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 .
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.
Recommended Reading: Prostate Cancer With Bone Mets Icd 10
> > > One Crazy Prostate Trick All Men Over 40 Should Try
Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
Other Factors Affecting Prostate Cancer Treatment Cost
Apart from the type of surgery or treatment and the choice of technology, the following are some of the factors that affect the overall prostate cancer treatment cost:
Type of Hospital
There are several hospitals around the world that provide world-class medical treatment to patients. The greater the number and quality of services offered by the hospital, the expensive is the treatment at the hospital.
Therefore, the total cost of prostate cancer treatment that you have to pay actually depends on the level of services that you expect from the hospital. To be able to receive five-star services from the hospital, you must be willing to pay lavishly for it.
Experience of the Surgeon
Expertise and skills of the treating doctor matter a lot when it comes to successful treatment of any cancer type. It takes a lot of patience, courage, and knowledge to treat a cancer patient and this is the reason why the most experienced surgeons tend to charge a greater fee for their services.
However, that does not mean that all the experienced and qualified surgeons charge fees that an average patient cannot afford. There are many highly educated and skilled doctors for prostate cancer treatment that offer their services with an equal compassion at a reasonable rate. Therefore, one must try to find a credible doctor with required credential who charges a fee that a patient can afford.
Length of Stay at the Hospital
Incidental Costs
Cost of Accommodation, Food, and Local Travel
| Cost per Day |
Read Also: How Do Doctors Check For Prostate Cancer
The Nyulmc/sperling Prostate Cancer Center
Between April 2013 and April 2014, 21 men underwent focal laser ablation as part of a collaboration between the NYULMC Smilow Comprehensive Prostate Cancer Center and the Sperling Prostate Cancer Center. All candidates for this collaborative focal laser ablation of the prostate study signed informed consent to participate in a longitudinal outcomes study.
The selection criteria for focal laser ablation included a 10-year life expectancy, between one to two focal abnormalities on mpMRI consistent with prostate cancer, no Gleason pattern 4 disease on random TRUS-guided biopsies of the normal appearing prostate on mpMRI, focal abnormality on MRI < 15 mm, and no Gleason score over 7. In most cases, preservation of potency was a very high priority. Candidates are extensively counseled regarding the very limited short-term and lack of long-term oncologic outcomes data with focal prostate cancer laser ablation.
Fiber placement T2-weighted axial sequence.
Temperature-sensitive fast spoiled gradient-recalled echo images.
Postablation gadolinium-enhanced T1-weighted axial sequence.
To date, there has been no significant change in the mean AUASS, IPSS, or SHIM between 3 to 6 months and baseline . Incontinence has not been reported by any patient in the perioperative or postoperative setting. The mean preoperative PSA value was 5.40 . Among the 12 patients in whom the 6-month PSA was available, the mean PSA value decreased from 5.10 at baseline to 3.69 at 6-month follow-up .
What Are The Disadvantages Of Focal Therapy
The key consideration to bear in mind is that choosing focal therapy is associated with a high likelihood of needing more treatment because the first treatment has not been successful. That is why you will need continued monitoring for prostate cancer after the first treatment. This is likely to involve clinic visits at least once a year, repeated MRI scans and repeat biopsies if there is any evidence of abnormality.
Failure to cure the cancer first time almost certainly will increase the likelihood of having to have hormone therapy and may have an impact on survival. To compare this with surgery, if the cancer was indeed confined to the prostate gland, then cure is almost guaranteed. If the PSA blood results after surgery indicate cancer clearance, patients will have reviews at three months, 12 months, and then annually for five years before being discharged.
The other main consideration is that by choosing focal therapy, you may be reducing your future treatment options. For example, you may not be suitable for surgery, or suitable for nerve-sparing surgery .
Read Also: How Is Radiation Done For Prostate Cancer
How Does Laser Focal Therapy Compare To Other Focal Methods
In comparison to another popular focal treatment methods like high-intensity focused ultrasound , laser focal therapy is not limited to only small glands and has demonstrated much higher levels of accuracy with lower risk of side effects such as, erectile dysfunction.
High intensity focused ultrasound uses ultrasound instead of laser to heat the tissue. To obtain the ablation diameter of the laser used in our approach, HIFU would require > 20 overlapping ablations. What if the patient moves a little and the device misses a spot? When treating cancer, its important to get all of it. The vast majority of HIFU centers use ultrasound guidance , losing the precision of MRI and the important real-time information that MRI thermometry provides in protecting vital structures. Studies show significant urinary and sexual problems after HIFU because important tissues and nerves can be damaged during the procedure.
Laser focal therapy boasts many benefits for patients compared to other treatment methods for prostate cancer. No general anesthesia is required for the therapy, and patients are able to return to work as early as the day after the operation. Additionally, laser focal therapy carries lower risk of side effects compared to other treatment methods such as, impotence, and urinary incontinence. Laser focal therapy also does not rule out the exploration of further treatment options such as surgery or radiation therapy if needed later.
