Laser Ablation For Prostate Cancer

What Is The Outlook For Patients Who Receive Focal Therapy

While the use of focal therapy for localized prostate cancer appears to be a promising development in a number of ways, it is still considered investigational and not yet part of standard therapy. There are a number of reasons for this, as follows:

• The criteria for selecting ideal candidates havent been fully agreed on. This is an important question because mistakenly using focal therapy in place of a more traditional treatment could allow a cancer to go under-treated.
• The criteria for defining an index lesion still need to be agreed on.
• The idea that the index lesion determines how the cancer will develop hasnt yet been proven.
• The factors that define treatment success or failure, and the triggers for re-treatment still need to be determined.
• The long-term effectiveness of focal therapy is unknown.
• It isnt clear that all side effects are eliminated by using focal therapy.
• Focal therapy doesnt allow for firsthand pathologic and biologic study of cancerous tissue, as can be done when using surgical treatment.
• Focal therapy sometimes leaves behind untreated cancer, which could possibly raise the risk of more serious problems in the future.
• The overall cost to the healthcare system may be greater for focal therapy than for standard treatments.

Primary Focal Therapy For Localized Prostate Cancer: A Review Of The Literature

Oncology

Focal therapy for prostate cancer could balance undertreatment and overtreatment of localized prostate cancer for highly selected patients. Long-term oncologic outcomes are not yet available for any modality. Patients should be informed regarding currently available outcomes, the necessity of adherence to a stringent follow-up protocol, and the possible need for additional targeted therapy or future radical treatment in case of recurrence.

How Does It Work

Hear Dr. Michael Bedecs FLA story

Sperling Diagnostic Group, in conjunction with Sperling Prostate Center has developed a simple, proprietary 4-step treatment protocol utilizing our advanced technological capabilities and expertise.

Candidates are qualified for BlueLaser treatment based on a detailed prostate map from our multi-parametric MRI, and targeted biopsy of suspicious prostate tissue.

A personalized procedure blueprint is developed based the patients prostate anatomy including tumor location, size, stage, and grade of confirmed prostate cancer.

Focal Laser Ablation of the prostate using BlueLaser is performed by leading laser expert Dr. Dan Sperling and his staff. During the procedure Dr. Sperling uses real-time MRI to visualize the tumor, guide laser placement, and destroy tumors while protecting healthy tissue surrounding it. Heres how the procedure works:

First, pre-procedure MRI images confirm placement of applicator in the target tissue.

Then a thin laser fiber is placed into the tumor under MRI guidance, in order to heat the tumor. MR images and device software allow the doctor to see the tissue being heated and control how much energy is deliveredfor optimal oversight of tumor ablation and healthy tissue preservation.

Imaging and special temperature-sensitive software confirm the area of ablation and treatment success.

Immediately after treatment, patients meet with Dr. Sperling to go over results before leaving the Center.

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Function Of The Prostate Gland

As part of the male reproductive system, the prostate glands main job is to secrete a slightly alkaline fluid that forms part of the seminal fluid. This is the fluid that carries sperm. During ejaculation, the muscular glands of the prostate help to propel the prostate fluid, and sperm that was made in the testicles, into the urethra and out of the body.

What Are The Side Effects Of Radiofrequency Ablation

As is the case with any other injection procedure, there is always potential for side effects or other complications. The risk of complications from radiofrequency ablation is very low. The main side effect of the procedure include:

Fatigue.

Mild discomfort at the site where the needles were inserted into your skin.

Any procedure that penetrates the skin carries a risk of infection.

However, in most cases, this will go away after a few days.

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What Is Focal Laser Ablation

Patient Dr. Michael Bedecs tells his story

Laser ablation generates intense heat that completely encompasses the targeted area. Under real-time MRI guidance, a special optical fiber is guided precisely into place at the core of the tumor. When activated, the laser emitted at the tip of the fiber destroys the tumor within minutes while special tracking called thermometry confirms the proper temperature. Afterward, multi-parametric MRI scans reveal that the destruction is complete, and the laser fiber is removed.

Did you know Focal Laser Ablation can ease the symptoms of BPH?

How Are We Different

Unlike conventional whole-gland surgery or radiation, the Sperling Prostate Center offers a precise, targeted prostate cancer treatment called Focal Laser Ablation . For appropriate patients, this outpatient procedure ablates a cancerous tumor plus a margin of safety around the tumor. FLA preserves sexual and urinary function in order to preserve total quality of life. Learn more about the FLA procedure.

Another important benefit of minimally invasive FLA is its minimal interruption into a patients life, especially for those traveling from a distance. With its reduced procedure time and a very brief recuperation, theres no lengthy medical vacation travelthough South Florida is a lovely place to linger for a few extra relaxing days.

Many of our Canadian patients book additional leisure time to enjoy our year-round balmy weather, lovely beaches, and resort vacations. Whether your stay in The Sunshine State is short or extended, any additional follow-up after your return home can be accomplished by phone consultation.

