Gone are the days when a prostate cancer (PCa) patient was faced with only two treatment strategies: all or nothing.
The first strategy, whole-gland treatment, brought risks of long recovery and poor quality of life after treatment. The second, Active Surveillance or Watchful Waiting, brought risk of losing control of the cancer.
Today, patients have more choices than ever. These include focal therapy, a middle ground between all-or-nothing conventional treatments. Thanks to new methods to deliver focal therapy, there is a growing array of image-guided ablation procedures that target and destroy PCa while sparing healthy tissue.
Benefits of Focal Therapy
- ✓ All methods aim to balance cancer control with optimum quality of life.
- ✓ All available methods use some form of energy to destroy tumor plus safety margin.
- ✓ Usually done under an alternative to general anesthesia.
- ✓ Can be done outpatient, with choices ranging from minimal-to-noninvasive.
- ✓ Now a standard of care for qualified patients.
- ✓ Does not rule out future treatments, including repeat focal therapy.
- ✓ Real-time MRI is recognized as a superior imaging technology over ultrasound for planning, guiding and confirming the zone of focal ablation.
- ✓ Each method has certain strengths in some areas of the gland than others.
Are you a candidate for focal therapy?
Three MRI-guided Focal Therapies for Prostate Cancer
There are three available FDA-cleared focal therapies that use heat energy to ablate prostate tumors.
- MRI-guided Focal laser ablation (FLA) is a minimally invasive outpatient approach in which the tip of a laser optic fiber is placed into the core of the tumor. When activated, the laser generates an encompassing globe of heat that surrounds the tumor plus an extra safety margin. Special MRI software tracks the size, location and temperature of the ablation in real time. Afterward, MRI is used to confirm treatment success.
- MRI-guided Focused Ultrasound (MRgFUS) delivers up to 1000 ultrasound waves to precisely heat and ablate prostate tissue with no surgical incisions or radiation. As with FLA, it is guided by MR imaging for patient-specific planning, real-time temperature monitoring, and immediate confirmation of treatment outcome.
- MRI-guided Transurethral Ultrasound Ablation of the Prostate (TULSA-PRO) uses a slender applicator device inserted into the prostate through the urethra (tube that carries urine from the bladder to the penis). Following MRI treatment planning, real-time MRI guides the robotically driven, directional ultrasound to deliver the physician-planned heat ablation to the targeted tumor plus a safety margin. After treatment is complete, MRI immediately confirms success.
Choosing the Method Best for You with Dr. Sperling
When it comes to making a PCa treatment decision, “comparison shopping” could easily become an overwhelming process. Most patients can’t afford the time and expense of seeking additional meetings with doctors with a particular specialty in a given treatment. And yet, national PCa patient organizations advise patients to explore various options and seek a doctor who has the most experience.
While it’s true that each focal method can claim to be tailored to the patient, they differ in the strengths they bring to particular areas of the gland such as anterior, posterior, close to the urethra, close to the neurovascular bundles, etc. Because Dr. Dan Sperling has all three MRI-guided focal therapies under one roof, he offers a unique advantage for PCa patients who want to be sure that a) they are good candidates for focal therapy and b) they are able to have the best treatment match for their unique situation.
Consider the following benefits of working with Dr. Sperling:
- He is a very early pioneer in multiparametric MRI (mpMRI) of the prostate, and is internationally recognized for his expertise.
- He is knowledgeable about the precision of MRgFUS for treating uncontrollable hand tremors by destroying a tiny malfunctioning area deep in the brain, confirming the power and precision of MRgFUS when applied to PCa tumors.
- He was site clinical director for Sperling Prostate Center’s participation in a national clinical study of MRgFUS for the focal treatment of localized low and intermediate risk PCa lesions.
- He has contributed to published research on applying Artificial Intelligence (AI) to MRI of the prostate, and currently integrates AI in his PCa detection and diagnostic services.
- The Sperling Prostate Center uses a state-of-the-art 3T magnet for treatment planning, guidance, and confirmation of results. In-bore MRI provides superior 3-D resolution, tissue functional information to distinguish healthy from cancerous tissues, anatomic information for the prostate zones, and thermal tracking software. In-bore MRI affords real-time accuracy over conventional transrectal ultrasound, and freedom from potential registration errors and positioning inaccuracies of fusion guidance systems.
- For our patients’ comfort and confidence, the Sperling Prostate Center team includes a board-certified anesthetist to administer appropriate types of anesthesia ranging from light to deep sedation as needed.
Most importantly, with his authoritative knowledge and extensive experience with all three focal ablation methods, Dr. Sperling works with each patient to develop a truly customized choice of: a) which method, and b) how to best use it to target the tumor for cancer control while preserving sexual and urinary function.