More About Ed And Urinary Function
All study patients were treated between 2013 and 2017, with a median patient age of 64 years.
Pre-treatment biopsy Gleason scores were 3 + 3 = 6 in 30.8% of patients 3 + 4 = 7 in 46.7% of patients and 4 + 3 = 7 in 22.5% of patients.
Most of the men had a pre-treatment clinical stage of cT1c. Nearly all of them had either one or two tumor sites on their gland.
This is an admirable mix of patients, suggested Eggener. “I give Dr Walser credit that two thirds of the patients he has treated have Gleason score seven or higher cancers, because most clinicians would agree that it should not be used routinely on people with lower grade cancers,” he said
The median PSA level of patients prior to treatment was 6.05 ng/mL and decreased to 3.25 ng/mL at 12 months post-treatment .
Tumor diameter above the median was the lone statistically significant predictor for a post-treatment positive MRI and thus the need for biopsy and the possibility of a confirmed recurrence.
Walser said that the patients in this study were overall highly educated and affluent. They tended to be white-collar professionals such as engineers and doctors who search online for alternative treatments to prostatectomy. Other alternative treatments including high intensity ultrasound and microwave ablation also appeal to this type of patient, he said.
Currently, FLA is not reimbursed by insurance or Medicare. Walser’s patients come via his Internet marketing or are self-referred.
Who Are Good Candidates For Focal Therapy
When focal therapy for prostate cancer first began to be used in about 2007, it was only as an alternative to active surveillance in very low-risk patients. Since then, the use of focal therapy has expanded to include those with favorable intermediate risk disease . The best candidates have a prostate gland of about 40cc in size or a tumor in the lower half of a larger gland, a single visible tumor on MRI, and the absence of cancer elsewhere in the gland .
In each case, the doctor will consider the patients general health and mental outlook, the size and location of the tumors present, and their chances of spreading more. Use of tests such as MRI, ultrasound, and biopsy can help decide if a patient will benefit more from focal therapy or from traditional treatments.
Can Focal Laser Ablation Treat Benign Prostatic Hyperplasia
After pioneering the use of FLA as a treatment for localized prostate cancer, Dr. Sperlings observation of his patients provided an exciting discovery. After undergoing FLA for prostate cancer, a number of patients who also had BPH-related urinary problems reported that their urinary symptoms had faded, due to the reduction of prostate volume following FLA.
Dr. Sperling developed a specialized FLA protocol for treating BPH as effectively as prostate cancer. Thanks to mpMRIs ability to depict the most problematic BPH areas, men with BPH can experience relief without medication or more invasive procedures. Dr. Sperling is able to use MRI guidance to direct FLA strategically for durable relief of urinary blockage.
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Minimal Urinary Erectile Problems Say Investigators
Nick Mulcahy
May 01, 2019
Focal laser ablation for prostate cancer shows “promising early oncologic results” and “acceptable morbidity” 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
“There’s a huge untapped population of men who don’t want to undergo surgery this gives them an alternative,” 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 “no significant changes in quality of life,” and 83% were free from re-treatment.
Walser predicts that the rate of cancer recurrence will drop to around 10% because his team modified its technique.
Dont Waittake Action Today
Schedule a free consultation with Dr. Sperling to map out a diagnosis and treatment plan personalized for your needs.
iGBD 2016 Healthcare Access and Quality Collaborators. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. The Lancet. 2018 June 2 391:2236-2271.
iiCIHI. Medical Imaging in Canada 2012. https://www.cihi.ca/en/mit_summary_2012_en.pdf
iiiGagnon, Louise, Canadian group tackles MRI wait through scheduling. Aunt Minnie Newsletter. Oct. 31, 2018. http://www.acr.inloop.com/en/article/11703
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Focal Therapy For Prostate Cancer
Video Transcript
Some men with early stage prostate cancer who previously had to choose between active surveillance and aggressive treatment with a greater risk for side effects, now have a new option for treatment: focal therapy.
Focal therapy is an overall term that refers to several minimally invasive treatments that target only the parts of the prostate gland where cancer is located. The goal of the treatment is to ablate, or destroy, the tumor and a safety margin within the prostate, while leaving the remainder of the gland intact.
