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 there 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, and I recommend an annual 3T multiparametric MRI (3T mpMRI) such as we offer at our Center.
Last year, 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! After any focal treatment (cryo, HIFU or laser) PCa can either come back in the treatment site—called treatment failure, meaning the treatment did not destroy all the cancer—or recur in a different location.