By Dr. Sperling

The term “ablation” refers to a type of medical procedure, usually minimally-to-noninvasive, that destroys tissue within the body. Ablation can be accomplished with thermal energy (extreme heat or cold) or chemically.

Laser ablation of the prostate is not new. It is minimally invasive and effective in treating a noncancerous condition known as benign prostatic hyperplasia (BPH), meaning enlargement of the prostate gland. Such enlargement is common as men grow older, but in severe cases it can constrict the flow of urine out of the body since the urethra (tube that carries urine) passes through the prostate gland.

Blockage of urine due to BPH causes symptoms like difficulty emptying the bladder, feeling of urgency, interrupted sleep due to increased frequency, slow flow or stopping and staring of flow. Serious cases can result in complications like repeat urinary tract infections, bladder damage, even kidney damage.

There are other common treatments besides laser ablation to enlarge the urethra. Most men with BPH have heard the term “reaming out” and the most common conventional procedures are:

  1. TUNA . Transurethral needle ablation
  2. TUMT . Transurethral microwave therapy
  3. TUIP . Transurethral incision of the prostate
  4. TURP . Transurethral resection of the prostate
  5. Radical prostatectomy . Less common; surgical removal of the gland

With the development of precision laser ablation to enlarge the urethral passage, certain advantages soon became apparent that are making laser ablation more appealing. These include outpatient treatment, quick recovery, less need for a catheter, more immediate results than with some of the other treatments, and less risk of bleeding than with a surgical procedure. These factors logically led to the question: if laser ablation is such a positive option for BPH, can it be focally applied to target prostate cancer lesions rather than surgically remove the entire gland? Since laser ablation is FDA-cleared for targeted use in any soft tissue, the path was open to explore FLA for appropriate-sized prostate tumors.

To date, the results are promising. In the U.S., respected medical centers were early Focal Laser Ablation (FLA) adopters . The first published case was done by Dr. Al Barqawi at the University of Colorado’s medical center in September, 2009. The Mayo Clinic (Rochester, MN) initially applied FLA to cases of prostate cancer recurrence. Since then, research teams in the U.S. and abroad have validated the precision of FLA by analyzing surgically removed prostates following focal ablation, and correlating the results with the pre- and post-treatment MRI images. Although the procedure is too recent to accumulate long-term data, the results are promising.

Equally significant is the ability of FLA to greatly reduce the risk of side effects. Incontinence is virtually nonexistent, and a precise focal treatment spares the neurovascular bundles that control sexual function. What began as a treatment for noncancerous BPH is rapidly gaining ground as a focal treatment for qualified prostate cancer patients.

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