The Role Of Mri For Target Identification
Focal ablation is based on the premise that clinically significant prostate cancer can be identified and localized prior to intervention. Ultrasonography, computed tomography imaging, and T1/T2-weighted MRI lack adequate sensitivity and specificity for detecting clinically significant prostate cancer. As mentioned above, mpMRI, which incorporates diffusion-weighted imaging and dynamic contrast enhancement, is emerging as a useful modality to reliably detect and even characterize clinically significant prostate cancer., A meta-analysis reported that the sensitivity and specificity of DWI for prostate cancer detection are 0.69 and 0.89, respectively, compared to the sensitivity and specificity of T2-weighted imaging alone .
Several studies support the utility of mpMRI for detecting the site of clinically significant prostate cancer.
Haffner and colleagues were the first to demonstrate the utility of mpMRI for directing prostate biopsies. A standard 12-core TRUS random guided biopsy was performed in all 555 cases. Of the 351 cases with a positive mpMRI result, additional tissue cores were directed into the focal abnormalities using visual estimation, or cognitive co-registration. Visual estimation identified virtually all of the clinically significant cancers while failing to detect many of the clinically insignificant cancers
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Diagnosis Using Real Time Mri
A real time prostate biopsy done in the bore of our powerful 3T magnet excels over all other biopsy methods. Standard 12-14 needle TRUS biopsies miss 30-40% of tumors. They over-detect insignificant prostate cancer and under-detect significant prostate cancer . In-bore biopsy with fewer needles is twice as accurate as TRUS biopsy.
Our Center uses the biopsy analysis services of top pathology labs. Results are available in 24-48 hours, lessening the need for multiple trips.
What Can Be Expected After Treatment Using Focal Therapy
Patients treated with focal therapy still need to be actively monitored afterwards. This includes watching for disease that may have gone undetected, has returned, is spreading, or is appearing for the first time. If follow-up tests show that some of the treated cancer still remains, additional ablation, surgery, or radiation may be needed.
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Financial Support And Sponsorship
NIH and Philips have a Cooperative Research and Development Agreement. NIH has intellectual property in the field, including among other patents and patent applications, Patent: System, methods, and instrumentation for image-guided prostate treatment US Patent number: 8948845, with inventors/authors B.W. and P.P. NIH and Philips have a licensing agreement. NIH and authors B.W. and P.P. receive royalties for a licensing agreement with Philips/InVivo Inc. NIH does not endorse or recommend any commercial products, processes, or services. The views and personal opinions of authors expressed herein do not necessarily reflect those of the US Government, nor reflect any official recommendation nor opinion of the NIH nor National Cancer Institute.
Prostate Cancer Treatment In Stuart Fl
The prostate gland is located just under the bladder in every man. This gland helps produce and transport sperm. Prostate canceris one of the most common types of cancer in men. Prostate cancer can range from minor to life-threatening.
Request more information about prostate cancer treatment today: call 623-9344 or .
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Featured Patient Testimonial: Wayne Gregory
Family, safety, and preserving quality of life were top of mind for Wayne Gregory when he chose laser focal therapy, also known as focal laser ablation , to treat his prostate cancer.I had lesions ultimately on both sides of the prostate near the nerve bundles,” said Gregory. “I knew that the skill and precision it was going to take to get that cancer ablated was going to have to be very, very high.He shared his story while on a trip back to Houston, Texas, where he had the procedure performed by Dr. Ara Karamanian, Director of HALO Diagnostic’s Prostate Program and Medical Director of the Prostate Laser Center.
Focal Therapy For Prostate Cancer: Recent Advances And Future Directions
Alex Wang, Luke P. OConnor, Nitin K. Yerram, MD, Naveen Nandanan, MD, Michael Ahdoot, MD, Amir H. Lebastchi, MD, Sandeep Gurram, MD, Heather Chalfin, MD, and Peter A. Pinto, MD
The authors are affiliated with the Urologic Oncology Branch of the National Cancer Institute at the National Institutes of Health in Bethesda, Maryland. Mr Wang and Mr OConnor are research scholars, Drs Yerram, Ahdoot, Lebastchi, Gurram, and Chalfin are clinical fellows, Dr Nandanan is a resident surgeon, and Dr Pinto is an investigator and head of the prostate cancer section.
