combination with magnetic resonance-ultrasound fusion imaging to focally ablate low-intermediate-grade tumors within the prostate. The overall goal is to provide highly localized regional control of prostate cancer that also results in greatly reduced patient morbidity and improved functional outcomes. This pilot device study reports feasibility and safety data from 16 cases of patients diagnosed with low- or intermediate-risk localized prostate cancer. After GSN infusion and high-precision laser ablation, patients underwent multiparametric MRI of the prostate at 48 to 72 h, followed by postprocedure mpMRI/ultrasound targeted fusion biopsies at 3 and 12 mo, as well as a standard 12-core systematic biopsy at 12 mo. GSN-mediated focal laser ablation was successfully achieved in 94% (15/16) of patients, with no significant difference in International Prostate Symptom Score or Sexual Health Inventory for Men observed after treatment. This treatment protocol appears to be feasible and safe in men with low- or intermediate-risk localized prostate cancer without serious complications or deleterious changes in genitourinary function.