Focal Laser Ablation of Prostate Cancer: Results in 120 Patients with Low- to Intermediate-Risk Disease

Abstract

Purpose: Can focal laser ablation (FLA) of the prostate preserve sexual and urinary function with low morbidity in men with low to intermediate-risk prostate cancer while providing adequate oncologic outcomes? Materials and methods: 120 patients with low to intermediate risk prostate cancer had transrectal FLA done. MRI thermometry controlled the ablation. Procedures were performed between 2013 and 2017. At 6 and 12 months, patients had clinical and MRI follow-up with biopsies of suspicious areas. Patients submitted the Sexual Health in Men (SHIM) survey to evaluate erectile function and the the International Prostate Symptom Score (IPSS) to assess urinary continence and flow.. Multivariate logistic regression identified determinants of positive imaging and biopsies. Two-sided Wilcoxon signed rank test evaluated scores and laboratory values. Results:The median age was 64 and median PSA was 6.05 ng/mL. Eight (6.7%) of patients were African-American. The median follow up period was 34 months (from 17 to 55 months). Gleason score was 3+3 in 37 (30.8%), 3+4 in 56 (46.7%), and 4+3 in 27 (22.5%). AJCC tumor stage was T1c in 89 (74.2%), T2a in 26 (21.7%) and T2b in 5 (4.2%). Tumors were located in the peripheral zone in 108 (73%) of patients. Number of tumors treated were one in 72 (60%) of patients and 2 tumors in 47 (39.2%) of patients. One patient had 3 tumors treated. Twenty (17%) of men had additional oncologic therapy one year after FLA when biopsy confirmed cancer after an abnormal MRI. There was no difference between functional scores pre-and post-ablation.Median SHIM score at baseline was 24 vs 22 at one year (p=0.51) and the IPSS score was 6.5 at baseline and 6.0 at one year (p=0.12). The median PSA fell to 3.25 at 12 months (p<0.001). Tumor diameter above the median (Odds Ratio (OR), 3.36; 95% CI, 1.41-7.97) was the only significant predictor for a positive post-treatment MRI..

Magnetic resonance image‐guided focal laser ablation in clinically localized prostate cancer: safety and efficacy

“…Oncologic outcome revealed no clinically‐significant cancer in ablated areas in 81.1% of lesions. Compared to similar studies using laser that showed no significant cancer in 60–100% of ablated areas, our results sit within that range. Our results are encouraging and confirm that focal laser ablation can be effective for Gleason 7 cancer.…”

“…IPSS results demonstrated no significant changes in urinary symptoms for up to 18 months after ablation compared to baseline readings. This finding is consistent with other studies …”

“…PSA measurements at 3–18 months following ablation demonstrated a significant decrease compared to baseline with a mean drop of 1.5 ng/mL at 18 months. Other studies also reported similar drop in PSA . This drop in PSA may be due to ablation of some benign prostatic tissue.…”

“…Other studies also reported similar drop in PSA. [15][16][17] This drop in PSA may be due to ablation of some benign prostatic tissue. However, previous reports by Lindner et al 18 and Eggener et al 19 demonstrated the lack of significant changes in PSA after ablation.…”

The Yin and Yang of PDT and PTT

“…PTT. In prostate cancer, PTT has been used only for treating focal lesions rather the whole gland (33,36,(77)(78)(79). Such lesions can be treated using 1-3 cylindrically diffusing fibers activated either simultaneously or sequentially.…”