• No risk of hospital-borne infection
• Short outpatient procedure reduces travel time away from home
• Rapid routine to normal work, leisure, exercise, and intimacy
• Cancer control competitive with whole-gland treatments
• Leaves all future treatment options open if cancer recurs

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How Long Does It Take To Recover From Radiofrequency Ablation For Prostate Cancer

After the focal laser ablation procedure, one may experience soreness in the targeted area for a couple of days. A catheter may be used to divert urine out of the body, allowing time for the body to heal after the procedure. After the procedure, you ought to be able to return to your regular activities in 3 to 5 days. 2 to 3 weeks later, most patients will have fully recovered. Most patients will have recovered completely 2 to 3 weeks following the procedure.

Dont Confuse Fusion Biopsy With Real

A recent development, fusion-guided biopsy, is often called an MRI-guided biopsy but this is misleading. In fact, it fuses previously captured MRI images with real-time ultrasounda computerized image manipulation process that compromises accuracy. See a comparison of TRUS, fusion, and real-time in-bore MRI biopsies.

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About Your Prostate Ablation Procedure

Prostate ablation is a procedure used to treat prostate cancer. During a prostate ablation procedure, energy is used to kill the cancer cells. The energy may also destroy some of the surrounding normal prostate tissue.

Youll get anesthesia before your procedure unless your healthcare provider tells you otherwise. Once youre asleep, youll be positioned on your back with your legs supported and raised above your hips with your knees bent.

Your healthcare provider may place a cystoscope through your urethra to your prostate and bladder after youre asleep, before your ablation. This is to check for anything that might affect your procedure.

Prostate ablation can be done with a needle ablation or with high-frequency ultrasound energy. Your healthcare provider will talk with you about which type of ablation is best for you.

Minimal Urinary Erectile Problems Say Investigators

Nick Mulcahy

May 01, 2019

Focal laser ablation for prostate cancer shows âpromising early oncologic resultsâ and âacceptable morbidityâ in men with low- to intermediate-risk prostate cancer, concludes a new single-center study of the experimental treatment method.

However, outcomes from this series of 120 patients, which is the largest data set published to date, indicate that nearly 20% of the men needed some form of re-treatment after one year.

Also, an expert not involved with the study, who congratulated the authors for collecting and publishing data, believes the study has important limitations.

The new study appeared in the March issue of the Journal of Vascular and Interventional Radiology

âThereâs a huge untapped population of men who donât want to undergo surgery this gives them an alternative,â lead author Eric Walser, MD, an interventional radiologist at the University of Texas Medical Branch in Galveston, told Medscape Medical News.

Walser is one of the first practitioners in the US to use FLA to treat prostate cancer.

With FLA, the prostate is accessed via the rectum. The laser fiber and rectal probe are guided to the tumors using an interventional magnetic resonance imaging system.

The investigators report that, 1 year after FLA, study patients had âno significant changes in quality of life,â and 83% were free from re-treatment.

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What Happens After A Radiofrequency Ablation Procedure

When the procedure is over, the needle electrode is taken out, and the area of the skin where the probe was inserted into a patients skin is dressed up. Most focal ablation patients return home the same day as their procedure however, some elect to spend the night in the hospital. After your focal laser ablation procedure, if you plan to leave the hospital, make arrangements for someone to drive you home. Youre not supposed to engage in any physically demanding activities after the procedure.

Before leaving the hospital, discuss follow-up care with your doctor, and follow all the post-hospital instructions your healthcare provider gives you after leaving the hospital.

Different Types Of Focal Therapy

• HIFU : HIFU focuses the energy of sound waves to create heat and destroy cancer cells. Just like a magnifying glass concentrating sun rays to burn a hole in the paper. During the procedure, an ultrasound probe is inserted into the patients rectum while the patient is asleep from anesthesia. Guided by MRI and ultrasound 3D-images, the physician finds the tumor, plus the area to be treated, and delivers the energy aimed at the diseased tissue in the prostate gland. HIFU is a noninvasive precision treatment that spares healthy tissue and lowers the chances of negative side effects associated with radical prostate surgery or radiation, such as impotence, incontinence and bowel function disturbance. UChicago Medicine is the first medical center in the Midwest to offer and perform this procedure with the newest Focal One advanced robotic HIFU technology. This fills a significant treatment void for men with localized prostate cancer who find themselves in between active surveillance and whole gland treatments such as radiation or surgery. The treatment has been used for years in both Europe and Asia.

Urologists Ariel Shalhav, MD, and Scott Eggener, MD, answer questions about new treatment options for prostate cancer, including focal therapy and HIFU, as well as specialized care programs for men diagnosed with advanced prostate cancer or at high risk for the disease.

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Principles Of Laser Ablation

Laser ablation refers to the destruction of tissue using a focused beam of electromagnetic radiation emitted from a laser. Other terms for laser ablation include , laser interstitial therapy, and laser interstitial photocoagulation.

