Focal Laser Ablation of Prostate Cancer: An Office Procedure

Abstract

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually similar to a fusion biopsy and is performed under local anesthesia in a clinic setting; treatment time is usually less than one hour. Laser insertion is guided by ultrasound; lesion targeting is via magnetic resonance imaging-ultrasound (MRI/US) fusion, as in targeted prostate biopsy. Real-time ablation monitoring is achieved utilizing a thermal probe adjacent to the laser fiber. The video demonstrates procedure planning, patient preparation, various steps during the procedure, and treatment monitoring. Safety, feasibility, and efficacy of this approach have been established during a previous trial. Outpatient FLA under local anesthesia is an option for management of intermediate risk prostate cancer. IntroductionProstate cancer (PCa) is the most common internal malignancy in U.S. men 1 . Approximately 190,000 new cases and 33,000 deaths are expected during 2020, making it the second most common cause of cancer death in men 2 . Most cases of PCa are curable if treated while localized to the prostate. However, identifying cancer within the prostate is often not possible with conventional ultrasound (US) imaging; thus, treatment has traditionally involved surgery or radiation of the whole gland. The 'whole-gland' paradigm has been altered with the introduction of magnetic resonance imaging (MRI), which, in contrast to US, enables localization of PCa and targeted biopsy 3 , 4 , 5 , 6 . While MRI likely underestimates the multifocality of PCa 7 , and may miss small lesions 8 , it can reliably identify the index lesion, which is almost always the driver of metastatic disease 9 , 10 .Reliable MRI identification of index lesions has provided a path for focal treatment of PCa (i.e., partial gland ablation (PGA)). The aim of PGA is to destroy the index lesion while preserving the organ and thus minimizing side effects. Focal laser ablation (FLA), which employs light energy to destroy

RETRACTED: Laser technology in urologic oncology

“…Real-time ablation monitoring is obtained utilizing a thermal probe adjacent to the laser fiber. 54 Prostate specific antigen (PSA) monitoring recommended for follow-up alone is insufficient and multiparametric MRI is the most reliable follow-up tool. Even if it has limited ability to detect recurrence in early months after treatment, it has good sensitivity for detection of recurrence in the long-term follow-up.…”