*Results may vary
Is There Anything Else You Feel Our Audience Should Know About This Topic
I want people to get involved. Join the society, come to the meetings, talk to people. We have a mentoring system where you can have the opportunity to speak to leaders in the field to help start your own program. Our next meeting will be June 2022. The Focal Therapy Society has a hands-on meeting run by Dr Arvin George, but due to COVID-19, it was postponed this year. Dr Georges meeting is more of a community-based approach with hands-on courses teaching these new technologies. By supporting the society, it helps grow the whole field.
Recommended Reading: Beginning Signs Of Prostate Cancer
What Are Promising Treatments Under Study For Prostate Cancer
High-intensity focused ultrasound is an approach to therapy that is presently approved for use in Europe, and is under study in the U.S. It uses high-intensity sound waves focused on the prostate gland to heat and thereby kill cancer cells. It should only be used as part of a research study . The safety, side effects, and comparative effectiveness of surgery and radiation therapy must be established.
Clinical trials are research studies being conducted to evaluate new treatments for prostate cancer. These include approaches such as HIFU, as well as modifications of surgical and radiation techniques, and new drugs and immune therapy approaches.
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.
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.
Recommended Reading: Greenlight Photovaporization Of The Prostate
Our Approach To Focal Therapy
At USC Urology, we are here to deliver a tailored prostate cancer treatment plan that is based on your needs. You will be carefully evaluated by a team of prostate cancer experts with experience in prostate cancer surgery, as well as focal therapy.
With advanced treatment options, like focal therapy, our world-class medical team will keep you informed and in control of your treatment plan every step of the way.
Make an appointment with USC Urology to meet with one of our focal therapy specialists. Our expert care team has the information you need and the answers to your questions. Together, we will help you take an important step toward treating your prostate cancer.
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?
Recommended Reading: How Accurate Is Blood Test For Prostate Cancer
Selecting Candidates For Focal Ablation
There is no consensus how to optimally stratify men with localized prostate cancer to RP, RT, FA, or AS. A consensus statement recommends that all candidates for FA should undergo an MRI, MRFTB, and SB., An alternative would be to perform transperineal saturation biopsy to map the disease. We offer FA to men with a single MRI lesion without gross extracapsular extension who have high-volume GGG 1 or any volume GGG 2-3 and very select cases of GGG 4. Generally, we do not exclude cases with low-volume contralateral GGG 4 .
You May Like: Erleada For Metastatic Prostate Cancer
The Initial Causes What Is Focal Therapy For Prostate Cancer
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
Also Check: What Doctor Treats Prostate Cancer
Rationale For Focal Therapy
Focal therapies have an established role in the treatment of numerous malignancies, including those of the kidney, breast, and liver. The guiding principle of focal therapy and partial gland ablation is to provide an organ-sparing approach to preserve function while achieving adequate tumor treatment. Ablative techniques for prostate cancer include whole-gland ablation, hemi-ablation of a single lobe of the prostate, and focal ablation- in which a single dominant or index lesion is destroyed using targeted image guidance, such as mpMRI. Studies have shown that up to 86% of prostates have more than two cancer foci, with over 80% of patients harboring bilateral disease . However, the driving principle behind focal ablation is the concept that the index lesion is the primary driver of disease progression and metastasis, and thus destruction of this lesion can effectively mitigate the risk of spread . The combination of MRI-targeted biopsy and standard systematic biopsy further allows for improved detection of cancers, and may reduce the risk of under-staging, aiding with better selection of focal therapy candidates .
Figure 1
Focal Therapy Offers Potentially Significant Advantages Over Standard Of Care
Focal therapy is a minimally invasive treatment that targets and ablates only specific parts of glands, organs, and tissue needing treatment, while preserving the surrounding and remaining tissue. This generally produces faster recovery, fewer side effects, and less pain and discomfort for patients that may not be good candidates or are inoperable for traditional open surgery.
Focal therapy offers to preserve these vital functions while still treating the cancer effectively. Focal therapy concentrates on treating the index lesion, which is usually defined as a tumor visible on MRI. By precisely targeting and detroying index lesions with focal therapy, the cancer tumor can be effectively treated while preserving surrounding tissue and minimizing side effects.
In a European Urology consensus meeting, it was agreed, with a high level of consensus, that focal therapy should be recommended for intermediate-risk patients .
Also Check: Aggressive Prostate Cancer Survival Rates
> > > All Natural Technique Fixes Enlarged Prostate Watch Here< <
Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
Focal Therapy Treatment Options
At USC Urology, we offer a variety of noninvasive focal therapy options. Our experienced care team will work closely with you to understand each option and keep you in control of your treatment plan.
One focal therapy treatment option is cryotherapy, which targets and destroys prostate cancer cells using very cold temperatures. Another effective treatment option is high-intensity focused ultrasound , which uses ultrasonic waves to heat up and destroy prostate cancer tissue and tumors.
You May Like: Hormone Shot For Prostate Cancer Treatment
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.