The principle of focal laser ablation therapy is to destroy a tissue target using laser radiation energy. The resulting rapid temperature elevation of the targeted tissue induces protein denaturation, resulting in in vivo tissue destruction. Prostate tissue is well suited for focal laser ablation due to its optical absorption rate without excess vascularity, which allows for finely controlled ablation.20

Effective focal laser ablation for the treatment of prostate cancer requires accurate delivery of the laser energy to the target tissue, sufficient thermal destruction to reliably destroy the target tissue, and minimal thermal destruction to surrounding tissues and neurovascular structures. Each step provides its own set of technical challenges, but ongoing advances in image acquisition and analysis, bioheat transfer modeling, and laser delivery technology make laser ablation of prostate cancer feasible today.

Laser Focal Therapy: What To Expect

You will receive both email and phone contact information for our medical team so that you can always reach us. In addition, we conduct a pre-operative consultation prior to the procedure, we meet the day of the procedure, and will see you frequently in follow-up.

Our team will have collected and reviewed your medical records to evaluate you for inclusion and suitability. Our surgical team will have discussed your case during Tumor Board and conducted a surgical plan based on size, number, shape and location of ablation areas. Prior to the procedure, we will review the Informed Consent Document with you to ensure you understand every aspect of the procedure. We will discuss the risk, benefits, and paperwork of the procedure.

The day of the procedure, our nurse will place an intravenous catheter in your arm so that she/he can administer IV antibiotics, pain medications and fluids . Should other medications be necessary, they will be administered through this IV as well.

You may have a urinary catheter placed so that we can provide cooled urethral saline through Continuous Bladder Irrigation protection. This catheter remains in place depending on the size, shape, and location of treatment. Our urologist will perform the insertion and removal.

Patients will return home or to their hotel room after at least two hours in the recovery room that same day. They must be accompanied by a family member or care giver as driving is not permitted.

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Quality Of Life Is An Important Endpoint

It is important to provide realistic expectations for men considering RP. Although RP is the best curative option for localized prostate cancer, disease recurrence does occur. Epstein and colleagues reported that the 5-year probability of biochemical recurrence following RP for men with biopsy GGG 1, 2, 3, 4, and 5 is approximately 4%, 12%, 37%, 52%, and 74%, respectively. Furthermore, RP is not without risk of long-term erectile and urinary morbidity. Haglind and colleagues reported on functional outcomes 1 year following over 2000 open and robotic RP performed in Sweden. The rates of incontinence defined by using two or more pads a day was 20% and 21% following open and robotic RP, respectively. The likelihood of an International Index of Erectile Function score decreasing to < 17 was 81% and 77% following open and robotic RP, respectively. Barry and colleagues reported similar results based on pre-operative and post-operative survey of RPs performed in the US Medicare population. Donovan and colleagues recently reported on patient-reported quality-of-life measures to compare functional outcomes between AS, RP, and RT cohorts as part of the ProtecT trial. As expected, men randomized to RP had greater compromise of urinary and erectile function as compared with AS or RT at all time points but had less bowel-related morbidity than the RT cohort.

Clinical Trial In Progress For Mri

The Sperling Medical Group is pleased to be participating in a Phase 2 & 3 clinical trial titled Focal ExAblate MR-Guided Focused Ultrasound Treatment for Management of Organ-Confined Intermediate Risk Prostate Cancer.

MRgFUS is the integration of two groundbreaking technologies into a precise, noninvasive treatment that destroys the tumor while sparing healthy structures. Real time MRI provides clear visualization of the anatomy and tumor with thermometry to monitor precision and effectiveness while focused ultrasound is used to ablate the tumorno surgery, no radiation.

The anticipated benefits of this treatment are:

• Low complication rate
• Non-invasive treatment, patients back to their life within a day or two
• Non-ionized radiation

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Our Workup Treatment And Follow

We look at your entire prostate health picture including your PSA, pathology results, MRI, and your personal treatment goals and desires.

Based on the MRI, we create a prostate map, outline where the cancer is located, whether or not it appears confined to the prostate, and its proximity to vital structures. Putting all the pieces together, we give a recommendation regarding whether or not you are a good candidate for focal laser ablation . The good news is that about 4 out of 5 new diagnoses of prostate cancer are in the local stage, usually amenable to focal treatment.

If you are a good candidate for FLA and choose to proceed, we perform the procedure in our 3T MRI location in Houston, Texas. Please look at our What To Expect page for more information about what to expect on the day before, day of, and day after the procedure.

We provide you with a detailed and personalized follow-up plan.

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Focal Laser Ablation Of Prostate Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.

Recruitment Status : Active, not recruitingFirst Posted : March 12, 2020Last Update Posted : December 6, 2021

Condition or disease

Not Applicable

The primary objective is to evaluate the safety and feasibility of MR-ultrasound image fusion-guided transrectal-based focal laser ablation of prostate cancer using the Orion System, an investigational laser-based interstitial irradiation/thermal soft-tissue ablation system. Safety and feasibility will be determined by analyzing the number, type, and severity of adverse events. In addition, changes in health-related quality of life will be evaluated using Expanded Prostate Index Composite for Clinical Practice , Memorial Anxiety Scale for Prostate Cancer , and Decision Regret Scale.

Safety based on cumulative adverse events incurred Safety will be determined by the cumulative number, type, and severity of adverse events incurred by subjects.

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