Before a prostate cancer patient makes a final decision to have focal laser ablation, I go over the details of MRI-guided FLA and what to expect after treatment. I always point out that we do not yet have long term data on the success rates as far as cancer control, so we don’t know how many men might have their cancer recur (come back). I remind each person that it’s important to monitor for PCa recurrence. After any focal treatment (cryo, HIFU, Focal Laser Ablation, MRgFUS, TULSA) PCa can either come back in the treatment site—called treatment failure, meaning the treatment did not destroy all the cancer at the site—or recur in a different location.

Last year [2014], the journal Current Opinion in Urology carried an article by a French team^[i]. I was struck by their point that focal prostate therapy “…presents a clinical challenge to the urologist, as typical disease surveillance parameters are not as reliable in post-ablation follow-up.” What they mean is that an elevated or rising PSA, which is used most often by urologists as a tip-off that prostate cancer may be back, does not give enough information. I wholeheartedly agree!

In their article, the authors suggest an integration of three ways to monitor for the return of PCa: PSA kinetics (upward movement in the PSA), mpMRI and control biopsies (prescribed at regular intervals). They state that “good treatment response” is indicated by a reduction in pre-treatment PSA of at least 50%, absence of lesion as demonstrated on imaging, and a negative control biopsy.

At our Center, we recommend an annual 3T mpMRI unless PSA movement sends up a “red flag” that imaging is needed sooner. The earlier any recurrence is identified, the more treatment options the patient has, including another focal ablation, a radical treatment, or active surveillance.

We know that FLA is a blessing for many patients who would otherwise have undergone a radical treatment that might have left them with short- or long-term reduced quality of life. Patients who are qualified for focal therapy benefit from the high probability of successful cancer control with low risk of side effects.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Barret E1, Harvey-Bryan KA, Sanchez-Salas R et al. How to diagnose and treat focal therapy failure and recurrence? Curr Opin
Urol. 2014 May;24(3):241-6.

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.