Corresponding author:
Introduction
Oncologic Rationale and Use of Magnetic Resonance Imaging
Current Practices
Focal Laser Ablation
Focal laser ablation has recently gained popularity as a focal therapy option for the treatment of localized prostate cancer. During FLA, a small laser fiber is inserted into the tumor via a transperineal or transrectal approach.20 Thermal energy discharged through the laser fiber rapidly heats the lesion, creating a homogenous, spherical area of coagulative necrosis with well-defined borders .21 Although the extent of tissue destruction depends on the temperature and duration of the treatment, it has been shown that irreversible cell damage and protein denaturation occur at approximately 60°C.22
High-Intensity Focused Ultrasound
Irreversible Electroporation
Cryotherapy
Future Directions
Imaging: 7-Tesla MRI
MRI-Guided Transurethral Ultrasound Ablation
Disclosures
References
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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.
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?
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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.
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.
Focal Laser Ablation: The Casit Approach
Focal laser ablation achieves oncologic control by inducing hyperthermic conditions throughout the target lesion. Successful treatment requires accurate guidance of the laser fiber to the target lesion as well as real-time monitoring. Both of these tasks can be achieved with magnetic resonance imaging, however, this method is time consuming and expensive. We are developing an alternative approach in which ultrasound and interstitial probes are used for laser fiber guidance and treatment monitoring respectively .
Figure 2: A Setup during focal laser ablation. Ultrasound is used to guide a laser fiber to a target lesion with the resulting ablation monitored via four interstitial thermal probes. B Thermal data acquired by the interstitial thermal probes for two laser activations at different locations in the prostate. Note that the probe monitoring the laser tip exceeds 60°C while safety probes outside the target treatment zone remain relatively cool. C The treated tissue appears as a dark region on post-operative MRI. The location of each probe is indicated with the probe at the laser tip lying inside the treatment zone and all safety probes positioned in untreated tissue.
This project is a multi-disciplinary effort involving urologists, radiologists, pathologists, engineers and industry collaborators. The video below outlines our journey which started with the development of targeted biopsy for prostate cancer diagnosis.
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Choosing A Treatment Option
Treatment Options for Localized or Locally Advanced Prostate Cancer A man diagnosed with localized or locally advanced prostate cancer has 3 major treatment options: Active Surveillance, surgery, and radiation therapy. For patients whose cancer appears more aggressive, combination treatment may be recommended. For example, radiation therapy…
Expert Review And References
- American Cancer Society. Prostate Cancer. Atlanta, GA: American Cancer Society 2015: .
- American Society of Clinical Oncology. Prostate Cancer. 2014: .
- Garnick MB . Harvard Medical School 2015 Annual Report on Prostate Diseases. 2015.
- National Cancer Institute. Prostate Cancer Treatment . 2015: .
- National Cancer Institute. Prostate Cancer Treatment for Health Professionals . 2015: .
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . .
- Princess Margaret Cancer Centre. Princess Margaret Cancer Centre Clinical Practice Guidelines: Prostate Cancer. 2015: .
- Saad F, Chi KN, Finelli A, Hotte SJ, Izawa J, Kapoor A, et al. The 2015 CUA-CUOG Guidelines for the management of castration-resistant prostate cancer . Canadian Urological Association Journal. 2015: .
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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 4, 2020 |
| 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.
A Healthcare Actuarys Survey Of 100 Focal Laser Ablation Patients
Background: Until recently, newly diagnosed PCa patients often had an all or nothing choice. Assuming there was no evidence of spread outside the capsule, the patient was told that he could have either: definitive treatment, which includes prostatectomy or some type of radiation or Active Surveillance, which entails monitoring the situation indefinitely. For men with more aggressive PCa, the Option 1 would be suggested, perhaps in some combination with Androgen Deprivation Therapy. For patients who appear to have low risk factors including Gleason Score 6, Option 2 Active Surveillance might be considered.
What about men with low-to-intermediate risk? The Prostate Cancer Intervention Versus Observation Trial has showed no statistically significant improvement in longevity, based on 12 years follow-up. “The chance of recurrence is significant according to the meta-analysis of 31,000+ prostate studies performed by the Prostate Cancer Results Study Group, chaired by Peter Grimm, DO, Seattle, WA.And there is almost certain reduction in Quality of Life due to risks of impotence, wearing pads and other side effects and complications. Clearly, Option1 is over-treatment for these men.
But what about Option 2? The Urologist is often not supportive, and there is fear that AS could lead to progression and metastasis. So, Option 2 is viewed by many as Under-treatment.
2) Patients are well educated, higher socio-economic group, and have low-to-intermediate risk
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