A growing number of prostate cancer patients are choosing a focal treatment for low-risk localized prostate cancer. Focal therapy is recognized as a middle ground between radical treatment and Active Surveillance. It offers cancer control with very low risk of urinary and sexual side effects.

Focal therapy appeals to patients who want to preserve their quality of life (as in Active Surveillance) without the worry of cancer growing in their prostate (as in radical treatment). Thus, it provides a balanced alternative to either end of the treatment spectrum.

Focal Laser Ablation (FLA)

One of the earliest focal therapy approaches is MRI-guided Focal Laser Ablation (FLA), as pioneered by Dr. Dan Sperling over 10 years ago. FLA is minimally invasive and highly effective, thanks to the precision power of laser. Pre-treatment mapping using multiparametric MRI (mpMRI) defines the location and size of a suspicious lesion (tumor).

Although long-term data based on large patient numbers is not yet available, a 2019 paper by Dr. Eric Walser, et al. reported 12-month results on 120 patients. “One year after FLA, selected patients had low morbidity, no significant changes in quality of life, and 83% freedom of retreatment rate. Sexual and urinary function did not significantly change after FLA.”^[i]

Transperineal Focal Laser Ablation (TPLA)

Since FLA was first introduced, it has typically been done as a transrectal procedure; that is, the approach for laser fiber insertion is through the rectal wall into the prostate gland.

More recently, in a number of international centers, there is a new insertion approach. Unlike the transrectal route, the new pathway is through the perineum (outer skin between the scrotum and anus). Therefore, it is a transperineal procedure called Transperineal Focal Laser Ablation (TPLA).

TPLA was initially used for treating BPH (benign prostatic hyperplasia), a noncancerous aging-related enlargement of the prostate.^[ii] Once TPLA’s relative technical ease and success were demonstrated, it made sense to apply it to treat localized prostate cancer. It is is a less complex procedure than the transrectal method. “Compared with MRI-guided FLA, TPLA requires less specialized equipment, enabling a shorter, simpler, and less costly procedure that improves treatment accessibility, workflow efficiency, and patient comfort.”^[iii]

A big factor in the difference is the use of ultrasound guidance during the procedure, rather than MRI. However, MRI still plays a major role. Prior to the procedure, multiparametric MRI precisely defines the size, shape and precise location of the targeted tumor.

Since experienced prostate physicians know the map of prostate anatomy, based on the accurate MRI images they know exactly where to insert the laser fiber. This is called cognitive fusion. Thanks to the ultrasound, they have visualization of the patient’s prostate. The ultrasound also clearly reveals the laser guide needles as the physician targets the tumor, based on his/her knowledge of the prostate map and the tumor location as revealed by the MRI.

When the laser is activated, the tumor plus a larger margin surrounding it are ablated by the laser heat. The extra margin is a safety measure to help prevent recurrence.

Dr. Walser and colleagues have now published 1-year TPLA results on a series of 195 patients from four international centers (followup was a minimum of 12 months). The data was drawn from a global registry created to record and store 12-month TPLA results regarding cancer control and side effects. Here are the key results as summarized in their paper:

• One year after US-guided transperineal focal laser ablation, infield recurrence of clinically significant prostate cancer (csIFR) was detected in 17% of treated lesions in this registry study of 195 patients.
• MRI correctly identified 80% of recurrent disease and was a strong independent predictor of csIFR
• An initial prostate-specific antigen density level greater than 0.16 ng/mL2 was associated with recurrence^[iv]

The Sperling Prostate Center is proud to have Dr. Walser on our clinical team. Just as Dr. Sperling has been a leader in real-time MRI guidance for focal treatment of localized prostate cancer, Dr. Walser is a leader in TPLA for treating both BPH and localised prostate cancer. Our Center is proud to offer a menu of focal therapy choices in order to offer patients the best method tailored to their clinical needs.

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.

References

[i] Walser E, Nance A, Ynalvez L, Yong S et al. Focal Laser Ablation of Prostate Cancer: Results in 120 Patients with Low- to Intermediate-Risk Disease. J Vasc Interv Radiol. 2019 Mar;30(3):401-409.e2.
[ii] Locke MR, Locke DR. A Case Series on the Efficacy and Safety of Transperineal Laser Ablation for Benign Prostatic Hyperplasia. J Clin Med. 2026 Jan 9;15(2):540. doi: 10.3390/jcm15020540.
[iii] de Bie KCC, Cornud FC, Walser EM, van Riel LAMJG et al. One-year Follow-up after US-guided Transperineal Focal Laser Ablation of Localized Prostate Cancer: Worldwide Registry Study. Radiology. 2026 Jun;319(3):e251658
[iv] Ibid.