Focal Laser Ablation for Prostate Cancer
What is Focal Laser Ablation?
Focal Laser Ablation (FLA) is a minimally invasive treatment for localized prostate cancer. Unlike surgery or radiation aimed at the whole prostate, Focal Laser Ablation accurately targets and destroys specific tumors without harming surrounding healthy tissue. Using laser heat energy, Focal Laser Ablation encompasses the cancer tumor plus a preemptive extra margin. It is used to treat low- to intermediate-risk cancer tumors.
Compared with whole gland treatments, Focal Laser Ablation significantly lowers the risk of urinary incontinence and erectile dysfunction.
In short, “Focal laser ablation is an emerging treatment paradigm for prostate cancer that aims to successfully eradicate disease while also reducing the risk of side effects compared to whole-gland therapies.”[i]
Compare the benefits of Focal Laser Ablation versus other treatments.
| Focal Laser Ablation | Radical prostatectomy | Radiation | Active Surveillance |
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Compare the side effect risks of Focal Laser Ablation versus other treatments.
| Focal Laser Ablation | Radical prostatectomy | Radiation* | Active Surveillance | |
| Incontinence | <1% | 5-30% | 12-33% | 0% |
| Erectile dysfunction | 0-15% | 30-70% | 40%+ | 0% |
| Dry orgasm | <1% | 100% | 16%+ | 0% |
| Bowel problems | 0% | no risk associated | 4-15% | 0% |
| Secondary cancer | no risk associated | no risk associated | 27.4% | 0% |
| Anxiety | — | — | — | 34-55% |
* Progressive side effects may occur.
What does Focal Laser Ablation Treatment Involve?
Focal Laser Ablation is an outpatient treatment. At the Sperling Prostate Center, each patient’s unique clinical needs and lifestyle preferences enable Dr. Sperling and our staff to provide customized, concierge-level treatment. We recognize that cancer treatment is unfamiliar territory, so we help each patient navigate every step along the way.
For patients who experience claustrophobia, we can assist with medication.
Patients should expect the following steps:
Step 1: Procedure preparation
- Diagnosis confirmed by multiparametric MRI and biopsy. If no prior MRI is available, a pre-planning MRI is performed before the procedure.
- Identification and mapping of the target
- Bowel cleanse and antibiotic administration
- Urinary catheter is inserted to protect the urethra
Step 2: Patient positioned in the MRI scanner
- Patient lies face down on the MRI table
- Local anesthesia administration
Step 3: Placing the laser fiber guide
- Insertion of a small, hollow guide through the rectum or perineum
- Insertion of a laser optic fiber through the guide into the tumor
- Continuous MRI scans confirm successful mapping and fiber placement
Step 4: Activating ablation
- The physician turns on the laser to deliver targeted thermal energy.
- Tumor is destroyed via high heat generated by the laser energy.
- Ongoing MRI thermometry (heat monitoring) and urinary catheter assure protection of the urethra and neighboring healthy structures
- Removal of laser fiber and guide
Step 5: Treatment effect verified and patient discharged
- Immediate post-procedure contrast-enhanced MRI verifies complete tumor destruction.
- In-office
- Patient returns home (outpatient means no overnight stay)
- Catheter is removed at home within about 7 days depending on extent of ablation
Who is a candidate for Focal Laser Ablation?
Typically, patients who prefer Focal Laser Ablation are those who want an alternative to whole gland treatments and Active Surveillance.
To qualify clinically, patients are those whose 3T multiparametric MRI reveals a lesion that is suspicious for significant prostate cancer. If confirmed by biopsy, it should be low-to-intermediate risk prostate cancer that is confined to the gland. The targeted lesion must have a volume that can be completely encompassed by laser energy (plus a margin of safety) without damaging urinary or sexual function.
Finally, candidates should be willing and able to follow a protocol of follow-up monitoring that includes PSA tests and multiparametric MRI scans at specified intervals.
What makes Focal Laser Ablation at the Sperling Prostate Center special?
The Sperling Prostate Center is a highly specialized center for MRI-based detection, diagnosis, and image-guided focal therapy for localized prostate cancer.
Dr. Dan Sperling, Medical Director, is a recognized pioneer and expert in Focal Laser Ablation. Our Center boasts a powerful state-of-the-art 3T (3 Tesla) magnet. Our team of authoritative physicians and staff embrace values of professional excellence, caring and attentive empathy.
Just as we are confident in our experience and services, we want our patients to feel that they are in great hands, and have made the best choice in provider and treatment method.
If you or a loved one is facing a diagnosis of localized prostate cancer, please contact us for more information.
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NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you have health concerns or questions of a personal medical nature.
References
[i] Wenger H, Yousuf A, Oto A, Eggener S. Laser ablation as focal therapy for prostate cancer. Curr Opin Urol. 2014 May;24(3):236-40.
