Focal Laser Ablation of Prostate Cancer

Jones, Tonye A.; Natarajan, Shyam; Priester, Alan; Marks, Leonard S.

doi:10.1016/j.urology.2016.10.002

Cited by 6 publications

(4 citation statements)

References 3 publications

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“…The adventages of the small needle and precise thermal energy distribution theoretically could minimize the risk of off-target burning and decrease problems in treating lymph nodes and particularly in difficult anatomical location. Previous studies have focused on laser ablation in the prostate [ 14 , 15 ], thyroid [ 16 – 19 ] and liver [ 20 , 21 ] while the present study aimed to assess the safety and efficacy of ultrasonography (US)-guided local Nd:YAG laser ablation for metastatic lymph nodes in the retroperitoneal region. Additionally, we performed a systematic review of the literature.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous laser ablation: a new contribution to unresectable high-risk metastatic retroperitoneal lesions?

et al. 2016

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BACKGROUND & AIMSMetastasis in retroperitoneal lymph nodes is one of the signs of advanced stage or terminal stage of malignancy. We performed a trial to assess the safety and efficacy of ultrasonography (US)-guided local neodymium-doped yttrium aluminum garnet (Nd:YAG) laser ablation for metastatic lymph nodes in the retroperitoneal region.METHODSWe evaluated 4 cases of retroperitoneal metastatic lymph nodes treated using US-guided Nd:YAG laser ablation. Additionally, we reviewed the PubMed database for articles on thermal ablation of retroperitoneal lesions until March 2016, without language limitations.RESULTSIn our study, all lesions were nearly completely ablated with mild discomfort, including pain and fever at the 3-month follow-up. In the literature review, a total of 398 patients with 491 retroperitoneal tumors were identified, and complications after the procedure included enterovesical fistula, fecal incontinence, and hematoma.CONCLUSIONSPercutaneous laser ablation could be a theoretically promising approach for retroperitoneal metastatic lesions.ClinicalTrials.gov number: NCT02822053.

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Section: Introductionmentioning

confidence: 99%

Percutaneous laser ablation: a new contribution to unresectable high-risk metastatic retroperitoneal lesions?

et al. 2016

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“…As a result, ablation with a safety margin up to 9 mm on the non-capsular side of the visible lesion was recommended to gain better oncologic control. [22][23][24] An interesting finding in our study is that in-bore persistent cancer was not predicted by factors such as Gleason grade, PI-RADS score, baseline PSA, prostate volume, tumour volume, tumour location, and treatment route. In fact, when comparing MRI images before and immediately after ablation, the only noticeable difference is that all lesions with persistent cancer after ablation were under-treated.…”

Section: Discussionmentioning

confidence: 56%

“…Evidence from literature suggests that MRI underestimates tumour volume, especially for tumours with a high PI‐RADS score and (or) a high Gleason grade. As a result, ablation with a safety margin up to 9 mm on the non‐capsular side of the visible lesion was recommended to gain better oncologic control …”

Section: Discussionmentioning

confidence: 99%

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

Al-Hakeem

Raz

Gacs

et al. 2019

ANZ Journal of Surgery

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Background To evaluate the safety and efficacy of focal laser ablation (FLA) in low‐intermediate risk prostate cancer. Methods Inclusion criteria were men aged 50–75 years, prostate‐specific antigen (PSA) ≤15 ng/mL, clinical stage T1c–T2a, one or two lesions (PI‐RADS ≥3) on magnetic resonance imaging (MRI), and Gleason score 6 (>3 mm) or Gleason 7 on targeted biopsy. Treatment success was defined as no clinically significant cancer in ablated areas. The study is prospective. Under MRI guidance, laser ablation was applied to the visible lesion(s). International Prostate Symptoms Score, Sexual Health Inventory in Men score and PSA levels were assessed at baseline and repeated at 1, 3, 6, 12 and 18 months. MRI was repeated at 3 and 12 months. Cancer control was assessed at 6 months using targeted and systematic biopsies. Results FLA was performed in 49 patients. Gleason scores were 3 + 3 in 13 patients (26.5%), 3 + 4 in 29 (59.2%) and 4 + 3 in 7 (14.3%). No significant complications were noticed. International Prostate Symptoms Score measurements up to 18 months were not different from baseline (all P > 0.05). Sexual Health Inventory in Men scores dropped in the first year (all P < 0.05), but were not different from baseline levels at 18 months (P = 0.097). PSA levels dropped significantly at 3–18 months (all P < 0.05). Treatment was successful in 39 patients (79.6%). Persistent cancer in treated areas was found in 10 patients (20.4%). Conclusions FLA is safe with no impact on urinary and sexual functions at 18 months follow‐up. Oncologic control is encouraging. Larger scale studies and longer follow‐up are required.

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“…With the emergence of various intracavitary minimally invasive devices, new technologies are being applied to the medical field, such as transurethral enucleation of the prostate (TUEP), which including plasma kinetic enucleation of the prostate (PKEP), holmium laser enucleation of prostate (HoLEP), thulium laser enucleation of the prostate (ThuleP) and some other laser based methods (22). Lasers show better haemostatic effects and cause less bleeding during operations (23)(24)(25)(26). Additionally, lasers are non-conductive; thus, they can be applied in patients with heart pacemakers and other electric implants.…”

Section: Introductionmentioning

confidence: 99%

The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia

Zhang

Guo

et al. 2021

Front. Surg.

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Background: Transurethral resection of the prostate (TURP) is regarded as the “gold standard” for the treatment of benign prostatic hyperplasia (BPH) in elderly men. However, ~15% of patients who had undergone TURP had intraoperative and postoperative complications, such as bleeding, urinary incontinence and urethral stricture. Transperineal percutaneous laser ablation (TPLA) is a method that places the optical fibre directly into the prostate with the guidance of ultrasound imaging, and the percutaneous transperineal approach is performed distal to the urethra and rectum to protect these structures and reduce urethral or postoperative infection. Several studies on TPLA for BPH treatment have been reported recently; however, high-quality randomised controlled trial (RCT) to evaluate its efficacy, safety, and long-term follow up remain absent.Methods: This study is a multicentre, open-label RCT to assess the efficacy and safety of TPLA vs. TURP to treat BPH. We hypothesise that the TPLA has non-inferior efficacy to TURP in the International Prostate Symptom Score (IPSS) at 3 months changing from the baseline and lower incidence of post-surgery complications. One hundred and fourteen patients with BPH will be recruited at 19 sites and randomly assigned at 1:1 to TPLA or TURP groups. The patients will be followed up at 1, 3, 6, 12, and 24 months after the procedure.Discussion: The study will be the first multicentre clinical trial including 16 participating centres in China, Italy, Switzerland, and Poland with relatively large sample size 114. By comprehensively compare the safety and efficacy of TPLA with TURP in patients with BPH, especially concerning the improvement of lower urinary tract symptoms (LUTS) and complication incidence, the study will help to illustrate the clinical value of TPLA and provide a beneficial alternative treatment for BPH patients.Clinical Trial Registration: The study has been registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn), identifier [ChiCTR1900022739].

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Focal Laser Ablation of Prostate Cancer

Cited by 6 publications

References 3 publications

Percutaneous laser ablation: a new contribution to unresectable high-risk metastatic retroperitoneal lesions?

Percutaneous laser ablation: a new contribution to unresectable high-risk metastatic retroperitoneal lesions?

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

The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia

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